Aw Tai-Juan, Haas Steven Joseph, Liew Danny, Krum Henry
Department of Clinical Pharmacology, Monash University, Alfred Hospital, Melbourne, Victoria 3004, Australia.
Arch Intern Med. 2005 Mar 14;165(5):490-6. doi: 10.1001/archinte.165.5.IOI50013. Epub 2005 Feb 14.
Nonselective nonsteroidal anti-inflammatory drugs (NSAIDs) are widely prescribed and are associated with blood pressure (BP) elevation. The development of selective cyclooxygenase-2 inhibitors (coxibs) raises the issue of the magnitude of BP response compared with nonselective NSAIDs. We therefore performed a meta-analysis comparing the effects of coxibs with placebo, nonselective NSAIDs, and each other on BP elevation and hypertension.
Nineteen randomized controlled trials involving coxibs were published before May 2004, with a total of 45 451 participants in which BP data were available. The Cohen method statistically combined weighted mean difference (WMD). The Der Simonian and Laird method pooled results concerning the relative risk (RR) of developing hypertension and the RR of clinically important BP elevations.
Among the trials analyzed, coxibs caused a WMD point estimate increase in systolic and diastolic BP compared with placebo (3.85/1.06 mm Hg) and nonselective NSAIDs (2.83/1.34 mm Hg). Cyclooxygenase-2 inhibitors were associated with a nonsignificantly higher RR of causing hypertension compared with placebo (RR, 1.61; 95% confidence interval [CI], 0.91-2.84; P = .10) and nonselective NSAIDs (RR, 1.25; 95% CI, 0.87-1.78; P = .23). Rofecoxib induced a WMD point estimate increase in systolic BP (2.83 mm Hg) and a nonsignificantly higher risk of developing clinically important systolic BP elevation (RR, 1.50; 95% CI, 1.00-2.26; P = .05) compared with celecoxib.
Cyclooxygenase-2 inhibitors were associated with a point-estimate BP elevation compared with placebo and nonselective NSAIDs. There was a nonsignificantly higher incidence of developing hypertension compared with nonselective NSAIDs, as was observed with rofecoxib compared with celecoxib. These BP elevations may be clinically significant in relation to increased cardiovascular risk.
非选择性非甾体抗炎药（NSAIDs）被广泛应用，且与血压（BP）升高有关。选择性环氧化酶-2抑制剂（coxibs）的出现引发了与非选择性NSAIDs相比，血压反应程度的问题。因此，我们进行了一项荟萃分析，比较coxibs与安慰剂、非选择性NSAIDs以及彼此之间对血压升高和高血压的影响。
2004年5月之前发表了19项涉及coxibs的随机对照试验，共有45451名参与者有可用的血压数据。采用Cohen方法对加权均数差（WMD）进行统计学合并。采用Der Simonian和Laird方法汇总关于发生高血压的相对风险（RR）和具有临床意义的血压升高的RR的结果。
在分析的试验中，与安慰剂（收缩压/舒张压为3.85/1.06 mmHg）和非选择性NSAIDs（收缩压/舒张压为2.83/1.34 mmHg）相比，coxibs导致收缩压和舒张压的WMD点估计值升高。与安慰剂（RR，1.61；95%置信区间[CI]，0.91 - 2.84；P = 0.10）和非选择性NSAIDs（RR，1.25；95% CI，0.87 - 1.78；P = 0.23）相比，环氧化酶-2抑制剂导致高血压的RR略高但无统计学意义。与塞来昔布相比，罗非昔布使收缩压的WMD点估计值升高（2.83 mmHg），且发生具有临床意义的收缩压升高的风险略高但无统计学意义（RR，1.50；95% CI，1.00 - 2.26；P = 0.05）。
与安慰剂和非选择性NSAIDs相比，环氧化酶-2抑制剂与血压点估计值升高有关。与非选择性NSAIDs相比，发生高血压的发生率略高但无统计学意义，如罗非昔布与塞来昔布相比。这些血压升高可能与心血管风险增加相关，具有临床意义。
