Cyclooxygenase-2???Specific Inhibitors and Cardiorenal Function: A Randomized, Controlled Trial of Celecoxib and Rofecoxib in Older Hypertensive Osteoarthritis Patients

Whelton, Andrew; Fort, John G.; Puma, Joseph A.; Normandin, Diane E.; Bello, Alfonso E.; Verburg, Kenneth M.

doi:10.1097/00045391-200103000-00003

Cited by 311 publications

(190 citation statements)

References 26 publications

Supporting

Mentioning

175

Contrasting

Unclassified

Order By: Relevance

“…[1][2][3][4]8 Recent data directly comparing celecoxib to rofecoxib in older hypertensive patients also confirm a significant difference between these agents in terms of their effects on systolic BP in the clinic and edema. 19 Differences in the level of BP control or stability in patients with hypertension clearly have the potential to drive overall cardiovascular morbidity, especially in terms of congestive heart failure and stroke. 20 The mechanisms associated with the apparent difference in the COX-2-specific inhibitors, as well as the differences between celecoxib and the conventional NSAIDs, remains to be elucidated.…”

Section: Discussionmentioning

confidence: 99%

“…Whelton et al 19 performed a randomized study in which 812 much older patients with osteoarthritis and controlled hypertension received either celecoxib (200 mg daily) or rofecoxib (25 mg daily). Approximately 40% of the patients randomized to the celecoxib group had been treated chronically with ACE inhibitors, whereas 30% of the rofecoxib-treated patients were on ACE inhibitors.…”

Section: Comparisons Between Cox-2 Inhibitors Added To Antihypertensimentioning

confidence: 99%

See 1 more Smart Citation

Effects of Celecoxib on Ambulatory Blood Pressure in Hypertensive Patients on ACE Inhibitors

et al. 2002

Self Cite

View full text Add to dashboard Cite

Abstract-Nonselective nonsteroidal anti-inflammatory agents have been shown to attenuate the antihypertensive efficacy of ACE inhibitors with average increases in systolic blood pressure (BP) of 5 to 10 mm Hg. Less is known about the specific cyclooxygenase-2 (COX-2) inhibitors now widely used for the treatment of arthritis. The objective of this study was to determine the effects of celecoxib compared with placebo on 24-hour BP levels in ACE inhibitor-treated patients with hypertension. This was a randomized, double-blind, placebo-controlled, parallel-group clinical trial involving 178 men and women (mean age, 53 years) with essential hypertension who were treated and controlled with lisinopril monotherapy (10 to 40 mg daily). Baseline BP values were obtained using 24-hour ambulatory recordings. Patients received either celecoxib, 200 mg twice daily (twice the recommended dose for osteoarthritis) (nϭ91), or placebo (nϭ87) for 4 weeks, and changes in the 24-hour BP, body weight, and clinical laboratory parameters were assessed. Mean changes from baseline in the 24-hour systolic and diastolic BP were 2.6/1.5Ϯ0.9/0.6 mm Hg on celecoxib versus 1.0/0.3Ϯ1/0.6 mm Hg on placebo (Pϭ0.34 for systolic BP; Pϭ0.45 for diastolic BP). The proportion of patients whose 24-hour BP increased by at least 5, 10, 15, or 20 mm Hg were also similar on celecoxib and placebo. No changes in body weight, serum creatinine, or potassium occurred in either group. Thus, these data demonstrate that high doses of celecoxib have no significant effect on the antihypertensive effect of the ACE inhibitor lisinopril.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Comparisons Between Cox-2 Inhibitors Added To Antihypertensimentioning

confidence: 99%

Effects of Celecoxib on Ambulatory Blood Pressure in Hypertensive Patients on ACE Inhibitors

et al. 2002

Self Cite

View full text Add to dashboard Cite

show abstract

“…In a review of clinical studies that involved Ͼ13,000 subjects, Whelton et al (54) found that the overall incidence of renal adverse events that were induced by celecoxib was greater than that seen with placebo and was similar to the effects of the NSAID comparators. Because of the high prevalence of NSAID use among people 65 yr old or older, subsequent studies (SUCCESS VI [55] and VII [56]) compared the renal safety in older hypertensive patients with osteoarthritis (890 and 1092 patients in VI and VII, respectively) and found that at week 6, rofecoxib was more likely to increase the systolic BP than celecoxib. Similarly, in patients with type II diabetes and hypertension, ambulatory BP monitoring indicated that unlike celecoxib and the nonselective NSAID comparator naproxen, rofecoxib led to significant increases in 24-h systolic BP, although all three drugs induced some destabilization of BP control (57).…”

Section: Effect Of Cox-2 Inhibitors On Salt and Water Homeostasis And Bpmentioning

confidence: 99%

Update on Cyclooxygenase-2 Inhibitors

Harris

Breyer

2006

Clinical Journal of the American Society of Nephrology

View full text Add to dashboard Cite

Nonsteroidal anti-inflammatory drugs represent the most commonly used medications for the treatment of pain and inflammation, but numerous well-described side effects can limit their use. Cyclooxygenase-2 (COX-2) inhibitors were initially touted as a therapeutic strategy to avoid not only the gastrointestinal but also the renal and cardiovascular side effects of nonspecific nonsteroidal anti-inflammatory drugs. However, in the kidney, COX-2 is constitutively expressed and is highly regulated in response to alterations in intravascular volume. COX-2 metabolites have been implicated in mediation of renin release, regulation of sodium excretion, and maintenance of renal blood flow. This review summarizes the current state of knowledge about both renal and cardiovascular side effects that are attributed to COX-2 selective inhibitors.Clin J Am Soc Nephrol 1: 236 -245, 2006236 -245, . doi: 10.2215 N onsteroidal anti-inflammatory drugs (NSAID) are the most commonly used class of medications for the treatment of pain and inflammation and represent one of the most common classes of medications used worldwide, with an estimated usage of Ͼ30 million per day (1). Nonselective NSAID inhibit both constitutive cyclooxygenase-1 (COX-1) and inducible cyclooxygenase-2 (COX-2), the rate-limiting enzymes that are involved in production of prostaglandins and thromboxane. In addition to their role in inflammation, prostaglandins are important regulators of vascular tone, salt and water balance, and renin release, and nonselective NSAID exhibit adverse effects, including salt retention and reduced GFR, which may elevate BP or make pre-existing hypertension worse (2). It has been estimated that as many as 2.5 million Americans experience NSAID-mediated renal effects yearly (3). Risk factors that predispose to NSAID-induced renal functional alterations include age Ͼ65 yr, cardiovascular disease, diabetes, male gender, high NSAID dosage, and concurrent use of other nephrotoxic drugs (3). Up to 20% of patients who take nonselective NSAID and have more than one of these risk factors may manifest alterations in renal function.In addition to renal side effects, nonselective NSAID have long been known to predispose to gastrointestinal (GI) toxicity. It has been estimated that one third of patients who taking long-term nonselective NSAID develop endoscopically proven gastric or duodenal ulcers (4). The risk for serious bleeding from these lesions is somewhat lower, with approximately 100,000 hospitalizations for GI complications of NSAID (5). One study estimated that nonselective NSAID-induced GI abnormalities constitute the 15th leading cause of death in the United States (6). The premise that COX-1 performs cellular "housekeeping" functions for normal physiologic activity and is the predominant isoform expressed in platelets and the GI tract, whereas COX-2 acts at inflammatory sites, led to the development of COX-2 selective inhibitors. It also was originally hypothesized that the renal effects of nonselective NSAID were also linked to COX-...

show abstract

“…67 In a randomized, controlled trial by the SUCCESS VI Study Group, 810 elderly hypertensives with osteoarthritis were randomized to 6 weeks of therapy with rofecoxib or celecoxib. 60 During the study period, 17% of rofecoxib patients and 11% of celecoxib patients (p = 0.032) had significant (>20 mm Hg) increases in systolic blood pressure. No significant difference in diastolic blood pressure were noted.…”

Section: Hypertensionmentioning

confidence: 92%

Review of the selective COX-2 inhibitors celecoxib and rofecoxib: focus on clinical aspects

Loewen

2002

CJEM

View full text Add to dashboard Cite

The selective cyclooxygenase-2 (COX-2) inhibitors celecoxib and rofecoxib were designed to have similar efficacy but less gastrointestinal toxicity than traditional nonsteroidal anti-inflammatory drugs (NSAIDs). Their efficacy has been demonstrated in the treatment of osteoarthritis, rheumatoid arthritis, ankylosing spondylitis, postoperative dental pain and dysmenorrhea. These agents produce fewer endoscopic ulcers, symptomatic ulcers and gastrointestinal bleeds than traditional NSAIDs; although the absolute benefit is small and the gastropreserving effect is negated by concurrent use of low-dose aspirin for cardiovascular risk reduction. Nephrotoxicity and hyptertension remain concerns with COX-2 inhibitors, as they are with traditional NSAIDs. COX-2 inhibitors may be safe alternatives to traditional NSAIDs for patients with aspirin-sensitive asthma. RÉSUMÉLes inhibiteurs sélectifs de la cyclo-oxygénase-2 (COX-2) célécoxib et rofécoxib ont été conçus pour agir de manière aussi efficace que les anti-inflammatoires non stéroïdiens (AINS) traditionnels, mais avec moins de toxicité gastro-intestinale. Ils se sont révélés efficaces dans le traitement de l'arthrose, de l'arthrite rhumatoïde, de la spondylarthrite ankylosante, de la dentalgie post-chirurgicale et de la dysménorrhée. Ces agents provoquent moins d'ulcères endoscopiques, d'ulcères symptomatiques et de saignements gastro-intestinaux que les AINS traditionnels; cependant, le bienfait absolu est faible et l'effet de gastro-préservation est annulé par le recours concomitant à de l'aspirine à faible dose pour la réduction du risque cardiovasculaire. La néphrotoxicité et l'hypertension demeurent une préoccupation avec les inhibiteurs de la COX-2, tout comme avec les AINS traditionnels. Les inhibiteurs de la COX-2 peuvent se révéler une solution de rechange sécuri-taire aux AINS traditionnels chez les patients atteints d'asthme hypersensible à l'aspirine.

show abstract

Cyclooxygenase-2???Specific Inhibitors and Cardiorenal Function: A Randomized, Controlled Trial of Celecoxib and Rofecoxib in Older Hypertensive Osteoarthritis Patients

Cited by 311 publications

References 26 publications

Effects of Celecoxib on Ambulatory Blood Pressure in Hypertensive Patients on ACE Inhibitors

Effects of Celecoxib on Ambulatory Blood Pressure in Hypertensive Patients on ACE Inhibitors

Update on Cyclooxygenase-2 Inhibitors

Review of the selective COX-2 inhibitors celecoxib and rofecoxib: focus on clinical aspects

Contact Info

Product

Resources

About