Treating Osteoarthritis With Cyclooxygenase-2–Specific Inhibitors

Abstract

Abstract-Osteoarthritis and hypertension are highly prevalent among older Americans. Anti-inflammatory medications can destabilize blood pressure control. We estimated the decreased cardiovascular risk, premature mortality, and direct health care costs that could be avoided if blood pressure control is not destabilized among hypertensive Americans taking cyclooxygenase-2 (COX-2)-specific inhibitors for osteoarthritis. Data from the Third National Health and Nutrition Examination Survey (NHANES III) provided the distribution of cardiovascular risk factors among American adults with osteoarthritis and hypertension. The Cardiovascular Disease Life Expectancy Model was used to estimate the impact of a 2.26% increase in systolic blood pressure on the basis of results of a randomized trial comparing COX-2-specific inhibitors. A similar analysis was completed for American adults with osteoarthritis and untreated hypertension (Ն140/90 mm Hg). Among 7.3 million Americans with treated hypertension, maintaining blood pressure control would avoid Ͼ30 000 stroke deaths and 25 000 coronary deaths resulting in Ͼ449 000 person years of life saved and $1.4 billion in direct health care cost savings. When an additional 3.8 million Americans with untreated hypertension are considered, maintaining blood pressure control could prevent Ͼ47 000 stroke deaths, 39 000 coronary deaths, and result in 668 000 person years of life saved and Ͼ$2.4 billion in direct health care cost savings. We conclude that even a small increase in systolic blood pressure among hypertensive Americans with osteoarthritis may substantially increase the clinical and economic burden of cardiovascular disease. Maintaining blood pressure control may be associated with substantial benefits.

Cardiovascular Effects of the Cyclooxygenase Inhibitors

“…33 Metaanalyses of the NSAIDs from the early 1990s showed that many agents within the class (eg, ibuprofen, indomethacin, and naproxen) could increase mean arterial pressure by as much as 5 to 6 mm Hg in hypertensive patients. 34,35 As reported by Grover et al, 36 increases in BP by NSAIDs of this magnitude are of sufficient magnitude to be of clinical concern. Sustained BP elevations in the elderly are associated with increases in the risk of both ischemic and hemorrhagic stroke, congestive heart failure, and ischemic cardiac events.…”

Acetaminophen Increases Blood Pressure in Patients With Coronary Artery Disease

“…Indeed, in view of the established continuous incremental risk of cardiovascular and cerebrovascular disease in relation to BP, an increase in BP associated with the use of acetaminophen could further substantially increase the risk of myocardial infarction and stroke in patients at high cardiovascular risk or, in particular, with established cardiovascular or cerebrovascular disease. 32,33 Importantly, more antihypertensive therapy may have to be prescribed to counter the rise in BP, leading to increased costs. 34 NSAIDs most likely induce a rise in BP by blocking the synthesis of prostaglandins, which regulate vascular tone and sodium excretion.…”

“…dada la alta prevalencia del uso de paracetamol, la respuesta presora observada en nuestro estudio constituye un importante motivo de preocupación para la salud pública. de hecho, teniendo en cuenta el incremento continuo del riesgo de enfermedad cardiovascular y cerebrovascular que se ha demostrado en relación con el incremento de la pa, un aumento de pa asociado al empleo de paracetamol podría comportar un incremento adicional considerable del riesgo de infarto de miocardio e ictus en pacientes con un riesgo cardiovascular alto o, en especial, en pacientes con una enfermedad cardiovascular o cerebrovascular ya establecida 32,33 . Es importante señalar que puede tener que prescribirse una mayor terapia antihipertensiva para contrarrestar la elevación de la pa, con el consiguiente aumento de los costes 34 .…”

Physical Inactivity as a Predictor of High Prevalence of Hypertension and Health Expenditures in the United States: A Cross-Sectional Study

“…Hypertensive patients are at higher risk of myocardial infarction, heart failure, stroke, and kidney disease [1]. Blood pressure control in hypertensives is essential to prevent morbidity and mortality, reduce health care utilization, and ultimately lower health care costs [3]. Only 35 % of hypertensive patients have adequate blood pressure control [2].…”