Cox-2 Drugs Boost Blood Pressure: Study

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Cox-2 Drugs Boost Blood Pressure: Study

 

 

February 14, 2005 08:41:21 PM PST

By Amanda Gardner

HealthDay Reporter

 

 

MONDAY, Feb. 14 (HealthDay News) -- As a U.S. advisory panel

prepares to discuss the future of cox-2 drugs later this week, a new

round of studies debating the cardiovascular risks of this class of

medication has just surfaced.

 

One study found that cox-2s raise blood pressure more than

traditional nonsteroidal anti-inflammatory inhibitors (NSAIDs) or a

placebo. The research, by Australian scientists, appears in the

March 15 issue of Archives of Internal Medicine, which was released

online Monday.

 

The finding, said Dr. Kevin Stone, an orthopedic surgeon at the

Stone Clinic in San Francisco, is " another nail in the coffin " of

cox-2s, which include Celebrex, Bextra and the now-withdrawn Vioxx.

 

" It jibes with many other things we know, " added Dr. Richard Re,

head of the hypertension section at the Ochsner Clinic Foundation in

New Orleans. " People have had suspicions that this is the case, and

this study more or less confirms it. "

 

Another new study, also released Monday, found that Vioxx and

Celebrex increased patients' risk of heart attack and stroke by

about 20 percent, while Bextra increased the risk by 50 percent.

 

The study was carried out by Indianapolis-based WellPoint Inc., the

nation's largest provider of health benefits, according to the

Associated Press. And it was done ahead of Vioxx' removal last

September.

 

Dr. Sam Nussbaum, WellPoint's executive vice president and chief

medical officer, said Monday that the study is further evidence of

an " increasingly compelling trend "

 

of data that show such drugs elevate patients' risk of heart attack

and stroke.

 

A third study, involving laboratory research by scientists at Johns

Hopkins University in Baltimore, found more of a middle ground:

Properties of the cox-1 and cox-2 enzymes can both protect and

damage the brain.

The authors state this may help explain why some NSAIDs can relieve

pain even while they have other detrimental effects in the body.

The findings appear in the February issue of the Journal of

Neurochemistry.

 

Traditional NSAIDs such as aspirin and ibuprofen are used to relieve

pain, but are associated with an increased risk of gastrointestinal

problems such as bleeding ulcers. The newer cox-2 inhibitor NSAIDs

were hailed as wonder drugs when they were introduced in the late

1990s because they relieved pain without the side effects.

 

Recently, cox-2 inhibitors have been linked to an increased risk of

cardiovascular problems. Vioxx was pulled from the market by its

manufacturer, Merck & Co., after a study showed that long-term use

increased the risk of heart attack and stroke. Celebrex and Bextra,

made by Pfizer, are still available to consumers.

 

For the Australian study, its authors analyzed results from all 19

randomized controlled trials of cox-2 inhibitors that were published

before May 2004. Blood pressure information was available for 45,451

participants.

 

Compared with traditional NSAIDs and with placebos, people taking

cox-2 inhibitors had higher blood pressure levels, the researchers

found.

Participants taking cox-2s had a 60 percent higher chance of

elevated blood pressure compared with a placebo, and a 25 percent

higher chance compared with the older NSAIDs.

 

Although these increases were statistically " nonsignificant " when

looked at individually, Dr. Henry Krum, senior author of the study,

said he felt the changes were clinically significant or " highly

relevant when applied to a population. "

 

There were few differences between the different cox-2 drugs,

although Vioxx may have been associated with a higher risk compared

with Celebrex, he added.

 

According to Krum, who is director of the NHMRC Center of Clinical

Research Excellence in Therapeutics at Monash University/Alfred

Hospital in Melbourne, Australia, the study is " not the final word

but certainly a potential contributor. " Studies looking specifically

at cardiovascular outcomes now need to be performed, he added.

 

 

" What's being lost is, what the heck should patients and doctors be

doing and what are the questions they should be asking as all this

conflicting information keeps coming through all these venues, " he

said.

 

 

" Unfortunately, marketing got way ahead of the science and most

likely -- whether or not the FDA forces a recall -- most physicians

will step back quite a bit " from cox-2s, Stone said.

 

 

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