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HYPERTENSION

Blood Pressure in Native Americans Switched from Celecoxib to Rofecoxib

Lieutenant, US Public Health Service, at time of writing, Pharmacy Practice Resident; now, Clinical Staff Pharmacist, Phoenix Indian Medical Center, Phoenix, AZ

Daniel A Diggins, Jr, PharmD BCPS

Captain, US Public Health Service; Assistant Chief Pharmacist, Phoenix Indian Medical Center; Clinical Assistant Professor, University of Arizona College of Pharmacy, Tucson, AZ

Gregory B Morrill, PharmD

Clinical Education Consultant, Pfizer, Inc., Phoenix, AZ

Reprints: Dr. Diggins, Department of Pharmacy, Phoenix Indian Medical Center, 4212 N. 16th St., Phoenix, AZ 85016-5319, fax 602/263-1621, dan.diggins{at}ihs.gov

BACKGROUND: Nonsteroidal antiinflammatory drugs have been associated with exacerbation of hypertension. Differing effects on blood pressure (BP) have been reported in studies comparing celecoxib and rofecoxib. Concern regarding the cardiovascular safety of the cyclooxygenase-2 (COX-2) inhibitor class has intensified since the removal of rofecoxib from the market.

OBJECTIVE: To evaluate the effect of a formulary change from celecoxib to rofecoxib on the BP of Native American patients at an Indian Health Service medical center.

METHODS: Medical records of patients switched from celecoxib to rofecoxib were retrospectively reviewed. BP during the respective treatments was compared as follows: measurements recorded while taking celecoxib within 6 months before the index date and while taking rofecoxib from 1 week after the index date through 6 months of treatment were averaged. Differences in systolic and diastolic BP before and after the therapy change were evaluated using a paired Student's t-test. Subgroup analysis was performed for patients with preexisting hypertension.

RESULTS: During rofecoxib therapy, the mean systolic BP was 2.9 mm Hg higher (p = 0.015) and the mean diastolic BP was 1.5 mm Hg higher (p = 0.042) than during celecoxib therapy. Among hypertensive patients, the respective mean systolic and diastolic BPs were 4.8 mm Hg (p = 0.009) and 2.0 mm Hg (p = 0.063) higher while taking rofecoxib.

CONCLUSIONS: Switching patients from celecoxib to rofecoxib resulted in an increase in BP, with a larger difference observed in patients with hypertension. Future studies assessing the cardiovascular safety of currently marketed and investigational COX-2 inhibitors should evaluate the possible contribution of BP effects of these agents to overall risk.

Key Words: American Indian, celecoxib, cyclooxygenase inhibitors, hypertension, rofecoxib

Published Online, March 29, 2005. www.theannals.com, DOI 10.1345/aph.1E624

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