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HYPERTENSION

New Diagnosis of Hypertension Among Celecoxib and Nonselective NSAID Users: A Population-Based Cohort Study

Postdoctoral Fellow, Pharmaceutical Health Services Research Department, School of Pharmacy, University of Maryland, Baltimore, MD

C Daniel Mullins, PhD

Professor and Chair, Pharmaceutical Health Services Research Department, School of Pharmacy, University of Maryland

Muhammad Mamdani, PharmD MA MPH

Director, US Outcomes Research, Pfizer, Inc., New York, NY

Dale A Rublee, PhD

Director, Global Outcomes Research, Pfizer, Inc.

Fadia T Shaya, PhD MPH

Associate Professor, Associate Director, Center on Drugs and Public Policy, Pharmaceutical Health Services Research Department, School of Pharmacy, University of Maryland

Reprints: Dr. Mullins, Pharmaceutical Health Services Research Department, University of Maryland School of Pharmacy, 220 Arch St., Baltimore, MD 21201, fax 410/706-5394, dmullins{at}rx.umaryland.edu

BACKGROUND: The use of nonsteroidal antiinflammatory drugs (NSAIDs) has been associated with increased blood pressure and hypertension. However, less is known about how the risk of hypertension is associated with cyclooxygenase 2 selective inhibitors (coxibs), especially celecoxib, the only coxib remaining on the market.

OBJECTIVE: To compare the risk of incident hypertension associated with the use of celecoxib and nonselective (NS) NSAIDs.

METHODS: A cohort study was conducted using secondary data from the GE Centricity Electronic Medical Record database, which contains millions of patient records seen by thousands of physicians across the US. The index date was defined as the date of the first NSNSAID or celecoxib prescription between January 1, 1999, and June 30, 2004. Patients were included if they were aged 18 years or older and were enrolled for at least 365 days prior to the index date. Excluded were patients who had any prior diagnosis of hypertension or pregnancy-related hypertension during the pre- or postindex date period. Also excluded were patients who had any prior prescription for antihypertensive drugs, coxibs, or NSNSAIDs. After applying inclusion/exclusion criteria, each celecoxib user was matched to 2 NSNSAID users by sex, age (±5 y), propensity score (within 0.2 SD), and number of unique drugs (±20%). Descriptive and survival analyses were conducted.

RESULTS: The final sample consisted of 51 444 patients, of whom 17 148 were on celecoxib and 34 296 were on NSNSAIDs. Relative to NSNSAID users, patients on celecoxib had a similar rate of postexposure hypertension incidence (HR 1.013; 95% CI 0.862 to 1.190).

CONCLUSIONS: Results from a population-based cohort analysis of electronic medical records did not show any difference in the hazard rates of incident hypertension between celecoxib and NSNSAID users.

Key Words: celecoxib, hypertension, nonsteroidal antiinflammatory drugs

Published Online, May 8, 2007. www.theannals.com, DOI 10.1345/aph.1H659