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Celebrex's Effect on BP Downplayed

Study Shows Advil and Aleve Associated With Higher Rate of Hypertension
By
WebMD Health News
Reviewed by Louise Chang, MD

May 19, 2006 (New York City) -- The popular antiarthritis drug Celebrex appears to raise blood pressure, but the effect is not as large as that associated with the use of some other painkillers such as Advil or Aleve, according to a study of over 44,000 people.

"Hypertensionwas more prevalent in patients given Celebrex than those given placebo, which didn't raise blood pressure at all," says researcher William B. White, MD, of the University of Connecticut School of Medicine in Farmington.

But when Celebrex, a so-called Cox-2 drug, was compared with other types of nonsteroidal anti-inflammatory pain relievers, called NSAIDs, "the other NSAIDS raised blood pressure more," he tells WebMD.

The findings were presented at the American Society of Hypertension meeting here.

Controversy Over Cox-2 Drugs

The Cox-2 drugs have been a cause of concern since one such drug, Vioxx, was voluntarily removed from the market in September 2004 due to an increased risk of heart attacks among people who took the drug daily for more than 18 months. Then another drug, Bextra, was pulled from the U.S. market after the FDA said its risks of heart, stomach, and skin problems outweighed its benefits.

That left Celebrex as the only Cox-2 drug on the market. But even it was forced by the FDA to carry strict new warnings alerting doctors and patients that it elevates the risk of heart attacks and strokes.

Meanwhile, other studies showed that other NSAIDS, such as Advil and Aleve, also increase the risk of heart attacks in people with arthritis. So doctors have been urging all involved to weigh their individual risks when choosing a painkiller.

Due to the controversy surrounding the use of Celebrex and other NSAIDs, White's study, which was originally scheduled to be featured in a news conference here, was removed from its agenda. After his presentation to other doctors, which reporters were allowed to attend, White told WebMD that the American Society of Hypertensions simply told him the issue was controversial and to avoid the press room.

Celebrex vs. Other NSAIDs

The new study was an analysis of 41 trials comparing Celebrex either to other NSAIDs or placebo for disorders ranging from osteoarthritisto Alzheimer's disease.

Of the total, 24,933 patients received Celebrex at doses ranging from 50 milligrams to 800 milligrams a day; 13,990 received the NSAIDS Aleve, Advil, Voltaren, Orudis, or Loxonin, and 4,057 received a placebo.

In the studies comparing Celebrex to placebo, 1.1% of people taking Celebrex developed high blood pressurecompared with 0.7% of placebo patients. Also, 0.2% of people on Celebrex developed heart failurevs. less than 0.1% on placebo.

But in the studies comparing Celebrex to the other NSAIDs, just 1.5% of those on Celebrex developed hypertension compared with 2% on NSAIDs. The risk of heart failure was 0.1% in the Celebrex group and 0.2% in the NSAID group.

White says that the dose of Celebrex did not affect the results.

"While Celebrex at all doses yielded a higher rate of high blood pressure than placebo, it was still very low," he says.

Billy Arant Jr., MD, of the University of Tennessee College of Medicine in Chattanooga, says the study provides important new information for doctors to share with their patients when weighing the risks and benefits of using the popular painkillers.

"It is data that were not available on such a large scale until this point," he tells WebMD.

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