Equal Cardiovascular Risks in Hypertensive Patients Treated with Selective and Nonselective NSAIDS Save

A Taiwanese study of 55,629 hypertensive patients shows no increased risk of  major cardiovascular events comparing outcomes of patients started on COX-2 selective NSAIDs compared with nonselective NSAIDs (including ibuprofen, diclofenac and naproxen).

This was a cohort study comparing hypertensive patients starting COX-2 selective NSAIDs or nonselective NSAIDs form Taiwan.  The outcomes of interest were major cardiovascular events of hospitalization for ischemic stroke, acute myocardial infarction, congestive heart failure, transient ischemic attack, unstable angina, or coronary revascularization. Patients were only followed for up to 4 weeks. 

Comparison groups included 2,749 eligible COX-2 selective NSAID users and 52,880 eligible nonselective NSAID users.

The HR of major cardiovascular events comparing COX-2 selective NSAIDs to nonselective NSAIDs after adjusting for baseline and time-varying covariates was 1.07 (95% CI, 0.65-1.74). The results were the same when comparing celecoxib to to diclofenac (HR, 1.17; 95% CI, 0.61-2.25), ibuprofen (HR, 1.36; 95% CI, 0.58-3.18), or naproxen (HR, 0.75; 95% CI, 0.23-2.44). There was an increased risk with COX-2 selective NSAIDs, however, when comparing COX-2 to mefenamic acid (HR, 2.11; 95% CI, 1.09-4.09).

These data mirror that seen in the recent completed PRECISION study.