Differential blood pressure effects of ibuprofen, naproxen, and celecoxib in patients with arthritis: the PRECISION-ABPM (Prospective Randomized Evaluation of Celecoxib Integrated Safety Versus Ibuprofen or Naproxen Ambulatory Blood Pressure Measurement)

In patients with arthritis with or at increased risk for coronary artery disease, randomisation to ibuprofen (600-800mg three times daily) was associated with an increase in systolic BP of 3.9mmHg versus celecoxib (100-200mg BD) and 2.1mmHg vs naproxen (375–500mg BD).

The authors also report that more patients randomised to ibuprofen who had normal BP at baseline developed hypertension (23.2% versus 19.0% for naproxen and 10.3% for celecoxib).

 

They say the results of this substudy extend the findings of the PRECISION Trial, which found moderate doses of celecoxib were non-inferior to naproxen or ibuprofen in terms of the primary cardiovascular outcomes. As the results of this study suggest differential effects of NSAIDs on blood pressure (BP), they suggest clinicians weigh the potential hazards of worsening BP control and its clinical sequelae as well as the risks to gastrointestinal safety when considering the use of these agents, particularly ibuprofen), especially in the elderly who have a high prevalence of arthritis and hypertension.