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) Trial
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Aims: Non-steroidal anti-inflammatory drugs (NSAIDs), both non-selective and selective cyclooxygenase-2 (COX-2) inhibitors, are among the most widely prescribed drugs worldwide, but associate with increased blood pressure (BP) and adverse cardiovascular (CV) events. PRECISION-ABPM, a substudy of PRECISION was conducted at 60 sites, to determine BP effects of the selective COX-2 inhibitor celecoxib vs. the non-selective NSAIDs naproxen and ibuprofen. Methods and results: In this double-blind, randomized, multicentre non-inferiority CV-safety trial, 444 patients (mean age 62 ± 10 years, 54% female) with osteoarthritis (92%) or rheumatoid arthritis (8%) and evidence of or at increased risk for coronary artery disease received celecoxib (100–200 mg bid), ibuprofen (600–800 mg tid), or naproxen (375–500 mg bid) with matching placebos in a 1: 1: 1 allocation, to assess the effect on 24-h ambulatory BP after 4 months. The change in mean 24-h systolic BP (SBP) in celecoxib, ibuprofen and naproxen-treated patients was -0.3 mmHg [95% confidence interval (CI), −2.25, 1.74], 3.7 (95% CI, 1.72, 5.58) and 1.6 mmHg (95% CI, −0.40, 3.57), respectively. These changes resulted in a difference of − 3.9 mmHg (P = 0.0009) between celecoxib and ibuprofen, of − 1.8 mmHg (P = 0.12) between celecoxib and naproxen, and of − 2.1 mmHg (P = 0.08) between naproxen and ibuprofen. The percentage of patients with normal baseline BP who developed hypertension (mean 24-h SBP ≥ 130 and/or diastolic BP ≥ 80 mmHg) was 23.2% for ibuprofen, 19.0% for naproxen, and 10.3% for celecoxib (odds ratio 0.39, P = 0.004 and odds ratio 0.49, P = 0.03 vs. ibuprofen and naproxen, respectively). Conclusions: In PRECISION-ABPM, allocation to the non-selective NSAID ibuprofen, compared with the COX-2 selective inhibitor celecoxib was associated with a significant increase of SBP, and a higher incidence of new-onset hypertension. ClinicalTrials: gov number NCT00346216
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Blood pressure effects from the use of NSAIDs vary by type, with selective COX-2 inhibitors such as celecoxib having less blood pressure effect than traditional NSAIDs.
“BP effects from the use of NSAIDs vary by type, with selective COX-2 (cyclooxygenase-2) inhibitors such as celecoxib having less BP effect than traditional NSAIDs.192,202”
From Resistant Hypertension: Detection, Evaluation, and Management: A Scientific Statement From the American Heart Association (2018) · cites this paper as [202]
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- Authors
- Ruschitzka, F., Borer, J. S., Krum, H., Flammer, A. J., Yeomans, N. D., Libby, P., Lüscher, T. F., Solomon, D. H., Husni, M. E., Graham, D. Y., Davey, D. A., Wisniewski, L. M., Menon, V., Fayyad, R., Beckerman, B., Iorga, D., Lincoff, A. M., & Nissen, S. E.
- Affiliations
- University Hospital Zurich (CH)
- State University of New York (US)
- University of Zurich (CH)
- Western Sydney University (AU)
- Brigham and Women's Hospital (US)
- Cleveland Clinic (US)
- Baylor College of Medicine (US)
- Pfizer (United States) (US)
- Corresponding author
- Ruschitzka, Frank
- ORCID
- Venue
- European Heart Journal
- Publisher
- Oxford University Press (OUP)
- Published
- 2017-08-28
- Volume
- 38
- Issue
- 44
- Pages
- 3282-3292
- ISSN
- 0195-668X (ISSN-L)
- 1522-9645
- PMC
- PMC8139400
- OpenAlex
- W2787676533
- Cited by
- 130
- References
- 47
- Citations by year
- 2026: 8 · 2025: 7 · 2024: 16 · 2023: 15 · 2022: 21 · 2021: 11 · 2020: 14 · 2019: 16 · 2018: 16 · 2017: 5
- FWCI
- 9.73
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Licence
- academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model (vor)
- Locations
- European Heart Journal (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Zurich Open Repository and Archive (University of Zurich) (submittedVersion)
- Zurich Open Repository and Archive (University of Zurich) (submittedVersion, other-oa)
- Funders
- NIH
- Topics
- Health Sciences › Medicine › Pharmacology › Inflammatory mediators and NSAID effects
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Biochemistry › Eicosanoids and Hypertension Pharmacology
- Keywords
- blood pressure effects, celecoxib, ibuprofen, naproxen, nonsteroidal anti-inflammatory drugs, COX-2 inhibitors, osteoarthritis, rheumatoid arthritis, ambulatory blood pressure monitoring, hypertension, cardiovascular safety, coronary artery disease risk, PRECISION trial, non-inferiority, non-selective NSAIDs
- MeSH terms
- Celecoxib, Anti-Inflammatory Agents, Non-Steroidal, Arthritis, Rheumatoid, Blood Pressure, Coronary Artery Disease, Double-Blind Method, Female, Humans, Hypertension, Ibuprofen, Male, Naproxen, Osteoarthritis, Prospective Studies, Cyclooxygenase 2 Inhibitors
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