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GPs should assess and modify cardiovascular risk factors in patients beginning treatment with cox-2 inhibitors because of the additional dangers, warn UK researchers.
Cox-2 inhibitors can raise blood pressure and substantially increase the risk of heart attacks and other cardiovascular events, a review of available evidence found.
The authors concluded modifying risk was 'a serious issue' and advised GPs to co-treat arthritic patients with drugs for blood pressure and high cholesterol.
GPs acknowledged evidence of an increased cardiovascular risk with cox-2s, but questioned whether they had the time for additional monitoring and treatment.
Cox-2 inhibitors increased blood pressure by between 3 and 5mmHg, refuting earlier suggestions of a smaller effect than conventional NSAIDs, according to the review of 22 clinical studies published online in the Journal of Human Hypertension.
One study the VIGOR trial found the rate of myo-cardial infarction was five times higher in patients taking rofecoxib than those on the non-selective NSAID naproxen. And the CLASS trial found users of celecoxib were 1.7 times more likely than non-users to suffer cardiovascular events.
Lead author Dr David Carruthers, consultant rheumatologist at the City Hospital in Birmingham, said: 'One has to look at risk reduction in all patients.' He added untreated hypertension was the greatest danger and recommended use of statins for their dual anti-
inflammatory and lipid-lowering effects.
Dr Iain Gilchrist, a board member of the Primary Care Rheumatology Society, said GPs should not only monitor blood pressure but also check the renal function of patients taking cox-2s.
'I doubt whether we have heard the last of the risk versus benefit profile of cox-2s,' he added.
But Dr Rubin Minhas, CHD lead for Medway PCT, said: 'Getting people in for blood pressure checks when a patient has hypertension is difficult enough. This only adds to the number of indications for blood pressure checks.'
By Rob Finch