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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

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