Does celecoxib (Celebrex) significantly increase blood pressure in the short term?

From the Guidelines

Celecoxib may increase blood pressure in some individuals, particularly those with pre-existing hypertension or cardiovascular risk factors, although the overall effect on blood pressure is generally minimal in the short term for most patients. The mechanism of celecoxib's effect on blood pressure involves the reduction of prostaglandin production, which can affect kidney function and fluid balance 1. According to a study published in the American Family Physician, all NSAIDs, including COX-2 inhibitors like celecoxib, have the potential to aggravate hypertension, congestive heart failure, and edema, with an estimated average increase in mean blood pressure of 5 mm Hg while taking nonselective NSAIDs 1. However, a scientific statement from the American Heart Association suggests that celecoxib may be safer than other COX-2 inhibitors in terms of cardiovascular risk, but still recommends caution and monitoring of blood pressure, especially in patients with cardiovascular risk factors 1.

Some key points to consider when prescribing celecoxib include:

• Monitoring blood pressure during the first few weeks of treatment, especially in patients with cardiovascular risk factors
• Using celecoxib cautiously in patients with uncontrolled hypertension or pre-existing kidney disease
• Considering alternative therapies or using the smallest effective dose of celecoxib to minimize potential cardiovascular risks
• Being aware of the potential for celecoxib to interact with other medications, such as blood pressure medications, and adjusting treatment plans accordingly 1.

Overall, while celecoxib may not significantly increase blood pressure in the short term for most patients, it is essential to carefully evaluate individual patient risk factors and monitor blood pressure closely to minimize potential cardiovascular risks.

From the FDA Drug Label

In the PRECISION-ABPM substudy, among the total of 444 analyzable patients at Month 4, celecoxib dosed at 100 mg twice daily decreased mean 24-hour systolic blood pressure (SBP) by 0.3 mmHg, whereas ibuprofen and naproxen at the doses taken increased mean 24-hour SBP by 3.7 and 1. 6 mmHg, respectively. The FDA drug label does not support that celecoxib significantly increases blood pressure short term, in fact, it shows a decrease in mean 24-hour systolic blood pressure. 2

From the Research

Blood Pressure Effects of Celecoxib

• The study 3 found that celecoxib did not significantly increase blood pressure in patients with osteoarthritis or rheumatoid arthritis, with a change in mean 24-h systolic BP of -0.3 mmHg.
• In contrast, ibuprofen and naproxen were associated with significant increases in blood pressure, with changes in mean 24-h systolic BP of 3.7 mmHg and 1.6 mmHg, respectively.
• Another study 4 found that celecoxib inhibited COX-2 activity to a lesser degree than naproxen, resulting in a less pronounced blood pressure increase.
• The study 5 found that celecoxib caused a smaller increase in systolic blood pressure compared to rofecoxib in patients with systemic hypertension and osteoarthritis.
• A retrospective cohort study 6 found no significant differences in blood pressure changes between patients taking celecoxib and those taking rofecoxib, but found that rofecoxib was associated with a higher likelihood of antihypertensive drug dosage increases.
• A double-blind, randomized trial 7 found that celecoxib did not significantly increase 24-hour blood pressure in patients with hypertension, osteoarthritis, and type 2 diabetes mellitus, whereas rofecoxib was associated with a significant increase in 24-hour systolic blood pressure.

Comparison with Other NSAIDs

• The studies suggest that celecoxib may have a more favorable blood pressure profile compared to other NSAIDs, such as ibuprofen and naproxen.
• However, the degree of COX-2 inhibition and the dose of the medication may influence the blood pressure response, as seen in the study 4.
• The comparison between celecoxib and rofecoxib suggests that celecoxib may be a better option for patients with hypertension, as it is associated with a smaller increase in blood pressure 5, 7.