Can the blood pressure effects of COX-2 selective inhibitors be explained by changes in plasma aldosterone levels?
OBJECTIVE: The increased cardiovascular risk associated with rofecoxib may relate to differential effects on blood pressure (BP) in comparison with other cyclooxygenase-2 (COX-2) selective inhibitors. Rofecoxib is uniquely metabolized by cytosol reductase and may compete with aldosterone for metabolism. We hypothesized that the effect of rofecoxib on BP may be due to an increase in aldosterone levels. DESIGN: Prospective, randomized, cross-over study. SETTING: Tertiary institution. PATIENTS: Eleven patients (all female, age 65 +/- 11 years) with osteoarthritis and hypertension. INTERVENTIONS: Patients received rofecoxib 50 mg once/day or celecoxib 400 mg once/day for 8 weeks, followed by cross-over after a 2-week wash-out period. OUTCOME MEASURES: Office BP, heart rate (HR), plasma aldosterone and aldosterone related-markers, markers of sympathetic and parasympathetic activity, catecholamines and heart rate variability (HRV) were measured. RESULTS: Rofecoxib caused an increase in BP co
