Fifty-one trials (n=130,405) were included in the review. Most of the patients had arthritis. Trials ranged in size from 67 to 23,498 patients. Mean age of patients ranged from 35 to 75. Study duration ranged between four and 208 weeks.
There were significantly higher risks of patients developing hypertension after administration of COX-2 inhibitors compared to placebo (RR 1.49, 95% CI 1.18 to 1.88). In a subgroup analysis by type of COX-2 inhibitor, increased risks of hypertension were observed with use of rofecoxib (RR 1.87, 95% CI 1.63 to 2.14) and etoricoxib (RR 1.1, 95% CI 0.7 to 1.75) compared to placebo. There were no significant differences in risk between the remaining COX-2 inhibitors and placebo for hypertension.
For the comparison between COX-2 inhibitors and NSAIDs, there were no significant differences in the risk of hypertension (RR 1.12, 95% CI 0.93 to 1.35). In a subgroup analysis by type of COX-2 inhibitor, there were higher risks of hypertension with rofecoxib (RR 1.53, 95% CI 1.34 to 1.75) and etoricoxib (RR 1.52, 95% CI 1.39 to 1.66). There was also a significant increased risk associated with use of COX-2 inhibitors compared to the NSAID naproxen (RR 1.31, 95% CI 1.08 to 1.60). There were no significant differences in risk between the remaining COX-2 inhibitors and NSAIDs for hypertension.