Nonselective
nonsteroidal anti-inflammatory agents have been shown to attenuate the
antihypertensive efficacy of
ACE inhibitors with average increases in systolic blood pressure (BP) of 5 to 10 mm Hg. Less is known about the specific
cyclooxygenase-2 (COX-2) inhibitors now widely used for the treatment of
arthritis. The objective of this study was to determine the effects of
celecoxib compared with placebo on 24-hour BP levels in
ACE inhibitor-treated patients with
hypertension. This was a randomized, double-blind, placebo-controlled, parallel-group clinical trial involving 178 men and women (mean age, 53 years) with
essential hypertension who were treated and controlled with
lisinopril monotherapy (10 to 40 mg daily). Baseline BP values were obtained using 24-hour ambulatory recordings. Patients received either
celecoxib, 200 mg twice daily (twice the recommended dose for
osteoarthritis) (n=91), or placebo (n=87) for 4 weeks, and changes in the 24-hour BP,
body weight, and clinical laboratory parameters were assessed. Mean changes from baseline in the 24-hour systolic and diastolic BP were 2.6/1.5+/-0.9/0.6 mm Hg on
celecoxib versus 1.0/0.3+/-1/0.6 mm Hg on placebo (P=0.34 for systolic BP; P=0.45 for diastolic BP). The proportion of patients whose 24-hour BP increased by at least 5, 10, 15, or 20 mm Hg were also similar on
celecoxib and placebo. No changes in
body weight, serum
creatinine, or
potassium occurred in either group. Thus, these data demonstrate that high doses of
celecoxib have no significant effect on the
antihypertensive effect of the
ACE inhibitor lisinopril. The placebo-subtracted changes observed in 24-hour BP (1.6/1.2 mm Hg) are less than what has been reported for nonselective
nonsteroidal anti-inflammatory agents in
ACE inhibitor-treated patients.