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Vol. 2. Núm. 1.
Páginas 10-14 (Enero - Febrero 2006)
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Vol. 2. Núm. 1.
Páginas 10-14 (Enero - Febrero 2006)
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Efecto del tratamiento a corto plazo con antiinflamatorios no esteroideos en la presión arterial media. Un ensayo clínico aleatorizado
Effect of short-term nonsteroidal antiinflammatory therapy on mean blood pressure. A prospective, randomized clinical trial
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J. Álvarez-Nemegyeia,
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nemegyei@hotmail.com

Correspondencia: Dr. J. Álvarez Nemegyei. Calle 57 # 503 X 60 Y 62. Centro. 97000 Mérida. Yucatán. México.
, E.N.J. Rubio-Solísb, G.M. Herrera-Correac
a Unidad de Investigación en Epidemiología Clínica. Unidad Médica de Alta Especialidad. Instituto Mexicano del Seguro Social. Mérida. Yucatán. México
b Servicio de Medicina Interna. Unidad Médica de Alta Especialidad. Instituto Mexicano del Seguro Social. Mérida. Yucatán. México
c Facultad de Medicina. Universidad Autónoma de Yucatán. Mérida. Yucatán. México
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El objetivo del estudio fue evaluar el efecto a corto plazo de la terapia con antiinflamatorios no esteroideos (AINE) sobre la presión arterial media (PAM). Doscientos treinta y nueve pacientes consecutivos (185 mujeres, 54 varones, con una edad media de 53,9±13,5 años) que requerían terapia con AINE fueron prospectivamente aleatorizados para recibir: indometacina (21), naproxeno (33); diclofenaco (40), sulindaco (42), meloxicam (35) y celecoxib (40) durante 8,5±2 días. La presión arterial fue medida al inicio y al final del seguimiento con un monitor Kenz OS22. Fueron evaluables 211 sujetos (88%), quienes mostraron una ligera disminución postratamiento de la PAM (–1,4±9,0 mmHg; intervalo de confianza [IC] del 95%, –2,7 a –0,2). No hubo diferencias significativas en los cambios de la PAM postratamiento entre los diferentes AINE evaluados. Cincuenta y cinco sujetos (el 23%, IC del 95%, 18-29) tuvieron un incremento postratamiento de la PAM ≥ 5 mmHg. Este desenlace no se asoció a la presencia de hipertensión, edad avanzada o alguno de los AINE utilizados. Concluimos que, considerado grupalmente, el tratamiento a corto plazo con AINE no parece tener un efecto clínicamente significativo sobre la PAM. Sin embargo, el 23% de los sujetos con este tratamiento desarrolló un grado de incremento de la PAM que podría aumentar el riesgo de enfermedad cardiovascular si fuese persistente. Se requiere una mayor investigación a fin de identificar si tal desenlace persiste con el tratamiento crónico con AINE y sus factores de riesgo.

Palabras clave:
Antiinflamatorios no esteroideos
Presión arterial
Efectos adversos
Ensayo clínico

Our objective was to evaluate the effect of short-term therapy with nonsteroidal antiinflammatory drugs (NSAID) on mean blood pressure (MBP). Two hundred thirty-three consecutive patients (185 women, 54 men; 53.9±13.5 years) requiring NSAID therapy were prospectively randomized to: indomethacin (21 patients), naproxen (33 patients), diclofenac (40 patients), sulindac (42 patients), meloxicam (35 patients) and celecoxib (40 patients) for 8.5±2 days. BP was measured at the beginning and end of follow-up using a Kenz OS22 monitor. At the end of follow-up, 211 (88%) patients were still available for evaluation. A slight posttreatment decrease in MBP (–1.4±9.0 mm Hg, 95%CI: –2.7 to –0.2) was found.

No significant differences in posttreatment changes in MBP were found among the distinct NSAIDs evaluated. Fifty-five patients (23%; 95% CI: 18-29) showed a posttreatment increase in MBP of>5 mm Hg. This increase was not associated with hypertension, old age, or any specific NSAID. We conclude that, overall, shortterm NSAID therapy does not seem to have a clinically significant effect on MAP. However, 23% of patients undergoing this therapy showed an increase in MBP that, if persistent, could lead to a higher risk of cardiovascular disease. Further research is needed to identify whether this outcome persists in long-term NSAID therapy.

Key words:
Non-steroidal anti-inflammatory drugs
Blood pressure
Adverse effects
Clinical trial
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Proyecto apoyado por el Fondo de Fomento a la Investigación (FOFOI/ IMSS).

Copyright © 2006. Elsevier España S.L. Barcelona
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