Efectos de la inhibición selectiva y no selectiva de la ciclooxigenasa en la vasodilatación dependiente de óxido nítrico y prostaciclina en pacientes hipertensos

Abstract

BackgroundThe cardiovascular safety of new selective COX-2 inhibitors, especially when used in hypertensive or high risk patients, has been recently questioned. This may be related to the effects of these drugs on endothelial function. AimEvaluate the effects of selective and non-selective COX-inhibition on NO and PGI2 dependent vasodilation in hypertensive patients. Methods. Twenty-four hypertensive patients were included in a controlled, randomized, prospective, double-blind trial in which the effects of indomethacin and rofecoxib on flow-dependent vasodilation and the acute hypotensive captopril effect were evaluated. Brachial artery flow-dependent vasodilation in response to 5-minute ischemia was measured by means of a high resolution Doppler ultrasound device with 10 MHz arterial transducers. The acute hypotensive captopril effect was measured by means of an electronic validated device at 0, 1, 2, 3, 4, 5, 12 and 24h after treatments. ResultsNeither indomethacin, rofecoxib, captopril, captopril plus indomethacin nor captopril plus rofecoxib modified the flow-dependent vasodilation. Captopril-induced vasodilation indomethacin but not rofecoxib blunted the acute hypotensive effect of captopril. ConclusionsThese results suggest that the acute vasodilation induced by captopril is COX-1 dependent and the excess of cardiovascular risk of COX-2 inhibitors may be decreased by concomitant administration of ACE-inhibitors in hypertensive patients.