Can you take acetaminophen if you have high blood pressure

EDINBURGH, Scotland — Acetaminophen is one of the most common medications worldwide for treating and managing both short-term and chronic aches and pains. Now, however, researchers from the University of Edinburgh say long-term use of these pain relievers may increase the risk of both heart attack and stroke among those with high blood pressure.

In light of these results, study authors recommend patients with a long-term prescription for acetaminophen do their best to lower their dosages and overall intake as much as possible while still relieving their pain. This is the first ever large randomized clinical trial to investigate this topic.

Acetaminophen, of course, is best known under brand names Tylenol, Mapap, and Panadol. However, in other parts of the world such as Europe and Australia, acetaminophen is known as paracetamol.

“This is not about short-term use of paracetamol for headaches or fever, which is, of course, fine – but it does indicate a newly discovered risk for people who take it regularly over the longer term, usually for chronic pain,” says lead investigator Dr. Iain MacIntyre, a consultant in clinical pharmacology and nephrology at NHS Lothian, in a university release.

“This study clearly shows that paracetamol – the world’s most used drug – increases blood pressure, one of the most important risk factors for heart attacks and strokes. Doctors and patients together should consider the risks versus the benefits of long-term paracetamol prescription, especially in patients at risk of cardiovascular disease,” explains Professor James Dear, Personal Chair of Clinical Pharmacology at the University of Edinburgh.

Acetaminophen as bad as NSAIDs?

Typically, doctors consider acetaminophen a safer alternative to non-steroidal anti-inflammatory (NSAID) painkilling drugs. Studies show NSAIDs can increase blood pressure and a person’s risk of heart disease.

In the new study, participants with a history of high blood pressure took one gram of acetaminophen four times daily for two weeks. That dose is quite common and a normal prescription for patients dealing with chronic pain. Meanwhile, another sub-set of participants received a placebo to take for two weeks. In all, 110 subjects took part in this project. Importantly, all of the patients received both treatments, with researchers randomizing the prescriptions in a blind clinical trial.

While the placebo groups saw no or minimal increases in blood pressure, those taking acetaminophen experienced significant increases. In fact, study authors explain that the increases in blood pressure while taking acetaminophen were quite similar to those seen in people taking NSAIDs. They estimate such blood pressure fluctuations may increase the risk of heart disease or stroke by roughly 20 percent. Study authors believe an extensive, long-term review of prescribing practices for the pain reliever is now necessary to examine risks to patients.

Occasional use is still safe

“We would recommend that clinicians start with a low dose of paracetamol, and increase the dose in stages, going no higher than needed to control pain. Given the substantial rises in blood pressure seen in some of our patients, there may be a benefit for clinicians to keep a closer eye on blood pressure in people with high blood pressure who newly start paracetamol for chronic pain,” explains principal investigator Professor David Webb, Chair of Therapeutics and Clinical Pharmacology at the University of Edinburgh.

“This research shows how quickly regular use of paracetamol can increase blood pressure in people with hypertension who are already at increased risk of heart attacks and strokes. It emphasizes why doctors and patients should regularly review whether there is an ongoing need to take any medication, even something that may seem relatively harmless like paracetamol, and always weigh up the benefits and risks. However, if you take paracetamol occasionally to manage an isolated headache or very short bouts of pain, these research findings should not cause unnecessary concern,” concludes Professor Sir Nilesh Samani, Medical Director at the British Heart Foundation.

The study is published in the journal Circulation.

When matters of the heart matter most, recommend TYLENOL®

TYLENOL® may be a good analgesic choice for patients with certain cardiovascular conditions1

92.1 million American adults have at least one type of cardiovascular disease2

When recommending an analgesic, it’s important to consider patients’ heart risks. The combination of certain pain relievers with some medicinal therapies can interfere with cardiovascular treatment. Because of its safety and analgesic efficacy, the American Heart Association has identified acetaminophen as a first-line pain relief option for patients with, or at high risk for, cardiovascular disease.3*

50 million American adults are on aspirin heart therapy4

Ibuprofen may inhibit aspirin’s cardioprotective benefits. Ibuprofen binds to the cyclooxygenase (COX-1) enzyme, which can interfere with aspirin’s ability to bind to COX-1 and exert its antiplatelet effect.1*

Watch ibuprofen interfere with aspirin’s cardioprotective benefits—and learn how TYLENOL® does not1

Aspirin binds to platelet COX-1 to inhibit platelet aggregation and to protect against myocardial infarction. Ibuprofen binds to the same area of the COX-1 enzyme. When a patient takes ibuprofen prior to taking aspirin, aspirin is blocked from reaching its binding sites.1 Adding an NSAID to aspirin can also increase the risk of stomach bleeding.5

TYLENOL® does not interfere with the cardioprotective benefits of aspirin the way ibuprofen can1

Visit the Resource Library to explore patient and practice support resources.

TYLENOL® is an appropriate analgesic choice to consider for patients on aspirin heart therapy1

Updated NSAID warnings: help your patients understand risks

The U.S. Food and Drug Administration (FDA) required an update to the Drug Facts labeling of all adult and pediatric non-aspirin OTC nonsteroidal anti-inflammatory drugs (NSAIDs), for example Motrin®, Advil®, and Aleve® products. These strengthen and expand existing warnings relating to the risk of heart attack and stroke associated with NSAIDs.6

TYLENOL® does not have a cardiovascular risk warning on its label

Download the NSAID Warning Comparison Guide for more information.

*When symptoms are not controlled by nonpharmacological approaches.

REFERENCES: 1. Catella-Lawson F, Reilly MP, Kapoor SC, et al. Cyclooxygenase inhibitors and the antiplatelet effects of aspirin. N Engl J Med. 2001;345(25):1809-1817. 2. American Heart Association. Heart disease and stroke statistics 2017 at-a-glance. https://healthmetrics.heart.org/wp-content/uploads/2017/06/Heart-Disease-and-Stroke-Statistics-2017-ucm_491265.pdf. Accessed January 12, 2018. 3. Antman EM, Bennett JS, Daugherty A, Furberg C, Roberts H, Taubert KA. Use of nonsteroidal anti-inflammatory drugs: an update for clinicians: a scientific statement from the American Heart Association. Circulation. 2007;115(12):1634-1642. 4. Campbell CL, Smyth S, Montalescot G, Steinhubl SR. Aspirin dose for the prevention of cardiovascular disease. JAMA. 2007;297(18):2018-2024. 5. Bhatt DL, Scheiman J, Abraham NS, et al. ACCF/ACG/AHA 2008 expert consensus document on reducing the gastrointestinal risks of antiplatelet therapy and NSAID use. Circulation. 2008;118(8):1894-1909. 6. U.S. Food and Drug Administration. FDA strengthens warning of heart attack and stroke risk for non-steroidal anti-inflammatory drugs. https://www.fda.gov/ForConsumers/ConsumerUpdates/ucm453610.htm. Accessed January 12, 2018.  7. Rahman MM, Kopec JA, Cibere J, Goldsmith CH, Anis AH. The relationship between osteoarthritis and cardiovascular disease in a population health survey: a cross-sectional study. BMJ Open. 2013;3(5):e002624.

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