Is tylenol safe for someone with 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.

Women taking daily amounts of non-aspirin painkillers — such as an extra-strength Tylenol — are more likely to develop high blood pressure than those who don’t, a new study suggests.

While many popular over-the-counter painkillers have been linked before to high blood pressure, acetaminophen, sold as Tylenol, has generally been considered relatively free of such risk.

It is the only one that is not a non-steroidal anti-inflammatory drug or NSAID, a class of medications the federal government just required to carry stricter warning labels because of the risk for heart-related problems. Those include ibuprofen (sold as Advil and Motrin) and naproxen (sold as Aleve). Many had turned to those painkillers in the wake of problems with prescription drugs, such as Vioxx.

However, the new study found that women taking Tylenol were about twice as likely to develop blood pressure problems. Risk also rose for women taking NSAIDS other than aspirin.

“If you’re taking these over-the-counter medications at high dosages on a regular basis, make sure that you report it to your doctor and you’re checking your blood pressure,” said Dr. Christie Ballantyne, a cardiologist at the Methodist DeBakey Heart Center in Houston who had no role in the study.

The research found that aspirin still remains the safest medicine for pain relief. It has long been known to reduce the risk of cardiovascular problems and was not included in the government’s requirement for stricter labels for NSAIDs.

The study involved 5,123 women participating in the Nurses Health Study at Harvard Medical School and Brigham and Women’s Hospital in Boston. None had had high blood pressure when it began.

Use doubles risk of hypertension
Results were published online Monday in the American Heart Association journal Hypertension.

“It certainly sets the basis for more studies,” said Dr. Stephanie Lawhorn, a cardiologist at St. Luke’s Mid America Heart Institute in Kansas City. “Most of the time we think that things like acetaminophen are fairly safe drugs.”

In this study, the risk of developing high blood pressure for women who weren’t taking painkillers was about 1 to 3 percent a year, researchers said. They found that that women ages 51-77 who took an average daily dose of more than 500 milligrams of acetaminophen — one extra-strength Tylenol — had about double the risk of developing high blood pressure within about three years.

Women in that age range who take more than 400 mg a day of NSAIDS — equal to say two ibuprofen — had a 78 percent increased risk of developing high blood pressure over those who didn’t take the drug.

Among women 34-53 who take an average of more than 500 mg of acetaminophen a day had a two-fold higher risk of developing high blood pressure. And those who took more than 400 mg of NSAIDS a day had a 60 percent risk increase over those who didn’t take the pills.

“We are by no means suggesting that women with chronic pain conditions not receive treatment for their pain,” lead author Dr. John Phillip Forman, of Harvard Medical School and associate physician at Brigham and Women’s Hospital in Boston, said in an e-mail. “By pointing out risks associated with these drugs, more informed choices can be made by women and their clinicians.”

Previous research linking these drugs to blood pressure problems did not look at dose.

The results in this study held up even when researchers excluded women who were taking pills for headaches, something that could itself be a result of very high blood pressure, said Dr. Gary Curhan, another study author also of Harvard Medical School.

As for why aspirin didn’t raise risk, it might be because “aspirin has a different effect on blood vessels than NSAIDS and acetaminophen have,” said Dr. Daniel Jones, dean of the school of medicine at University of Mississippi Medical Center in Jackson.