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#339 Is acetaminophen under pressure?


CLINICAL QUESTION
Does regular use of acetaminophen increase blood pressure?

BOTTOM LINE
Taking 3-4g of acetaminophen per day for 2-4 weeks increases systolic blood pressure by 3-4 mmHg. Clinicians should consider that regular use of acetaminophen can be a cause of elevated blood pressure in some patients.


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EVIDENCE
  • Evidence review focused on double-blind randomized controlled trials (RCTs).
  • Results statistically significant unless stated.
  • A 2022 systematic review identified 3 double-blind RCTs:1
    • Largest crossover RCT, 110 hypertensive participants (mean age 62, baseline blood pressure ~134/81 mmHg, ~70% on blood pressure medications) given 1g acetaminophen 4 times daily or placebo for 2 weeks:2
      • Acetaminophen increased mean 24-hour systolic blood pressure by 4.2mmHg and 1.4mmHg diastolic over placebo.
    • Crossover RCT, 33 participants with stable coronary artery disease (mean age 61, baseline blood pressure ~122/73 mmHg) given acetaminophen 1g 3 times daily or placebo for 2 weeks:3
      • Acetaminophen increased mean 24-hour systolic blood pressure by 3.4mmHg and 1.9mmHg diastolic over placebo.
    • Parallel RCT, 29 treated hypertensive participants (mean age 52, baseline blood pressure 126/90 mmHg) given 1g acetaminophen 3 times daily or placebo for 3 weeks:4
      • No blood pressure difference.1,4
    • 1984 double-blind crossover RCT (not in above systematic review), 22 hypertensive participants using NSAIDs for pain given 1g acetaminophen 3 times daily or placebo.5 At 4 weeks:
      • Sitting blood pressure: No difference.
      • Supine and standing systolic blood pressure: 4mmHg higher with acetaminophen over placebo.
Context
  • The RCT evidence for acetaminophen producing blood pressure changes is limited to a time frame of <4 weeks.
  • Long-term blood pressure or cardiovascular safety data comes from observational studies only and results are inconsistent.6-14
  • Long-term regular use of acetaminophen is ineffective for various chronic pain conditions such as osteoarthritis and low back pain.15-17

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#339 Is acetaminophen under pressure?

Does regular use of acetaminophen increase blood pressure?
Read 0.25 credits available
May 1, 2023

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Author(s):

  • Émélie Braschi MD PhD
  • James McCormack BSc(Pharm) PharmD
  • Nicolas Dugré PharmD MSc BCPAC

1. Gupta R, Behnoush AH, Egeler D, et al. Eur J Prev Cardiol. 2022; 29(14):e326-e330.

2. McIntyre IA, Turtle E, Farrha TE, et al. Circulation. 2022; 145(6): 416–423.

3. Sudano I, Flammer AJ, Periat D, et al. Circulation. 2010; 122:1789–1796.

4. Radack KL, Deck CC, Bloomfield SS. Ann Intern Med. 1987; 107(5):628-35.

5. Chalmers JP, West MJ, Wing LM, et al. Clin Exp Hypertens A. 1984; 6(6):1077-93.

6. Turtle EJ, Dear JW, Webb D. Br J Clin Pharmacol. 2013; 75(6):1396-405.

7. Gonzalez-Valcarcel J, Sissani L, Labreuche J, et al. Stroke. 2016 Apr; 47(4):1045-52.

8. Chan AT, Manson JE, Albert CM, et al. Circulation. 2006 Mar 28; 113(12):1578-87.

9. Roberto G, Simonetti M, Piccinni C, et al. Pharmacotherapy. 2015 Oct; 35(10):899-909.

10. Dawson J, Fulton R, McInnes GT, et al. J Hypertens. 2013 Jul; 31(7):1485-90; discussion 1490.

11. Fulton RL, Walters MR, Morton R, et al. Hypertension. 2015 May; 65(5):1008-14.

12. Girard P, Sourdet S, Cantet C, et al. J Am Geriatr Soc. 2019 Jun; 67(6):1240-1247.

13. Roberts E, Delgado Nunes V, et al. Ann Rheum Dis. 2016 Mar; 75(3):552-9.

14. Lipworth L, Friis S, Mellemkjær L, et al. J Clin Epidemiol. 2003; 56(8), 796-801.

15. Korownyk CS, Montgomery L, Young J, et al. Can Fam Physician. 2022 Mar;68(3):179-190.

16. Leopoldino AO, Machado GC, Ferreira PH, et al. Cochrane Database Syst Rev. 2019; 2:CD013273.

17. Saragiotto BT, Machado GC, Ferreira ML, et al. Cochrane Database Syst Rev. 2016; 6:CD012230.

Authors do not have any conflicts of interest to declare.