#339 Is acetaminophen under pressure?

Reading Tools for Practice Article can earn you MainPro+ Credits
Join NowAlready a CFPCLearn Member? Log in
- 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.
- 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
- 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