Tools for Practice Outils pour la pratique


#339 Is acetaminophen under pressure?


CLINICAL QUESTION
QUESTION CLINIQUE
 Does regular use of acetaminophen increase blood pressure?

BOTTOM LINE
RÉSULTAT FINAL
 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
DONNÉES PROBANTES
  • 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

Habtu Demsas May 1, 2023

Good session

Maxwell Meyer May 3, 2023

good info to learn and watch pts on overuse of acetaminophen

Luc Chagnon May 3, 2023

Need long term use to better assess, transient effect? or cumulative effect with time

Gilbert Bretecher May 9, 2023

acetaminophen does apparently increase BP mildly

Gilbert Bretecher May 9, 2023

acetaminophen in large doses om
acetaminophen in large doses a regular basis does apparently increase BP mildly.

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

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.

Les auteurs n’ont aucun conflit d’intérêts à déclarer.