Is Acetaminophen Really a Safe Medication?

High blood pressure, or hypertension, is the most common primary diagnosis in the United States,  and it is one of the most common worldwide diseases afflicting humans and is a major risk factor for stroke, myocardial infarction, vascular disease, and chronic kidney disease. Despite extensive research over the past several decades, the etiology of most cases of adult hypertension is still unknown, and control of blood pressure is suboptimal in the general population.

According to the American Heart Association (AHA), approximately 86 million adults (34%) in the United States are affected by hypertension, which is defined as a systolic blood pressure (SBP) of 140 mm Hg or more or a diastolic blood pressure (DBP) of 90 mm Hg or more, taking antihypertensive medication, or having been told by clinicians on at least 2 occasions as having hypertension.

It is well known that non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, diclofenac, ketorolac , naproxen, have side effects such as bleeding risk, raise the blood pressure, heartburn pain, nausea and dizziness, and that’s why it is not recommended to people who have cardiovascular diseases such as hypertension, heart failure, among others. On the other hand , acetaminophen has been recommended to treat fever and pain in patients because it has minor side effects and risk for cardiovascular diseases.

Acetaminophen is one of the most widely used over the counter medications, used for its analgesic and antipyretic properties. It has been widely utilized in part because of its favorable safety profile. 

It is often weighed against non-steroidal anti-inflammatory drugs (NSAIDs), and although it lacks the anti-inflammatory effects, it has been thought to be a safer medication for long term use. 

The side effects are generally mild and include nausea, headache, stomach pain, and a rash, while the most serious side effect is liver toxicity which does not occur unless taken in large quantities. 

One potential effect of acetaminophen that has not been well studied is its effect on blood pressure. NSAIDs have been known to raise blood pressure, but there have been limited studies looking at the effect of acetaminophen on blood pressure. 

Is Acetaminophen really safe for people with Hypertension? 

To investigate further, Rahul Gupta, MD, cardiologist with Lehigh Valley Health Network, Allentown, Pennsylvania and colleagues did a meta-analysis of three studies that compared the effect of acetaminophen (3-4 g/day) vs placebo on systolic and diastolic ambulatory blood pressure in patients with heart disease or hypertension. Together, the studies included 172 adults (mean age, 60 years; 73% male). 

They found that patients receiving acetaminophen had significantly higher systolic blood pressure compared with those receiving placebo (standard mean difference [SMD] = 0.35; 95% CI, 0.08-0.63; P = .01).

Subgroup analysis of the effect on hypertensive patients showed significant change in systolic blood pressure as well (SMD = 0.38; 95% CI, 0.05-0.71; P = .02).

However, most of the trials look at very high doses of acetaminophen use (eg, six to eight of the 500-mg pills each day) so they don’t really know whether the more common patterns of using one to two acetaminophen pills every once in a while is problematic. It would be necessary to do some study where use of some NSAID such as ibuprofen, and acetaminophen to see if there is a difference between them.

As we can see, these findings give us more information about this medication , and the recommendation here is no abuse auto medication and go to your doctor to get an evaluation and risk analysis of the use of any medication for pain, they are not candies.

SOURCE: 

Rahul Gupta, Amir Hossein Behnoush, David Egeler, Wilbert S Aronow, (June 3, 2022). Effect of acetaminophen on blood pressure: a systematic review and meta-analysis of randomized controlled trials .  European Journal of Preventive Cardiology. Retrieved from: https://academic.oup.com/eurjpc/advance-article-abstract/doi/10.1093/eurjpc/zwac112/6599100?redirectedFrom=fulltext 

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