Frequent Use of Pain Relievers Linked To Hypertension

All of us experience pain, inflammation or fever from time to time, and when we do, most of us reach for relief in the form of acetaminophen or non-steroidal anti-inflammatory drugs (NSAIDs). The most commonly used NSAIDs are aspirin, ibuprofen (brand names such as Motrin and Advil) naproxen (brand names Naprosyn, Aleve) and nabumetone (Relafen). Acetaminophen is sold under many brand names, including Tylenol, Anacin-3 and Panadol.

While we tend to see these over-the-counter drugs as fairly harmless, a recent study has cast some doubt on that assumption.

The study, reported last year in the Archives of Internal Medicine, concluded that the use of NSAIDs and acetaminophen was significantly associated with an increased risk of hypertension (high blood pressure). The study did not show the same increased risk with the use of aspirin.

Women Had No History of High Blood Pressure
For two years, researchers at Brigham and Women's Hospital (BWH) and the Harvard School of Public Health monitored over 80,000 women between the ages of 31 and 50 who had no previous history of hypertension. The overall health of the women was monitored by questionnaires that asked about their lifestyle practices. Participants answered questions about their age, weight, smoking, oral contraceptive use, alcohol use and other issues that can have an impact on blood pressure. They were also asked about their intake of sodium, potassium and magnesium, since these minerals can also affect blood pressure.

After two years, a total of 1,650 women in the study had developed hypertension. Those taking NSAIDs at least 22 days per month were 1.86 times more likely to develop hypertension as those not taking NSAIDs, and those taking acetaminophen at least 22 days per month were twice as likely to develop hypertension as those not taking acetaminophen.

"We decided to study these drugs because they are so widely used and could affect blood pressure," said Gary Curhan, MD, of BWH. "Up until now, however, little has been done to assess their long-term impacts on blood pressure, particularly when they are taken with any kind of frequency."

Short-Term Analgesic Use Also Associated with BP Increase
Even infrequent use of the painkillers increased the chances of hypertension. Women who took NSAIDs like ibuprofen one to four days a month were 14% more likely to have high blood pressure than women who did not take the drugs. A woman taking the same regimen of acetaminophen experienced a 19% risk increase. Dr. Curhan said that women typically take acetaminophen and ibuprofen more often than men.

Clarence Grim, MD, Professor of Medicine in the Medical College of Wisconsin Department of Cardiovascular Medicine, advises a dose of common sense regarding the use of NSAIDs or acetaminophen. “Watch your blood pressure if you’re taking analgesics,” he says. “I would recommend that anyone taking large doses get a blood pressure cuff of their own so they can monitor it closely.”

If you are not currently taking analgesics regularly but intend to start, Dr. Grim recommends having your blood pressure checked before starting and checking it frequently so you can tell if your numbers are changing. If your blood pressure does begin to rise, keep the link between analgesics and hypertension in mind, but don’t make any hasty decisions. Speak with your physician and switch to plain aspirin as a replacement if needed. “Because we didn’t see the same problems with aspirin, it would be a good replacement choice,” Dr. Grim says. “The only way to tell if your current analgesics are influencing your blood pressure is to stop taking those medications and see if your pressure goes back down.”

Like All Drugs, NSAIDS and Acetaminophen Call for Caution
Analgesic use is extremely common in the US, with billions of dollars spent each year on over-the-counter remedies for pain, inflammation and fever. A significant number of hypertension cases could be attributed to the overuse of NSAIDS and acetaminophen. And it’s possible that women are not the only ones at risk, says Dr. Grim: “We have known for a long time that NSAIDS can cause hypertension in some people. Although women were the population studied in this case, there’s no reason that men’s’ reactions would be different.”

Although not proven by this research, Dr. Curhan said it is thought that these drugs may increase blood pressure by inhibiting production of prostaglandins, a hormone-like body chemical that widens blood vessels for improved blood flow.

While the researchers in this study did not recommend that anyone discontinue the use of NSAIDS or acetaminophen, they did see the study as a starting point for further research. Possibly the most important thing to remember about this study is that every drug has an effect on our bodies.

“Even though they can be purchased over-the-counter,” Dr. Grim reminds us, “NSAIDs, acetaminophen and aspirin are medicines and – like all medicines – can have serious side effects. Always tell your physician that you are taking analgesics, and be sure not to take them for more than two weeks at a time unless your physician recommends it.”

P. J. Early
HealthLink Contributing Writer

This article includes information from Brigham and Womens Hospital.