Edinburgh, Scotland – Acetaminophen is one of the most common medications in the world for treating and managing chronic and short-term pain. Now, however, researchers from the University of Edinburgh say long-term use of these painkillers can increase the risk of heart attack and stroke in people with high blood pressure.
In light of these findings, the study authors recommend that patients on a long-term prescription for acetaminophen do their best to reduce their doses and overall intake as much as possible while still providing pain relief. This is the first large randomized clinical trial to investigate this topic.
Acetaminophen, of course, is best known under the brand names Tylenol, Mapap, and Panadol. However, in other parts of the world like Europe and Australia, acetaminophen is known as paracetamol.
“This is not for short-term use of paracetamol for headaches or fever, which is, of course, fine – but it does indicate a newly discovered risk for people who regularly take more term, usually for chronic pain,” lead researcher Dr Iain MacIntyre, consultant in clinical pharmacology and nephrology at NHS Lothian, said in an academic statement.
“This study clearly shows that paracetamol – the most widely used drug in the world – raises blood pressure, one of the most important risk factors for heart attacks and strokes. Physicians and patients should together consider the risks versus the benefits of long-term prescription of paracetamol, particularly in patients at risk for cardiovascular disease,” says Professor James Dear, Personal Director of Clinical Pharmacology at the University. from Edinburgh.
Acetaminophen as bad as NSAIDs?
Generally, doctors consider acetaminophen a safer alternative to nonsteroidal anti-inflammatory pain relievers (NSAIDs). Studies show that NSAIDs can increase blood pressure and the risk of heart disease.
In the new study, participants with a history of high blood pressure took one gram of acetaminophen four times a day for two weeks. This dose is quite common and is a normal prescription for patients with chronic pain. Meanwhile, another subset of participants received a placebo to take for two weeks. A total of 110 subjects participated in this project. Importantly, all patients received both treatments, with researchers randomizing prescriptions in a blinded clinical trial.
While the placebo groups saw no or minimal increases in blood pressure, those taking acetaminophen experienced significant increases. In fact, the study authors explain that the increases in blood pressure when taking acetaminophen were quite similar to those seen in people taking NSAIDs. They estimate that such fluctuations in blood pressure can increase the risk of heart disease or stroke by around 20%. The study authors believe that a thorough, long-term review of painkiller prescribing practices is now needed to examine the risks to patients.
Occasional use is still safe
“We recommend that clinicians start with a low dose of paracetamol and increase the dose in stages, without exceeding the dose needed to control pain. Given the substantial increases in blood pressure observed in some of our patients, it may There may be a benefit for clinicians to monitor blood pressure more closely in people with high blood pressure who have recently started taking paracetamol for chronic pain,” says lead researcher Professor David Webb, Chair of Therapeutics and Clinical Pharmacology at the University of Edinburgh.
“This research shows how quickly regular use of paracetamol can raise blood pressure in people with hypertension who are already at increased risk of heart attacks and strokes. It underscores why doctors and patients should regularly check whether there is a continued need to take medication, even something that may seem relatively harmless like paracetamol, and always weigh the benefits and risks.However, if you occasionally take paracetamol to manage an isolated headache or very short periods of pain, these research results shouldn’t worry you unnecessarily,” concludes Professor Sir Nilesh Samani, Medical Director of the British Heart Foundation.
The study is published in the journal Traffic.