The Pharmaceutical Journal
Vol 278 No 7441 p238
3 March 2007

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Study links paracetamol, NSAID and aspirin use with high blood pressure in men

Men who regularly take over-the-counter analgesics have an increased risk of high blood pressure compared with those who do not use these medicines, according to a study published this week in Archives of Internal Medicine (2007;167:394).

The link was investigated as part of the ongoing US Health Professionals Follow-up Study, which is collecting information from over 50,000 male health professionals. A sub-group of 16,031 men with no history of hypertension were asked about their use of paracetamol, non-steroidal anti-inflammatory drugs (NSAIDs) and aspirin in 2000 and again in 2002. They were also asked to report any new diagnoses of hypertension.

Over four years of follow-up, 1,968 men developed hypertension. Compared with men who did not take analgesics, those who took paracetamol six or seven days a week had a 34 per cent higher risk of hypertension (relative risk 1.34, 95 per cent confidence interval 1.00–1.79; P=0.01 for trend). Those who took NSAIDs six or seven days a week had a 38 per cent higher risk (CI 1.09–1.75; P=0.002) and those who took aspirin six or seven days a week had a 26 per cent higher risk (CI 1.14–1.40; P<0.001).

When the number of tablets or capsules taken each week was analysed, irrespective of type, the researchers found that men who took 15 or more had a 48 per cent higher risk of hypertension than men who took none (CI 1.22–1.80; P<0.001).

The researchers suggest that the association between use of these analgesics and hypertension may be mediated through inhibition of vasodilatory prostaglandins. For paracetamol, increases in cellular oxidative stress and reduction of endothelial function may also be implicated. For NSAIDs, increased renal sodium and water reabsorption may exert a deleterious effect on endothelial function by increasing endothelin-1 production, they add.

“These data add further support to the hypothesis that non-narcotic analgesics independently elevate the risk of hypertension. Given their common consumption and the high prevalence of hypertension, our results may have substantial public health implications and [we] suggest that these agents be used with greater caution. The contribution of non-narcotic analgesics to the hypertension disease burden merits further study,” the authors conclude.