Clinical question: Does regular intake of acetaminophen cause an increase in blood pressure?
Background: Acetaminophen is one of the most commonly used analgesics in the world. Because of its widespread use and limited demonstrated efficacy, there have been growing reservations regarding its long-term safety, particularly its influence on blood pressure (BP).
Study design: Single-center, randomized, double-blinded, placebo-controlled crossover trial
Setting: United Kingdom
Synopsis: 110 patients were randomized to receive 1 g of acetaminophen four times daily or a corresponding placebo for two weeks; a two-week washout period completed the trial. The patients were subsequently transferred to the other treatment arm for an additional two weeks. The participants attended two long visits on days 0 and 14 and two short visits on days 4 and 7. Based on acetaminophen assays, 90 participants were included in the final analysis.
Regular acetaminophen caused a significant rise in mean daytime systolic blood pressure (132.8 ±10.5 to 136.5 ±10.1 mmHg [acetaminophen] versus 133.9 ±10.3 to 132.5 ±9.9 mmHg [placebo]; P<0.0001) and mean daytime diastolic blood pressure (81.2 ±8.0 to 82.1 ±7.8 mmHg [acetaminophen] versus 81.7 ±7.9 to 80.9 ±7.8 mmHg [placebo]; P=0.005).
This study’s limitations include: being a single-center study, exclusively done on the white population, and including only patients with underlying hypertension so its impact on the normotensive population is unknown. Moreover, because the trial only lasted two weeks, it is challenging to predict whether the results would persist over time.
Bottom line: Acetaminophen elevates blood pressure by roughly 5/2 mmHg in patients with underlying hypertension (treated or untreated) within a two-week period when compared to placebo.
Citation: MacIntyre IM, et al. PATH-BP (paracetamol in hypertension–blood pressure) investigators. Regular acetaminophen use and blood pressure in people with hypertension: the PATH-BP trial. Circulation. 2022;145(6):416-423.
Dr. Sheikh is associate program director for the department of internal medicine and assistant professor of medicine at the University of New Mexico Hospital, Albuquerque, N.M.