Is it safe to take tylenol with high blood pressure

Women taking daily amounts of non-aspirin painkillers — such as an extra-strength Tylenol — are more likely to develop high blood pressure than those who don’t, a new study suggests.

While many popular over-the-counter painkillers have been linked before to high blood pressure, acetaminophen, sold as Tylenol, has generally been considered relatively free of such risk.

It is the only one that is not a non-steroidal anti-inflammatory drug or NSAID, a class of medications the federal government just required to carry stricter warning labels because of the risk for heart-related problems. Those include ibuprofen (sold as Advil and Motrin) and naproxen (sold as Aleve). Many had turned to those painkillers in the wake of problems with prescription drugs, such as Vioxx.

However, the new study found that women taking Tylenol were about twice as likely to develop blood pressure problems. Risk also rose for women taking NSAIDS other than aspirin.

“If you’re taking these over-the-counter medications at high dosages on a regular basis, make sure that you report it to your doctor and you’re checking your blood pressure,” said Dr. Christie Ballantyne, a cardiologist at the Methodist DeBakey Heart Center in Houston who had no role in the study.

The research found that aspirin still remains the safest medicine for pain relief. It has long been known to reduce the risk of cardiovascular problems and was not included in the government’s requirement for stricter labels for NSAIDs.

The study involved 5,123 women participating in the Nurses Health Study at Harvard Medical School and Brigham and Women’s Hospital in Boston. None had had high blood pressure when it began.

Use doubles risk of hypertension
Results were published online Monday in the American Heart Association journal Hypertension.

“It certainly sets the basis for more studies,” said Dr. Stephanie Lawhorn, a cardiologist at St. Luke’s Mid America Heart Institute in Kansas City. “Most of the time we think that things like acetaminophen are fairly safe drugs.”

In this study, the risk of developing high blood pressure for women who weren’t taking painkillers was about 1 to 3 percent a year, researchers said. They found that that women ages 51-77 who took an average daily dose of more than 500 milligrams of acetaminophen — one extra-strength Tylenol — had about double the risk of developing high blood pressure within about three years.

Women in that age range who take more than 400 mg a day of NSAIDS — equal to say two ibuprofen — had a 78 percent increased risk of developing high blood pressure over those who didn’t take the drug.

Among women 34-53 who take an average of more than 500 mg of acetaminophen a day had a two-fold higher risk of developing high blood pressure. And those who took more than 400 mg of NSAIDS a day had a 60 percent risk increase over those who didn’t take the pills.

“We are by no means suggesting that women with chronic pain conditions not receive treatment for their pain,” lead author Dr. John Phillip Forman, of Harvard Medical School and associate physician at Brigham and Women’s Hospital in Boston, said in an e-mail. “By pointing out risks associated with these drugs, more informed choices can be made by women and their clinicians.”

Previous research linking these drugs to blood pressure problems did not look at dose.

The results in this study held up even when researchers excluded women who were taking pills for headaches, something that could itself be a result of very high blood pressure, said Dr. Gary Curhan, another study author also of Harvard Medical School.

As for why aspirin didn’t raise risk, it might be because “aspirin has a different effect on blood vessels than NSAIDS and acetaminophen have,” said Dr. Daniel Jones, dean of the school of medicine at University of Mississippi Medical Center in Jackson.

When matters of the heart matter most, recommend TYLENOL®

TYLENOL® may be a good analgesic choice for patients with certain cardiovascular conditions1

92.1 million American adults have at least one type of cardiovascular disease2

When recommending an analgesic, it’s important to consider patients’ heart risks. The combination of certain pain relievers with some medicinal therapies can interfere with cardiovascular treatment. Because of its safety and analgesic efficacy, the American Heart Association has identified acetaminophen as a first-line pain relief option for patients with, or at high risk for, cardiovascular disease.3*

50 million American adults are on aspirin heart therapy4

Ibuprofen may inhibit aspirin’s cardioprotective benefits. Ibuprofen binds to the cyclooxygenase (COX-1) enzyme, which can interfere with aspirin’s ability to bind to COX-1 and exert its antiplatelet effect.1*

Watch ibuprofen interfere with aspirin’s cardioprotective benefits—and learn how TYLENOL® does not1

Aspirin binds to platelet COX-1 to inhibit platelet aggregation and to protect against myocardial infarction. Ibuprofen binds to the same area of the COX-1 enzyme. When a patient takes ibuprofen prior to taking aspirin, aspirin is blocked from reaching its binding sites.1 Adding an NSAID to aspirin can also increase the risk of stomach bleeding.5

TYLENOL® does not interfere with the cardioprotective benefits of aspirin the way ibuprofen can1

Visit the Resource Library to explore patient and practice support resources.

TYLENOL® is an appropriate analgesic choice to consider for patients on aspirin heart therapy1

Updated NSAID warnings: help your patients understand risks

The U.S. Food and Drug Administration (FDA) required an update to the Drug Facts labeling of all adult and pediatric non-aspirin OTC nonsteroidal anti-inflammatory drugs (NSAIDs), for example Motrin®, Advil®, and Aleve® products. These strengthen and expand existing warnings relating to the risk of heart attack and stroke associated with NSAIDs.6

TYLENOL® does not have a cardiovascular risk warning on its label

Download the NSAID Warning Comparison Guide for more information.

*When symptoms are not controlled by nonpharmacological approaches.

REFERENCES: 1. Catella-Lawson F, Reilly MP, Kapoor SC, et al. Cyclooxygenase inhibitors and the antiplatelet effects of aspirin. N Engl J Med. 2001;345(25):1809-1817. 2. American Heart Association. Heart disease and stroke statistics 2017 at-a-glance. https://healthmetrics.heart.org/wp-content/uploads/2017/06/Heart-Disease-and-Stroke-Statistics-2017-ucm_491265.pdf. Accessed January 12, 2018. 3. Antman EM, Bennett JS, Daugherty A, Furberg C, Roberts H, Taubert KA. Use of nonsteroidal anti-inflammatory drugs: an update for clinicians: a scientific statement from the American Heart Association. Circulation. 2007;115(12):1634-1642. 4. Campbell CL, Smyth S, Montalescot G, Steinhubl SR. Aspirin dose for the prevention of cardiovascular disease. JAMA. 2007;297(18):2018-2024. 5. Bhatt DL, Scheiman J, Abraham NS, et al. ACCF/ACG/AHA 2008 expert consensus document on reducing the gastrointestinal risks of antiplatelet therapy and NSAID use. Circulation. 2008;118(8):1894-1909. 6. U.S. Food and Drug Administration. FDA strengthens warning of heart attack and stroke risk for non-steroidal anti-inflammatory drugs. https://www.fda.gov/ForConsumers/ConsumerUpdates/ucm453610.htm. Accessed January 12, 2018.  7. Rahman MM, Kopec JA, Cibere J, Goldsmith CH, Anis AH. The relationship between osteoarthritis and cardiovascular disease in a population health survey: a cross-sectional study. BMJ Open. 2013;3(5):e002624.

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