BOSTON, Massachusetts—Men who routinely use nonprescription pain relievers such as acetaminophen, NSAIDs, or aspirin have moderately but significantly increased risk of developing hypertension (HTN), according to a prospective cohort analysis reported by John P. Forman, MSc, MD, in Archives of Internal Medicine.1 Dr. Forman, with the department of medicine at Brigham and Women's Hospital and Harvard Medical School, in Boston, collaborated on the study with Eric B. Rimm, ScD, and Cary C. Curhan, MD, ScD, both also of Brigham and Women's Hospital and Harvard Medical School.

"The frequency of nonnarcotic analgesic use is independently associated with a moderate increase in the risk of incident hypertension." —John P. Forman, MSc, MD.
"The frequency of nonnarcotic analgesic use is independently associated with a moderate increase in the risk of incident hypertension. Given the widespread use of these medications and the high prevalence of hypertension, these results may have important public health implications," writes Dr. Forman.

Acetaminophen, NSAIDs, aspirin all raise risk

This study included a cohort of 16,031 male health professionals who had no history of HTN at baseline. The investigators gathered detailed information about use of acetaminophen, NSAIDs, and aspirin at baseline and again 2 years later. They examined the relationship between analgesic use and incident HTN during 4 years (52,673 person-years) of follow-up.

Compared with nonusers, men who used one of the analgesics for 6 to 7 days per week had the following relative risks (RRs) of developing HTN over the next 4 years:

  • 1.34 for acetaminophen (P = .05 for trend)
  • 1.38 for NSAIDs (P = .02)
  • 1.26 for aspirin (P <.001).

    The researchers also found that men who took 15 or more analgesic pills per week had a RR of 1.48 for developing HTN compared with men who took no pills (P <.001).

    The effect of analgesic use was modified by weight. For acetaminophen, the association with HTN was significant only for men with a body mass index (BMI) of less than 25. Conversely, the association between NSAID use and risk of HTN was significant only for heavier men, ie, those with a BMI of greater than 25. BMI did not alter the aspirin-HTN association.

    The authors note that these findings are consistent with those of the Nurses' Health Study reviewed by Julien Dedier, et al.2 In that study the HTN RRs comparing the highest versus lowest frequency of analgesic use were 1.20 for acetaminophen, 1.35 for NSAIDs, and 1.21 for aspirin.

    "These data add further support to the hypothesis that nonnarcotic analgesics independently elevate the risk of hypertension," Dr. Forman concludes.

    Patients need to know about the risks and benefits

    This has obvious implications for clinicians treating large numbers of patients who rely on routine use of such pain relievers.

    Eric L. Matteson, MD, division chair of rheumatology and professor of medicine at the Mayo Clinic College of Medicine in Rochester, Minnesota, told CIAOMed, "I think it is important that patients know that the use of all of these analgesics can increase their blood pressure. Certainly stress from pain can cause an increase in blood pressure. However, the study does show that the effect is due to the medications. I think having the perspective that one should only take medication for need (in this case pain relief), ‘as little as possible, for as short a time as possible' is helpful, while knowing that pain relief is very important. The main issue is that the patients need to be informed of the risks and benefits of the medications."

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    References

    1. Forman JP, Rimm EB, Curhan GC. Frequency of analgesic use and risk of hypertension among men. Arch Intern Med. 2007;167:394-399.
    2. Dedier J, Stampfer MJ, Hankinson SE, et al. Nonnarcotic analgesic use and the risk of hypertension in US women. Hypertension. 2002;40:604-608.