Practice Evidence Based Case Report

Does paracetamol cause hypertension?

BMJ 2008; 336 doi: http://dx.doi.org/10.1136/bmj.39526.654016.AD (Published 22 May 2008) Cite this as: BMJ 2008;336:1190
  1. Brett Montgomery, clinical senior lecturer1
  1. 1Discipline of General Practice, School of Primary, Aboriginal and Rural Health Care, University of Western Australia, 328 Stirling Highway, Claremont, WA 6010, Australia
  1. brett{at}multiline.com.au
  • Accepted 2 February 2008

A newspaper article led this general practitioner and his patient to search for evidence and reach a decision on treatment

“Doc, I read in the paper that painkillers can give you high blood pressure. What do you think?” My patient was a 49 year old man with rheumatoid arthritis. His disease had previously been severe, but it had been improving in recent months with etanercept and intra-articular corticosteroids. In trying to answer his question, I began by explaining the cardiovascular risks of non-steroidal anti-inflammatory drugs.1 However, the newspaper article he had read also linked paracetamol to the development of hypertension. I had not heard of this risk before.

Together, we retrieved the newspaper article from the internet.2 It cited a recent American study which linked analgesic use to hypertension. I felt sceptical about this finding, but I needed to keep an open mind about this potentially common and important risk. I resolved to locate and appraise the study and to share my findings with my patient at a future consultation.

Critically appraising the study

From clues in the newspaper article, I traced the study in question, which was by Forman and colleagues and had been published in Archives of Internal Medicine.3 The paper began by explaining several possible mechanisms by which paracetamol may affect blood pressure, including inhibition of vasodilatory prostaglandins and effects on endothelial function. These “basic science” theories added plausibility to the possible association. The study was a prospective cohort study of 16 031 men followed for four years. The participants were male health professionals, aged on average in their mid-60s (older than my patient). The study aimed to measure the association between frequency of analgesic use and risk of new onset hypertension in men. The analgesic agents studied were paracetamol, non-steroidal anti-inflammatory drugs, and …

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