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Tylenol Linked To High Blood Pressure In Women
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 hypertensionResults 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.
Everyday Pain Relief: High Blood Pressure
There are many over-the-counter pain relievers on the market. They can help in many cases, but you'll want to know about their risks and how to use them correctly.
That's especially true for people with high blood pressure. Many over-the-counter (OTC) painkillers can push your blood pressure higher. That can be dangerous. Since high blood pressure has no symptoms that you can feel, you may be hurting yourself without realizing it.
"People with high blood pressure don't know the risks of taking some of these painkillers," says Nieca Goldberg, MD, a cardiologist and spokesperson for the American Heart Association. "They assume that anything you can buy over the counter is safe. But these drugs are chemicals that can cause side effects."
The problem isn't only with OTC painkillers. In fact, many remedies for colds, sinus problems, and even heartburn contain the same ingredients.
If you have high blood pressure, keeping it under control is crucial. So before you reach for a bottle of pain reliever for your next backache, learn some dos and don'ts.
When you feel pain, it's the result of an electrical signal being sent from the nerves in a part of your body to your brain.
But the whole process isn't electrical. When tissue is injured (by a sprained ankle, for instance), the cells release certain chemicals in response. These chemicals cause inflammation and amplify the electrical signal coming from the nerves. As a result, they increase the pain you feel.
Painkillers block the effects of these pain chemicals. The problem is that you can't focus most pain relievers specifically on your headache or aching back. Instead, the medicine travels through your whole body. This can cause some unexpected side effects.
For people with high blood pressure, some types of nonsteroidal anti-inflammatory drugs (NSAIDs) can be risky. They include ibuprofen, naproxensodium, and ketoprofen.
Other pain relievers may be less dangerous. Aspirin is also an NSAID, but experts think that it's safer for people with hypertension. Acetaminophen is a different type of painkiller that doesn't raise blood pressure as a side effect. But like any drug, it does have side effects of its own. You shouldn't take any over-the-counter painkiller for more than 10 days without your health care provider's approval.
Why are people with high blood pressure at special risk? Some of these NSAIDs reduce the blood flow to the kidneys. The kidneys,which filter your blood,work more slowly, so fluid builds up in your body. The increased fluid drives up your blood pressure.
"When I have patients with heart disease that suddenly gets much worse, the first thing I ask them is if they've used an over-the-counter pain medicine," Goldberg says.
These drugs have additional risks. If you take them often enough and at a high enough dose, they can seriously damage the kidneys.
So what's a person with high blood pressure and a headache to do? In general, people with high blood pressure should use acetaminophen or possibly aspirin for over-the-counter pain relief.
Unless your health care provider has said it's OK, you should not use ibuprofen, ketoprofen, or naproxen sodium. If aspirin or acetaminophen doesn't help with your pain, call your doctor.
Of course, painkillers aren't the only answer for many of life's aches and pains. Many effective and safe alternatives don't have any side effects at all.
So remember: Pain relief doesn't only come from a pill bottle.
Here's a rundown of the benefits and risks of some popular pain medications. It should help simplify your choices the next time you're shopping for one.
Keep in mind that you shouldn't use any over-the-counter painkiller on a regular basis. If you're in that much pain, you need to talk with your doctor.
ACETAMINOPHENTylenol, Panadol, Tempra (and also an ingredient in Excedrin)
Acetaminophen is also less likely to cause gastrointestinal problems than NSAIDs. It is safe for women who are pregnant and nursing.
Acetaminophen doesn't reduce swelling, like aspirin and other NSAIDs do. It may be less helpful in treating pain that's caused by inflammation, such as some types of arthritis.
ASPIRINBayer, Bufferin, Ecotrin (and also an ingredient in Excedrin)
Aspirin also lowers the risk of heart attacks and strokes, particularly in people at high risk of these problems. Usually, only very low daily doses -- 81 milligrams or one baby aspirin -- are recommended for cardiovascular protection.
Other NSAIDs (like ibuprofen ketoprofen, or naproxen sodium) and acetaminophen do not have this effect. However, you should never start taking aspirin daily without talking with your doctor first.
Aspirin can also cause heartburn, upset stomach, pain, or ulcers even in very low doses. It can be dangerous for people with liver disease, gout, juvenile arthritis, or rheumatic fever. Pregnant women shouldn't use aspirin, since it can harm the mother and cause birth defects. Unless your health care provider says it's OK, children and teenagers should not use aspirin because it puts them at risk of Reye's syndrome.
Some people have an allergy to aspirin. It can cause wheezing, hives, facial swelling, and shock. Rarely, aspirin can cause ringing in the ears and hearing loss.
While inflammation can cause pain, it's often a key part of the body's natural healing process. Since this medicine at high doses can prevent inflammation, it can also slow down recovery after certain injuries.
IBUPROFENAdvil, Motrin IB, Nuprin
Ibuprofen can cause heartburn, upset stomach, pain, and ulcers. It may also increase the risk of heart attacks and strokes. The FDA now requires that drug companies highlight ibuprofen's potential risks. This drug isn't safe during the last three months of pregnancy.
Some people are allergic to ibuprofen and other NSAIDs. It can cause hives and facial swelling. It can be dangerous to some people with asthma. In some cases, ibuprofen can slow down the body's natural healing process.
KETOPROFENOrudis, Orudis KT, Oruvail
Ketoprofen can cause heartburn, upset stomach, pain, and ulcers. It may increase the risk of heart attacks and strokes. The FDA requires that companies that sell ketoprofen highlight these risks. This drug isn't safe during the last three months of pregnancy.
Some people are allergic to ketoprofen and other NSAIDs. It can cause hives and facial swelling. It can be dangerous to some people with asthma. In some cases, ketoprofen can slow down the body's natural healing process.
NAPROXENAleve
One study seems to show a link between naproxen sodium and an increased risk of heart attack or stroke. More research needs to be done before doctors know for sure. For now, ask your health care provider for advice.
Naproxen sodium can cause heartburn, upset stomach, pain, or ulcers. The FDA requires that companies that sell naproxen sodium highlight these risks. This drug isn't safe during the last three months of pregnancy.
Some people are allergic to naproxen sodium and other NSAIDs. It can cause hives and facial swelling. It can be dangerous to some people with asthma. In some cases, naproxen sodium can slow down the body's natural healing process.
Many painkillers -- including higher doses of NSAIDs -- are available by prescription. Since they are more powerful versions of over-the-counter NSAIDs, they often have the same or greater risks. Some examples are Daypro, Indocin, Lodine, Mobic, Naprosyn, Relafen, and Voltaren.
Cox-2 inhibitors are a relatively newer kind of NSAID. Although these drugs are supposed to have fewer gastrointestinal side effects than standard NSAIDs, they can still cause some of the same problems. They may also raise the risk of heart attacks and strokes. So people with coronary artery disease, those who've had a stroke, and those who have narrowed arteries to the brain --- or people who are at higher than average risk for developing these conditions -- -- should not take Cox-2 inhibitors.
Two of these drugs, Vioxx and Bextra, have been taken off the market because of various side effects. Cox-2 inhibitors that are still available are Celebrex, Mobic, Relafen, and Voltaren.
Narcotics are another type of prescription painkiller. Examples include OxyContin, Percocet, and Vicodin. These drugs are only used in people with severe chronic pain. They don't pose a risk for people with high blood pressure. They do have other side effects, including constipation, fatigue, and a risk of addiction.
Acetaminophen May Not Be As Safe For Heart Health As Previously Thought
Acetaminophen — the active ingredient in Tylenol — is a widely used over-the-counter (OTC) medication used for the treatment of mild to moderate pain, as well as for fever reduction.
Past studies show that in people with heart disease, acetaminophen is the preferred pain treatment over other types of pain medications like aspirin and ibuprofen, which are known as nonsteroidal anti-inflammatory drugs (NSAIDs).
A new study presented during the annual meeting of the American Physiological Society April 4–7 has discovered — using a mouse model — that acetaminophen changes proteins in the heart tissue.
These implications could potentially affect biochemical pathways needed for functions like energy production and antioxidant use.
For this study, researchers used a mouse model to study the effects of acetaminophen on heart tissue.
Some mice were given plain water, while others were administered water containing an amount of acetaminophen equivalent to 500 mg — the concentration found in one tablet of extra-strength Tylenol.
After seven days, researchers found significant changes in the heart tissue proteins of the mice given acetaminophen compared to the mice that only had water.
These protein alterations were associated with biochemical pathways responsible for many functions, including energy production, antioxidant usage, and the breakdown of damaged proteins.
The scientists found more than 20 different signaling pathways affected by the protein changes.
"We were surprised by the findings since we predicted that acetaminophen, when used at these concentrations, would have minimal effects on the heart," Gabriela Del Toro Rivera, a doctoral student in the laboratory of Aldrin Gomes, PhD, at the University of California, Davis, and the first author of this study, told Medical News Today.
"While existing literature primarily associates acetaminophen overuse with liver damage, our research suggests that acetaminophen may influence tissues beyond the liver."
Historically, acetaminophen has been the safest pain reliever for people with cardiovascular disease.
A study published in March 2015 found the use of acetaminophen was not linked to a higher risk of stroke, myocardial infarction, or any cardiovascular event.
Other recent studies have evaluated the safety of acetaminophen in people with heart disease.
Research published in 2022 found the use of sodium-containing acetaminophen as associated with increased risk for cardiovascular disease and all-cause mortality in people with or without high blood pressure.
Another 2022 study reported that regularly taking 4 grams of acetaminophen each day increased systolic blood pressure in people with high blood pressure, potentially increasing their heart disease risk.
"Since acetaminophen is one of the most commonly used over-the-counter drugs worldwide, gaining a better understanding of how acetaminophen may affect the heart is essential for improving patient safety, optimizing treatment decisions, managing comorbidities, and guiding future research and development efforts," Del Toro Rivera said.
"Findings regarding acetaminophen's effects on the heart have the potential to enhance doctor-patient communication by enabling more personalized recommendations, informed decision-making, and proactive management of potential risks associated with its use. Utilizing acetaminophen for the shortest duration and at the lowest effective dosage appropriate for an individual's ailment is likely advisable."
— Gabriela Del Toro Rivera, first study author
While both acetaminophen and NSAIDs assist with pain relief, NSAIDs also help lower inflammation, which acetaminophen does not do.
Past studies show that NSAID use is associated with an increased risk for several cardiovascular concerns, including:
"Non-steroidal anti-inflammatory drugs, such as naproxen, ibuprofen, and diclofenac, are associated with an increased risk of stroke, and our research suggests that these commonly used drugs alter signaling pathways and cause mitochondrial dysfunction in mouse hearts," Del Toro Rivera said.
"To determine if the anti-inflammatory properties of NSAIDs were responsible for the changes observed in mouse hearts from mice treated with NSAIDs, we investigated the impact of acetaminophen on proteins in heart tissue," she continued.
"Since acetaminophen is commonly used and does not contain anti-inflammatory properties, the effects on the heart that would be observed would not be due to anti-inflammatory results."
After reviewing this research, Cheng-Han Chen, MD, a board certified interventional cardiologist and medical director of the Structural Heart Program at MemorialCare Saddleback Medical Center in Laguna Hills, CA, told MNT he was surprised by the findings.
"We typically recommend acetaminophen as a medicine that people can take for pain that should not have any harm to the heart," Chen explained.
"(With) NSAIDs, we do worry about its effects such as increased risk of clotting and increasing blood pressure. Typically, we recommend (that) our heart patients take acetaminophen instead since most of our studies show that it does not have a harmful effect on the heart. With so many patients taking acetaminophen, It would definitely be important to know whether it has effects that we don't know about."
— Cheng-Han Chen, MD, cardiologist
MNT spoke with Rigved Tadwalkar, MD, a board certified consultant cardiologist at Providence Saint John's Health Center in Santa Monica, CA, about the study.
Tadwalkar said he was concerned and cautious about the implications of the study findings.
"The findings indicate that even at moderate doses considered safe for use, acetaminophen may have significant effects on signaling pathways within the heart tissue," Tadwalkar said.
"This suggests that the commonly used painkiller might not be as benign as previously thought, especially when used regularly over time."
"As a cardiologist, it is particularly troubling given that many of our patients rely on acetaminophen for pain relief, especially considering that other pain medications often pose significant risks," he added. "Understanding the potential risks associated with acetaminophen use underscores the need for increased awareness, in order to make better decisions for patient care."
— Rigved Tadwalkar, MD, cardiologist
Chen said the changes in how the heart responds to acetaminophen in mice show the heart was under more stress.
"It remains to be seen whether this also translates to humans," Chen said. "This mouse research should lead to human studies, probably starting from observational studies, to investigate whether there are cardiac outcome effects from acetaminophen."
Tadwalkar said the next steps for this research should involve further investigation into the mechanisms by which acetaminophen affects the heart and cardiovascular system and whether similar findings can be reproduced in humans.
"This should include studies in human subjects to determine if the findings observed in mice translate to humans," Tadwalkar said.
"It would be valuable to explore whether there are certain subpopulations of patients who may be more susceptible to the cardiac effects of acetaminophen, such as those with preexisting cardiovascular conditions or other comorbidities," he concluded.
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