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Is Paracetamol Detrimental for Blood Pressure? Know More About the Impact and Implications

M3 India Newsdesk Aug 05, 2022

Concerns over Paracetamol's long-term safety, particularly its impact on blood pressure, have been gradually growing in response to its widespread use. This article enlightens the impact of the use of Paracetamol on patients with hypertension

Universal drug - Paracetamol

The most prevalent cause of seeing a doctor is pain. Even Celsus, who lived a little over two millennia ago, named pain (dolour) as one of inflammation's five foundations. Consequently, it makes a great deal of sense to treat pain with anti-inflammatory medicines, especially nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs are infamous in nephrology and cardiology since they have been recognised to cause a variety of renal and heart problems for decades.

Paracetamol is regarded as the drug with the fewest negative side effects (outside of overdose causing hepatotoxicity). In the WHO analgesic ladder for pain therapy, paracetamol is the first step and is presently the most often used painkiller in the world.

For decades, we have prescribed it at therapeutic amounts (up to 4 grammes per day) without considerable worry for adverse effects. Paracetamol is the most common drug prescribed in India, even though it is available over the counter easily.

 Initial information about its safety was based on cohort studies, observational data, and a few tiny RCTs with contradictory findings, resulting in safety concerns.

The online publication of the Paracetamol in Hypertension–Blood Pressure (PATH-BP):

Research indicates that we have actually been lulled into a false feeling of security.

Findings of the study that raises concerns -

  1. Previous studies had implied this issue, so researchers planned a clinical study to confirm the potential threat.
  2. They enrolled 110 individuals with hypertension and randomly assigned them to consume 1,000 mg of paracetamol or a placebo four times daily for two weeks.
  3. The highest suggested daily dosage for healthy people is 4,000 mg per day. After a two-week washout period, participants were transferred from paracetamol to placebo and vice versa for a total of four weeks.
  4. The researchers discovered that when patients were taking paracetamol, their blood pressure increased by an average of 5 points.

Clinical implications 

  1. Clinicians should pay careful attention to the blood pressure of hypertensive patients using frequent paracetamol for chronic pain and ensure that these patients are receiving the lowest effective analgesic dosage.
  2. A gain of 5 mm Hg in blood pressure is similar to maybe losing one blood pressure pill, so if you could eliminate the paracetamol, you could require one fewer tablet. Maybe for someone with low hypertension, no medication is necessary. Therefore, it would be good to avoid taking paracetamol when unnecessary.
  3. PATH-BP study overcomes various limitations of earlier research and offers substantial additional data supporting a clinically significant BP-raising impact of paracetamol in preexisting hypertensive individuals.
  4. Unanswered issues include whether the rise in blood pressure seen with paracetamol correlates with an increase in cardiovascular risk.

In spite of accumulating evidence to the contrary, there seems to be a widespread perception that paracetamol has no cardiovascular side effects. These ideas are also imparted, if poorly, to a substantial number of hypertensive persons. The findings of the PATH-BP study may not fully disprove these ideas, but they should give us pause before habitually suggesting paracetamol as a safe' alternative to prolonged NSAID usage, particularly in patients with or at risk for hypertension.

Click here to see references


Disclaimer- The views and opinions expressed in this article are those of the author and do not necessarily reflect the official policy or position of M3 India.

The author is a practising super specialist from New Delhi.

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