Is acetaminophen really safer than NSAIDs for heart disease?

New research calls into question the assumption that acetaminophen It is considered safer than non-steroidal anti-inflammatory drugs (NSAIDs) for patients with known cardiovascular disease (CVD) or cardiovascular risk factors.

The analysis found a significant association between acetaminophen use and increased systolic blood pressure.

While acetaminophen may be safer than NSAIDs from a bleeding risk standpoint, or in patients with known kidney disease, “the gap may not be as large as previously thought,” Rahul Gupta, cardiologist at Lehigh Network Valley Health Network, Allentown, Pennsylvania, tell theheart.org | Medscape Heart.

Long-term cautious use is recommended, especially in patients with a previous presence Hypertension or Cardiovascular risk factorsGupta said.

The study was presented at the American Heart Association (AHA) Hypertension Science Sessions 2022 in San Diego, California.

Gupta explained that acetaminophen is one of the most commonly used over-the-counter medications, as it is considered a safer drug for long-term use because it lacks the anti-inflammatory effects of NSAIDs.

It is known that NSAIDs raise blood pressure, but the effect of acetaminophen in this regard has not been well studied. He pointed out that observational studies showed contradictory results in terms of their effect on blood pressure.

To investigate further, Gupta and colleagues conducted a meta-analysis of three studies comparing the effect of acetaminophen (3-4 g/day) versus placebo on ambulatory systolic and diastolic blood pressure in patients with heart disease or hypertension. Together, the studies included 172 adults (median age 60 years; 73% male).

They found that patients receiving acetaminophen had significantly higher systolic blood pressure compared to those receiving a placebo (standard mean difference). [SMD] = 0.35; 95% CI, 0.08-0.63; s = .01).

Subgroup analysis of the effect on hypertensive patients also showed a significant change in systolic blood pressure (SMD = 0.38; 95% CI, 0.05–0.71; s = .02).

“Interestingly, there was no significant difference in the effect on diastolic blood pressure,” Gupta commented.

After reaching for the comment, Timothy S. Anderson, MD, clinical investigator in the division of general medicine at Beth Israel Deaconess Medical Center and associate professor of medicine at Harvard Medical School in Boston, Massachusetts, said this was an “interesting and not a particularly good-known problem.” “.

“However, most trials are looking at very high doses of acetaminophen use (eg, six to eight 500mg pills each day) so we don’t really know if the most common patterns of using one or two acetaminophen pills each are,” he said. Anderson ‘occasionally a problem’ theheart.org | Medscape Heart.

“We also do not have data showing direct harm from these drugs in relation to strokes, heart attacks or other consequences of high blood pressure. Ideally, we would need a direct trial comparing ibuprofen-type drugs with acetaminophen,” Anderson said.

The study has no specific funding. Gupta and Anderson did not report any relevant disclosures.

American Heart Association (AHA) Hypertension Scientific Sessions 2022. Poster 033. Filed September 7, 2022.

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