From the Guidelines
NSAIDs can increase blood pressure and cause hypertension, while acetaminophen is generally a safer alternative for patients with hypertension or cardiovascular concerns. According to the most recent and highest quality study, the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults 1, NSAIDs should be avoided when possible, and alternative analgesics such as acetaminophen should be considered. This is because NSAIDs can raise blood pressure by approximately 3-5 mmHg in some individuals, particularly those with existing hypertension or kidney issues, by inhibiting prostaglandins that help regulate kidney function and blood vessel dilation, leading to sodium and water retention and increased vascular resistance.
Key Points to Consider
- NSAIDs like ibuprofen, naproxen, and diclofenac can increase blood pressure and worsen hypertension 1
- Acetaminophen is generally a safer alternative for patients with hypertension or cardiovascular concerns, as it works differently and does not affect blood pressure in the same way as NSAIDs 1
- If NSAIDs are necessary, using the lowest effective dose for the shortest duration possible and monitoring blood pressure is recommended 1
- People taking blood pressure medications should be particularly cautious with NSAIDs as they can reduce the effectiveness of many antihypertensive drugs, especially diuretics, ACE inhibitors, and ARBs 1
Management Strategies
- Avoid systemic NSAIDs when possible 1
- Consider alternative analgesics, such as acetaminophen, tramadol, or topical NSAIDs, depending on indication and risk 1
- Monitor blood pressure closely when initiating treatment with NSAIDs, and adjust the antihypertensive regimen as necessary 1
From the Research
Effect of NSAIDs on Blood Pressure
- Nonsteroidal anti-inflammatory drugs (NSAIDs) can increase blood pressure by decreasing the synthesis of prostaglandins, which are important in controlling blood pressure through their effects on the kidney and blood vessels 2, 3, 4, 5.
- The pressor effect of NSAIDs varies among different types, with indomethacin, naproxen, and piroxicam having the greatest effect, and sulindac having the least effect 2.
- NSAIDs can antagonize the antihypertensive effect of diuretics, beta-blockers, and ACE inhibitors, and the elderly and those with salt-sensitive hypertension are more susceptible to the blood pressure-increasing effect of NSAIDs 2, 3.
Effect of Acetaminophen on Blood Pressure
- Acetaminophen is widely used as a first-line therapy for chronic pain, but its effect on blood pressure is not well understood 6.
- A recent study found that regular acetaminophen use increases systolic blood pressure in individuals with hypertension by approximately 5 mmHg compared to placebo 6.
- This increase in blood pressure can increase cardiovascular risk and calls into question the safety of regular acetaminophen use in individuals with hypertension 6.
Interaction between NSAIDs, Acetaminophen, and Antihypertensive Medications
- NSAIDs and acetaminophen can interact with antihypertensive medications, reducing their effectiveness and increasing blood pressure 2, 3, 4, 5.
- Clinicians should be aware of the potential impact of NSAIDs and acetaminophen on blood pressure control, especially in high-risk patients such as the elderly and those with chronic pain or uncontrolled hypertension 2, 3, 4, 5.
- Alternative analgesics that do not affect prostaglandin synthesis, such as tramadol and narcotic analgesics, may be considered for patients at risk 4.