Does Tylenol (acetaminophen) lower blood pressure?

Acetaminophen Can Increase Blood Pressure

Yes, acetaminophen (Tylenol) can increase blood pressure, with regular use associated with an increased relative risk of 1.34 of hypertension. 1

Evidence on Acetaminophen and Blood Pressure

• The 2020 International Society of Hypertension guidelines specifically list acetaminophen among medications that can increase blood pressure or interfere with blood pressure control 1
• In the most recent randomized controlled trial (PATH-BP Trial, 2022), regular acetaminophen at 4g daily (1g four times daily) resulted in a significant increase in mean daytime systolic BP by 4.7 mmHg compared to placebo in patients with hypertension 2
• A 2010 randomized controlled trial in patients with coronary artery disease found that acetaminophen (1g three times daily) significantly increased both systolic and diastolic ambulatory blood pressures compared to placebo 3
• While NSAIDs are well-known to increase blood pressure by 3/1 mmHg, acetaminophen was previously thought to be safer but now shows similar concerning effects 1, 4

Mechanism and Clinical Significance

• The blood pressure-raising effect of acetaminophen appears dose-dependent, with almost daily use showing the strongest association with hypertension 1
• A 4-5 mmHg increase in systolic blood pressure, as demonstrated in recent trials, is clinically significant and could increase cardiovascular risk 2, 4
• The effect may be more pronounced in:
  • Elderly patients 1
  • Those with higher baseline blood pressure 1
  • Patients already on antihypertensive therapy 1
  • Those with kidney disease 1

Clinical Recommendations

• Screen all patients with hypertension for substances that may increase blood pressure, including regular acetaminophen use 1
• For patients requiring pain management who have hypertension or cardiovascular disease:
  • Consider acetaminophen at the lowest effective dose and for the shortest duration necessary 1, 2
  • Monitor blood pressure more closely in patients who require regular acetaminophen use 2, 3
  • If analgesics are necessary, acetaminophen may still be preferable to NSAIDs in subjects with resistant hypertension, but recognize that it also carries blood pressure effects 1

Important Caveats

• Rare cases of acetaminophen-induced hypotension have been reported, particularly in critically ill patients, likely representing allergic reactions 5
• The individual effect of acetaminophen on blood pressure can be highly variable between patients 1
• If acetaminophen is required for pain management, blood pressure should be treated to target regardless 1

Alternative Approaches

• For patients with hypertension requiring pain management, consider:
  • Non-pharmacological pain management strategies when appropriate 1
  • Using the lowest effective dose of acetaminophen for the shortest duration 2, 4
  • More frequent blood pressure monitoring during periods of regular acetaminophen use 2, 3
  • Adjusting antihypertensive therapy if necessary when acetaminophen cannot be avoided 1

The evidence clearly shows that acetaminophen is not blood pressure neutral as previously thought, and clinicians should consider its potential impact on blood pressure when prescribing it, especially for regular use in patients with hypertension or cardiovascular disease.