Nonnarcotic Analgesic Use and the Risk of Hypertension in US Women

Abstract

Abstract-Acetaminophen, aspirin, and other nonsteroidal anti-inflammatory drugs (NSAIDs) are widely consumed. Each is theoretically capable of elevating blood pressure by altering prostaglandin homeostasis; however, there is little prospective information on the relation between these agents and physician-diagnosed hypertension. We examined the association between the use of aspirin, acetaminophen, or NSAIDs and incident hypertension in a prospective cohort study of 51 630 women 44 to 69 years of age in 1990 who had no history of hypertension or chronic renal insufficiency. Analgesic use was assessed in 1990 by a mailed questionnaire, and the women were followed for 8 years. Key Words: hypertension, essential Ⅲ drug therapy Ⅲ blood pressure Ⅲ risk factors A spirin, acetaminophen, and ibuprofen are the three most commonly used medications among adults 18 years of age and older, according to a national survey of US households conducted between 1998 and 1999. 1 Seventeen percent of respondents reported using aspirin in the preceding week, 23% reported acetaminophen use, and 17% ibuprofen use. Prevalence of use was greater among women than men for acetaminophen and ibuprofen.Short-term prospective studies suggest nonsteroidal antiinflammatory drugs (NSAIDs) can cause acute elevations in blood pressure, 2,3 but a diagnosis of hypertension was used as the primary outcome in only one case-control study. 4 Although aspirin and acetaminophen also influence prostaglandin homeostasis, 5-7 prospective data on their potential hypertensive effects have been sparse and inconclusive. 8,9 A recent study of these effects in a large cohort of younger US women demonstrated an increased incidence of hypertension in users of NSAIDs and acetaminophen but not aspirin (OR 1.86 and 2.00, respectively, for the highest use category, PϽ0.001). 10 Twenty-four percent of US adults and 50% to 70% of those Ͼ60 years of age have hypertension. 11 Even small elevations in blood pressure caused by nonnarcotic analgesic use could affect cardiovascular morbidity and mortality. 12 To examine this issue, we studied the association between the use of aspirin, acetaminophen, and NSAIDs and incident hypertension in a large cohort of US women. Methods The Nurses' Health StudyThe Nurses' Health Study cohort was assembled in 1976 when 121 700 female registered nurses, 30 to 55 years of age, completed and returned a mailed questionnaire. 13 Follow-up questionnaires have been mailed every 2 years to update information on healthrelated behaviors and medical events. In 1990, questions were included regarding frequency of use of acetaminophen, aspirin, and other NSAIDs. Study PopulationThe 1990 questionnaire was answered by 85 625 women. Women who reported a history of hypertension (nϭ27 344) or chronic kidney failure (nϭ10) on or before the 1990 questionnaire were excluded from the study, as were women who did not answer any of the questions on analgesic use (nϭ336). We also excluded subjects who did not report having had a physical examination between 1988

Resistant Hypertension: Diagnosis, Evaluation, and Treatment

“…32,33 NSAIDs, in particular, are associated with modest but predictable increases in blood pressure. Meta-analyses of the effects of NSAIDs have indicated average increases in mean arterial pressure of approximately 5.0 mm Hg.…”

Aspirin, Non-Aspirin Analgesics and the Risk of Hypertension in the SUN Cohort

“…Analyses from the Nurses' Health Study (NSH) comparing the highest (>22 days/month) with the lowest (none) exposure group found that increased frequency of use of aspirin, acetaminophen, or NSAIDs, was associated with an increased risk of self reported physician-diagnosed HTN (aspirin, RR = 1.21; 95% CI, 1.13-1.30; acetaminophen, RR = 1.20; 95% CI, 1.08-1.33; NSAIDs, RR = 1.35; 95% CI, 1.25-1.46). 6 A later analysis of the NHS II found similar results for acetaminophen (RR = 2; 95% CI, 1.52-2.62) and for NSAIDs (RR = 1.86; 95% CI, 1.51-2.28), but no significant association was found for aspirin. 5 However, the mean age in this second analysis was lower (range, 31-50) than in the first one (range, 49-61).…”

“…4 Results from different prospective studies conducted in the United States assessing the association between use of aspirin, NSAIDs and other analgesics and the risk of hypertension suggest that chronic users of aspirin, NSAIDS, and acetaminophen have a higher risk of hypertension. [5][6][7][8][9] However, some clinical trials conducted in Spain have shown the opposite effect 10,11 and no previous prospective study has assessed this potential relationship in a European cohort, where a different health system probably means different access to medication and a different pattern of drug use. 12 Our objective was to assess the association between regular use of aspirin and non-aspirin analgesic drugs and the incidence of HTN in a prospective dynamic cohort study consisting of Spanish university graduates, the SUN (Seguimiento Universidad de Navarra, University of Navarra Follow-up) project.…”

Paracetamol, Ibuprofen, and Recurrent Major Cardiovascular and Major Bleeding Events in 19 120 Patients With Recent Ischemic Stroke

“…[5][6][7] In addition, chronic paracetamol consumption maybe related to hypertension, a major vascular risk factor. [8][9][10] Indeed, some studies have shown an increased risk of cardiovascular events and stroke in patients treated with paracetamol, particularly in high-dose users. 10,11 Nevertheless, the hypothesis of a paracetamol-associated cardiovascular risk remains controversial.…”