Effect of Paracetamol on Blood Pressure: A Systematic Review

Area of Science:

• Pharmacology
• Cardiovascular Medicine
• Pain Management

Background:

• Paracetamol is a common first-line analgesic for chronic pain, often presumed safe with no cardiovascular effects.
• Emerging evidence suggests long-term paracetamol use may be linked to elevated blood pressure (BP), questioning its risk-free status compared to NSAIDs.

Purpose of the Study:

• To systematically review existing data on the association between paracetamol intake and changes in blood pressure.
• To clarify the potential hypertensive effects of paracetamol.

Main Methods:

• A comprehensive literature search of Medline, Cochrane Library, and Embase databases.
• Inclusion of randomized clinical trials and longitudinal observational studies in adults using standard paracetamol doses.
• Exclusion of studies on pregnant women, preeclampsia/eclampsia patients, and supratherapeutic doses; primary outcome was BP variation.

Main Results:

• 10 studies (4 observational, 6 RCTs) were included. Two observational studies found a significant link between regular, high-dose (>3 g/day) or prolonged (>30 days) paracetamol use and increased hypertension risk.
• Four RCTs showed a small but consistent increase in systolic blood pressure (SBP) (+0.2 to +4.0 mmHg), appearing dose-dependent (>2 g/day).

Conclusions:

• Paracetamol may induce minor BP elevations, posing potential clinical implications for high-risk individuals.
• Caution is advised, and further research using ambulatory BP monitoring is necessary to fully understand this relationship.