Effect of Paracetamol on Blood Pressure: A Systematic Review

Paracetamol is widely used as a first-line analgesic for chronic pain, primarily due to its presumed safety profile. Unlike non-steroidal anti-inflammatory drugs (NSAIDs), paracetamol has been for long time considered free of significant cardiovascular effects, particularly on blood pressure (BP). However, emerging evidence suggests that long terme paracetamol use may be associated with elevated BP, challenging its status as a risk-free alternative to NSAIDs. This systematic review aimed to investigate the association between paracetamol intake and changes in BP by screening existing clinical and epidemiological data to clarify its potential hypertensive effects.

A comprehensive search of Medline, Cochrane Library, and Embase databases was conducted. Eligible studies included randomized clinical trials, interventional and longitudinal observational studi involving adults receiving standard doses of oral paracetamol. Exclusion criteria were studies on pregnant women, patients with preeclampsia/eclampsia, and those using supratherapeutic doses. The primary outcome was variation in systolic and diastolic BP.

A total of 10 studies was included comprinzing observational studies (n = 4) and randomized controlled trials (n = 6). Two observational studies reported a significant association between regular paracetamol use and an increased risk of hypertension particularly with high-dose (> 3 g/day) or prolonged use (> 30 days). The remaining two studies found no significant association, though one noted a trend toward elevated BP in older adults. Four RCTs demonstrated a small but consistent increase in systolic blood pressure (SBP), ranging from +0.2 to +4.0 mmHg. The effect appeared dose-dependent, with higher doses (> 2 g/day) linked to greater BP elevation.

Paracetamol may cause slight elevations in BP, with potential clinical implications in high- risk patients. Caution is warranted, and further prospective studies using ambulatory BP monitoring are needed to clarify this relationship.