Study Sees Painkiller Risk for Women
Women who regularly take acetaminophen, ibuprofen or similar painkillers have as much as double the normal risk of developing high blood pressure, Boston researchers reported Monday.
The regular use of the drugs by millions of Americans may help explain the growing incidence of hypertension in the United States, where one in five people suffers from the problem, a team from Brigham and Women’s Hospital reported in the online edition of the journal Hypertension.
High blood pressure is a major contributor to heart disease and strokes.
The researchers originally reported their conclusion three years ago using data from the massive Nurses’ Health Study, an epidemiological study in which more than 120,000 female nurses have been followed since 1976.
At the time, critics charged they did not have enough data about actual dosages of the drugs or about complicating factors, such as headaches, which might have caused the increased risks. Hypertension can cause headaches, for example, which could lead to increased use of painkillers, rather than vice versa.
The new study was designed to answer those critics, said coauthor Dr. Gary C. Curhan of Brigham and Women’s Hospital.
“What is important and new in this study is that acetaminophen can raise blood pressure” just like ibuprofen, said Dr. Gregg C. Fonarow, a cardiologist at UCLA Medical Center who was not involved in the study. “That has not been completely appreciated.”
Combined with what was already known about the drugs, “I do think this is compelling support of this association,” Fonarow said.
The study found no increased risk of hypertension from regular use of aspirin, Curhan said. But the authors do not recommend that women switch from ibuprofen or other drugs to aspirin because of its increased risk of gastrointestinal bleeding.
The study represents a second black mark against acetaminophen -- best known by the brand name Tylenol. Regular use of acetaminophen and related drugs triples the risk of kidney disease, and by some measures accounts for as much as 20% of all kidney disease requiring dialysis or transplants.
Acetaminophen, aspirin and ibuprofen are the three most commonly used drugs in the United States, with total sales exceeding $2 billion per year. As many as 45 million Americans take them for chronic headaches and nearly 32 million for arthritis.
Curhan, Dr. John P. Forman and Dr. Meir J. Stampfer studied 1,903 women between the ages of 51 and 77 and another 3,220 women aged 34 to 53.
None had high blood pressure at the beginning of the study. The women, who participated in the original Nurses’ Health Study, were given supplementary questionnaires about how much of the drugs they took and why they took them.
Older women taking more than 500 milligrams of acetaminophen daily -- the equivalent of one extra-strength tablet -- were 93% more likely to develop hypertension than those not taking the drugs, while younger women taking the same dosage were 99% more likely.
For ibuprofen, older women taking at least 400 milligrams per day -- two nonprescription tablets -- were 78% more likely to have high blood pressure while younger women were 60% more likely.
The absolute risk of developing hypertension, however, was small in the entire group.
Among the older women, there were 211 cases during the course of the study. Among the younger women, there were 299 cases.
The researchers concluded that the increase in risk was directly related to dosage, but there were not enough women in the study using higher doses to quantify their risks.
Although the researchers do not recommend that women stop using the pain relievers, they suggest alternatives in some cases. Lower back pain, for example, can be treated more effectively with physical therapy than with ibuprofen or acetaminophen, Curhan said.
