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Are Painkillers Safe to Take with High Blood Pressure?

cartoon doctor taking patients blood pressure

According to the CDC and the American Heart Association, more than 100 million adults in the US have high blood pressure or hypertension. High blood pressure is known as a “silent killer” because it typically does not cause symptoms, especially in the beginning, but can put you at risk of heart disease, heart attack, and stroke. 

Lifestyle changes, including physical activity, a healthful, balanced diet, and medications, can help with blood pressure control. A survey conducted by the American Heart Association in 2021 has found that most American adults with high blood pressure are unaware that some over-the-counter (OTC) pain relievers may raise blood pressure. Another concerning finding from this survey was that only a little more than half of the adults with hypertension check with their doctor before taking an OTC pain reliever. One may guess that most people are not too concerned with the safety of OTC products because these medicines are widely available and easily accessible at local pharmacies without requiring a prescription. 

With hypertension being the second preventable cause of death for any reason, only after cigarette smoking, awareness and education about the safe use of OTC pain relievers are necessary and beneficial for patients and their loved ones. 

Please continue reading to learn about some pain relievers that can affect blood pressure. 

Do pain relievers raise blood pressure?

Both prescription and over-the-counter pain medications can raise blood pressure, thus, in time, increasing the risk of cardiovascular disease. In fact, two prescription medications for arthritis pain relief, rofecoxib (Vioxx) and valdecoxib (Bextra) were withdrawn from the market because they were found to be associated with an increased risk of high blood pressure, heart disease, heart attack, and stroke. Both Vioxx and Bextra are prescription non-steroidal anti-inflammatory drugs (NSAIDs), which is in the same drug class as commonly-used OTC pain relievers such as Advil (ibuprofen) and Aleve (naproxen).

Can I take ibuprofen with high blood pressure?

Generally, taking ibuprofen is not recommended if you have high blood pressure. OTC pain relievers like ibuprofen can lead to increased blood pressure, which can pose serious health risks. However, one of the most common OTC alternatives, Tylenol (acetaminophen), may not be appropriate for people with severe liver disease. That being said, you should discuss with your doctor before taking an OTC pain reliever since many factors must be considered. Your healthcare providers will guide you in determining the safest and most effective option to treat your pain. 

Ibuprofen (Motrin, Advil) is a type of nonsteroidal anti-inflammatory drug (NSAID). Other NSAIDs like naproxen sodium (brand names Naprosyn, Aleve) and ketoprofen (brand name Orudis) also carry similar risks. Ketoprofen is a prescription medication, while naproxen is available with a prescription or over the counter at a lower dose. 

However, pain relievers such as aspirin, also an NSAID, are relatively safer for people with hypertension. Aspirin is commonly prescribed to people at risk of coronary artery disease. 

Why do pain medications like NSAIDs cause hypertension?

Nonsteroidal anti-inflammatory drugs (NSAIDs) work by blocking the COX (cyclo-oxygenase) enzymes COX-1 and COX-2. The COX enzymes are responsible for the production of prostaglandins, a group of body chemicals that take part in different processes in the body, including pain, inflammation, blood clotting, and blood flow. By prohibiting the activity of the COX enzymes, NSAIDs alleviate pain and inflammation.

So what is the relationship between NSAIDs, COX enzymes, and high blood pressure? COX-1 promotes blood flow to the kidneys and glomerular filtration rate (GFR); GFR measures how much blood gets filtered every minute based on a person’s body size. On the other hand, COX-2 regulates salt and water excretion. Blocking either or both of these enzymes will have negative effects on the kidneys. Therefore, blocking either or both of these enzymes impairs the flood flow to the kidneys and increases sodium (salt) retention, leading to edema, which is the build-up of fluid in the body, causing an increase in blood pressure.  

Additionally, NSAIDs can have drug interactions with certain antihypertensive drugs like diuretics (water pills), ACE (angiotensin-converting enzyme) inhibitors, or ARBs (angiotensin receptors blockers). These interactions can make high blood pressure treatment less effective. 

Can I take Tylenol with blood pressure medication?

You can take Tylenol with blood pressure medication. This is because the active ingredient in Tylenol is acetaminophen. This is a different type of painkiller than NSAIDs, and it does not raise blood pressure. 

However, like all medicines, acetaminophen can cause side effects, and you should not use Tylenol if you have severe liver problems. You should not take any over-the-counter painkillers, including Tylenol, for more than 10 days without talking to your healthcare provider first.

Can I take Extra Strength Tylenol with high blood pressure?

You can take Extra Strength Tylenol with high blood pressure. As mentioned above, Tylenol products contain acetaminophen as the active ingredient. They do not increase blood pressure. Acetaminophen is a fever reducer that can provide pain relief from mild to moderate acute injuries and chronic overuse injuries. Chronic overuse injuries refer to the type of injury involving the damage of bones, ligaments, or tissues caused by repetitive demand of a certain body part over an extended period of time; this is a common health problem in sports medicines. 

What painkiller does not raise blood pressure?

As noted above, over-the-counter medications like acetaminophen (Tylenol) are relatively safer for people with high blood pressure and those taking medications for elevated blood pressure. Other pain relievers like aspirin are also safe.

With that said, keeping an eye on your blood pressure numbers is a good idea. You can measure your blood pressure at home. Or your doctor may ask you to come in and have your blood pressure checked regularly, for example, if you have new onset hypertension and they are adjusting your blood pressure medications. Remember, high blood pressure has no symptoms and can cause health risks without you realizing it. 

It is also worth noting that besides OTC painkillers, other medications used to treat common ailments like colds, flu, sinus problems, and heartburn may also contain active ingredients that can increase blood pressure. So, before you grab a bottle of an over-the-counter pain reliever or other medicine, check with your doctor if it can potentially interfere with blood pressure control.
 

References:

  1. https://www.reuters.com/article/us-stroke-risk-idUSCOL74824520080807
  2. https://www.uptodate.com/contents/nsaids-and-acetaminophen-effects-on-blood-pressure-and-hypertension#
  3. https://www.heart.org/en/news/2018/05/01/more-than-100-million-americans-have-high-blood-pressure-aha-says
  4. https://www.cdc.gov/bloodpressure/facts.htm#:~:text=Nearly%20half%20of%20adults%20in,are%20taking%20medication%20for%20hypertension.
  5. https://newsroom.heart.org/news/most-u-s-adults-unaware-that-over-the-counter-pain-relievers-may-increase-blood-pressure
  6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC526313/
  7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4036662/#:~:text=COX%2D1%20functions%20mainly%20in,function%20%5B7%2C8%5D.

https://www.pharmacytimes.com/view/diuretics-aceis-arbs-and-nsaids-a-nephrotoxic-combination