I take acetaminophen (Tylenol, others) every day to control joint pain from osteoarthritis. Recently, I heard that acetaminophen may increase my risk of high blood pressure. Is this true? If so, which arthritis pain medications are safe for my heart?
Answers from April Chang-Miller, M.D.
It is true, though there's more to learn about how much additional risk you take on when you use acetaminophen regularly. For years, heart and arthritis specialists thought that acetaminophen was relatively safe for your heart, but recent studies have found that the drug may increase your risk of heart problems. The risk appears to be most significant if you already have high blood pressure or other risk factors for heart disease, but more studies are needed before we can be sure.
Other over-the-counter (OTC) arthritis medications — specifically, the nonsteroidal anti-inflammatory drugs (NSAIDs) ibuprofen (Advil, Motrin, others) and naproxen (Aleve, others) — also are associated with an increased risk of cardiovascular disease. More is known about how — and to what degree — these drugs affect your heart, blood vessels and blood pressure. You need to be especially careful about using these drugs if you've had a heart attack or are at risk of heart attack, as they increase your risk and interfere with the preventive effects of aspirin.
NSAIDs also increase the risk of bleeding. This is a particular concern for people who have heart disease and are already taking aspirin and other medications that increase bleeding risk, such as clopidogrel (Plavix) or warfarin (Coumadin). In addition, because NSAIDs cause fluid retention, people with heart failure should avoid them.
Keep in mind that medication isn't the only treatment for arthritis pain. Mild to moderate arthritis pain may be relieved with a combination of self-care measures and lifestyle changes, such as weight loss, exercise, heat or cold therapy, and physical therapy. Many doctors recommend trying this combined approach before starting medication.
If you need medication to help manage your arthritis pain, use the lowest dose necessary for the shortest time possible. Also, discuss with your doctor which pain medication is most appropriate for your specific situation. All medications — prescription and nonprescription — have risks and potential side effects.
When taking OTC pain relievers for arthritis, keep these tips in mind:
Aug. 16, 2011
- Get your blood pressure checked regularly.
- Avoid alcohol.
- Tell your doctor about any herbal supplements, nutritional supplements or other medications you are taking.
See more Expert Answers
- Acetaminophen may boost blood pressure. Harvard Heart Letter. 2011;21(6):1.
- Sudano I, et al. Acetaminophen increases blood pressure in patients with coronary artery disease. Circulation. 2010;122:1789.
- White WB, et al. Blood pressure destabilization on nonsteroidal antiinflammatory agents acetaminophen exposed? Circulation. 2010;122:1779.
- Kalunian KC. Nonpharmacologic therapy of osteoarthritis. http://www.uptodate.com/home/index.html. Accessed July 22, 2011.
- Grogan M (expert opinion). Mayo Clinic, Rochester, Minn. July 27, 2011.
- Chang-Miller A (expert opinion). Mayo Clinic, Rochester, Minn. July 27, 2011.