A systematic review of the effect of paracetamol on blood pressure in hypertensive and non-hypertensive subjects
Article first published online: 20 MAY 2013
© 2012 The Authors. British Journal of Clinical Pharmacology © 2012 The British Pharmacological Society
British Journal of Clinical Pharmacology
Volume 75, Issue 6, pages 1396–1405, June 2013
How to Cite
Turtle, E. J., Dear, J. W. and Webb, D. J. (2013), A systematic review of the effect of paracetamol on blood pressure in hypertensive and non-hypertensive subjects. British Journal of Clinical Pharmacology, 75: 1396–1405. doi: 10.1111/bcp.12032
- Issue published online: 20 MAY 2013
- Article first published online: 20 MAY 2013
- Accepted manuscript online: 12 NOV 2012 11:35PM EST
- Manuscript Accepted: 6 NOV 2012
- Manuscript Received: 18 JUL 2012
- blood pressure;
To review current evidence on the effect of paracetamol on blood pressure (BP), the quality of the previous studies and the validity of the results, and to summarize these findings.
A systematic literature review was performed by searching PubMed, the Cochrane library and EMBASE for publications between the years 1963 and 2012.
We identified three case reports, seven prospective observational trials, six randomized controlled trials, one commentary and two reviews. Some, but not all, of the observational studies, which included over 147 000 patients, showed an increased risk of hypertension with paracetamol use. The randomized studies were generally small and the results were inconsistent. Three studies, which included 104 patients, showed an increase of systolic BP by ∼4 mmHg, two studies, which included 27 patients, reported no change in BP and one study, which included 21 patients, reported a fall in BP although no placebo arm was included for comparison.
The overall effect of paracetamol on BP is unclear. Given that paracetamol is often suggested as a safer alternative to non-steroidal anti-inflammatory drugs (NSAIDs), it would seem that further prospective evidence is now needed to address the effect of paracetamol on BP. This would be best done with larger studies in relevant cohorts using BP measured by ambulatory BP monitoring as the primary endpoint.