Non-Narcotic Analgesic Dose and Risk of Incident Hypertension in U.S. Women

Forman JP, Stampfer MJ, Curhan GC

A prospective cohort study between two groups of women was conducted to determine the relationship between non-narcotic analgesic dose and the risk of incident hypertension in women. These women were part of the Nurses' Health Studies (NHS) I and II. The first group of women from the NHS I were 51 to 77 years of age (n = 1903) and the second group of women from the NHS II were 34 to 53 years of age (n = 3220). The women described their analgesic use their reason for use, and also reported if they suffered from hypertension. Those who were afflicted with hypertension were excluded for the purposes of this study. Patients who selected "headache" as a reason for their medication use were also excluded due to the controversial nature of this condition as it pertains to hypertension and the knowledge that headache resulting from hypertension could lead to analgesic use. Physical activity levels were higher in both cohorts for those women who did not take analgesic medications. Doses per day were calculated based on information that was self-reported by the members of the study. For matters of adequate comparison all NSAID doses were converted into roughly equivalent doses of ibuprofen since this was the most commonly used NSAID. In this study an association between aspirin dose and hypertension was not observed, as had been the case in earlier studies. NSAIDs and a higher average daily dose of acetaminophen (> 500mg per day) were significantly and independently associated with a higher risk of incident hypertension. The older women who participated in the NHS I who consumed more than 500mg of acetaminophen per day had a 2.4-fold increased risk of hypertension while the younger women who were in the NHS II study experienced a 4.7-fold increased risk. When examining the NSAID data it became evident that the older women who exceeded 400mg per day had a 1.75-fold higher risk of incident hypertension. The younger women who consumed NSAIDs had a 3.7-fold increased risk. This study highlights the need for greater monitoring of patients with hypertension who take over-the-counter doses of NSAIDs and acetaminophen. It is a commonly held belief that acetaminophen is safe in all patients. While acetaminophen's risk/benefit profile is good overall, there are cases where increased patient education and pharmacist oversight is warranted. Hypertension, 2005;46:500-507. Return to Top