Abstract
Introduction: Acetaminophen is one of the most widely used over the counter medications, used for its analgesic and antipyretic properties. NSAIDs have been known to raise blood pressure, but there have been limited studies looking at the effect of acetaminophen on blood pressure. Observational studies have shown contradictory results regarding the effect of acetaminophen on blood pressure. Purpose: We aimed to perform a systematic review and meta-analysis of the randomized controlled trials (RCTs) to compare the effect of acetaminophen vs placebo on systolic and diastolic ambulatory blood pressure. Methods: A systematic comprehensive search using Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement was done in PubMed, Embase and Cochrane library for the RCTs investigating the effect of acetaminophen on blood pressure in patients compared to placebo. Standardized mean difference (SMD) and 95% confidence interval was used to compare the changes in blood pressure and p-values of <0.05 was considered as statistically significant. Finally, subgroup analysis was performed when possible. Results: Systematic search through April 2022 resulted in 3 relevant trials. The analysis showed that the patients receiving acetaminophen had significantly higher systolic blood pressure compared to those having placebo (SMD = 0.35, 95% CI = 0.08-0.63, p-value = 0.01). Moreover, subgroup analysis of the effect on hypertensive patients showed the significant change in systolic blood pressure as well (SMD = 0.38, 95% CI = 0.05-0.71, p-value = 0.02). In terms of diastolic pressure, our analysis showed that there is not any significant change in blood pressure when comparing acetaminophen and placebo (SMD = 0.18, 95% CI = -0.09-0.45, p-value = 0.19). This effect remains insignificant even after subgroup analyzing for hypertensive patients with SMD of 0.09 (95% CI = -0.34-0.52, p-value = 0.68). Conclusion: Our study demonstrated a significant correlation between the use of acetaminophen and elevated systolic blood pressure. This adds to concern regarding the safety of regular acetaminophen use, particular in patients with pre-existing hypertension or cardiovascular risk factors.
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