Paracetamol Warning UK: Regular Use Linked to Higher Blood Pressure
A medical study found that regular paracetamol use may increase blood pressure in people with hypertension. Here is what UK patients need to know.
Paracetamol is one of the most widely used painkillers in the UK, commonly taken for headaches, fever, muscular aches and other everyday discomforts. While the medicine remains an important treatment option for many people, research has raised concerns about the possible effect of regular, long-term paracetamol use on blood pressure.
The warning is particularly relevant to people who already have high blood pressure or who take paracetamol regularly to manage chronic pain.
Importantly, the research does not suggest that people should stop taking paracetamol for occasional headaches, fever or short-term pain. Instead, it highlights a potential concern around repeated daily use, particularly among people who already have hypertension or a higher risk of cardiovascular disease.
What did the paracetamol study find?
Researchers from the University of Edinburgh investigated whether taking paracetamol regularly could affect blood pressure in people who already had hypertension.
The study, known as the PATH-BP trial, involved 110 participants with high blood pressure. Participants were given either paracetamol or a placebo for two weeks before switching to the other treatment. The researchers monitored their blood pressure using measurements taken over a 24-hour period.
The results were significant.
People taking 1 gram of paracetamol four times a day, equivalent to 4 grams per day, experienced an average placebo-adjusted increase in daytime systolic blood pressure of around 4.7 mmHg. Diastolic blood pressure also increased by approximately 1.6 mmHg compared with placebo.
The study was published in the medical journal Circulation in 2022.
Researchers said the findings were particularly important because paracetamol has traditionally been viewed as having fewer cardiovascular effects than some other commonly used painkillers.
Why is high blood pressure a concern?
High blood pressure, also known as hypertension, is a major risk factor for cardiovascular disease.
According to Blood Pressure UK, around one in three adults in the UK has high blood pressure. In England, the organisation reports that approximately 31% of men and 26% of women have the condition.
The problem is that hypertension often has no obvious symptoms. Many people can have elevated blood pressure without feeling unwell.
Over time, uncontrolled high blood pressure can place additional strain on blood vessels and the heart. It is associated with an increased risk of serious conditions including heart attacks and strokes.
This is why even relatively modest changes in blood pressure can matter when they occur in people who are already at increased cardiovascular risk.
Who should be particularly cautious?
The study's findings are most relevant to people who take paracetamol regularly over a longer period, especially those with existing hypertension.
This could include people who have been prescribed paracetamol for chronic pain and take it every day rather than occasionally.
Researchers from the University of Edinburgh said doctors and patients should consider the potential benefits and risks when deciding whether long-term treatment remains necessary. They also suggested using the lowest effective dose for the shortest appropriate period.
This does not mean that everyone who takes paracetamol is automatically at risk.
The study specifically looked at people with hypertension and regular high-dose treatment over a two-week period. It should therefore not be interpreted as evidence that occasional use will cause dangerous increases in blood pressure.
What about occasional paracetamol use?
This is one of the most important points for people reading the headlines.
The research was focused on regular use, rather than someone taking a couple of paracetamol tablets occasionally for a headache, cold or fever.
Dr Iain MacIntyre, the lead investigator, specifically explained that the findings were not intended to raise concern about short-term use for headaches or fever. Instead, the potential risk identified by the research relates to people taking the medicine regularly over longer periods, commonly for chronic pain.
Therefore, people should not panic simply because they have taken paracetamol.
Anyone who is worried about how often they are taking it, however, should discuss their medication with a pharmacist, GP or other qualified healthcare professional.
Why could paracetamol affect blood pressure?
The exact biological explanation is still an area of scientific interest.
Paracetamol is different from traditional non-steroidal anti-inflammatory drugs, or NSAIDs, such as ibuprofen. Historically, paracetamol has often been regarded as a preferable option for some patients because it was thought to have less impact on blood pressure.
The PATH-BP trial challenged that assumption by providing controlled clinical evidence that regular paracetamol could increase blood pressure in people with hypertension.
The researchers noted that the increase observed in the trial was comparable to the type of blood pressure effect previously associated with NSAIDs.
That does not mean paracetamol and NSAIDs are identical medicines or that one can simply be substituted for the other. Different painkillers have different benefits, risks, interactions and suitability depending on a person's health.
What should people taking paracetamol do?
If you only take paracetamol occasionally and follow the instructions on the packaging or advice from a healthcare professional, there is no reason to assume that this research means you need to stop taking it.
However, people who take paracetamol every day or very frequently may want to review their treatment.
This is particularly important if you:
- Have diagnosed high blood pressure
- Have been prescribed paracetamol for chronic pain
- Have a history of heart disease or stroke
- Take several medicines at the same time
- Are unsure how long you should continue taking paracetamol
- Regularly take the maximum recommended dose
Do not stop prescribed medication suddenly without speaking to your doctor or pharmacist.
A healthcare professional can assess why you are taking paracetamol, how much you are taking, whether you still need it and whether another approach to managing your pain may be appropriate.
Regular blood pressure checks remain important
The paracetamol research also highlights a broader issue: knowing your blood pressure is important.
Blood Pressure UK says that high blood pressure frequently causes no noticeable symptoms, meaning people cannot reliably tell whether their blood pressure is elevated simply by how they feel. Regular checks can therefore help identify the condition.
For people who take medicines regularly, blood pressure monitoring can be especially useful when recommended by a healthcare professional.
If you already have hypertension, keeping the condition under control is important because high blood pressure is a significant risk factor for cardiovascular disease.
The key message for people in the UK
The latest concern surrounding paracetamol should not be interpreted as a warning that the medicine is unsafe for everyone.
Instead, the research raises an important question about long-term, regular paracetamol use, particularly among people who already have high blood pressure.
A controlled clinical trial found that people with hypertension taking 4 grams of paracetamol daily experienced an average increase in systolic blood pressure of about 5 mmHg compared with placebo.
For someone taking the medicine occasionally, this is a very different situation from taking it every day for chronic pain.
The safest approach is to use medicines as directed and regularly review long-term treatment with a qualified healthcare professional. If you have high blood pressure and regularly rely on paracetamol for pain, speak to your GP or pharmacist about whether your current treatment remains appropriate.
Sources
- MacIntyre I, Turtle EJ, Farrah TE, et al. Regular Acetaminophen Use and Blood Pressure in People With Hypertension: The PATH-BP Trial. Circulation, 2022.
- University of Edinburgh. Regular paracetamol use linked to raised blood pressure.
- Blood Pressure UK. Blood pressure facts and figures.
- Blood Pressure UK. Who should have a blood pressure check?
Medical disclaimer
This article is for general information and educational purposes only. It is not medical advice and should not be used to diagnose, treat or prevent any medical condition. Do not stop, reduce or change prescribed medication without speaking to your GP, pharmacist or another qualified healthcare professional. If you are concerned about high blood pressure, long-term painkiller use or possible side effects, seek advice from an appropriate healthcare professional. In an emergency, contact NHS emergency services or seek urgent medical attention.