TYLENOL AND BLOOD PRESSURE: THERE’S MORE THAN MEETS THE EYE!

Most people think of Tylenol (acetaminophen) as a safe drug. They substitute if for aspirin because they are continually reminded of the harmful and dangerous situations aspirin can cause. Thinning of the blood and bleeding from the stomach or intestines are a few of the big concerns. Tylenol has become the preferred alternative because, just like aspirin, it treats fever and relieves minor pain; two desirable uses. 

What most people don’t know is that acetaminophen has harmful effects of its own. At doses above the amount people usually take, acetaminophen has a direct toxic effect on the cells of the liver, damaging them, causing altered liver function, and even liver failure. In Tylenol’s early years, overdoses were treated casually and were not a matter of concern. Over time, however, the toxic effects on the liver became known, and patients overdosing with Tylenol suddenly drew a lot of attention. Deaths from Tylenol overdoses have not been rare, and are mainly the result of liver failure. Single doses of 3-4 grams (that’s 6-8 extra strength Tylenol tablets) and amounts of 4-6 grams (8-12 tablets) taken over 24 hours, have caused liver failure. 

Tylenol, in addition to liver problems, now, also, is known to raise BP. New information from a study in Scotland reveals that compared to placebo, Tylenol can significantly affect the blood pressure. Yes, it’s true. A group of researchers from The University of Edinburgh compared routine dosing of 1000 mg of acetaminophen four times a day to placebo and found that Tylenol raised the systolic BP from 132.9 to 136.5 mmHg, and the diastolic BP from 81.2 to 82.1 mmHg. The increase was demonstrated in people who had known high blood pressure and were “already at increased risk for heart attacks and strokes.” 

Patients are occasionally prescribed a dose of 1000 mg of acetaminophen four times a day for pain or arthritis. This dose, after only two weeks, elevated the BP. The patients taking placebo did not see a similar rise in their BP, but when they were given Tylenol, their blood pressure rose a similar amount. 

The bottom line of this article is that a benign drug (at least one everyone thinks is benign), Tylenol, is not so benign, and has a statistically significant effect on a patient’s blood pressure after two weeks on a higher dose. One gram taken four times a day for two weeks raised a patient’s systolic BP an average of 4.7 mmHg and diastolic BP 1.6 mmHg. That doesn’t sound like very much, but we know small incremental changes of BP in a person with known hypertension can have significant adverse effects over a long period of time. People with high BP, even when controlled, for some unknown reason are more prone to heart attack and stroke than folks with normal BP. That’s just the nature of patients with HBP. 

Aspirin and NSAID’s, such as ibuprofen and naproxen, will raise BP, too, but they have the added insult of stomach and intestinal bleeding and affect kidney function. What a wonderful pharmaceutical world we live in. At least GI bleeding isn’t reported in patients taking Tylenol. No drug is perfect. Every drug has some adverse effect in someone. It’s unavoidable. Of all the possible bad drugs, in my opinion, acetaminophen is one of the least worrisome, unless you take a very high dose on a regular basis or take an intentional overdose.  

This information adds to the concern doctors and patients must feel when acetaminophen is recommended. Most folks have no awareness of this effect and naively continue to take Tylenol with impunity. BP elevations are minimal, but over a long period time these effects may have consequences. Just be cognizant that if you do need a high dose of Tylenol, try to limit the duration as much as possible. 

References: https.//www.practicalcardiology.com/view/path-BP-regular-acetaminophen-use-could-increase-hypertension-risk.

https.//www.ntk-institute.org/article/regular-acetaminophen-use-linked-to-higher-blood-pressure.