Managing Pain in Patients with High Blood Pressure: Is There No Safe PATH?

Authors:
Lizzie Baumeister, PharmD
Austin Morgan, PharmD, BCACP, CDCES

Reviewers:
Sarah Anderson, PharmD, BCPS, BCACP
Brittany Schmidt, PharmD, BCACP

Citation:
MacIntyre IM, Turtle EJ, Farrah TE, et al. Regular acetaminophen use and blood pressure in people with hypertension: The PATH-BP trial. Circulation. 2022;145(6):416-423. 

The Problem

Pain and HTN are two of the most prevalent conditions affecting Americans.^1-2 Acetaminophen (APAP) is often considered the “go-to” and the “safe” over-the-counter (OTC) analgesic for patients with hypertension (HTN) because it is not commonly believed to be associated with increased blood pressure (BP) or cardiovascular (CV) events. APAP (paracetamol outside of the US) is one of the most used analgesics, along with non-steroidal anti-inflammatory drugs (NSAIDs).³ While both APAP and NSAIDs may help with pain management in a variety of conditions, they each carry unique risks. NSAIDs are consistently associated with gastrointestinal, renal, and CV risks, including increased BP, while APAP is associated with liver damage at high doses and irreversible liver toxicity at very high doses (aka acute overdose). Additionally, both options are available OTC and can be used by patients without provider knowledge, recommendation, or prescription.  Indeed, pharmacists are often the only health professional who can properly assess and advise patients.