Forman JP, RimmEB, Curhan GC. Frequency of analgesic use and risk of hypertension among men. Arch Intern Med 2007;167:394-399.

Ibuprofen, acetaminophen, and aspirin are among the most frequently used drugs in the United States, and their use by people with arthritis is substantially higher than among the general public. At low doses, ibuprofen and other drugs in the same category called nonsteroidal anti-inflammatory drugs (NSAIDs) help a wide range of problems, from muscle aches and headaches to minor pain and fever. At higher doses, NSAIDs help reduce joint inflammation. Acetaminophen, an analgesic used to ease pain, is among the most-used drugs for many forms of arthritis. Unlike NSAIDs, which target both pain and inflammation, analgesics are designed purely for pain relief. Because of its low cost, effectiveness and safety, rheumatologists recommend acetaminophen as a first-line option against osteoarthritis (OA) pain. The amount of aspirin needed to control inflammation is quite high and can cause stomach side effects. Much lower doses of aspirin, that are less likely to be associated with side effects, are used frequently for heart health or on occasion for headache.

What Problem Was Studied?
Because these three pain relievers are so commonly taken and because of the chemical effects they have on the body's circulatory system, researchers at Brigham and Women's Hospital, Harvard Medical School, and Harvard School of Public Health in Boston, sought to determine the association between these medications and high blood pressure (hypertension). Furthermore, in 2002, two large studies of women reported an increased risk of developing hypertension with a high frequency of analgesic use; the current study investigated the relationship among men. Results of this study were published in the February 26, 2007 issue of Archives of Internal Medicine.

What Was Done In the Study?
An ongoing study of more than 51,000 male health professionals provided the data needed for the analysis. Starting in 2000, detailed information about pain reliever use was gathered from these study participants through a questionnaire. Only those who returned the complete questionnaire and who did not already have hypertension were included in the study. The final sample included 16,031 men. These men filled out detailed health questionnaires again in 2002 and 2004.

What Were the Study Results?
John P. Forman, MSc, MD, and colleagues analyzed the questionnaires and determined that 1,968 men developed hypertension during the 4-year follow-up period. The research team then compared medication use among and between those with and those without new cases of hypertension. They found that all three analgesic classes "moderately increased" a man's risk of developing high blood pressure. Compared with men who did not take any of the analgesics, those who took NSAIDs six or seven days per week had a 38 percent higher risk of developing hypertension; those who took acetaminophen at the same frequency had a 34 percent higher risk; and those who took aspirin at this frequency had a 26 percent higher risk. Likewise, compared with men who did not take any pain relievers, those who took 15 or more NSAID pills per week had a 33 percent higher risk of developing high blood pressure; those who took 15 or more acetaminophen pills per week had a 4 percent higher risk; and those who took 15 or more aspirins per week had a 17 percent greater risk.

What Does This Mean for People with Arthritis?
As Dr. Forman states in the article's conclusion, "These data add further support to the hypothesis that nonnarcotic analgesics independently elevate the risk of hypertension. Given their common consumption and the high prevalence of hypertension, our results may have substantial public health implications, and suggest that these agents be used with greater caution."

"Given the number of studies being released over the past few years regarding potential side effects of various pain relievers," says Arthritis Foundation Chief Science Officer John Hardin, MD, "we urge people considering taking acetaminophen or NSAIDs for arthritis pain or inflammation to weigh the benefits of these medications with the potential risks. This is especially true for people with known cardiovascular or liver risk factors." The Arthritis Foundation recommends that people considering or taking any pain reliever for arthritis work with their doctor to determine a treatment plan that is best for their individual situation.

The recent concern over safety of arthritis pain relievers underscores the tremendous impact of arthritis on the nation, and the need for ongoing research for development of new medications, treatment and understanding of the disease.

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