Document Detail

Acetaminophen increases blood pressure in patients with coronary artery disease.
MedLine Citation:
PMID:  20956208     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Because traditional nonsteroidal antiinflammatory drugs are associated with increased risk for acute cardiovascular events, current guidelines recommend acetaminophen as the first-line analgesic of choice on the assumption of its greater cardiovascular safety. Data from randomized clinical trials prospectively addressing cardiovascular safety of acetaminophen, however, are still lacking, particularly in patients at increased cardiovascular risk. Hence, the aim of this study was to evaluate the safety of acetaminophen in patients with coronary artery disease.
METHODS AND RESULTS: The 33 patients with coronary artery disease included in this randomized, double-blind, placebo-controlled, crossover study received acetaminophen (1 g TID) on top of standard cardiovascular therapy for 2 weeks. Ambulatory blood pressure, heart rate, endothelium-dependent and -independent vasodilatation, platelet function, endothelial progenitor cells, markers of the renin-angiotensin system, inflammation, and oxidative stress were determined at baseline and after each treatment period. Treatment with acetaminophen resulted in a significant increase in mean systolic (from 122.4±11.9 to 125.3±12.0 mm Hg P=0.02 versus placebo) and diastolic (from 73.2±6.9 to 75.4±7.9 mm Hg P=0.02 versus placebo) ambulatory blood pressures. On the other hand, heart rate, endothelial function, early endothelial progenitor cells, and platelet function did not change.
CONCLUSIONS: This study demonstrates for the first time that acetaminophen induces a significant increase in ambulatory blood pressure in patients with coronary artery disease. Thus, the use of acetaminophen should be evaluated as rigorously as traditional nonsteroidal antiinflammatory drugs and cyclooxygenase-2 inhibitors, particularly in patients at increased cardiovascular risk.
CLINICAL TRIAL REGISTRATION: URL: Unique identifier: NCT00534651.
Isabella Sudano; Andreas J Flammer; Daniel Périat; Frank Enseleit; Matthias Hermann; Mathias Wolfrum; Astrid Hirt; Priska Kaiser; David Hurlimann; Michel Neidhart; Steffen Gay; Johannes Holzmeister; Juerg Nussberger; Pavani Mocharla; Ulf Landmesser; Sarah R Haile; Roberto Corti; Paul M Vanhoutte; Thomas F Lüscher; Georg Noll; Frank Ruschitzka
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2010-10-18
Journal Detail:
Title:  Circulation     Volume:  122     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2010 Nov 
Date Detail:
Created Date:  2010-11-02     Completed Date:  2010-12-02     Revised Date:  2011-08-15    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1789-96     Citation Subset:  AIM; IM    
Cardiovascular Center Cardiology University Hospital Zurich, Rämistrasse 100, CH-8091 Zurich, Switzerland.
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MeSH Terms
Acetaminophen / adverse effects*,  pharmacology*
Anti-Inflammatory Agents, Non-Steroidal / adverse effects*,  pharmacology*
Blood Pressure / drug effects*,  physiology
Circadian Rhythm / drug effects,  physiology
Coronary Artery Disease / physiopathology*
Cross-Over Studies
Dose-Response Relationship, Drug
Double-Blind Method
Endothelium, Vascular / drug effects,  physiopathology
Heart Rate / drug effects,  physiology
Hypertension / chemically induced*,  epidemiology,  physiopathology
Middle Aged
Platelet Adhesiveness / drug effects,  physiology
Prospective Studies
Risk Factors
Vasodilation / drug effects,  physiology
Reg. No./Substance:
0/Anti-Inflammatory Agents, Non-Steroidal; 103-90-2/Acetaminophen
Comment In:
Circulation. 2011 Jun 28;123(25):e645; author reply e646   [PMID:  21709069 ]
Circulation. 2010 Nov 2;122(18):1779-81   [PMID:  20956214 ]

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