Everyday Medications That Raise Blood Pressure: NSAIDs or Acetaminophen?

Have you ever felt as if you were driving with your foot on the brake and the gas at the same time? If you are caught in stop and go traffic, you know how frustrating it can be. It’s hard to get very far in such a situation. That’s what could happen when you are prescribed a drug to help control hypertension while you are simultaneously taking medications that raise blood pressure. You might be surprised to learn how many prescription and OTC meds can contribute to hypertension. Pain relievers may be especially problematic, including NSAIDs and even acetaminophen. Such ingredients are found in hundreds of products.

NSAIDs (Nonsteroidal Anti-inflammatory Drugs) Are Popular:

People in pain frequently turn to NSAIDs for relief.

According to the publication U.S. Pharmacist (March 17, 2016):

“It is estimated that more than 30 million people use these drugs on a daily basis, and they account for 60% of the analgesic market in the United States.”

We’re talking about over-the-counter ibuprofen (Advil, Motrin IB, etc) and naproxen (Aleve).

Doctors prescribe drugs such as ibuprofen, meloxicam (Mobic), naproxen (Naprosyn), celecoxib (Celebrex), diclofenac (Voltaren) and indomethacin (Indocin). At last count, over 25 million people fill more than 65 million prescriptions for such NSAIDs annually in the United States.

Our back of the envelope calculations correspond to the CDC’s estimate that over 50 million Americans experience chronic pain. Many, if not most, rely upon NSAIDs or acetaminophen to ease their agony.

A study published in Pharmacoepidemiology & Drug Safety (Jan. 26, 2018) reports that:

“• 15% of adult ibuprofen users in the US exceed the maximum recommended daily dose of 1 or more over-the-counter or prescription NSAIDs during a week in which they use ibuprofen. The maximum was exceeded on 9.1% of usage days, and on 20% of days with more than 1 usage occasion.”

It was not unusual for people taking ibuprofen to also take naproxen.

Perhaps more alarming, the study found that:

“The daily limit for naproxen was exceeded by 23% of users of that drug, a significantly higher prevalence than for ibuprofen, and almost all with OTC products.”

NSAIDs Are Medications That Raise Blood Pressure:

People often assume incorrectly that most over-the-counter drugs are quite safe. Why would the FDA approve them for such use if they weren’t relatively harmless? We have written about the hidden dangers of over-the-counter drugs at this link.

But the point of this article is that NSAIDs can raise blood pressure and make it harder to control hypertension. That can lead to serious health problems.

A study published in the journal Hypertension (July 13, 2015) concludes:

“Our results demonstrated that the use of NSAIDs significantly elevated the risk of CKD [chronic kidney disease] among subjects with hypertension in this propensity score–matched study cohort.

“The results from this study are in line with those reported from previous studies, suggesting an association between NSAID use and an increased risk for CKD.”

Another article published in the American Journal of Cardiovascular Drugs (June, 2017) states:

“Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used to treat pain, inflammation, and fever in the USA. NSAIDs are widely available in over-the-counter (OTC) and prescription products. While effective for many indications, NSAIDs also carry risks associated with use, including gastrointestinal bleeding, hepatotoxicity, renal dysfunction, and cardiovascular disease.

“One potential mechanism might be NSAID-induced increased blood pressure in both normotensive and hypertensive patients.”

Were You Warned?

Doctors may not caution their patients with hypertension to avoid NSAIDs. And we suspect that when people buy ibuprofen or naproxen over the counter the clerk 1) won’t notice or 2) care enough to warn about medications that raise blood pressure. It is also likely that the clerk or pharmacy tech won’t know that NSAIDs can contribute to hypertension.

Will the Pharmacist Warn About Medications That Raise Blood Pressure?

If a pharmacist fills a prescription for a common NSAID such as meloxicam, will she be aware of the official prescribing information for this pain reliever?

It states:

“NSAIDs, including meloxicam, can lead to new onset or worsening of pre-existing hypertension, either of which may contribute to the increased incidence of CV [cardiovascular] events. Patients taking angiotensin converting enzyme (ACE) inhibitors, thiazide diuretics, or loop diuretics may have impaired response to these therapies when taking NSAIDs.”

The FDA advises doctors to:

“monitor blood pressure (BP) during the initiation of NSAID treatment and throughout the course of therapy.”

Sadly, over-the-counter NSAID labels do not encourage people to monitor their own blood pressure when taking such pain relievers.

One reader reported:

“I was prescribed Mobic [meloxicam] for severe knee pain by an orthopedic surgeon who did a total knee replacement. My blood pressure was normal prior to the Mobic prescription, but 18 days later it went to 196/89!”

What About Acetaminophen?

Many health professionals believe that acetaminophen, the ingredient in Tylenol, is one of the safest drugs in the pharmacy. Even many doctors who are aware of the problems with NSAIDs believe that acetaminophen (APAP) could not possibly raise blood pressure.

Here is a recent message we received from a visitor to this website:

Q. I took naproxen for six months or so (two tabs per day, four on bad days) because of acute back and leg pain caused by fibromyalgia. When I discovered my blood pressure was elevated to around 170/80, I stopped the naproxen and switched to acetaminophen.

At first, my blood pressure dropped to normal for a while but then rose again and is now fluctuating up and down. Does naproxen destabilize blood pressure in the long term? Or is acetaminophen responsible for blood pressure fluctuations?

A. We’re not surprised that naproxen raised your systolic blood pressure so dramatically. This is a known side effect of nonsteroidal anti-inflammatory drugs (NSAIDs) including ibuprofen, celecoxib, diclofenac and meloxicam, as well as naproxen.

The link between acetaminophen and elevated blood pressure is underappreciated. While less common, hypertension has been reported as a complication of acetaminophen use (Arthritis Care & Research, Nov. 24, 2024).

An article in the journal Hypertension (Sept. 2022) reveals little-recognized complications of acetaminophen:

Conclusions:

“A common misperception is that acetaminophen is distinct from other NSAIDs. In fact, it shares their primary mechanism of action—inhibition of COX-dependent prostaglandin formation. However, as it is a less potent inhibitor at commonly prescribed doses, it is less potent as an analgesic drug. Given at sufficient doses it assumes a risk profile similar to that of therapeutically administered conventional NSAIDs such as ibuprofen. This includes the GI adverse effect profile and the predisposition to hypertension, consistent with the recent reports in the literature.

“It seems that acetaminophen does indeed raise blood pressure, affect anticoagulation by warfarin through an effect on vitamin K metabolism, and may increase cardiovascular risk.”

To learn more about medications that can raise blood pressure and many strategies to get it under control, you may be interested in our eGuide to Blood Pressure Solutions. This online resource can be found under the Health eGuides tab.

Corticosteroids Are Medications That Raise Blood Pressure:

Corticosteroids such as methylprednisolone or prednisone can also raise blood pressure. One study found that hypertension was a relatively common complication of long-term use (Current Medical Research and Opinion, Aug. 2018).

How common is “relatively common”? In one study, 40% of the patients treated with prednisolone for three months developed hypertension (Hormozgan Medical Journal, June-July, 2017). None of the patients had high blood pressure at the beginning of the study.

Are Antidepressants Medications That Raise Blood Pressure?

Antidepressants have also been associated with higher blood pressure. French researchers report that drugs such as citalopram, escitalopram, fluoxetine, paroxetine and sertraline may make it harder to control hypertension (Fundamental & Clinical Pharmacology, June, 2019).

The authors conclude:

“This study, performed in real conditions of life, shows a significant pharmacovigilance safety signal between the use of SRIs [serotonin reuptake inhibitors] and the development or worsening of hypertension.”

The FDA seems unaware of this potential complication. It does not list hypertension as a side effect of Prozac (fluoxetine) except in an overdose situation.

Decongestants Are Medications That Raise Blood Pressure:

Over-the-counter decongestants can also raise blood pressure. Phenylephrine, often abbreviated PE, is found in many popular allergy and cold medicines. It is also found in some nasal sprays and hemorrhoid preparations. The latter may come as a surprise to many readers.

Several years ago, we heard from a visitor to our website:

“I used Preparation H twice yesterday and once today. I noticed a headache yesterday and attributed it to a lack of sleep.

“When I applied the Prep H today, my headache returned. I checked my blood pressure and it was 16 points higher than normal. My typical BP reading with meds is 117/78. A diastolic reading of 94 concerns me.”

Certain other common products can also raise blood pressure. One surprising item is mouthwash.

Mouthwash May Raise Blood Pressure:

Q. It was fascinating to read in a recent column that mouthwash might raise blood pressure. I found that is true in my own case, though I realize each person is different.

Coffee also elevates my blood pressure. What other common foods or OTC pharmaceuticals might raise blood pressure? I’m trying my best to avoid such things, but it would help to know what they are.

Why Antiseptic Mouthwash Could Cause Trouble:

A. The antiseptic mouthwashes you are referring to kill a variety of oral bacteria. There is growing recognition that the ecology of the mouth is important for good health. Although the benefits and risks of antiseptic mouthwash remain controversial, some experts worry that disrupting the mouth microbiome may increase the risk for cardiovascular complications (Intensive Care Medicine, Jan. 2021).

Bacteria that convert nitrate from foods like spinach or beets into nitric oxide help control the flexibility of blood vessels (International Journal of Molecular Sciences, Oct. 13, 2020). Products that interfere with this conversion appear to raise blood pressure.

Coffee and Hypertension:

Coffee drinking is also controversial. Some studies suggest that coffee and caffeine can raise blood pressure, at least in the short term. Then again, other research demonstrates no effect (American Journal of Clinical Nutrition, Oct. 2011).  As you suggest, individuals appear to vary in their response (Journal of Agricultural and Food Chemistry, May 30, 2018).

Snack Foods Can Raise Blood Pressure:

Processed foods high in salt and sugar are prime suspects. Young people with elevated blood pressure that has not crossed the threshold into hypertension are more likely than their peers to indulge in fast foods, especially salty or sweet ones (Journal of Basic Clinical Physiology and Pharmacology, Dec. 18, 2013). Diets rich in fruit, vegetables, whole grains, legumes and nuts seem to help lower blood pressure (Advances in Nutrition, Jan. 15, 2016).

Watch Out for Licorice:

You might not imagine that candy could raise blood pressure, but licorice is actually notorious for this. While a cup of licorice tea or a bite or two of black candy may be okay, regular consumption could get a person into a lot of trouble (Journal of Human Hypertension, Nov. 2017).

Final Words:

We encourage readers to monitor their blood pressure at home. That may help reveal when a new medication has an unexpected impact on hypertension management.

To help with this process, we offer our eGuide to Blood Pressure Solutions. This online resource discusses medications that can raise blood pressure along with many strategies to lower it. It may be found under the Health eGuides tab.

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