Effect of Paracetamol on Blood Pressure: A Systematic Review

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Published Nov 9, 2025
https://doi.org/10.62438/tunismed.v103i9.6243
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Vol. 103 No. 9 (2025): Tunis Med sept 2025

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Saoussen Miladi
Rheumatology department, Mongi Slim Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
Leila Rouached
Rheumatology department, Charles Nicolle Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
Selma Bouden
Rheumatology department, Charles Nicolle Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
Hiba Boussaa
Rheumatology department, Mongi Slim Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
Yasmine Makhlouf
Rheumatology department, Mongi Slim Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
Aicha Ben Tekaya
Rheumatology department, Charles Nicolle Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
Siwar Ben Dhia
Rheumatology department, Charles Nicolle Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
Ines Mahmoud
Rheumatology department, Charles Nicolle Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
Raoudha Tekaya
Rheumatology department, Charles Nicolle Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
Olfa Saidane
Rheumatology department, Charles Nicolle Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
Kawther Ben Abdelghani
Rheumatology department, Mongi Slim Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
Alia Fazaa
Rheumatology department, Mongi Slim Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
Leila Abdelmoula
Rheumatology department, Charles Nicolle Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
Ahmed Laatar
Rheumatology department, Mongi Slim Hospital, Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia

Abstract

Background: Paracetamol is widely used as a first-line analgesic for chronic pain, primarily due to its presumed safety profile. Unlike non-steroidal anti-inflammatory drugs (NSAIDs), paracetamol has been for long time considered free of significant cardiovascular effects, particularly on blood pressure (BP). However, emerging evidence suggests that long terme paracetamol use may be associated with elevated BP, challenging its status as a risk-free alternative to NSAIDs.


This systematic review aimed to investigate the association between paracetamol intake and changes in BP by screening existing clinical and epidemiological data to clarify its potential hypertensive effects.


Methods: A comprehensive search of Medline, Cochrane Library, and Embase databases was conducted. Eligible studies included randomized clinical trials, interventional and longitudinal observational studi involving adults receiving standard doses of oral paracetamol. Exclusion criteria were studies on  pregnant women, patients with preeclampsia/eclampsia, and those using supratherapeutic doses. The primary outcome was variation in systolic and diastolic BP.


Results: A total of 10 studies was included comprinzing observational studies (n = 4) and randomized controlled trials (n = 6). Two observational studies reported a significant association between regular paracetamol use and an increased risk of hypertension particularly with high-dose (> 3 g/day) or prolonged use (> 30 days). The remaining two studies found no significant association, though one noted a trend toward elevated BP in older adults


Four RCTs demonstrated a small but consistent increase in systolic blood pressure (SBP), ranging from +0.2 to +4.0 mmHg. The effect appeared dose-dependent, with higher doses (> 2 g/day) linked to greater BP elevation.


Conclusion: Paracetamol may cause slight elevations in BP, with potential clinical implications in high- risk patients. Caution is warranted, and further prospective studies using ambulatory BP monitoring are needed to clarify this relationship.

Keywords:

acetaminophen, hypertension, review, cardiovascular events, side effects

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