Everyday Pain Relief: High Blood Pressure

Many common over-the-counter drugs taken for pain can push your high blood pressure even higher. Here's what you need to know.

From the WebMD Archives

Although popular prescription medications for arthritis pain, such as Vioxx and Bextra, have been removed from the market because of health risks, you may not realize that many over-the-counter pain relief drugs also pose some serious risks.

That's especially true for people with high blood pressure. Many over-the-counter (OTC) painkillers can push your blood pressure higher. They can even be dangerous. Since high blood pressure has no symptoms that you can feel, you may be hurting yourself without realizing it.

"People with high blood pressure don't know the risks of taking some of these painkillers," says Nieca Goldberg, MD, a cardiologist and spokesperson for the American Heart Association. "They assume that anything you can buy over the counter is safe. But these drugs are chemicals that can cause side effects."

The problem isn't only with OTC painkillers. In fact, many remedies for colds, sinus problems, and even heartburn contain the same ingredients.

If you have high blood pressure, keeping it under control is crucial. So, before you grab a bottle of pain reliever for your next backache, learn some dos and don'ts.

How Do Pain Relief Drugs Work?

In a certain way, all pain is in your head. When we feel pain, it's the result of an electrical signal being sent from the nerves in a part of your body to your brain.

But the whole process isn't electrical. When tissue is injured (by a sprained ankle, for instance), the cells release certain chemicals in response. These chemicals cause inflammation and amplify the electrical signal coming from the nerves. As a result, they increase the pain you feel.

Painkillers work by blocking the effects of these pain chemicals. The problem is that you can't focus most pain relievers specifically on your headache or bad back. Instead, it travels through your whole body. This can cause some unexpected side effects.

What Are the Risks for People with High Blood Pressure?

For people with high blood pressure, some types of nonsteroidal anti-inflammatory drugs (NSAIDs) can be risky. They include ibuprofen, naproxen sodium, and ketoprofen, the active ingredients in medicines like Advil and Aleve.

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Other pain relievers may be less dangerous. Aspirin is also an NSAID, but experts think that it's safer for people with hypertension. Acetaminophen -- the active ingredient in Tylenol -- is a different type of painkiller that doesn't raise blood pressure as a side effect. However, like any drug, it does have side effects of its own. You shouldn't take any over-the-counter painkiller for more than 10 days without your health care provider's approval.

Why are people with high blood pressure at special risk? Some of these NSAIDs reduce the blood flow to the kidneys. The kidneys -- which filter your blood -- work more slowly, and so fluid builds up in your body. The increased fluid drives up your blood pressure.

"When I have patients with heart disease that suddenly gets much worse," Goldberg tells WebMD, "the first thing I ask them is if they've used an over-the-counter pain medicine."

These drugs have additional risks. If you take them often enough and at a high enough dose, they can seriously damage the kidneys.

So, what's a person with high blood pressure and a headache to do? In general, people with high blood pressure should use acetaminophen or possibly aspirin for over-the-counter pain relief.

Unless your health care provider has said it's OK, you should not use ibuprofen, ketoprofen, or naproxen sodium. If aspirin or acetaminophen doesn't help with your pain, call your doctor.

Other Options for Pain Relief

Of course, painkillers aren't the only answer for many of life's aches and pains. Many effective and safe alternatives don't have any side effects at all.

  • Ice packs, for acute injuries like a sprained ankle, can keep down swelling and ease pain.
  • Heat -- with a hot towel or heating pad -- can be helpful for treating chronic overuse injuries. (However, you shouldn't use heat on recent injuries.)
  • Physical activity can help reduce some kinds of discomfort, such as arthritis pain.
  • Relaxation -- with techniques like yoga or meditation -- may reduce pain. Biofeedback may help as well. These approaches are best for pain that's amplified by stress, like tension headaches.
  • Nontraditional techniques with low risks -- like acupuncture -- benefit some people.

So remember: Pain relief doesn't only come from a pill bottle.

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The Pros and Cons of Pain Relief Drugs

Here's a rundown of the benefits and risks of some popular pain medications. It should help simplify your choices the next time you're in the drugstore.

Keep in mind that you shouldn't use any over-the-counter painkiller on a regular basis. If you're in that much pain, you need to talk with your doctor.

ACETAMINOPHEN
Tylenol, Panadol, Tempra
(and also an ingredient in Excedrin)

  • How it works. Acetaminophen is not an NSAID. Experts aren't actually sure how it works, but it seems to affect chemicals that increase the feeling of pain.

  • Benefits. Acetaminophen reduces pain and lowers fevers. Experts believe that acetaminophen is safe for people with high blood pressure.

    Acetaminophen is also less likely to cause gastrointestinal problems than NSAIDs. It is safe for women who are pregnant and nursing.

  • Side effects and risks. Experts believe that acetaminophen is safe for people with high blood pressure. Very high doses of acetaminophen can cause serious liver damage. Long-term use of acetaminophen in high doses -- especially when combined with caffeine (Excedrin) or codeine (Tylenol with codeine) can cause kidney disease.

    Acetaminophen doesn't reduce swelling, like aspirin and other NSAIDs do. It may be less helpful in treating pain that's caused by inflammation, such as some types of arthritis.

ASPIRIN
Bayer, Bufferin, Ecotrin (and also an ingredient in Excedrin)

  • How it works. Aspirin is an NSAID that circulates through your bloodstream. It blocks the effects of chemicals that increase the feeling of pain.

  • Benefits. Aspirin has earned its reputation as a "wonder drug." It eases pain and lowers fevers. It can also reduce inflammation, which means that it can treat the symptom (pain) and sometimes the cause (swelling.)

    Aspirin also lowers the risk of blood clots, heart attacks, and strokes, particularly in people at high risk of these problems. Usually, only very low daily doses -- 81 milligrams or one baby aspirin -- are recommended for cardiovascular protection.

    Other NSAIDs (like ibuprofen ketoprofen, or naproxen sodium) and acetaminophen do not have this effect. However, you should never start taking aspirin daily without talking with your doctor first.

  • Side effects and risks. Aspirin can impair the effects of common blood pressure medicines like ace inhibitors (such as Lotensin, Capoten, and Vasotec) and beta blockers (such as Coreg, Lopressor, and Corgard.) If you use any medicine for high blood pressure, ask your doctor if it's safe to use aspirin.

    Aspirin can also cause heartburn, upset stomach, pain, or ulcers even in very low doses. It can be dangerous for people with liver disease, gout, juvenile arthritis, or rheumatic fever. Pregnant women shouldn't use aspirin, since it can harm the mother and cause birth defects. Unless your health care provider says it's OK, children and teenagers should not use aspirin because it puts them at risk of Reye's syndrome.

    Some people have an allergy to aspirin. It can cause wheezing, hives, facial swelling, and shock. Rarely, aspirin can cause ringing in the ears and hearing loss.

    While inflammation can cause pain, it's often a key part of the body's natural healing process. Since this medicine at high doses can prevent inflammation, it can also slow down recovery after certain injuries.

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IBUPROFEN
Advil, Motrin IB, Nuprin

  • How it works. Like all NSAIDs, ibuprofen blocks the effects of chemicals that increase the feeling of pain.

  • Benefits. Ibuprofen can lower fevers, ease pain, and reduce inflammation.

  • Side effects and risks. You should not use ibuprofen if you have high blood pressure, unless your doctor has explicitly told you that you can. Ibuprofen can also impair the effectiveness of common blood pressure medicines like ace inhibitors (such as Lotensin, Capoten, and Vasotec) and beta blockers (such as Coreg, Lopressor, and Corgard.)

    Ibuprofen can cause heartburn, upset stomach, pain, and ulcers. It may also increase the risk of heart attacks and strokes. The FDA now requires that drug companies highlight ibuprofen's potential risks. This drug isn't safe during the last three months of pregnancy.

    Some people are allergic to ibuprofen and other NSAIDs. It can cause hives and facial swelling. It can be dangerous to some people with asthma. In some cases, ibuprofen can slow down the body's natural healing process.

KETOPROFEN
Actron, Orudis KT

  • How it works. Ketoprofen blocks the effects of chemicals that increase the feeling of pain.

  • Benefits. Ketoprofen can lower fevers, ease pain, and reduce inflammation.

  • Side effects and risks. Do not use ketoprofen if you have high blood pressure, unless your health care provider has told you that it's safe. Ketoprofen can also impair the effectiveness of common blood pressure medicines like ace inhibitors (such as Lotensin, Capoten, and Vasotec) and beta blockers (such as Coreg, Lopressor, and Corgard.)

    Ketoprofen can cause heartburn, upset stomach, pain, and ulcers. It may increase the risk of heart attacks and strokes. The FDA requires that companies that sell ketoprofen highlight these risks. This drug isn't safe during the last three months of pregnancy.

    Some people are allergic to ketoprofen and other NSAIDs. It can cause hives and facial swelling. It can be dangerous to some people with asthma. In some cases, ketoprofen can slow down the body's natural healing process.

NAPROXEN
Aleve

  • How it works. Naproxen sodium blocks the effects of chemicals that increase the feeling of pain.

  • Benefits. Naproxen sodium can lower fevers, ease pain, and reduce inflammation.

  • Side effects and risks. Do not use naproxen sodium if you have high blood pressure, unless your doctor has said that it's safe. Naproxen sodium can also impair the effectiveness of common blood pressure medicines like ace inhibitors (such as Lotensin, Capoten, and Vasotec) and beta blockers (such as Coreg, Lopressor, and Corgard.)

    A recent study seems to show a link between naproxen sodium and an increased risk of heart attack or stroke. More research needs to be done before doctors know for sure. For now, ask your health care provider for advice.

    Naproxen sodium can cause heartburn, upset stomach, pain, or ulcers. The FDA requires that companies that sell naproxen sodium highlight these risks. This drug isn't safe during the last three months of pregnancy.

    Some people are allergic to naproxen sodium and other NSAIDs. It can cause hives and facial swelling. It can be dangerous to some people with asthma. In some cases, naproxen sodium can slow down the body's natural healing process.

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PRESCRIPTION PAIN RELIEVERS

Many painkillers -- including higher doses of NSAIDs -- are available by prescription. Since they are more powerful versions of over-the-counter NSAIDs, they often have the same or greater risks. Some examples are Daypro, Indocin, Lodine, Naprosyn, Relafen, and Voltaren.

Cox-2 inhibitors are a newer kind of NSAID. These medicines have recently come under fire for their dangers. Although these drugs are supposed to have fewer gastrointestinal side effects than standard NSAIDs, they can still cause some of the same problems. They may also raise the risk of heart attacks and strokes. Two of these drugs, Vioxx and Bextra, have been taken off the market because of various side effects. Celebrex is still available.

Narcotics are another type of prescription painkiller. Examples include OxyContin, Percocet, and Vicodin. These drugs are only used in people with severe chronic pain. They don't pose a risk for people with high blood pressure. They do have other side effects, including constipation, fatigue, and a risk of addiction.

WebMD Feature Reviewed by Louise Chang, MD

Sources

Published May 2005.
Medically updated April 6, 2006.

SOURCES. Nieca Goldberg, MD, spokesperson for the American Heart Association; chief of Women's Cardiac Care at Lennox Hill Hospital, New York City. Byron Cryer, MD, spokesperson for the American Gastroenterological Association; associate professor of medicine, University of Texas Southwestern Medical School, Dallas. Phillip E. Korenblat, MD, spokesperson for the American Academy of Allergy, Asthma, and Immunology; professor of clinical medicine, Washington University School of Medicine, St. Louis. American Academy of Family Physicians web site. American Heart Association web site. American Academy of Allergy, Asthma, and Immunology web site. American Gastroenterological Association web site. FDA web site. U.S. Department of Health and Human Services National Women's Health Information Center web site.
© 2005 WebMD, Inc. All rights reserved.

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