Lisa asked
I have had a minor knee injury and want to take an anti-inflammatory medication but am on blood pressure medicine for my hypertension. What over the counter anti-inflammatory would be safe for me to take?
Answer
It can be difficult to choose an over the counter medication when you have certain medical problems such as diabetes or high blood pressure (i.e. hypertension). This is certainly the case when looking for safe pain medications (i.e. analgesics) to use when you have high blood pressure.
In this article, we discuss the most popular over the counter medications pain medications in regard to their safety for use in those with high blood pressure. These medications include:
- Tylenol (acetaminophen)
- NSAIDs (such as ibuprofen, naproxen and aspirin)
Pain Medication Options For High Blood Pressure
Drug Free Treatment Options
First, it is important to discuss general first aid and non-drug therapy for aches, pain and minor injuries. Standard treatment for any injury involving a joint, which involves post-surgery, should be remembered by the mnemonic RICE
R: Rest - Try staying off of and not using the injured area
I: Ice - The area should be iced for the first 36 hours for 15-20 minutes at a time as much as every hour, though at least 3 times a day
C: Compression - Applying an elastic bandage to the affected joint can help reduce swelling and give support
E: Elevation - The injury should be elevated to help decrease swelling
Acetaminophen
Acetaminophen (brand name Tylenol) is a pain reliever that is not an anti-inflammatory drug. It will work on pain but will not do much for the inflammation of an injury. Aacetaminophen is considered a safe option for patients with high blood pressure. Acetaminophen is not known to increase blood pressure. The main concern when using acetaminophen is the effect on the liver with taking higher doses. Some key points regarding acetaminophen are:
- Patients will known liver disease or decreased liver function should not use acetaminophen.
- Acetaminophen has been associated with acute liver failure. Doses should not exceed 4 grams daily in adults.
- Caution should also be used in patients with renal (kidney) impairment, chronic malnutrition, dehydration and alcoholic liver disease.
Taking acetaminophen and using the above RICE method for injuries may provide enough relief for a minor knee injury that a NSAID is not necessary.
NSAIDs
Nonsteroidal anti-inflammatory drugs (NSAIDs), like Motrin (Ibuprofen), Aleve (Naproxen), and aspirin are drugs used in the treatment of pain and inflammation. NSAIDs are known to potentially increase patient's blood pressure however and need to be used cautiously in those with hypertension.
It can sometimes be difficult to discern whether or not short term (i.e. acute) use of NSAIDs are okay in those with controlled hypertension (i.e. hypertension controlled by medication or lifestyle changes). One review did find that the use of NSAIDs for a week or more can increase blood pressure by approximately 5 mmHg. Whether or not this increases the risk of cardiac complications is unknown. This same review did note that this was more likely to occur in patients with chronic kidney disease.
The American College of Cardiology and American Heart Association classifies normal blood pressure as less than 120/80. If you are a patient that meets these guidelines and your blood pressure is well controlled under your doctor's supervision, taking a NSAID or aspirin may be appropriate for short term treatment of 1 week or less. However, it is important to discuss with your doctor before taking as there may be contraindications on an individual basis.
In addition, there are other factors regarding NSAIDs to take into account.
Even patients with normal blood pressure have a risk when using a non-aspirin NSAIDs like Motrin (Ibuprofen) or Aleve (Naproxen). The FDA has a label warning for all NSAIDs stating NSAIDs cause an increased risk of cardiovascular events including life threatening myocardial infarction (MI) and stroke. Therefore, if you have a prior history of cardiac problems, you may need to stay ways from NSAIDs.
While NSAIDs both excellent pain relievers with anti-inflammatory properties, the risk of raising blood pressure and an increased risk of sudden myocardial infarction or stroke cannot be ignored. Should other pain medications not work for you or not be appropriate, then use of Motrin (Ibuprofen) or Aleve (Naproxen) could potentially be utilized at the lowest possible effective dose for the shortest amount of time. Again however, be sure to speak with your doctor.
It should also be noted that patients who use NSAIDs like Motrin (Ibuprofen) or Aleve (Naproxen) also have an increased risk for a gastrointestinal bleed. Thus, patients with known gastrointestinal disease such peptic ulcer disease, known gastrointestinal bleeds or dyspepsia should not use these medications.
Aspirin
As mentioned above, aspirin is an anti-inflammatory drug. In the review mentioned above, it was found aspirin was one of the least likely anti-inflammatory drugs to cause an increase in blood pressure. Furthermore, aspirin does not have a label warning from the FDA in regards to an increased risk of myocardial infarction and stroke. There are a couple of other considerations to take into account before using aspirin including:
- Patients with known platelet and bleeding disorders should not use without consulting the doctor
- Patients on blood thinners (like Coumadin (warfarin)) should not use without consulting the doctor
- Patients with known gastrointestinal disease such as ulcers, should use with caution under the care of a doctor
For patients without the above concerns, use of aspirin in a mild knee injury may be appropriate as long as their current blood pressure treatment is stable.
Prescription Medications
Lastly, while not over the counter, there are some topical anti-inflammatory agents available by prescription such as Voltaren (diclofenac) gel. Although classified as an NSAID, the topical route of administration means that it has a minimal effects on blood pressure, if at all. In addition, Voltaren gel is not associated with the bleeding risk of oral NSAIDs.
Summary
- Tylenol (acetaminophen) is considered a safe over the counter pain medication for high blood pressure.
- NSAIDs, like ibuprofen and naproxen, are generally are not recommended for use in those with high blood pressure.
- If blood pressure is well controlled, NSAIDs may be an option however and your should speak with your doctor regarding their use.
Additional References
Clinical Resource, Meds That Can Increase Blood Pressure. Pharmacist's Letter/Prescriber's Letter. September 2017
