Because traditional nonsteroidal antiinflammatory drugs have been 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. This study evaluated the safety of acetaminophen in patients with coronary artery disease. A total of 33 patients with coronary artery disease participated in a randomized, doubleblind, placebo-controlled, crossover study of acetaminophen or placebo (1g 3x/d) on top of standard cardiovascular therapy for 2 weeks. Treatment with acetaminophen resulted in a significant increase in mean systolic (from 122.4±11.9 to 125.3±12.0 mmHg, p=0.02 versus placebo) and diastolic (from 73.2±6.9 to 75.4±7.9 mmHg, p=0.02 versus placebo) ambulatory blood pressures. Heart rate, endothelial function, early endothelial progenitor cells, and platelet function did not change. This is the first study to demonstrate that acetaminophen induces a significant increase in ambulatory blood pressure in patients with coronary artery disease. Use of acetaminophen should be critically evaluated for use in patients at increased cardiovascular risk. Circulation. 2010 Nov 2;122(18):1789-96. PMID: 20956208.
