Study Links Painkillers, Hypertension

Women taking daily amounts of non-aspirin painkillers -- such as extra-strength Tylenol -- should monitor their blood pressure, doctors say following a new study suggesting a link between the drugs and hypertension.

"If you're taking these over-the-counter medications at high dosages on a regular basis, make sure that you report it to your doctor and you're checking your blood pressure," said Dr. Christie Ballantyne, a cardiologist at the Methodist DeBakey Heart Center in Houston who had no role in the study.

While many popular over-the-counter painkillers have been linked before to high blood pressure, acetaminophen, sold as Tylenol, has generally been considered relatively free of such risk.

It is the only one that is not a non-steroidal anti-inflammatory drug or NSAID, a class of medications the federal government just required to carry stricter warning labels because of the risk for heart-related problems. Those include ibuprofen (sold as Advil and Motrin) and naproxen (sold as Aleve). Many had turned to those painkillers in the wake of problems with prescription drugs, such as Vioxx.

However, the new study found that women taking Tylenol were about twice as likely to develop blood pressure problems. Risk also rose for women taking NSAIDS other than aspirin.

The research found that aspirin still remains the safest medicine for pain relief. It has long been known to reduce the risk of cardiovascular problems and was not included in the government's requirement for stricter labels for NSAIDs.

The study involved 5,123 women participating in the Nurses Health Study at Harvard Medical School and Brigham and Women's Hospital in Boston. None had had high blood pressure when it began.

Results were published online Monday in the American Heart Association journal Hypertension.

"It certainly sets the basis for more studies," said Dr. Stephanie Lawhorn, a cardiologist at St. Luke's Mid America Heart Institute in Kansas City. "Most of the time we think that things like acetaminophen are fairly safe drugs."

The study found that women ages 34-77 who took an average daily dose of more than 500 milligrams of acetaminophen -- one extra-strength Tylenol -- had about double the risk of developing high blood pressure within about three years.

Women 51-77 who take more than 400 mg a day of NSAIDS -- equal to say two ibuprofen -- had a 78 percent increased risk of developing high blood pressure over those who didn't take the drug. Those ages 34-53 had a 60 percent risk increase.

"We are by no means suggesting that women with chronic pain conditions not receive treatment for their pain," lead author Dr. John Phillip Forman, of Harvard Medical School and associate physician at Brigham and Women's Hospital in Boston, said in an e-mail. "By pointing out risks associated with these drugs, more informed choices can be made by women and their clinicians."

Previous research linking these drugs to blood pressure problems did not look at dose.

The results in this study held up even when researchers excluded women who were taking pills for headaches, something that could itself be a result of very high blood pressure, said Dr. Gary Curhan, another study author also of Harvard Medical School.

As for why aspirin didn't raise risk, it might be because "aspirin has a different effect on blood vessels than NSAIDS and acetaminophen have," said Dr. Daniel Jones, dean of the school of medicine at University of Mississippi Medical Center in Jackson.

"The research found that aspirin still remains the safest medicine for pain relief. It has long been known to reduce the risk of cardiovascular problems and was not included in the government's requirement for stricter labels for NSAIDs."

Yep.
Which is why one can see precisely how effective marketing hype and popular perception works.
Aspirin is not only the safest painkiller, it is actually good for you. The President, wisely, takes 81 mg of aspirin a day, along with his omega-3 fatty acids and his multivitamin. He has the best medical advice in the world, and takes aspirin as a health SUPPLEMENT.

But what do even the doctors say to take for pain?
Tylenol.
Advil.
My own doctor, upon being informed that I take aspirin for headaches, suggested Tylenol instead. He said "Aspirin is disfavored".
Disfavored by WHOM?
Not by people who want to be in the best health they can be. THEY take 81 mg of aspirin a day.

It is ridiculous.
If people just stopped and thought for a minute, Tylenol and Advil and co, would all be out of business, and aspirin would occupy the field again, because it's healthy and safe and very effective, but they are unhealthy and risky and no more effective.

But marketing and perception rule the roost. And even doctors will tell you to take Tylenol, not aspirin.

But carve out those two exceptions, which is perhaps 5% of the market, and if common sense drove consumption habits, 95% of painkillers bought would be aspirin.

Aspirin and the other NSAIDS cause a great deal of gastro-intestinal(GI) ulcers and bleeding, causing anemia and, not infrequently, death. That's why they developed COX-2 inhibitors, aka Vioxx, Celebrex and Bextra.

And unfortunately, some are saying that asprin can reduce the body's ability to clot blood quickly, which can promote retinal/macular problems when a little bleeding can turn into more than a little. (Maybe good for preventing strokes, maybe not so good for eyes.) I suppose this may have ramifications for some pre-menopausal ladies, too.

Platelet aggregation is irreversibly inhibited by aspirin.

Pharmacodynamic interaction of naproxen with low-dose aspirin in healthy subjects. (Check "Related Articles", upper right near the title at PubMed)

CONCLUSIONS: Naproxen interfered with the inhibitory effect of aspirin on platelet COX-1 activity and function. This pharmacodynamic interaction might undermine the sustained inhibition of platelet COX-1 that is necessary for aspirin's cardioprotective effects. That's also why it's prescribed to protect against the most common form of stroke, but not the worst kind, i.e. hemorrhagic stroke, aka bleeding in the brain.

Ibuprofen cuts Alzheimer protein build-up

p>John Travis

To stop Alzheimer's disease, a leading theory proposes reducing in-brain buildup of a protein fragment known as beta-amyloid. Scientists struggling to achieve this goal are, for example, testing a vaccine that prompts the immune system to clear this amyloid from the brain.

The solution may be even simpler. A study in mice suggests that ibuprofen, the common nonprescription drug, may lessen abnormal accumulation of beta-amyloid.

While this finding supports previous data indicating that ibuprofen and other nonsteroidal anti-inflammatory drugs (NSAIDs) slow or prevent the onset of Alzheimer's disease, researchers say it also opens up a new way to think about how ibuprofen protects the brain.

"We've shown that a drug that's available, that's been in use for 30 to 40 years, and [for which] we know the side-effect profiles...can reduce both the inflammatory response to amyloid and the amyloid" itself, says study leader Gregory M. Cole of the University of California in Los Angeles.

About 20 studies have revealed that people who took NSAIDs for various reasons had a smaller risk—60 percent less in one study—of developing Alzheimer's disease than people who didn't take the drugs. Yet NSAIDs can cause serious stomach problems, including bleeding. Investigators therefore hesitate to recommend widespread use of the drugs until they can develop safer versions and confirm that the drugs do check the progression of Alzheimer's disease.

At the same time, neuroscientists continue to look for the mechanisms by which NSAIDs defend the brain. There's plenty of evidence that inflammation within the brain, prompted by amyloid deposits, activates immune cells and elicits harmful substances that destroy nerve cells. That led to the conjecture that NSAIDs interrupt this dangerous sequence.

Cole and his colleagues confirmed this idea in their mouse studies. They tested mice deliberately modified to carry a mutated gene that causes early-onset Alzheimer's disease in people. These mice develop amyloid deposits, or plaques, as well as features of brain inflammation that show up in people with the disease.

Mice receiving ibuprofen in their daily meals, however, experienced much less inflammation, says Cole. For example, the investigators observed fewer active microglia, which are the brain's immune cells, near amyloid plaques.

Compared to untreated mice, those receiving ibuprofen also had about half the number of plaques and half of the total amount of brain amyloid, the investigators report in the Aug. 1 Journal of Neuroscience. That finding surprised Cole because studies of brain tissue from deceased elderly people who had remained mentally coherent have not shown less amyloid among NSAID users than among the others. A similar study, reported 2 months ago, that examined the brains of people with Alzheimer's disease offered the same conclusion.

"I'm not doubting [the mouse] data, but it's not entirely logical as to why they got that result," says Ian R.A. MacKenzie of the University of British Columbia in Vancouver, who conducted one of the studies of human brains. The research on people, he concedes, has its own limitations that leave open the question of whether ibuprofen lessens the amyloid burden in the brain.

Cole offers two theories of how the drug could act. It might alter the production of inflammatory chemicals that control microglia, prompting them to do a better job of clearing amyloid. Or it might decrease concentrations of inflammatory agents that trigger amyloid creation.

Whatever the mechanism, Cole suspects that ibuprofen may do better at preventing Alzheimer's disease than at treating people already afflicted. He's now arranging trials to evaluate the drug's protective powers.

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