5.10 Paracetamol Increases 24-Hour Blood Pressure and Heart Rate in Patients with Stable Coronary Artery Disease
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Heart 5.10 Paracetamol Increases 24-Hour Blood Pressure and Heart Rate in Patients with Stable Coronary Artery Disease ` (1), F. Enseleit (1), M. Hermann (1), I. Sudano (1), A.J. Flammer (1), D. Periat A. Hirt (1), P. Kaiser (1), T.F. Luscher (1), R. Corti (1), G. Noll (1), F. Ruschitzka (1) (1)Centro Cardiovascolare, Ospedale Universitario, Zurigo, Switzerland Introduction. Recent studies raised the question about cardiovascular safety of selective cyclooxygenase (COX)-2 inhibitors and traditional non-steroidal anti-inflammatory drugs (NSAIDs), in patients with coronary artery disease in particular. Physicians now frequently use paracetamol instead of NSAIDs, despite its weaker analgesic effect, because this drug is considered to be cardiovascular safe. However, data prospectively addressing cardiovascular safety of paracetamol are still lacking. Aim. To evaluate the impact of paracetamol on 24-hour ambulatory blood pressure monitoring (ABPM) and endothelial function. Methods. 24 patients with coronary artery disease were included in this randomized, double-blind, crossover study. Patients received paracetamol (3x1g/d) for 2 weeks followed by placebo or vice versa on top of standard cardiovascular therapy. Between the 2 treatment periods a 2-week washout period was scheduled. At baseline and after each treatment period, endothelial function, as assessed by flowmediated dilation of the brachial artery and ABPM were obtained. Results. Treatment with acetaminophen resulted in a significant increase of systolic (SBP, from 120.1±11.7 to 122.4±12.3mmHg, p=0.03) and diastolic (DBP, from 72.2±7.4 to 74±8.6mmHg, p=0.04) 24-hour BP and heart rate (HR, from 65.8±7.5 to 68.1±8.1 b/min p=0.04), whereas there was no change after placebo (SBP from 120.4±11.7 to 120.1±10.2; and DBP from 73.1±7.6 to 72.7±6.6mmHg, HR from 66.6±8.65 to 68±8.1 b/min, p=ns for all parameters). No significant change in flow-mediated and in nitroglycerin-induced vasodilation was observed after paracetamol and placebo. Conclusions. This study for the first time demonstrates that paracetamol induces a significant increase in 24-hour blood pressure and heart rate in patients with coronary artery disease indicating that careful risk benefit analysis needs to be undertaken for all anti-inflammatory agents
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