Painkiller Risk: High Blood Pressure

Study Shows Pain Drugs in Your Medicine Cabinet Carry Risk of High Blood Pressure By Daniel DeNoon /WebMD.com

The most widely used medicines in the world -- over-the-counter pain drugs -- raise a person's risk of high blood pressure. It's true for men as well as for women, suggest new findings from Gary C. Curhan, MD, ScD, and colleagues at Brigham and Women's Hospital and Harvard Medical School, Boston. The drugs in question include:

* NSAIDs such as ibuprofen (brand names include Advil and Motrin) and naproxen (brand names include Aleve and Naprosyn)
* Acetaminophen (brand names include Tylenol)
* Aspirin

"Even though these medications can be bought without a prescription, you have to think twice before taking them," Curhan tells WebMD. Curhan's team studied more than 16,000 male health professionals who did not already have high blood pressure. Their average age was 65.
Four years after entering the study, nearly 2,000 of the men had developed high blood pressure. High blood pressure -- called "the silent killer" by the American Heart Association -- can lead to stroke, heart attack, heart failure, or kidney failure.

More Blood Pressure Risk With Daily Painkillers
The study found that, compared with men who did not use pain relievers, the risk of high blood pressure:

* Went up 38% in men who took NSAIDs six or seven days a week.
* Went up 34% in men who took acetaminophen six or seven days a week.
* Went up 26% in men who took aspirin six or seven days a week.

That doesn't sound like a lot. But since the drugs are so widely used, the impact is huge. Curhan estimates that a 65-year-old man has a 3% annual risk of high blood pressure. With daily painkiller use, that risk becomes 4% a year. That 1% difference seems small, but it multiplies over time. Over just four years, a man's 12% risk of high blood pressure becomes 16%.
The findings aren't a total surprise, says Steven Nissen, MD, chairman of the Cleveland Clinic's department of cardiovascular medicine and president of the American College of Cardiology. "There has been a suspicion that all of these analgesics -- even a so-called safe analgesic like acetaminophen -- can raise blood pressure," Nissen tells WebMD. He notes that the design of the study does not definitively prove that these drugs raise the risk of high blood pressure. Only a full-scale clinical trial can do that. But Nissen says it's "probably true" that acetaminophen and other common painkillers raise blood pressure.

'Over-the-Counter' Doesn't Mean 'Safe'
Nissen warns that just because you can buy a drug without a prescription doesn't mean it's safe.
"Some of the most risky medications out there you can buy over the counter," he says. For some people, the drugs' risks outweigh their benefits. For others, the benefits still far outweigh the risks. "This doesn't mean you should never take these drugs," Curhan says. "But if you are taking them long term, it is important to talk to your health care provider to see if there are alternative ways of preventing your symptoms."
Curhan and colleagues report their findings in the Feb. 26 issue of Archives of Internal Medicine.

Biological Aging Predicts Heart Attack

People Who Age Fast Are at Highest Heart Attack Risk; Statin Drugs May Help

By Daniel DeNoon

People who age fast -- as measured by DNA shortening -- have a higher heart disease risk. Statin drugs may help, a Lancet study suggests. Every time a cell in the body replicates, the DNA string (the telomere) at one end of the chromosome gets shorter. When it gets too short, the cell dies. Current scientific thought holds that this process is directly related to aging. Telomere shortening happens at different rates for different people. This suggests that our chronological age (the number of years since our birth) is different from our biological age (as measured by telomere shortening).
Does our "biological age" really predict death and disease? Scott W. Brouilette, PhD, and colleagues have previously shown that telomere length in people who have heart attacks before age 50 and in people who are candidates for triple bypass surgery tends to be shorter than telomere length in healthy people of the same age and sex. In their current study, the researchers looked at people enrolled in a clinical trial of the cholesterol-lowering drug Pravachol. Over five years, 484 patients developed heart disease. The researchers compared their telomere length in white blood cell DNA to that of 1,058 matched people who remained free of heart disease. Sure enough, those who got heart disease had telomere lengths similar to those in the comparison group who were six years older. Study participants in the top third of telomere length were about 50% less likely to have heart disease as those in the middle or lower third in telomere length.
"Our findings lend support to the hypothesis that premature biological aging might contribute to the risk of coronary heart disease," Brouilette and colleagues suggest in the Jan. 13 issue of The Lancet. Oddly, the heart risk seen with shorter telomere length did not increase beyond a certain point. "This finding suggests that, especially with increasing age, there could be a threshold beyond which further shortening of telomeres does not confer additional risk," the researchers theorize.

Do Statins Slow Biological Aging?
Interestingly, Pravachol -- one of the "statin" family of cholesterol-lowering drugs -- dramatically lowered the heart disease risk of people with shorter telomeres. But the drug seemed to have little effect on heart disease risk in people with the longest telomeres. Brouilette and colleagues suggest that statin drugs may slow biological aging not by lowering cholesterol but by increasing blood levels of a molecule that stabilizes telomeres. The researchers suggest that by measuring telomere length, doctors could identify those patients most likely to benefit from statin treatment.
However, a Lancet editorial appearing alongside the study casts doubt on this idea. Ioakim Spyridopoulos, MD, and Stefanie Dimmeler, PhD, of the University of Frankfurt, Germany, agree with Brouilette and colleagues that biological aging could contribute to heart disease risk. But they note that different people start out life with different-length telomeres. An individual's telomere length, they suggest, says nothing about how fast that person is aging.
Looking at telomere length in a large number of people may provide insight into the relationship between biological aging and disease. But they flatly reject the idea that telomere length could predict an individual's risk of heart disease.