Paracetamol, also called acetaminophen, is one of the world’s most widely used medicines.
People commonly take it for headaches, muscle aches, fever and many types of short-term pain.
It is also sometimes used regularly by people living with long-lasting conditions such as arthritis.
For many years, paracetamol has often been viewed as a safer choice for people who need pain relief but have heart or blood pressure problems.
This is partly because other common painkillers, including non-steroidal anti-inflammatory drugs such as ibuprofen, can raise blood pressure. However, research from the University of Edinburgh suggests that regular paracetamol use may deserve more caution.
The researchers studied 110 adults who had a history of high blood pressure. Participants received either paracetamol or a placebo for two weeks and then switched to the other treatment after a break. During the paracetamol period, they took one gram four times a day, which is a commonly prescribed maximum daily dose.
The researchers closely monitored the participants’ blood pressure. They found that regular paracetamol caused both the upper and lower blood pressure readings to rise compared with placebo. The increase appeared fairly quickly after treatment began.
The size of the rise was similar to increases previously seen with some anti-inflammatory painkillers. This matters because even a modest increase in blood pressure, if it continues for a long time, can raise the chance of cardiovascular problems. High blood pressure places extra strain on arteries, the heart and other organs.
Based on the known relationship between blood pressure and cardiovascular disease, the researchers estimated that the increase could translate into roughly a 20% higher risk of heart disease or stroke if it were maintained over the long term.
This was an estimate rather than a direct finding that paracetamol caused 20% more heart attacks or strokes. The study itself was not designed to follow people for years and count those events.
The findings are particularly important because paracetamol is so widely used. People with high blood pressure may already have an increased risk of heart attack and stroke, so a medicine that pushes their blood pressure higher could add to that risk.
Researchers said doctors should think carefully when prescribing paracetamol regularly for chronic pain.
However, the study does not suggest that occasional paracetamol use for a headache or fever is dangerous. The research examined repeated high-dose use in people who already had hypertension. Short-term and occasional use is a different situation and was not the main question tested.
The results also do not mean that people taking prescribed paracetamol should suddenly stop it. Chronic pain can seriously affect mobility, sleep and quality of life, and alternative medicines may carry their own risks.
Anyone who uses paracetamol regularly should discuss the benefits, dose and duration with a doctor or pharmacist, especially if they have high blood pressure or cardiovascular disease.
Professor James Dear and colleagues suggested that doctors could begin patients who need long-term paracetamol on the lowest effective dose and increase it only when necessary.
Blood pressure could also be monitored after treatment begins, particularly in people who already have hypertension. This approach may help balance pain relief against possible cardiovascular effects.
The research adds to a broader change in how scientists think about familiar medicines. A drug can be safe and useful for millions of people while still carrying risks in particular circumstances, especially when taken regularly at high doses. Understanding those differences can help doctors choose treatments more carefully.
The University of Edinburgh study was published in the journal Circulation. Further research is needed to determine what happens during much longer periods of paracetamol use and whether the observed rise in blood pressure leads to more heart attacks or strokes in real-world patients.
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