title: Acetaminophen use and risk of myocardial infarction and stroke in a hypertensive cohort.
abstract: Recent data suggest that self-reported acetaminophen use is associated with increased risk of cardiovascular events and that acetaminophen causes a modest blood pressure rise. There are no randomized trials or studies using verified prescription data of this relationship. We aimed to assess the relationship between verified acetaminophen prescription data and risk of myocardial infarction or stroke in patients with hypertension. We performed a retrospective data analysis using information contained within the UK Clinical Research Practice Datalink. Multivariable Cox proportional hazard models were used to estimate hazard ratios for myocardial infarction (primary end point), stroke, and any cardiovascular event (secondary end points) associated with acetaminophen use during a 10-year period. Acetaminophen exposure was a time-dependent variable. A propensity-matched design was also used to reduce potential for confounding. We included 24,496 hypertensive individuals aged ≥ 65 years. Of these, 10,878 were acetaminophen-exposed and 13,618 were not. There was no relationship between risk of myocardial infarction, stroke, or any cardiovascular event and acetaminophen exposure on adjusted analysis (hazard ratio, 0.98; 95% confidence interval, 0.76-1.27; hazard ratio, 1.09; 95% confidence interval, 0.86-1.38; and hazard ratio, 1.17; 95% confidence interval, 0.99-1.37; respectively). Results in the propensity-matched sample (n=4000 per group) and when men and women were analyzed separately were similar. High-frequency users (defined as receiving a prescription for >75% of months) were also not at increased risk. After allowance for potentially confounding variables, the use of acetaminophen was not associated with an increased risk of myocardial infarction or stroke in a large cohort of hypertensive patients.
authors: From the Institute of Cardiovascular and Medical Sciences (R.L.F., M.R.W., R.M.T., A.F.D., S.P., G.T.M., J.D.), School of Medicine (R.M., P.A.M.), and West of Scotland Cancer Surveillance Unit (D.S.M.), College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom.
authors: Rachael L
authors: RL
authors: Fulton
authors: From the Institute of Cardiovascular and Medical Sciences (R.L.F., M.R.W., R.M.T., A.F.D., S.P., G.T.M., J.D.), School of Medicine (R.M., P.A.M.), and West of Scotland Cancer Surveillance Unit (D.S.M.), College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom.
authors: Matthew R
authors: MR
authors: Walters
authors: From the Institute of Cardiovascular and Medical Sciences (R.L.F., M.R.W., R.M.T., A.F.D., S.P., G.T.M., J.D.), School of Medicine (R.M., P.A.M.), and West of Scotland Cancer Surveillance Unit (D.S.M.), College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom.
authors: Ross
authors: R
authors: Morton
authors: From the Institute of Cardiovascular and Medical Sciences (R.L.F., M.R.W., R.M.T., A.F.D., S.P., G.T.M., J.D.), School of Medicine (R.M., P.A.M.), and West of Scotland Cancer Surveillance Unit (D.S.M.), College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom.
authors: Rhian M
authors: RM
authors: Touyz
authors: From the Institute of Cardiovascular and Medical Sciences (R.L.F., M.R.W., R.M.T., A.F.D., S.P., G.T.M., J.D.), School of Medicine (R.M., P.A.M.), and West of Scotland Cancer Surveillance Unit (D.S.M.), College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom.
authors: Anna F
authors: AF
authors: Dominiczak
authors: From the Institute of Cardiovascular and Medical Sciences (R.L.F., M.R.W., R.M.T., A.F.D., S.P., G.T.M., J.D.), School of Medicine (R.M., P.A.M.), and West of Scotland Cancer Surveillance Unit (D.S.M.), College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom.
authors: David S
authors: DS
authors: Morrison
authors: From the Institute of Cardiovascular and Medical Sciences (R.L.F., M.R.W., R.M.T., A.F.D., S.P., G.T.M., J.D.), School of Medicine (R.M., P.A.M.), and West of Scotland Cancer Surveillance Unit (D.S.M.), College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom.
authors: Sandosh
authors: S
authors: Padmanabhan
authors: From the Institute of Cardiovascular and Medical Sciences (R.L.F., M.R.W., R.M.T., A.F.D., S.P., G.T.M., J.D.), School of Medicine (R.M., P.A.M.), and West of Scotland Cancer Surveillance Unit (D.S.M.), College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom.
authors: Peter A
authors: PA
authors: Meredith
authors: From the Institute of Cardiovascular and Medical Sciences (R.L.F., M.R.W., R.M.T., A.F.D., S.P., G.T.M., J.D.), School of Medicine (R.M., P.A.M.), and West of Scotland Cancer Surveillance Unit (D.S.M.), College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom.
authors: Gordon T
authors: GT
authors: McInnes
authors: From the Institute of Cardiovascular and Medical Sciences (R.L.F., M.R.W., R.M.T., A.F.D., S.P., G.T.M., J.D.), School of Medicine (R.M., P.A.M.), and West of Scotland Cancer Surveillance Unit (D.S.M.), College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom.
authors: Jesse
authors: J
authors: Dawson
mesh_terms: D000082:Acetaminophen / Q000009:adverse effects* / Q000627:therapeutic use; D000368:Aged; D018712:Analgesics, Non-Narcotic / Q000009:adverse effects / Q000627:therapeutic use; D001794:Blood Pressure / Q000187:drug effects*; D059350:Chronic Pain / Q000188:drug therapy*; D015986:Confounding Factors, Epidemiologic; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000503:physiopathology; D015994:Incidence; D008297:Male; D009203:Myocardial Infarction / Q000139:chemically induced / Q000453:epidemiology*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D020521:Stroke / Q000139:chemically induced / Q000453:epidemiology*; D015996:Survival Rate / Q000639:trends; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D018712:Analgesics, Non-Narcotic; D000082:Acetaminophen
keywords: acetaminophen; hypertension