Medications many people reach for without a second thought can still pose health concerns, even when they’re sold without a prescription. Researchers and physicians caution that certain over-the-counter pain relievers are associated with elevated risks to the heart and blood vessels in some patients.
Doctors say the greatest concern centers on non-steroidal anti-inflammatory drugs, or NSAIDs, which are widely used to treat pain, fever, and inflammation. Studies have linked these medications to higher rates of high blood pressure, heart attacks, and strokes.
“This is because they reduce the production of certain chemicals called prostaglandins,” Maryam Jowza, M.D., an anesthesiologist at UNC Health in North Carolina, told Fox News Digital. “These chemicals are involved in inflammation, but they are also involved in other body functions, such as influencing the tone of blood vessels.”
Dr. Marc Siegel, Fox News senior medical analyst, said NSAIDs can affect the cardiovascular system in multiple ways.
“They can lead to high blood pressure, heart attack and stroke via fluid retention and salt retention,” he told Fox News Digital. “This increases volume, puts a strain on the heart and raises blood pressure.”
Widely used NSAIDs include ibuprofen, naproxen, aspirin, diclofenac, indomethacin, and celecoxib. Clinical trials have shown differences among these drugs, with ibuprofen linked to the largest increases in blood pressure, followed by naproxen and then celecoxib.
“In general, the increase in blood pressure is more likely with higher doses and longer duration of treatment,” said Jowza, who is also an associate professor in the Department of Anesthesiology at the UNC School of Medicine.
Stroke risk can also rise with NSAID use, particularly at higher doses and with prolonged treatment, she added. Among the drugs studied, diclofenac has been associated with the greatest cardiovascular danger. Ibuprofen has also been tied to higher rates of heart attack and stroke, though not to the same extent. Naproxen appears to carry a comparatively lower risk, but doctors stress it is not risk-free.
“The practical takeaway is that diclofenac is generally the least favorable choice in patients with elevated cardiovascular risk, and all NSAIDs should be used at the lowest effective dose for the shortest duration,” Dr. Nayan Patel, pharmacist and founder of Auro Wellness in Southern California, told Fox News Digital.
Aspirin stands apart from other NSAIDs. When taken in low doses under medical supervision, it can lower the risk of blood clots. At higher doses, however, it can raise blood pressure and increase bleeding risk.
Doctors also addressed non-NSAID pain relievers, which are commonly used for headaches, fever, and minor aches but do not treat inflammation. These medications primarily affect pain signals in the brain.
Acetaminophen, the most widely used drug in this category, has also been linked to increases in blood pressure, though typically to a lesser degree than NSAIDs.
“Acetaminophen was once thought to have little to no cardiovascular effects, but more recent evidence suggests it can increase blood pressure, especially with higher doses used in the long term,” she said, emphasizing the importance of blood pressure monitoring. “Its effect on stroke risk is less clear.”
Certain groups face greater danger from these medications, according to physicians, including people with high blood pressure, heart disease, a history of stroke, diabetes, or kidney disease.
“These groups are also more likely to experience NSAID-related fluid retention and destabilization of blood pressure control,” Patel said.
Age also plays a role. People 75 and older generally face higher cardiovascular risk when taking these drugs.
“Age amplifies risk largely because baseline cardiovascular risk increases with age, and kidney function reserve tends to decline,” Patel said. “Older adults are also more likely to be on antihypertensives, diuretics, antiplatelets or anticoagulants, so NSAIDs can destabilize blood pressure control and add safety complexity.”
Jowza urged patients to seek immediate medical care if they experience warning signs such as chest pain, shortness of breath, sudden weakness, confusion, slurred speech, vision changes, or a severe headache.
“These symptoms can point to a heart attack or stroke,” she warned. “Other symptoms of concern that may not develop as rapidly, like new swelling in the legs, should also prompt medical attention.”
Patel added that signs of fluid retention or kidney strain also warrant prompt evaluation.
“Patients should also seek medical advice if they notice signs of fluid retention or kidney stress, such as rapidly rising blood pressure, swelling in the legs, sudden weight gain over a few days, reduced urine output or worsening shortness of breath,” Patel added.
For people at elevated risk, Patel recommends avoiding NSAIDs when possible and considering alternatives.
“For many patients, this means starting with non-drug strategies such as heat or ice, physical therapy and activity modification,” he told Fox News Digital. “If medication is needed, acetaminophen is generally preferred over oral NSAIDs from a cardiovascular standpoint, although regular use should still be monitored in people with hypertension.”
He also noted that topical NSAIDs applied directly to joints or muscles can provide relief with significantly less systemic risk.
“Overall, pain management in high-risk patients should emphasize targeted therapy, conservative dosing and close blood pressure monitoring.”
Both doctors stressed that short-term, occasional use of OTC pain relievers is unlikely to cause harm in otherwise healthy individuals, but risks increase with frequent or high-dose use.
“I would not hesitate to use an occasional dose if it were a low-risk individual with no prior history of heart attack or stroke,” Jowza said. “I also think short-term use in diabetics and hypertensives who are well-controlled is acceptable.”
She advised patients who need NSAIDs to set clear limits, monitor blood pressure and kidney function, and avoid prolonged use whenever possible.
Patel agreed that most healthy people face minimal danger from infrequent use.
“The concern is primarily with repeated or chronic use, higher doses, and use in people with underlying cardiovascular, kidney or blood pressure conditions,” he confirmed to Fox News Digital.
“That said, large population studies show that cardiovascular events can occur early after starting NSAIDs, particularly at higher doses, which is why even short-term use should be approached cautiously in higher-risk patients.”
{Matzav.com}