Dedier Julien, Stampfer Meir J, Hankinson Susan E, Willett Walter C, Speizer Frank E, Curhan Gary C
Section of General Internal Medicine Research Unit, Department of Medicine, Boston Medical Center, Mass, USA.
Hypertension. 2002 Nov;40(5):604-8; discussion 601-3. doi: 10.1161/01.hyp.0000035856.77718.da.
Acetaminophen, aspirin, and other nonsteroidal anti-inflammatory drugs (NSAIDs) are widely consumed. Each is theoretically capable of elevating blood pressure by altering prostaglandin homeostasis; however, there is little prospective information on the relation between these agents and physician-diagnosed hypertension. We examined the association between the use of aspirin, acetaminophen, or NSAIDs and incident hypertension in a prospective cohort study of 51 630 women 44 to 69 years of age in 1990 who had no history of hypertension or chronic renal insufficiency. Analgesic use was assessed in 1990 by a mailed questionnaire, and the women were followed for 8 years. The primary outcome was physician-diagnosed hypertension reported on a follow-up biennial questionnaire. During 381 078 person-years of follow-up, 10 579 incident cases of hypertension were identified. Compared with nonusers, women who used aspirin or acetaminophen at least 1 day per month or NSAIDs 5 or more days per month were at a significantly higher risk for development of hypertension. After adjusting for potential confounders, the odds ratios for women in the highest frequency of use category (> or =22 days per month) compared with no use were as follows: aspirin, 1.21 (95% CI, 1.13 to 1.30); acetaminophen, 1.20 (1.08 to 1.33); and NSAIDs, 1.35 (1.25 to 1.46). For each analgesic type, there was a significant trend toward an increased risk of incident hypertension with increasing frequency of use (P<0.001). Given the observed odds ratios, biologic plausibility, and the sizeable population at risk, health professionals should consider potential hypertensive effects of aspirin, acetaminophen, and NSAIDs when counseling their patients about the use of nonnarcotic analgesics.
对乙酰氨基酚、阿司匹林及其他非甾体抗炎药（NSAIDs）的使用极为广泛。理论上，每种药物都有可能通过改变前列腺素稳态来升高血压；然而，关于这些药物与医生诊断的高血压之间的关系，前瞻性信息却很少。在一项针对1990年年龄在44至69岁、无高血压或慢性肾功能不全病史的51630名女性的前瞻性队列研究中，我们研究了阿司匹林、对乙酰氨基酚或NSAIDs的使用与新发高血压之间的关联。1990年通过邮寄问卷评估了镇痛药物的使用情况，并对这些女性进行了8年的随访。主要结局是在随访两年一次的问卷中报告的医生诊断的高血压。在381078人年的随访期间，共确定了10579例高血压新发病例。与未使用者相比，每月至少使用1天阿司匹林或对乙酰氨基酚或每月使用5天或更多天NSAIDs的女性发生高血压的风险显著更高。在对潜在混杂因素进行调整后，使用频率最高类别（每月≥22天）的女性与未使用者相比的优势比分别为：阿司匹林，1.21（95%CI，1.13至1.30）；对乙酰氨基酚，1.20（1.08至1.33）；NSAIDs，1.35（1.25至1.46）。对于每种镇痛药物类型，随着使用频率增加，发生高血压的风险有显著增加趋势（P<0.001）。鉴于观察到的优势比、生物学合理性以及大量的风险人群，健康专业人员在为患者提供关于使用非麻醉性镇痛药的咨询时，应考虑阿司匹林、对乙酰氨基酚和NSAIDs的潜在高血压作用。
