The Effects of Pain and Analgesic Medications on Blood Pressure

Curr Hypertens Rep. 2022 Oct;24(10):385-394. doi: 10.1007/s11906-022-01205-5. Epub 2022 Jun 15.

Abstract

Purpose of review: To review the blood pressure (BP) effects of pain and analgesic medications and to help interpret BP changes in people suffering from acute or chronic pain.

Recent findings: Acute pain evokes a stress response which prompts a transient BP increase. Chronic pain is associated with impaired regulation of cardiovascular and analgesia systems, which may predispose to persistent BP elevation. Also analgesics may have BP effects, which vary according to the drug class considered. Data on paracetamol are controversial, while multiple studies indicate that non-steroidal anti-inflammatory drugs may increase BP, with celecoxib showing a lesser impact. Hypotension has been reported with opioid drugs. Among adjuvants, tricyclic antidepressants and serotonin-norepinephrine reuptake inhibitors could be pro-hypertensive due to potentiation of adrenergic transmission. Pain and analgesics may induce a clinically significant BP destabilization. The implications on hypertension incidence and BP control remain unclear and should be explored in future studies.

Keywords: Blood pressure control; Hypertension; NSAIDs; Opioids; Paracetamol.

Publication types

  • Review
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acetaminophen / therapeutic use
  • Adrenergic Agents / therapeutic use
  • Analgesics / adverse effects
  • Analgesics, Opioid / therapeutic use
  • Anti-Inflammatory Agents, Non-Steroidal / adverse effects
  • Antidepressive Agents, Tricyclic / therapeutic use
  • Blood Pressure
  • Celecoxib / therapeutic use
  • Chronic Pain* / drug therapy
  • Humans
  • Hypertension* / drug therapy
  • Norepinephrine / therapeutic use
  • Serotonin / therapeutic use

Substances

  • Adrenergic Agents
  • Analgesics
  • Analgesics, Opioid
  • Anti-Inflammatory Agents, Non-Steroidal
  • Antidepressive Agents, Tricyclic
  • Serotonin
  • Acetaminophen
  • Celecoxib
  • Norepinephrine