Can You Take Painkillers When You Have High Blood Pressure?

Should you be taking painkillers when you have high blood pressure or hypertension?

The experts at Welbeck Heart Health explain how common pain relief medications may affect blood pressure, which painkillers may be safer, and when you should speak with a healthcare professional.

How do painkillers affect blood pressure?

When thinking about how painkillers work, it helps to understand what’s happening inside the body.

You may see advertisements referring to “targeted pain relief” that’s fast-acting and works directly at the source of pain. However, medicines such as paracetamol, ibuprofen, or naproxen don’t physically travel to one exact area. Instead, the medication circulates throughout the body and affects chemical pathways involved in inflammation and pain signalling.

Many painkillers — particularly non-steroidal anti-inflammatory drugs (NSAIDs) — work by reducing substances called prostaglandins. These chemicals help regulate inflammation, pain, and blood flow to the kidneys.

Reducing prostaglandins can sometimes affect kidney function, causing sodium and fluid retention. This may increase blood pressure in some individuals. On average, anti-inflammatory painkillers raise blood pressure by about 3-5mmHg, though this is highly variable.

Pain itself can also raise blood pressure because the body responds to discomfort with a stress response and nervous system activation.

For this reason, blood pressure readings taken during periods of severe pain may appear temporarily higher than usual.

Painkillers to avoid or use with caution with high blood pressure

Some painkillers may raise blood pressure or interfere with blood pressure medication, particularly when used regularly or over long periods.

Short-term or occasional use is usually not a problem for most people with hypertension, but prolonged use may increase cardiovascular risks.

Ibuprofen

Ibuprofen is a common NSAID used to reduce pain and inflammation. However, it may increase blood pressure due to fluid retention and changes in kidney blood flow.

It can also interact with blood pressure medications including:

• ACE inhibitors

• diuretics

• angiotensin receptor blockers (ARBs)

These interactions may reduce the effectiveness of blood pressure treatment.

Of note, taking an anti-inflammatory alongside a diuretic and an ACE inhibitor or ARB also significantly increases risk of kidney damage, especially during illness or dehydration.

If you have hypertension and are on more than one blood pressure tablet, it’s best to avoid taking ibuprofen regularly unless advised by a clinician.

Naproxen

Naproxen is another anti-inflammatory painkiller (non-selective NSAID) commonly used for muscle pain, arthritis, and inflammation.

Like ibuprofen, naproxen may contribute to fluid retention and elevated blood pressure, particularly with long-term use.

Short-term use may be acceptable for some people, but regular use should always be discussed with a healthcare professional if you have high blood pressure.

COX-2 inhibitors

Celecoxib and etoricoxib were developed to be gentler on the stomach, but no safer for blood pressure. Etoricoxib in particular should not be taken if your blood pressure is persistently above 140/90 mmHg and not well controlled.

Aspirin

Aspirin is slightly different because it’s commonly used in low doses for heart health and blood clot prevention.

Low-dose aspirin prescribed for cardiovascular protection is not the same as higher pain-relief doses.

Higher doses of aspirin used regularly for pain relief may still carry risks similar to other NSAIDs, including stomach irritation and possible blood pressure effects.

You should only take aspirin regularly if it has been recommended by a healthcare professional.

Are there any tablets that do NOT raise blood pressure?

As mentioned, short-term use of common painkillers like paracetamol, every now and then, is usually of no concern even for those with high blood pressure. Only with longer-term use may problems begin to emerge, and a clinician should be consulted in this context for best treatment options. Aspirin at painkilling doses is sometimes suggested as an alternative. Still, it is not commonly used this way in the UK, and regular use carries a risk of stomach irritation and bleeding.

Cold and flu medications

Some cold and flu remedies contain decongestants such as pseudoephedrine or phenylephrine that may constrict blood vessels and increase blood pressure.

Always check the label carefully before using over-the-counter medicines if you have hypertension.

Which painkillers are generally safer for people with hypertension?

Some painkillers are generally considered safer for people with high blood pressure when used correctly and for short periods.

Paracetamol

Paracetamol — also known internationally as acetaminophen, or Tylenol in the USA — does not typically raise blood pressure in the same way as NSAIDs.

For many people with hypertension, paracetamol remains the sensible first-line option for occasional pain. However, it’s not entirely without effect. One study in 2022 found that people with treated high blood pressure who took 1g of paracetamol 4 times a day every day for 2 weeks had a detectable increase in their blood pressure by 5mmHg compared to placebo.

This doesn’t mean paracetamol should be avoided. It just means regular, full-dose use over weeks or months should be reviewed with a doctor rather than continued out of habit.

The hidden danger: soluble and effervescent tablets

One overlooked issue is the salt content found in some soluble and effervescent tablets.

Effervescent medications often contain sodium to help the tablet dissolve quickly in water.

For people with hypertension, excessive sodium intake may contribute to increased blood pressure and fluid retention.

This means soluble paracetamol and similar preparations may not always be the best option for people trying to control their blood pressure.

If possible, standard tablet forms may be preferable unless otherwise advised.

Interactions with blood pressure medications

Some painkillers can interfere with blood pressure medication and make treatment less effective.

This is especially important for people taking medication long term for hypertension.

If you’re unsure whether a painkiller is safe alongside your blood pressure medication, you should check with a GP or pharmacist.

What are the alternative treatments for pain with high blood pressure?

If you experience chronic pain and have high blood pressure, there may be alternative pain management options worth discussing with a healthcare professional.

Topical treatments

Topical NSAID gels and creams may provide pain relief with lower absorption into the bloodstream compared to tablets.

This may reduce the impact on blood pressure for some people.

Lifestyle changes

Some non-drug approaches that may help manage pain include:

• regular low-impact exercise

• physiotherapy

• stretching and mobility work

• weight management

• heat or cold therapy

• stress reduction techniques

These approaches may reduce reliance on long-term painkiller use.

How does someone know if they have high blood pressure?

High blood pressure is often called a “silent condition” because many people do not experience symptoms.

It’s a common misconception that high blood pressure causes symptoms such as headaches or nosebleeds. Usually, waiting for symptoms is not a safe way to monitor or diagnose it. Symptoms occur only when blood pressure is extremely high — a hypertensive emergency — and these are urgent warning signs, not routine ones:

• severe headaches with visual disturbances or confusion

• chest pain

• breathlessness at rest

If you experience chest pain or sudden breathlessness, call 999 – do not wait to check your blood pressure first.

The only reliable way to diagnose hypertension is through a blood pressure reading.

Summary

• occasional short-term use of painkillers is usually safe for people with high blood pressure

• NSAIDs such as ibuprofen and naproxen may raise blood pressure through fluid and sodium retention

• paracetamol is a sensible first choice for occasional pain, but long-term regular daily use can increase blood pressure and should be reviewed.

• soluble and effervescent tablets may contain high levels of salt

• some painkillers may interfere with blood pressure medication

• people with chronic pain should seek medical advice before long-term painkiller use

• always speak with a GP, pharmacist, or healthcare professional if you’re unsure which medication is appropriate

Where can I find more information on treating high blood pressure?

This article is general educational information and does not replace individual medical advice. Please do not stop or change prescribed medication without speaking to a healthcare professional first.

If you have questions about this or blood pressure management or cardiovascular health, the cardiology team at Welbeck will be happy to discuss your options with you.