Sodium containing paracetamol increases CV mortality in hypertensives: finds study

The relationship between hypertension and dietary sodium intake is close and well recognized. A reduction in dietary sodium not only decreases the blood pressure and the incidence of hypertension, but is also associated with a reduction in morbidity and mortality from cardiovascular diseases. Sodium containing drugs are important source of sodium intake apart from diet. So Chao Zeng et.al conducted this study to compare the risks of incident CVD and all-cause mortality among initiators of sodium-containing acetaminophen with the risk of initiators of non-sodium-containing formulations of the same drug according to the history of hypertension.

Using The Health Improvement Network, two cohort studies were included with and without hypertension. The relation of sodium-containing acetaminophen to the risk of each outcome during 1-year follow-up was assessed. The outcomes were incident CVD (myocardial infarction, stroke, and heart failure) and all-cause mortality. Overall, 1,51,398 individuals with hypertension and 1,47,299 individuals without hypertension were analyzed.

Important observations of this study are

1) Among individuals with hypertension, 122 CVDs occurred among 4532 initiators of sodium containing acetaminophen (1-year risk: 5.6%) and 3051 among 146 866 non-sodium-containing acetaminophen initiators (1-year risk: 4.6%).

2) Among individuals without hypertension, 105 CVDs occurred among 5351 initiators of sodium-containing acetaminophen (1-year risk: 4.4%) and 2079 among 141 948 non-sodium-containing acetaminophen initiators (1-year risk: 3.7%).

3) The risk of incident CVD was higher among sodium-containing acetaminophen initiators than among non-sodium-containing acetaminophen initiators regardless of hypertension

4) Mortality was also higher in sodium-containing acetaminophen initiators than in non-sodium-containing acetaminophen initiators regardless of hypertension

5) There was a dose–response relationship between the number of sodium containing acetaminophen prescriptions and the risk of CVD. Compared with non-sodium-containing acetaminophen, the ORs of CVD for 1, 2–4, and ≥5 prescriptions of sodium-containing acetaminophen were 1.26, 1.33, and 1.45, respectively

6) The risk of incident hypertension was higher in the sodium containing acetaminophen initiators than in the non-sodium containing acetaminophen initiators.

Some of limitations of this study are

1) Lack of urinary sodium excretion or dietary sodium intake data.

2) Role of genetic traits cannot be assessed in an observational study.

3) Non availability of data regarding over-the-counter acetaminophen use.

Authors concluded that the initiation of sodium-containing acetaminophen was associated with increased risks of CVD and all-cause mortality among individuals with or without hypertension.