Effects of high-dose paracetamol on blood pressure in acute stroke

den Hertog HM, van der Worp HB, van Gemert HMA, van Gijn J, Koudstaal PJ, Dippel DWJ. Effects of high‐dose paracetamol on blood pressure in acute stroke. Acta Neurol Scand: 2012: 125: 265–271. © 2011 John Wiley & Sons A/S. Background – Early administration of paracetamol may improve outcome of patients with acute stroke and a baseline body temperature of 37°C or above by lowering body temperature and preventing fever. Besides its antipyretic effects, paracetamol may affect blood pressure through cyclooxygenase‐2 inhibition. We therefore aimed to assess the effect of high‐dose paracetamol on blood pressure in patients with acute stroke. Methods – We analyzed data of 540 patients admitted within 24 h of stroke onset who were randomized to treatment with either paracetamol (6 g daily) or placebo. Blood pressures were measured at 12, 24, and 48 h from the start of treatment. Changes in blood pressure from baseline in the two treatment groups and corresponding 95% confidence intervals (CI) were calculated with linear regression analysis. Adjustments for potential confounders were made with a multiple linear regression model. Results – Treatment with high‐dose paracetamol was associated with a significant reduction in systolic blood pressure of 4.5 mm Hg (95% CI 0.6–8.5) at 12 h from the start of treatment. This effect was no longer present after 24 and 48 h. Conclusion – High‐dose paracetamol reduces not only body temperature but also systolic blood pressure in the first 12 h after start of treatment. Both effects may improve functional outcome after stroke, but this needs further study.