Nonnarcotic Analgesic Use and the Risk of Hypertension in US Women

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Abstract
Onnarcotic Analgesic Use and the Risk of Hyperten- sion in US Women"1 presents epidemiological ob- servations that are intriguing and have potentially important public health and clinical implications. The high prevalence and incidence of hypertension in this comparatively healthy (nurses) cohort of middle-aged and older women 44 to 69 years of age was substantial. The prevalence of hypertension at baseline was 32%. The incidence of hypertension among the women who were normotensive in 1990 and followed an average of 7.4 years (381 078 person yr/51,630 persons) was an impressive 20.5% (51 630/10 579) or 2.8% annu- ally. The relatively high incidence of hypertension occurred despite the fact that 50% of these women had a reported body mass index of 24 kg/m2, whereas 60% of Americans in this age range have a body mass index 25 kg/m2. The high rate of analgesic use was also noteworthy. Eighty-five percent of women provided information on their use of 1 of 3 analgesics, including aspirin, acetaminophen, and nonsteroidal anti-inflammatory drugs (NSAIDs). Seventy percent of the sample reported using at least 1 of these 3 analgesics 1 or more days monthly. Self-reported use on a monthly basis was of similar magnitude for aspirin (44%), acetaminophen (43%), and NSAIDs (37%). A striking and novel observation in this report is the positive and consistent association between the frequency of use for all 3 classes of analgesics and the relative risk of hypertension after controlling for multiple confounders in the multivariate model. The Table represents one clinician's attempt to put the risks in simple quantitative terms for the individual, as well as for the population of women in this age range. The multivariate relative risks, taken from Table 2 of the authors' original paper, 1 and the calculated absolute risks (per 1000) to the individual associated with a given frequency of use for each analgesic are shown in the third column of the Table in this commentary. The population-attributable risk (PAR/1000) of developing hypertension among middle-aged women associated with analgesic use is shown in the fourth column. In the absence of analgesic use, 25.5 women/1000 (2.55%) in this cohort developed hypertension annually. Given the prevalence and frequency of analgesic use reported and the risk of incident hypertension associated with that use, 4.5 additional women/1000 (0.45%) develop hypertension annually, ie, the sum of the PARs for the 3 analgesics. These data suggest that 15% (4.5/(25.54.5)) of the hypertension developing in middle-aged women is associated with anal- gesic use. Epidemiological association between frequency of analge- sic use and incident hypertension does not establish a patho- genetic relationship. Therefore, it may be useful to examine the implications of the report from various perspectives.