Arthritis pain medications: Which are safe for my heart?

I have osteoarthritis and take acetaminophen daily for mild to moderate joint pain. Recently, I heard that over-the-counter pain relievers may increase my risk of high blood pressure. Is this true? If so, which arthritis pain medications are safe for my heart?

- Harold / Wisconsin

Mayo Clinic rheumatologist April Chang-Miller, M.D., and colleagues answer select questions from readers.

Answer

It is true. Two large studies suggest that over-the-counter arthritis pain medications, such as acetaminophen, ibuprofen and aspirin, increase the risk of high blood pressure — a risk factor for heart disease in both men and women. This comes just a few years after COX-2 inhibitors were linked to an increased risk of heart attack and stroke.

So you ask a fair question: Which arthritis pain medications are safe for your heart?

It's important to know that medication isn't the only treatment for arthritis pain. Mild to moderate arthritis pain may be relieved with a combination of self-care measures and lifestyle changes, such as weight loss, exercise, heat or cold therapy, and physical therapy. Many doctors now recommend trying this approach first before starting medication.

If you need medication to help manage your arthritis pain, use the lowest dose necessary for the shortest time possible. Also, discuss with your doctor which pain medication is most appropriate for your specific situation. All medications — prescription and nonprescription — have risks and potential side effects.

In March 2007, the American Heart Association (AHA) issued new guidelines for the use of nonsteroidal anti-inflammatory drugs (NSAIDs) in people with known heart disease or at high risk of heart disease. If medication is needed for arthritis pain, the AHA recommends that acetaminophen (Tylenol, others), aspirin or short-term narcotic pain relievers should be tried first. If this doesn't provide adequate pain relief, NSAIDs with no COX-2 selectivity, such as ibuprofen (Advil, Motrin IB, others) and naproxen (Aleve), should be tried next. Finally, COX-2 inhibitors, such as celecoxib (Celebrex), should be used as only a last resort.

If you take over-the-counter pain relievers for arthritis pain, keep these tips in mind:

Get your blood pressure checked regularly.
Avoid alcohol.
Tell your doctor about any herbal supplements, nutritional supplements or other medications you are taking.