3 Medications to Fix Nasal Congestion for High Blood Pressure Sufferers

Woman with nasal congestion
Nasal Congestion and High Blood Pressure? No Problem!
Image: © Piotr Marcinski | Dreamstime.com
Help. I have a stuffy nose and nasal congestion but also have high blood pressure. What is a good decongestant for high blood pressure sufferers?
– Brian M

 

Brian,

Don’t worry, you don’t have to suffer with a stuffy nose just because you have high blood pressure. I’ll review 3 different options you can use and which one is the best.  By the end of this quick article, you will have your question answered and will be feeling better in no time!

 

What’s the Connection Between Nasal Congestion and High Blood Pressure?

When you have nasal congestion (from any cause) the blood vessels in your nose swell and enlarge, which constricts your nasal passage and makes it harder to breathe. This is the underlying problem with any stuffy nose.

Nasal congestion, by itself, can cause some problems with high blood pressure (special thanks to Mitch, one of my readers who shared this article).  But there is also a concern if certain medications, which treat nasal congestion, could also cause worsening blood pressure!

All decongestants try to constrict the blood vessels in your nose and sinuses, which shrinks the swelling and lets you breathe easier.

Certain medications, such as pseudoephedrine (Sudafed, Wal-Phed), do a great job constricting the blood vessels in your nose. But the effects aren’t only in the nose so this medication can also constrict your body’s blood vessels leading to high blood pressure. This problem is of particular concern if you already have high blood pressure.

So the usual advice is to pick a decongestant that doesn’t affect the body’s blood vessels.

But is that the BEST advice?

What Are the ACTUAL Effects of Pseudoephedrine (Sudafed) on the Blood Pressure?

A meta-analysis (review of all the studies available on the subject) from 2005 tried to answer this question by reviewing the best 24 studies on the subject (1285 patients). They found that there was a statistically significant increase in systolic blood pressure (the top number) among patients taking Sudafed.

The effect: 0.99 mmHg increase in pseudoephedrine (Sudafed) users over controls (the range was from 0.08-1.90 mmHg).

Let me put that into perspective:

If you were not taking pseudoephedrine (Sudafed) and your blood pressure was (140)/(90), then:

  • After pseudoephedrine (Sudafed) your blood pressure would be (140.99) / (90)
  • At its worst, your blood pressure would be (141.90) / (90)
  • At its best, your blood pressure would be (140.08) / (90)

 

Now, this is not me minimizing blood pressure or telling you never to worry. But I also want you to know although there is a statistically significant increase in blood pressure, you should know the actual effect too.

There is also a dose dependent relationship

The effects I reviewed above were the overall outcome from the meta-analysis. The same article also looked at pseudoephedrine (Sudafed) dose and blood pressure and found that, overall, the effects were lower with lower doses of Sudafed and higher with higher doses.

Immediate vs Sustained Release

The meta-analysis also showed that using the immediate release pseudoephedrine (Sudafed) to treat nasal congestion had a greater effect on blood pressure than did the sustained release medication.

Women vs. Men

The study also showed that the effect on blood pressure was greater in men than in women. Women’s blood pressure did not increase as much when using pseudoephedrine (Sudafed) to treat nasal congestion.

Now that I went through the summary evidence, let me get to the main point of the article: the 3 options you can use to treat nasal congestion if you have high blood pressure.

3 Medications to Treat Nasal Congestion with High Blood Pressure

Medication #1 – pseudoephedrine (Sudafed)

Yes, the first medication I would have you consider is to use pseudoephedrine (Sudafed). Why?

  1.  It is one of the best medications to treat high nasal congestion
  2. As I reviewed above, the effects are minimal
  3. It doesn’t affect blood pressure that often

 

That last point comes from this article which said Sudafed only increases blood pressure in about 3% of high blood pressure sufferers. Overall, pseudoephedrine (Sudafed) is a safe medication to use.

Now, even if I think this medication is overall safe to use, I recommend you put in place a few safeguards:

  1. Regularly monitor your blood pressure while on the medication
    • Everyone with high blood pressure should have a home blood pressure cuff to help keep track of your blood pressure
      • If you don’t own one, this is a good one I’ve used before.
      • Remember: the closer to the heart, the more accurate the reading. Arm cuffs >> wrist cuffs > finger cuffs > guessing
    • I would recommend checking blood pressure about 3 times a day while on Sudafed
    • If your blood pressure rises more than 5mmHg (above normal) then consider changing medications
  2. Take the lowest dose possible to help your symptoms
    • Remember, the study showed that higher doses of pseudoephedrine (Sudafed) cause greater effects!
    • So a lower dose will have less of an effect on your blood pressure
  3. Take a 12 or 24 hour formulation
    • You want to avoid the immediate release tablets (the 30mg tablets every 4 hours) because these will have the greatest effect on blood pressure.
    • The 12 hour or once a day pseudoephedrine (Sudafed) tablets should have a lesser effect.
  4. Take the tablets for the shortest duration possible
    • As soon as you can stop taking the tablets then stop.
    • I guess this is good advice for any medication

 

In most of my patients, this is the advice I give them and as long as they can follow all 4 steps, I think pseudoephedrine (Sudafed) is a reasonable way to treat nasal congestion for high blood pressure sufferers.

Medication #2 – Oxymetazoline (Afrin)

Oxymetazoline (Afrin) is another fantastic medication that treats nasal congestion. What is better, it is a topical medication, so its effects are limited to the nose. So it is a GREAT choice to treat nasal congestion for high blood pressure sufferers!

But there is a catch.

Oxymetazoline (Afrin) reduces the swelling in the nose and sinus effectively, but if you use it for over 3 days, the nose “compensates” and can become stuffy again even if you are using the spray. Then, if you stop using the spray, the nose becomes ‘double stuffy’ and you will feel worse than before!

This is a condition called rhinitis medicamentosa and is what happens when your nose ‘becomes addicted’ to a nose spray.

For this reason, I place this as my second choice medication.

Please keep in mind that Oxymetazoline (Afrin) is safe to use as 1-2 sprays each nostril twice a day for 3 DAYS. Then stop for at least another 3 days before using it again. As long as you follow the package instructions, you will protect yourself against rhinitis medicamentosa and you can treat your nasal congestion without impacting your your blood pressure!

Medication #3 – Chlorpheniramine maleate (Coricidin HBP)

If you want to take a tablet that will improve your nasal congestion without affecting blood pressure, then you should pick a product with chlorpheniramine maleate (such as Coricidin HBP). Chlorpheniramine maleate is an older antihistamine that has some benefit for improving nasal congestion.

Its main benefit is that it does not affect blood pressure.

Its main drawback is that it is one of the lesser effective products to truly help nasal congestion.

Most nasal congestion from colds/viral infections or bacterial infections are not histamine driven. That means that chlorpheniramine maleate, as an antihistamine, is not as effective as the medications listed above. The main benefits come from some of the drying side effects of the medication.

Still, it is a safe tablet to treat nasal congestion for high blood pressure sufferers.

BONUS TIME!

If you read this far in the article, I included TWO MORE tips to help treat nasal congestion with high blood pressure. And better yet, either of these (or both of them) can be done in addition to any of the choices you made above.

Bonus #1 – Sinus rinse

If you’ve been reading my blog in the past, you know I often talk about sinus rinses (an example is their benefit in “How to Treat a Sinus Infection the Right Way”). You’ll also know I understand many people HATE sinus rinses.

To help with this, I wrote this article on some secrets on using a sinus rinse (and making it more comfortable). These are tips I have found through years of patient and personal feedback on how to make a sinus rinse better.

I recommend trying a sinus rinse because it helps improve nasal congestion. It doesn’t reduce the swelling of the blood vessels in the nose, but it will help remove any mucus stuck in your nose and sinus. And that will help you breathe better!

It is also NOT A MEDICATION, so it is safe to use with high blood pressure.

Bonus #2 – Breathe Right nasal strips

The second tip is to use breathe right nasal strips (or any nasal strip, really).

Here, you still have mucus in your nose and you still have swollen blood vessels causing nasal congestion. But by adding the breathe right nasal strip, you are opening up the passage wider.

This means that there is more room for you to breathe!

Again, this is NOT A MEDICATION, so it is safe to use as a high blood pressure sufferer!

Summary

I know we covered a lot for what was a seemingly simple question. Shoot, a simple Google search will show you tons or articles that give you the answer right away.

But my goal is not just to tell you to do something. Instead, I want you to know your options and pick them the way a doctor would pick them.

You now know there are 3 great choices to help fix your stuffy nose if you have high blood pressure:

  1. Pseudoephedrine (Sudafed)
    • Sudafed raises blood pressure in about 3% of people, and an average of 0.99 mmHg.
    • Sudafed has a lesser blood pressure effect with lower doses
    • Sudafed raises blood pressure less with a sustained release form
    • Sudafed affects blood pressure less in women
  1. Oxymetazoline (Afrin)
    • Afrin is a topical medication, does not affect blood pressure
    • Afrin can only be used for 3 days in a row
    • Afrin works great for those 3 days!
  2. Chlorpheniramine maleate
    • Chlorpheniramine has a lesser benefit for nasal congestion
    • Chlorpheniramine is a tablet that does not affect blood pressure

 

And there are 2 bonus choices to help your nasal congestion as well:

  1. Sinus rinses
    • A sinus rinse is not a medication and does not affect blood pressure
    • A sinus rinse is better tolerated by following these secrets/tips
  2. Breathe Right nasal strips
    • Nasal strips are also not a medication and do not affect blood pressure
    • They work and they work well.

Questions

If you have questions, email me and I will be happy to help.

And if you enjoyed reading this article and would like more tips and tricks, follow me on Facebook:

Did you enjoy that article? Here are some more I think you'd enjoy

Could Allergies be Causing your Sinus Migraines? Migraine headaches are the worst! They're not usually treated well and require a lot of medicine. But if you have allergies, then treating your alle...
U.S. Epipen Recall: What you NEED to Know It seems EpiPen can't get out of the news lately. This time it's because Epipens in the U.S. are being recalled due to a malfunction causing them NOT...
  • I am allergic to every weather change and it’s constant where I live. My allergies are terrible and the headaches are also. My eyes are swelled every morning. I am so tired of no Dr understanding this. I have high blood pressure and have been so tempted to take a decongestant. I am suffering so badly. Your article really helped me a lot. Thank you!!!!!!
    Janet Berneburg

  • Carol Greenberg says:

    Ok Doctor, I have the opposite problem. I have been on metoprolol 50mg bid for high BP since July of 2017. I noticed a constant runny drippy nose and ear popping but at the time didn’t associate it with the medicine.

    Then we went on a cruise in December of 2017. I got the South American nasal crud like a lot of other passengers and was taking Sudafed, one sustained release 12 hr. Just in the morning, because it keeps me awake. I knew we were going to fly home in a few days so I had to make sure my nose and ear passages cleared up as much as possible.

    On the way home, descending in the plane, I was in such severe ear and head pain I was sobbing uncontrollably. My ears didn’t pop until several days later and I had a hearing problem in my right ear and a lot of pressure behind the drum. My husband is a neuro doc and looked in my ears. He said he could tell there was fluid behind the drums but they weren’t red.

    Then by happenstance while looking for something else on the net I ran into people taking metoprolol who were complaining about runny drippy noses constantly. About a year ago my 90 yr old mother fell and broke her neck. Luckily she survived, but after that she was always complaining about a runny, drippy nose and carries a pack of Kleenex around. So then I asked mom “after you broke your neck were you put on metoprolol.” Yep, she said. Bingo!

    So this is a nuisance side affect of not only this drug but atenolol as well. It’s not so bad except we travel a lot and have a big trip to Egypt and the Middle East coming up in October. An overseas flight from the state’s to Israel, then 4 days later a hop to Cairo, 3 days later a hop to Luxor, 7 days later a hop back to Cairo and the next day an overseas flight home.

    This is going to be miserable for me and I don’t know how I’m going to handle it. The other big issue is I have lumbar back issues and SI joint issues that cause severe pain. I have been getting cortisone shots about every 3 months. They work but they raise my BP about 30-35 points over about 5 days. My BP runs with the medicine around 135/84. So what do I do? I have to have the shot. I won’t be able to do the trip without it. I have to have the BP Med. But then I can’t endure that horrible pain again with so much flying packed into it.

    This trip was booked and paid for well before the BP issues and it took 6 months for me to connect the drippy nose and ear congestion with the Med.

    Any suggestions?

    • Carol,

      Sorry for my delay in replying.

      First, thank you for bringing attention to medications (whether metoprolol/atenolol) or any medicine which causes nose symptoms. If your nose symptoms start or worsen with a new medicine, always consider the medicine first. I hate it when you are started on a medicine, which causes a side effect, and then another medicine is added to fix the side effect, etc.

      Second, my thought for you would be to consider a medicine like afrin (oxymetolazine) which is over the counter and often improves head congestion with flying. It doesn’t affect blood pressure, but you can’t use it for longer than 3 days or your nose will “become addicted” to it.

      I usually recommend taking it 1-2 sprays each nostril twice a day the day before and the day of air travel. Then do it again on the return trip.

      In your case, it may not stop the runny nose but should improve the congestion that caused your symptoms during descent.

      I hope that helped. If you have more questions, feel free to Email me and I will give you faster advice.

  • Karhy D. Bennett says:

    Thank you for your article l have the stuffy nose eyes puff up horrible sinus pressure and the only thing helps are the decongestion kind like vertex d tried flonase nasacort and Sudafed the zertec works and runs my blood pressure way to high l am at my wits end also have allergic asthma any help would be appreciated the one thing l found that helps my sinus pressure that changes and gets worse when its going to rain is Excedrin migrane…thanks again for being a caring Dr.

    • My guess is the Zyrtec D is working because the D is like sudafed. Which is great for stuffy noses, but doesn’t really fix the problem.

      I’d recommend seeing an allergist to find out if any triggers can be avoided. I would also consider COMBINING fluticasone (Flonase) as well as prescription azelastine. The combination (sold in the US as Dymista) is a great product that helps a lot with sinus pain and pressure (and possible sinus migraines… if that’s what you have).

  • Hello I am a 60 year old female who has high blood pressure anywhere from 177/105 to 190/112. I am trying very hard to control this with diet and exercise. Recently I started to take Allegra anthistamine and a nasal & sinus decongestant tablet for a block ear due to a recent airplane ride or some other reason. I was also prescribed a nose spray Apo=Mometasone. today I was pleasantly surprise to find my BP had dropped to a 135/95. I only take a supplement of CoQ10 . Just wondering what your thoughts are on this. I also, don’t smoke, seldom drink eat fairly healthy walk a lot and am not over weight. Thanks for your thoughts on this. Oh, just tested my BP and back up to 177/110…

    • As a general rule, I don’t think antihistamines should have any positive or significant negative affect on blood pressure. It is possible if you improve your sinus symptoms and breathe easier, that can temporarily improve blood pressure. But I think it would only be temporary. The goal would still be to improve blood pressure. And at those levels, I do think you should see your primary care doctor and consider starting a blood pressure medicine. This does not mean to give up on diet and exercise. I would think of it this way: take a medicine to stabilize the blood pressure, which will protect you and also may allow you to exercise longer. Then, keep doing the hard work and eventually stop the medicine.

      I think “protect then remove” is often a good approach. But I would defer this to a conversation between you and your primary care. But do strongly consider it.

  • >