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Decongestants and Hypertension: Dangerous Together

A 2003 Cochrane review concluded that monotherapy with antihistamines does not alleviate nasal congestion to a clinically significant degree. In that review, first-gener­ation antihistamines were found to have greater adverse effects than placebo, but neither first- nor second-gener­ation antihistamines increased BP. Antihistamines can be used in combination with decongestants; however, they should not be used in small children.8
Saline has been used to relieve congestion and is thought to thin mucus in the sinus cavities. Increasing humidity in the environment of patients with nasal con­gestion may also provide relief; therefore, the use of hu­midifiers is recommended. A third solution, nasal strips may help open the nostrils and improve breathing in pa­tients with congestion.11


With their training in OTC medications, pharmacists can play a major role in managing decongestion in their pa­tients. Because no product can be recommended to pro­vide safe and effective relief of congestion in all patients with hypertension, pharmacists’ medication knowledge, coupled with their keen ability to obtain valuable infor­mation from patients, can ensure optimal drug selection for individuals with hypertension.
*This article was previously published in the Pharmacy Times November 2016 issue and reprinted with permission.
Clarence D. Moore, PharmD, BCPS, is an assistant professor at Howard University College of Pharmacy and has a clinical practice site in the Division of Hematology and Oncology at Howard University Hospital in Washington, DC.
  1. Mozaffarian D, Benjamin EJ, Go AS, et al; American Heart Association Statistics Committee; Stroke Statistics Subcommittee. Heart disease and stroke statistics—2016 update: a report from the American Heart Association. Circulation. 2016;133(4):e38-e360. doi: 10.1161/CIR.0000000000000350.
  2. Naclerio RM, Bachert C, Baraniuk JN. Pathophysiology of nasal congestion. Int J Gen Med. 2010:3:47-57.
  3. Kiefer D, Cherney K. Decongestants to treat allergy symptoms. Healthline website. Published March 11, 2016. Accessed September 12, 2016.
  4. Sakethoo K, Januszkiewicz A, Sackner MA. Effects of drinking hot water, cold water, and chicken soup on nasal mucus velocity and nasal airflow resistance. Chest. 1978;74(4):408-410.
  5. Carretero OA, Oparil A. Essential hypertention, part I: definition and etiology. Circulation. 2000;101(3):329-335.
  6. American Heart Association (AHA). Over-the-counter medications. AHA website. Accessed September 13, 2016.
  7. Johnson DA, Hricik JG. The pharmacology of alpha-adrenergic decongestants. Pharmacotherapy. 1993;13(6 pt 2):110S-115S; discussion 143S-146S.
  8. Taverner D, Latte J. Nasal decongestants for the common cold. Cochrane Database Syst Rev. 2007;(1):CD001953.
  9. Horak F, Zieglmayer P, Zieglmayer R, et al. A placebo-controlled study of the nasal decongestant effect of phenylephrine and pseudoephedrine in the Vienna Challenge Chamber. Ann Allergy Asthma Immunol. 2009;102(2):116-120. doi: 10.1016/S1081-1206(10)60240-2.
  10. Herring CT, Maryansky K, Trivette K, Hemberg N. Decongestant use in hypertension. US Pharm. 2006;7:80-88.
  11. WS Pray, JJ Pray. Safe use of nasal decongestants. US Pharm. 2004;29(7).

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