From the Guidelines
Decongestants, particularly those containing pseudoephedrine or phenylephrine, should be used with caution or avoided by individuals with hypertension or those at risk for secondary hypertension, as they can significantly raise blood pressure, especially when used regularly or in high doses, as noted in the 2018 guideline for the prevention, detection, evaluation, and management of high blood pressure in adults 1. The relationship between decongestant use and secondary hypertension is a significant concern, as these medications can cause vasoconstriction, leading to increased blood pressure.
- Key points to consider:
- Decongestants can raise blood pressure, especially in individuals with pre-existing hypertension or those at risk for secondary hypertension.
- The use of decongestants should be limited to the shortest possible duration, typically no more than 3-5 days, and at the lowest effective dose.
- Alternative treatments, such as saline nasal sprays, steam inhalation, or nasal corticosteroids like fluticasone (Flonase) or mometasone (Nasonex), should be considered for individuals with hypertension or cardiovascular concerns.
- Monitoring blood pressure closely is essential when using decongestants, especially in individuals with pre-existing hypertension or other cardiovascular conditions. According to the 2018 guideline, decongestants, such as phenylephrine and pseudoephedrine, can cause elevated blood pressure, and their use should be avoided in severe or uncontrolled hypertension 1.
- The mechanism behind this effect is the vasoconstriction caused by decongestants, which narrows blood vessels and increases blood pressure, as discussed in the study on the diagnosis and management of rhinitis 1. It is essential to consult with a healthcare provider before using decongestants, especially for individuals with hypertension or cardiovascular concerns, to determine the best course of treatment and minimize the risk of secondary hypertension.
- In general, the use of decongestants should be approached with caution, and alternative treatments should be considered to minimize the risk of adverse effects on blood pressure and cardiovascular health.
From the FDA Drug Label
14 CLINICAL STUDIES Increases in systolic and mean blood pressure following administration of phenylephrine were observed in 42 literature-based studies in the perioperative setting
12 CLINICAL PHARMACOLOGY 12.1 Mechanism of Action Phenylephrine hydrochloride is an α-1 adrenergic receptor agonist.
Following parenteral administration of phenylephrine hydrochloride, increases in systolic blood pressure, diastolic blood pressure, mean arterial blood pressure, and total peripheral vascular resistance are observed
The relationship between decongestant use, specifically phenylephrine, and secondary hypertension is that phenylephrine can cause increases in blood pressure. However, the provided drug labels do not directly address the development of secondary hypertension as a result of decongestant use. The labels only report on the increases in blood pressure following administration of phenylephrine 2 2.
- Key points:
- Phenylephrine causes increases in blood pressure
- The labels do not directly address secondary hypertension
- Caution should be exercised when using decongestants, especially in patients with pre-existing hypertension or cardiovascular disease.
From the Research
Relationship Between Decongestant Use and Secondary Hypertension
- There is no direct evidence in the provided studies that establishes a relationship between decongestant use and secondary hypertension.
- However, the studies suggest that secondary hypertension can be caused by various factors, including the use of certain medications 3, 4, 5, 6, 7.
- The studies list several causes of secondary hypertension, including primary aldosteronism, renovascular hypertension, obstructive sleep apnea, and drug-induced hypertension 3, 4, 5, 6, 7.
- Decongestants are not explicitly mentioned as a cause of secondary hypertension in the provided studies.
- It is essential to note that secondary hypertension should be considered in patients with suggestive symptoms and signs, such as severe or resistant hypertension, age of onset younger than 30 years, malignant or accelerated hypertension, and an acute rise in blood pressure from previously stable readings 4, 7.