From the Guidelines
For patients with hypertension (HTN), pseudoephedrine-free options are the best decongestants to use, with phenylephrine (such as Sudafed PE) being generally considered safer due to its less systemic absorption and minimal effect on blood pressure compared to pseudoephedrine. According to the 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults 1, decongestants like phenylephrine and pseudoephedrine should be used for the shortest duration possible and avoided in severe or uncontrolled hypertension.
Some key points to consider:
- Nasal saline sprays and nasal steroid sprays like fluticasone (Flonase) or triamcinolone (Nasacort) are even better first-line options, as they have no significant cardiovascular effects 1.
- Oxymetazoline (Afrin) nasal spray can be used for short-term relief (no more than 3 days) to avoid rebound congestion 1.
- If medication is needed, antihistamines like cetirizine (Zyrtec) or loratadine (Claritin) may help with allergy-related congestion without affecting blood pressure 1.
- Traditional decongestants like pseudoephedrine work by stimulating alpha-adrenergic receptors, which constrict blood vessels and can raise blood pressure, potentially worsening hypertension 1.
- Always consult with your healthcare provider before starting any new medication if you have hypertension, as individual circumstances may vary.
From the FDA Drug Label
Principal Display Panel Compare to Sudafed® Congestion active ingredient Pseudoephedrine Hydrochloride, 30 mg Nasal Decongestant MAXIMUM STRENGTH • SINUS PRESSURE • SINUS CONGESTION 24 TABLETS actual size NON-DROWSY Padagis™ The FDA drug label does not answer the question.
From the Research
Decongestant Options for Hypertension
- Pseudoephedrine has been studied in patients with controlled hypertension, and the results suggest that it does not significantly affect blood pressure 2, 3.
- Phenylpropanolamine and ephedrine are best avoided by hypertensive patients due to a higher probability of causing pressor reactions 4.
- Phenylephrine appears to have non-significant effects on blood pressure in normotensive subjects when used at the recommended oral dose as a nasal decongestant 4.
- Oxymetazoline has been shown to provide relief of nasal symptoms for 12 hours without significant increases in blood pressure in patients without a history of hypertension 5, 6.
Key Findings
- Therapeutic doses of pseudoephedrine do not adversely affect control of hypertension in selected patients 3.
- Intranasal vasoconstrictors, including phenylephrine and oxymetazoline, do not significantly increase blood pressure in patients without a history of hypertension 5.
- Oxymetazoline provides both statistically significant and clinically meaningful relief of nasal congestion and improves nasal airflow for up to 12 hours following a single dose 6.