woman looking at over-the-counter drugs

Mind Your Meds for Blood Pressure Risks

By Ralph Russo III, MD, Cardiologist, Virtua Cardiology

You do all the right things to manage your blood pressure. You eat a Mediterranean-style, low-sodium diet, exercise daily, and even use a smartphone app to relax and reduce stress.

Yet some common over-the-counter (OTC) medications you may take to relieve a headache, lessen your cold symptoms, or ease an upset stomach may actually increase your blood pressure and cause other side effects.

If you have high blood pressure, it’s important to know what’s in OTC medications and the effects they can have on your blood pressure and overall health.

Pain Relievers

Nonsteroidal anti-inflammatory drugs (NSAIDs) are often a go-to strategy for treating headaches, reducing fevers, and easing pain and inflammation from injuries, arthritis, and more. They include aspirin, ibuprofen (Advil, Motrin), and naproxen (Aleve, Naprosyn), and also may be found in combination with other drugs like Exedrin.

Used on a long-term basis, NSAIDs can cause your body to retain fluid and decrease your kidney function, leading to a higher blood pressure. These medications may also lessen the blood pressure-lowering effects of ACE and ARB inhibitors (lisinopril, enalapril, losartan) and diuretics (hydrochlorothiazide, furosemide).

NSAIDs also can raise your risk for ulcers and internal bleeding, especially when used in combination with prescription blood thinners your health care provider may have prescribed for you. Check with your provider about switching to acetaminophen (Tylenol).

Cold Medicines

Decongestions work by narrowing the blood vessels in your nose and sinuses. Swollen tissue shrinks, allowing air to pass through more easily. While you may feel less congested, other blood vessels in the body can become narrowed, increasing both your blood pressure and heart rate.

Decongestant medications, including oxymetazoline (Afrin), phenylephrine (Neo-Synephrine) and pseudoephedrine (Sudafed), can cause an increase in blood pressure, as well as make your current antihypertensive medications less effective.

There are also many products marked as combating “cough and cold” or “cold and flu.” These combination drugs can blend decongestants and NSAIDs, both of which can negatively impact your blood pressure.

Ask your health care provider or pharmacist about nasal saline, antihistamines, or other products designed specifically for people with coexisting hypertension or other medical conditions, such as congestive heart failure.

Watch for Sodium and Supplements

We often tell patients about hidden salts in foods, but we don’t mention medications.

Some over-the-counter medications, such calcium carbonate (Alka-Seltzer), are high in sodium. Salts are used in the manufacturing process to make them more digestible and help them dissolve better.

People with hypertension should consume less than 2,300 milligrams of sodium a day, ideally less than 1,500. One dose of some of these medicines can contain more than the daily allowances.

Herbal supplements also can affect your blood pressure. These include ginseng, ephedra, and ginkgo. Always check with your physician before starting any herbal supplement.

The Takeaway

Do your homework. Take the time to read labels to make sure they do not contain ingredients that can worsen your blood pressure or other medical conditions. Your doctor or pharmacist can help you make the best and safest choice.

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Updated May 4, 2022

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