Which Nasal Sprays Are Safe To Use With High Blood Pressure?

Heart disease and stroke are two of the leading causes of death in the country, and high blood pressure increases the risk factor for both of these deadly conditions. What's worse is that many people who have high blood pressure don't even know they have it. Despite affecting 50% of men and 44% of women¹, there are few symptoms of high blood pressure (also known as hypertension).

If you've been diagnosed with high blood pressure, your doctor will likely have discussed changes you'll need to make to your lifestyle in order to minimize its impact. Your doctor will know about any potential conflicts when giving you prescription medicine, but when purchasing over-the-counter (OTC) medicine, you’ll need to be diligent.

In this article, we'll help you understand how OTC nasal sprays may exacerbate your high blood pressure. However, given the severity of heart problems, you should also consult your doctor about your specific condition before taking new medications when you have high blood pressure.

What is high blood pressure?

Like any fluid, blood exerts pressure on its container as it flows through it. Of course, in the case of blood, that container is made up of your blood vessels. Your arteries, veins, and capillaries are placed under two types of pressure while in use. The first is called systolic pressure and occurs when blood is pumped out of the heart and into the arteries. The second is called diastolic pressure and occurs when the heart rests between beats.

If you've had a blood pressure reading, you may already be familiar with the terms systolic and diastolic; they are the upper and lower numbers of a blood pressure reading, respectively. A normal blood pressure reading is 120/80. There's a little leeway for systolic pressure, but any reading over 130/80 is considered hypertension.

Hypertension is bad because a heart pushing at a higher than normal pressure is working harder. Over time, increased pressure on delicate arteries causes damage. That damaged tissue presents bad cholesterol with the opportunity it needs to form plaque² along the damaged arterial walls. And as plaque builds up, your arteries narrow, which increases blood pressure. Hence, a cycle has developed that continually worsens the condition.

The types of over-the-counter nasal sprays

If you have a prescription for a nasal spray, you should have made your doctor aware of your high blood pressure and any medications you are taking for it. But when you're looking for an over-the-counter (OTC) medication, you'll need to know what the possible interactions are. Of course, it's always best to talk with your doctor, but the general guidelines below can be helpful.

So which OTC nasal spray can you use if you have high blood pressure? In order to answer that question, we need to first look at the types of nasal spray available over-the-counter. OTC nasal sprays come in medicated and non-medicated, with several different medications available. The common types are:

Non-Medicated

Saline

These nasal sprays consist only of a saline nasal wash in spray form and work purely by using the force of the spray to loosen mucus buildup in the nose.

Medicated

Antihistamine

Like their allergy pill counterpart, antihistamine sprays are meant to reduce the symptoms of allergies. Azelastine³ (Astepro) was the first antihistamine spray approved for OTC use.

Decongestant

Designed to help relieve a stuffy nose so you can breathe easier, decongestant sprays work by shrinking blood vessels in the nasal passage. The most common decongestant nasal sprays are oxymetazoline⁴ (Afrin, Sinex, Dristan) and phenylephrine⁵ (Neo-Synephrine).

Corticosteroid

These sprays are typically used for allergies and sinusitis. They are designed to reduce inflammation. Popular corticosteroid nasal sprays include triamcinolone⁶ (Nasacort), budesonide⁷ (Rhinocort Allergy), and fluticasone⁸ (Flonase).

Safely using nasal sprays with high blood pressure

As you looked through the list of medications and their actions, one of them probably stood out more than the others in the context of high blood pressure. Nasal decongestants work by shrinking the size of the blood vessels in the nose. However, the drugs have no way of targeting just the vessels in the nose and therefore, will also reduce the size of other blood vessels in the body. As we discussed earlier in the article, shrinking blood vessels causes blood pressure to increase. So sprays containing nasal decongestants will certainly cause your blood pressure to rise. Whether it's enough to put you at risk is something to discuss with your doctor before using one.

The next class of nasal sprays to worry about is corticosteroids. This class of drugs includes cortisone. Cortisone is responsible for regulating several behaviors in your body, including the balance of water and electrolytes. Because of that, using cortisone nasal spray can result in fluid retention⁹, which in turn can increase blood pressure. Once again, to be on the safe side, you should always ask your doctor before using a steroid-based nasal spray.

Therefore, due to the risks associated with nasal decongestants and corticosteroids for people with high blood pressure, you should use antihistamines or saline-based nasal sprays. However, it’s always important to double-check that your OTC antihistamine spray doesn’t contain decongestants.

The lowdown

Living with high blood pressure is made easier with lifestyle changes. Eating more carefully, exercising, and regularly taking your medication are all things your doctor has likely discussed with you. Another aspect of that lifestyle change is being more careful about the medications that you take.

Of the four possible types of over-the-counter nasal spray we've discussed, two of them are likely to cause problems if you have high blood pressure. Although the consequences of high blood pressure can be severe, it is an easily managed condition as long as you pay attention to the choices you make and consult your doctor if you have any questions.