If you have high blood pressure, it’s helpful to know which types of cold medicine may not be safe — some can worsen blood pressure and other heart conditions. The common cold can cause a lot of unpleasant symptoms, such as a stuffy nose, sore throat, chills, and aches and pains. It’s important to select an over-the-counter (OTC) cold remedy that can bring relief without the risk of increased blood pressure.

MyHeartDiseaseTeam members living with high blood pressure sometimes wonder which kinds of cold medicines are safe. “What cold or flu medicine to take?” a member asked.

High blood pressure — also known as hypertension — occurs when the force of blood flowing through your blood vessels is elevated. Hypertension is a common condition, but it can cause serious complications, including life-threatening heart disease.

Risk factors for high blood pressure include:

• Older age
• Obesity
• Smoking
• Alcohol use
• Family history of high blood pressure
• Congenital heart disease
• Kidney disease
• Thyroid disease
• Sleep apnea

Some medications, including certain types of cold medicine, can cause or worsen high blood pressure.

Here are some important things to know about OTC cold medicine for high blood pressure. Talk with your health care team if you have any questions or concerns about using cold medicine, and always discuss a particular type of cold medicine with your cardiologist before you try it.

Cold Medicines That Pose Risks

If you have hypertension or other types of cardiovascular disease, two types of cold medicine to discuss with your doctor are decongestants and nonsteroidal anti-inflammatory drugs (NSAIDs). These medications have been linked to an increased risk of heart attack and stroke, as well as other heart problems — particularly for people with high blood pressure or other cardiovascular conditions.

Some OTC multisymptom medications, which aim to treat a range of cold or flu symptoms, may contain active ingredients that aren’t recommended for people with high blood pressure.

Decongestants

Decongestants may help relieve a stuffy nose but can also raise blood pressure. Decongestant use is also associated with drug-induced secondary high blood pressure, a serious side effect.

Members of MyHeartDiseaseTeam have recognized that decongestants may be off-limits for them: “Still have a cold,” one member wrote. “Don’t know what I can take for it. I know we can’t have any decongestant.”

Several compounds commonly found in decongestants work by narrowing blood vessels, which helps relieve nasal swelling that can cause congestion. However, other blood vessels in the body may also narrow, causing blood pressure to rise. Decongestants that may have this effect include:

• Ephedrine
• Naphazoline
• Oxymetazoline
• Phenylephrine
• Pseudoephedrine

Decongestant compounds that have a risk of raising blood pressure can be found in oral medications, topical decongestants, and nasal sprays.

Nonsteroidal Anti-Inflammatory Drugs

OTC NSAIDs have been shown to cause a small risk of heart problems such as increased blood pressure, atrial fibrillation (irregular heartbeat), heart attack, and stroke.

Because they are pain relievers, NSAIDs are typically used to reduce body aches and discomfort that can come with a cold. Some NSAIDs must be prescribed, but others are available over the counter, such as:

• Aspirin (including Bayer, Bufferin, and Excedrin)
• Ibuprofen (including Advil and Motrin)
• Naproxen (including Aleve)

NSAIDs can affect kidney function, which can cause the body to retain water and sodium (salt) — and that, in turn, can raise blood pressure. Furthermore, some blood pressure medications can increase salt sensitivity and, thus, the risk of higher blood pressure when using NSAIDs.

Who’s at Risk When Using NSAIDs

Large studies have found that the long-term use (over one month) of OTC NSAIDs can increase a person’s risk of a dangerous heart event by about 0.2 percent if they don’t have a prior heart condition. For people who do have a prior cardiovascular disease, however, the increased risk is around 0.75 percent.

Short-term use of OTC NSAIDs may not pose a significant risk for people with hypertension. However, it’s essential to talk to your doctor before using this type of medication.

People who take blood thinners or antiplatelet medication may have an increased risk of heart problems with OTC NSAIDs and should be especially cautious about using them. If you’ve had recent heart problems, such as chest pain or heart attack, the risks associated with NSAIDs are considered higher, and you should get medical advice before taking these medications.

If you must take an NSAID, it’s important to know that OTC naproxen and prescription celecoxib (Celebrex) may pose less risk for people with hypertension, according to a 2020 study.

Safe Cold Treatments if You Have High Blood Pressure

There is no cure for the common cold, but medicines that treat symptoms may help you feel better. Although certain cold medicines aren’t recommended for people with high blood pressure, some OTC medications are labeled as safe for hypertension.

Cold medications that are considered OK for those with high blood pressure include:

• Coricidin — A multisymptom cold medicine for people with hypertension
• Diphenhydramine (Benadryl) — An antihistamine to help relieve nasal stuffiness
• Zyrtec, Claritin, and Allegra — Antihistamines that don’t cause drowsiness

Acetaminophen (Tylenol) may be an appropriate alternative to more risky NSAIDs for some people with high blood pressure. Some research also indicates that aspirin may have less risk than other NSAIDs for increasing blood pressure.

Here are other safe — and nondrug — ways to help lessen symptoms of a cold:

• Use saline nasal spray to reduce congestion.
• Drink water, broth, and other fluids to stay hydrated and loosen mucus.
• Gargle with warm salt water to soothe a sore throat.
• Sip hot tea or water with lemon and honey to moisten a scratchy throat.
• Run a humidifier to help prevent dry air that may aggravate sinuses or a sore throat.

“I woke up with a sore throat,” a MyHeartDiseaseTeam member wrote. “Lots of gargling warm salt water.”

Discuss Cold Medicine With Your Doctor

Having a cold or flu can place extra strain on the heart for people with hypertension or other cardiovascular diseases. If you have high blood pressure, you may experience heart palpitations (rapid heart rate) with a cold or flu. Make sure to report any heart symptoms to your cardiologist.

Your cardiologist may recommend treating your cold symptoms to lessen inflammation from a cold that can affect the heart. Always follow your doctor’s recommendations, and let them know if you are considering an OTC cold medication so they can confirm if it is safe for you. It’s also essential to talk to your doctor about any supplements you’re interested in taking when you have a cold. For example, some herbal supplements can interact with certain medications, and others have a risk of raising blood pressure.

Also talk with your health care team about staying up to date on influenza, pneumonia, and COVID-19 vaccines. “I received my flu shot and the COVID shot yesterday, and that only has a little soreness on each shoulder — feeling great all day,” a MyHeartDiseaseTeam member wrote.

Finally, be sure to get plenty of rest, wash your hands regularly (especially in winter, when people spend more time inside and illnesses like colds and the flu spread more easily), and wear a mask in crowded indoor spaces. Taking steps like these may help you ward off colds in the first place.

Find Your Team

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Do you have high blood pressure and have questions about cold medicine? Share your experience in the comments below, or start a conversation by posting on your Activities page.