FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

HAVE A COLD? SPECIAL HANDLING REQUIRED WITH HIGH BLOOD PRESSURE!

Question: Most of the cough and cold remedies I previously took warn that I shouldn't take them now that I have high blood pressure. What makes these medications unsafe for me now when they were fine before?

Answer: Most cough and cold remedies contain several "active ingredients." Some of these ingredients help with excessive secretions, others help relieve general aches and pains and still others combat the nasal congestion that accompanies a cold. It is the decongestant medication in these preparations that causes trouble for those with high blood pressure.

The two most common decongestants are pseudoephedrine and phenylpropanolamine. Look for these words in the "ingredients" part of the label. These medications improve nasal congestion by mimicking the body's "fight or flight" reflex. This reflex causes the nose to "open up" during physical exertion so that it is possible to breathe more freely and, thereby, to escape one's pursuer. If you want a demonstration of this phenomenon, go for a brief run the next time you have a congested nose. You will find that it "opens up" quite nicely. Unfortunately, this effect wears off fairly quickly allowing the stuffy nose to return.

Decongestant medications mimic this same effect, but they continue to work for several hours as long as the medication is still in your system. In addition to decongesting the nose, these drugs cause the heart to beat more rapidly and forcefully, and this increases your blood pressure. For most individuals the increase in blood pressure does not pose a medical risk. This is why these drugs are O.K. for those without high blood pressure.

If you already have high blood pressure, this decongestant-induced increase can put your blood pressure into the danger zone, even if it is normally well controlled by medication. For some individuals the increase in blood pressure may be so dramatic that it becomes life threatening. This severe reaction is more common in those taking blood pressure medications in the beta-blocker and alpha-blocker classifications, but it occasionally happens to those taking other types of blood pressure medication.

Question: Is there anything I can safely take for relief of my cold symptoms?

Answer: Fortunately, there are a number of things that can give relief from the body aches, stuffy head and cough of a cold without aggravating high blood pressure. Acetaminophen or aspirin will help reduce the general aching feeling of a cold with a very low risk of causing other problems. It is also a good idea to consume large amounts of liquids. The best way to determine if you are drinking sufficient liquids is by noting the color of your urine. A very pale color indicates that you are drinking sufficient liquids.

Warm beverages will actually temporarily "open up" the nose. That is why chicken soup and hot tea have been advocated by generations of mothers. They decongest the nose, provide liquid, and give some sustenance. They taste good, too.

Decongestant nose sprays, like the brand name products Afrin or Neo-Synephrine, decongest the nose with little risk of raising the blood pressure. However, they should not be used for more than three days because, with a longer period of use, there is risk that they will make the congestion worse not better. Saline nose sprays, such as the brand name NaSal, can be used as long as it is necessary to soothe a dry and congested nose.

Cough preparations often contain decongestants. Therefore, read the label closely before taking a cough medication. Those that contain only an expectorant with the active ingredient guaifenesin are safe. So are those that have only dextromethorphan or dextromethorphan with guaifenesin. However, recent research has shown that these products work no better for a cough due to the common cold than plain, cherry-flavored syrup. I'd suggest that you talk to your family doctor about the non-prescription medications that are safe for you. I personally use chicken soup and a cough drop when I catch a cold, but your doctor may recommend another treatment for you.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.