By Sade Oguntola
People with stuffy nose and scratchy throat usually feel miserable, so it is not unusual for them to turn to over-the-counter (OTC) cough and cold remedies in the hopes of relieving the symptoms. Of course, they think that because they can buy these remedies without a prescription, they’re safe.
But it’s important to remember that the remedies are still medications that can interact with other drugs and interfere with existing health problems. Particularly, individuals with hypertension should pay especially close attention to some over-the-counter medications to avoid.
For instance, the main active ingredients in most OTC cough and cold medicines are cough suppressants, painkillers, antihistamines, expectorants, and decongestants. Some of these ingredients can cause an elevation in the blood pressure. Some can also interfere with blood pressure medication. Some also can be problematic for people with hypertension or heart disease.
Studies show that most people have a minimal increase in blood pressure after taking common cold medications like decongestants and painkillers like Non-steroidal Anti-inflammatory Drugs (NSAIDs).
Decongestants are drugs that help to alleviate the symptoms of a blocked nose. They are available to buy on their own or as an ingredient in multi-symptom cold and flu medications.
“Most of cough suppressants or cold medications contain substances like codeine and ephedrine that help to decongest the airway by narrowing blood vessels and reducing blood supply to those glands that secrete mucus, and in the process affect other blood vessels, and can raise the blood pressure to a dangerously high level,” said Dr Suraj Ogunyemi, a consultant cardiologist at the Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Osun state.
“So, anybody that is hypertensive shouldn’t use just any cold and cough over the counter medications, including those that contain NSAIDs like Ibuprofen and feldrene to relieve pain, flu or stuffy nose because of the same reason.
“Even though these cough and cold medications are effective, no cardiologist will prescribe them because they could make the blood pressure level increase or interfere with the effectiveness of prescription medications to control blood pressure.”
Moreover, Dr Abiodun Adeoye, a consultant cardiologist at the University College Hospital (UCH), Ibadan, Oyo State, said use of cough and old medications that contain NSAIDs like Ibuprofen and feldrene by persons with hypertension, is discouraged because they may end up causing sodium retention and with time, can cause damage the kidneys.
“Once the kidney is damaged, then the blood pressure will not be controlled. It is not that they cannot take drugs with Ibuprofen and feldrene in them, but it is discouraged because their abuse or use over a long period of time can affect their kidneys,” he added.
Ibuprofen and feldrene, like other NSAIDs, can make the body retain fluid and decrease the function of the kidneys. This may cause the blood pressure to rise even higher, putting greater stress on the heart and kidneys. NSAIDs can also raise the risk for heart attack or stroke, especially in higher doses.
New Zealand researchers recently found that over-the-counter cold remedies that combine acetaminophen with the decongestant phenylephrine can bring on serious side effects, including an irregular heartbeat, dangerously high blood pressure and tremors.
What is more, Dr Adeoye stated that cold decongestants that contain ephedrine can make the heart run faster and cause irregular or slow heartbeat, even in a person with hypertension, especially where there is an underlying heart problem.
“But whether the raise in blood pressure due to these cough and cold medications is sufficient to make the blood pressure not controlled, despite the fact that the person is taking antihypertensive medicines, I don’t know,” he declared.
According to him, blood pressure control in persons with hypertension generally in Africa is poor. Blood pressure control is only achieved in 3 out of every 10 individuals and for different reasons. Some are not compliant with taking their medications because of its side effects like erectile dysfunction.
Poor blood pressure control might be caused by poor drug compliance; many people take the drugs and yet continue in their bad lifestyle, so the blood pressure control will be difficult. Even when on hypertension medications, eating healthy, regular exercises, weight loss, increased intake of green leafy vegetables and fruits and abstinence from cigarette smoking and alcohol is important.
Also, in a percentage of individuals with what is called white collar effect, when the blood pressure is measured in the clinic, it will appear that their hypertension is not controlled.
Dr Adeoye, however, stated that it is important that the cause of hypertension in an individual is investigated as it will determine the type of hypertension medications that will be prescribed for use and the consequences of the high blood pressure on the other organs of the body.
According to a 2014 review, ibuprofen increases the risk of hypertension and stroke, whereas aspirin does not increase these risks.
In addition, a 2017 study investigated whether taking NSAIDs to treat an acute respiratory infection (ARI) increases the risk of a heart attack. The study included 9,793 people who had previously been in the hospital for a heart attack. The average age of the participants was 72 years.
The finding of the study is that people with hypertension who took NSAIDs for an ARI were around three times more likely to have a heart attack. However, the authors noted that merely being sick can raise a person’s blood pressure and increase their risk of having a heart attack.
Overall, the study suggested that a person who has hypertension or heart disease should avoid using NSAIDs to treat cold symptoms. People should talk to their doctor about other pain medications that may be safer.
Symptoms that may indicate a negative reaction to over the counter medications include heart palpitations due to an elevated heart rate; headaches, dizziness, and blurry vision caused by elevated blood pressure and chest discomfort, shortness of breath, or congestive heart failure, if there is an underlying heart disease, such as a heart attack or blockage in coronary blood vessels.
