What is an important consideration when using decongestants in patients with hypertension?

• A. They are always safe to use
• B. They can raise blood pressure
• C. They must be used with additional antihistamines
• D. They should be taken on an empty stomach

Answer: (B)

The important idea is that decongestants can raise blood pressure because they stimulate the sympathetic system. Systemic decongestants, such as pseudoephedrine and phenylephrine, activate alpha-adrenergic receptors that cause blood vessels to constrict. This vasoconstriction increases peripheral vascular resistance and can raise both systolic and diastolic blood pressure. In someone with hypertension, this extra push on the cardiovascular system can worsen BP control or provoke spikes, especially with higher doses or frequent use.

Because of this, people with high blood pressure should use decongestants with caution: opt for the lowest effective dose for the shortest duration, consider safer alternatives (like saline nasal sprays or intranasal steroids), and monitor blood pressure if a decongestant is used. It’s not a universal safety guarantee, and taking them on an empty stomach or using them only with antihistamines isn’t required. Even topical decongestants have some risk, though systemic forms pose the clearer BP concern.