You’re sniffling, sneezing, stuffed up and fed up. An over-the-counter cold remedy could work wonders. But if you’re among the one in three adults in the U.S. with high blood pressure, you’ll need to choose wisely. A cold medicine that contains a decongestant — and many do — may help you breathe easier, but it could also make your hypertension worse. 

"Decongestants work by constricting swollen blood vessels in the nose," says Brian Kolski, MD, an interventional cardiologist at St. Joseph Hospital of Orange in southern California. When blood vessels are constricted, blood pressure can rise. It’s tough to say how high it might go, but any increase is bad for someone with hypertension, says Kolski, because it further elevates the risk of stroke or heart disease.

What’s a miserably congested person to do? Some advice from Kolski:

Read cold medication labels. Steer clear of any drug that promises to relieve decongestion or contains any of the following ingredients:

  • Pseudoephedrine
  • Ephedrine
  • Phenylephrine
  • Naphazoline
  • Oxymetazoline

If you can’t tell from the label whether a drug contains a decongestant, check out the “Drug Facts” panel. It lists each active ingredient and what its purpose is.

Play it safe. Head straight for Coricidin HBP, a brand of cold medication that’s decongestant-free and marketed to people with high blood pressure.

Go drug-free. You may be able to clear some of the gunk from your nose by using an over-the-counter saline spray. A neti pot, which looks like a tiny teapot, is another option: You fill it with a sterile water solution, tilt your head over the sink and insert the spout into one nostril. As the solution flows out of your other nostril, it flushes out dust, pollen and debris and can loosen thick mucus. (If used improperly, a neti pot can cause potentially serious infections, though, so make sure you know what safety precautions to take before you use one.)

Focus on your other symptoms. Take an appropriate dose of a painkiller such as acetaminophen to ease body aches or a pounding head. Sip hot tea with honey or suck on lozenges to soothe a sore throat. Counter fatigue with lots of rest. If you can relieve everything except your clogged-up nose, the congestion may not seem so bad.

Be patient. Whatever remedy or medicine you choose, don't expect miracles. The average cold lasts for seven to 10 days, according to the Centers for Disease Control and Prevention. If you don’t feel better by then, see your doctor. 

Kathleen Doheny is a Los Angeles journalist specializing in health, behavior and fitness topics.