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Clinical Question:
Does pseudoephedrine (Sudafed) increase blood pressure in people or in
patients with hypertension?
Bottom Line:
Overall, immediate-release pseudoephedrine produces a small increase in
systolic blood pressure (1.5 mmHg) but has no effect on diastolic blood
pressure. Sustained-release products do not affect blood pressure. Both
types of products increase heart rate to a small degree. Unlike its cousin
phenylpropanolamine, pseudoephedrine rarely causes large increases in blood
pressure, although its effect on blood pressure is dose-related and a marked
effect could occur with overdose.
Reference:
Salerno SM, Jackson JL, Berbano EP. Effect of oral pseudoephedrine on blood
pressure and heart rate. Arch Intern Med 2005;165:1686-94.
Study Design:
Meta-analysis (randomized controlled trials)
Synopsis:
Oral pseudoephedrine is commonly used to treat symptoms of rhinitis and
rhinorrhea, but its effect on blood pressure (BP) and heart rate (HR)
remains uncertain. We assessed whether pseudoephedrine causes clinically
meaningful elevations in HR or BP. We searched MEDLINE, EMBASE, and the
Cochrane Library for English-language, randomized placebo-controlled trials
of oral pseudoephedrine treatment in adults. The primary data extracted were
systolic BP (SBP), diastolic BP (DBP), and HR. Study quality was assessed
using the methods of Jadad, and data were synthesized using a random-effects
model and weighted mean differences. Twenty-four trials had extractable
vital sign information (45 treatment arms; 1285 patients). Pseudoephedrine
caused a small but significant increase in SBP (0.99, mm Hg; 95% CI, 0.08 to
1.90) and HR (2.83 beats/min; 95% CI, 2.0 to 3.6), with no effect on DBP
(0.63 mm Hg, 95% CI, -0.10 to 1.35). The effect in patients with controlled
hypertension demonstrated an SBP increase of similar magnitude (1.20 mm Hg;
95% CI, 0.56 to 1.84 mm Hg). Higher doses and immediate-release preparations
were associated with greater BP increases. Studies with more women had less
effect on BP or HR. Shorter duration of use was associated with greater
increases in SBP and DBP. |