Safe Cold Relief for Older Adults with High Blood Pressure

What Causes the Common Cold?

There’s a reason they call it the common cold—it shows up often, especially in colder months. With runny noses, sore throats, and nagging coughs, the search for relief is understandable. But not all cold medicines are safe, especially for seniors with high blood pressure. More than 200 viruses can cause a cold, but rhinoviruses are the most common, affecting over 3 million people in the U.S. annually. Symptoms usually peak within 3–5 days and may include:

• Sneezing
• Runny or stuffy nose
• Sore throat
• Cough
• Mild fever

Symptoms typically resolve within 7–14 days, but can linger longer in older adults due to a slower immune response.

Preventive Measures and the Aging Immune System

Older adults are more vulnerable to infections due to age-related changes in immunity. “Wearing a mask and disinfecting surfaces regularly is a smart layer of defense, especially when caring for older adults,” notes Dr. Bulan. Prevention is a key approach. Caregivers can take key steps to minimize exposure:

1. Practice Good Hygiene

• Handwashing: Use soap and water for at least 20 seconds, especially after contact with others or surfaces.
• Avoid Face Touching: The nose, eyes, and mouth are virus entry points.
• Cough/Sneeze Etiquette: Use tissues or elbows, and dispose of tissues immediately.
• Surface Disinfection: Regularly clean doorknobs, remotes, and countertops.

2. Limit Exposure

• Isolate the Sick: Use a separate room and bathroom if available.
• Minimize Visitors: Especially during outbreaks.
• No Shared Items: Avoid sharing towels, utensils, or cups.

3. Boost Immunity

• Nutrition: Serve colorful fruits, vegetables, and whole grains.
• Hydration: Encourage water, tea, and broth.
• Sleep: Adequate rest strengthens immune function.

4. Consider Masking

• Face Masks: Use masks when in close contact with sick individuals.

5. Other Smart Habits

• Separate Laundry: Wash the sick person’s items separately.
• Stay Home if Sick: Seniors should rest at home when symptomatic.

Cold Medicine and High Blood Pressure: What to Watch For

Cold medicines may contain ingredients that raise blood pressure. These include decongestants and certain pain relievers, which may interact with prescribed blood pressure medications.

Decongestants are especially concerning for those with high blood pressure. Although they relieve nasal congestion, these medications constrict blood vessels, alleviating swelling in the nasal area and other body parts. However, this narrowing makes blood flow harder, leading to increased blood pressure. Therefore, it is advisable to limit the use of cold medicines if you have high blood pressure.

Common decongestants include:

• – Pseudoephedrine
• – Ephedrine
• – Phenylephrine*
• – Naphazoline
• – Oxymetazoline (nasal spray)

An Update on Oral Phenylephrine*: In 2023, an FDA advisory committee concluded that oral phenylephrine is ineffective at its current congestion dosage. Notably, the nasal form of phenylephrine was not included in this review, but it effectively relieves nose stuffiness. While still considered generally safe at recommended doses, it does not offer meaningful relief and may cause side effects like elevated blood pressure at higher doses. Many “PE” (phenylephrine) products remain on shelves, so always read labels and avoid unnecessary risks.

NSAIDs (Nonsteroidal Anti-Inflammatory Drugs), such as ibuprofen and naproxen, are pain relievers that can cause fluid retention, raise blood pressure, and may interact with blood pressure medications. Always check the label and consult a healthcare provider before giving cold medicines to a senior with high blood pressure.

Safer Cold Remedies for Seniors with Hypertension

Cough Suppressants

✔️ Dextromethorphan (e.g., Delsym, Robitussin DM) works on the brain’s cough center to suppress coughs without stimulating the heart or blood vessels, so it does not raise blood pressure and is effective for dry, nonproductive coughs.

Expectorants

✔️ Guaifenesin (e.g., Mucinex) helps loosen mucus to clear chest congestion and has no cardiovascular effects, so it’s considered safe for people with hypertension. For congestion, nasal sprays 

Nasal Relief (Drug-Free Options)

✔️ Saline Nasal Spray (like Simply Saline or Ocean) is potentially a safer alternative to oral decongestants, as noted by the Ochsner Health blog. This spray is a drug-free saltwater solution that is safe for users of any age. These saltwater solutions help moisturize nasal passages and clear out mucus, without containing any active drug ingredients that could influence blood pressure. For those with high blood pressure, the correct positioning of the spray in the nasal passage is essential for optimal effectiveness.

✔️ Steam inhalation or humidifiers moisten the airways naturally and help relieve nasal congestion without any drug interaction risk.

Cold Medicines Labeled “HBP”

✔️ Coricidin HBP Products (e.g., Cold & Flu, Cough & Cold) are formulated specifically for people with high blood pressure, meaning they do not contain decongestants like pseudoephedrine or phenylephrine that could raise blood pressure. 

Drug-Free Options for Cold Symptom Relief

Caregivers may also rely on natural, non-drug remedies to comfort their loved ones:

1. Warm Salt Water Gargles: A warm salt water gargle is an effective remedy for providing relief from the discomfort of sore throats. To prepare this soothing mixture, begin by heating a cup of water until it reaches a warm temperature—aim for a level that feels comfortable to the touch and avoid any boiling water, as it could aggravate your throat. Next, take 1/2 teaspoon of salt and carefully dissolve it in the warm water, stirring until fully integrated. Once prepared, take a generous mouthful of the solution and gargle for as long as you find comfortable—usually around 30 seconds to a minute works well. After gargling, be sure to spit the solution into a sink or basin, as swallowing it is not advised. This process can be repeated multiple times throughout the day, particularly during times when you’re suffering from throat irritation.
2. Tea with Lemon and Honey: For a warm, comforting drink that helps alleviate coughing and promotes hydration, consider a nourishing blend of tea, lemon, and honey. Start by boiling water and pour about 8 ounces into a glass. Add 2-3 fresh slices of lemon, which not only provides a delightful citrus flavor but also delivers vitamin C. To sweeten this healthy beverage, stir in a tablespoon of pure honey. Honey is renowned for its soothing properties and can coat the throat, making this drink an ideal choice when you’re feeling under the weather.
3. Hydration: Staying hydrated is crucial for your recovery. Aim to drink a variety of fluids, including water, clear broths or soups, and herbal teas. Each of these options plays a vital role in maintaining hydration levels in your body, as they help thin out mucus, making it easier to expel. The more fluids you consume, the better your body can effectively flush out irritants and recover from congestion.
4. Cool-Mist Humidifier: A cool-mist humidifier can greatly improve your comfort, especially if you’re experiencing nasal dryness or congestion. To use this device, fill the water reservoir according to the manufacturer’s instructions and turn it on. The humidifier will gently produce a cool mist that is released into the air, adding moisture that helps soothe dry nasal passages. This added humidity can also relieve sinus pressure and ease breathing, making it an excellent option for nighttime use.
5. Menthol Lozenges: Menthol lozenges are a popular over-the-counter option for soothing coughs and throat irritation.
   When choosing menthol lozenges for rhinovirus, focus on symptom relief rather than a specific antiviral effect, as there’s no proven antiviral action in lozenges. Consider lozenges with a cooling sensation, as menthol can help soothe a sore throat and ease coughs, which are common cold symptoms. Some studies have shown that zinc lozenges, particularly those with a single zinc salt like zinc acetate or zinc gluconate, may have a modest effect in reducing the duration of colds. However, their effectiveness is not consistently proven, according to EBSCO Research Starters. For sugar-free lozenges sweetened with low FODMAP, select options like sorbitol or mannitol.

Be Cautious with Combination Cold Medications

Many cold medications include acetaminophen, which means you could unintentionally take too much if you also use acetaminophen for headaches, pain relief, or fevers. Cough suppressants and decongestants are other frequent ingredients in these cold medications. Products such as NyQuil and DayQuil often contain several components (including acetaminophen and decongestants), resulting in a greater risk of accidental double dosing. Always examine the ingredients closely and be aware of what you’re taking. Avoid using multiple over-the-counter cough and cold remedies simultaneously without consulting your doctor, as many share the same or similar ingredients.

Another important consideration is potential interactions: specific components in cold medications, such as decongestants (pseudoephedrine, phenylephrine), may interact with other drugs, including antidepressants, blood thinners, and MAO inhibitors. 

Understanding Antihistamines for Older Adults

While antihistamines may help if allergies are involved, many are sedating and may cause confusion, dizziness, or drowsiness in seniors. Be mindful of antihistamines for seniors with high blood pressure. Many nighttime cold medicines contain diphenhydramine, which causes drowsiness. This effect can be amplified when combined with other medications that also cause drowsiness, such as opioids, anti-anxiety drugs, or alcohol. Caregivers should consult healthcare providers before giving any antihistamines, especially first-generation types like diphenhydramine (Benadryl).

Final Tips for Family Caregivers

• Focus on treating symptoms one at a time (e.g., cough vs. congestion).
• Always consult your loved one’s doctor or pharmacist before introducing new over-the-counter medications.
• Get plenty of rest and fluids.
• Don’t ignore persistent or worsening symptoms—call a healthcare professional if they last more than 10 days or worsen suddenly.

Summary

Older adults with high blood pressure require special care when treating colds. Decongestants and NSAIDs may elevate blood pressure or interact with medications. Choose HBP-friendly cold remedies, non-drug options, and when in doubt, consult with a healthcare provider to keep your loved one safe and comfortable.