Over-the-Counter Medications That Can Increase Blood Pressure

Primary OTC Culprits

The American College of Cardiology notes that NSAIDs can increase blood pressure by 3-6 mm Hg in patients with controlled hypertension, with effects potentially appearing within the first weeks of treatment 1
NSAIDs antagonize the blood pressure-lowering effects of multiple antihypertensive classes, including ACE inhibitors, ARBs, diuretics, and beta-blockers, according to the American College of Cardiology and Hypertension guidelines 1, 3
The American College of Cardiology recommends avoiding systemic NSAIDs when possible and considering alternative analgesics such as acetaminophen, tramadol, or topical NSAIDs 1, 2
Pseudoephedrine and phenylephrine are sympathomimetic agents that directly raise blood pressure, as stated by the American College of Cardiology, Circulation, and Hypertension guidelines 1, 2, 3
The American Heart Association, as published in Circulation, advises using decongestants for the shortest duration possible and avoiding them entirely in severe or uncontrolled hypertension 2
Regular acetaminophen use increases the relative risk of hypertension by 1.34, according to Hypertension 3
The American College of Cardiology suggests limiting caffeine intake to less than 300 mg daily and avoiding caffeine use in patients with uncontrolled hypertension 1, 2

The American College of Cardiology and Circulation recommend avoiding high-risk herbal products such as Ma Huang, yohimbine, St. John's wort, ginseng, and liquorice due to their potential to increase blood pressure 1, 2, 3
The American Heart Association, as published in Circulation, advises limiting alcohol to ≤1 drink daily for women and ≤2 drinks daily for men 1, 2

The American College of Cardiology and Hypertension guidelines recommend screening all patients with hypertension or at risk for hypertension for OTC medications, supplements, and substances that may increase BP 1, 3
The American College of Cardiology suggests taking a careful history including prescription medications, OTC substances, illicit drugs, and herbal products 1, 6
When feasible, the American College of Cardiology recommends reducing or discontinuing drugs associated with increased BP and using alternative agents 1, 6
The Hypertension guideline advises monitoring blood pressure closely during initiation of any new OTC medication or supplement, especially in the first weeks of treatment 5