If you’re among the millions of people controlling high blood pressure (hypertension), your daily routine likely includes some mixture of medication, diet, and lifestyle changes. But did you know that certain common pills—even over-the-counter ones—could be silently raising your blood pressure and increasing your risk of stroke or heart attack?

Let’s be clear: This isn’t about scaring you away from necessary medication. It’s about empowering you with information so you can have informed conversations with your doctor and pharmacist.

Why This Matters

High blood pressure affects nearly half of all adults in the United States—about 116 million people. For those managing this condition, every medication counts. But many people don’t realize that common over-the-counter drugs, supplements, and even prescription medications can:

  • Raise blood pressure
  • Interfere with blood pressure medications
  • Increase heart rate

  • Cause fluid retention

  • Worsen hypertension symptoms

Over-the-Counter Medications to Watch

1. Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

Common names: Ibuprofen (Advil, Motrin), Naproxen (Aleve), Diclofenac, Celecoxib

What they do: Reduce pain and inflammation

The risk: NSAIDs can cause the body to retain sodium and fluid, which increases blood pressure. They can also reduce the effectiveness of many common blood pressure medications, including:

  • Diuretics
  • ACE inhibitors
  • Beta-blockers

  • Angiotensin II receptor blockers

  • Safer alternatives:
  • Acetaminophen (Tylenol) – but use with caution if you have liver issues

  • Topical pain relievers (creams, gels)

  • Non-drug approaches (heat, ice, physical therapy)

  • Important: If you must take NSAIDs, use the lowest effective dose for the shortest possible time—and tell your doctor.
  • 2. Decongestants
  • Common names: Pseudoephedrine (Sudafed), Phenylephrine (Sudafed PE), Oxymetazoline (Afrin nasal spray)
  • Found in: Many cold, flu, and allergy medications
  • The risk: Decongestants constrict blood vessels to relieve stuffiness—but they also constrict arteries throughout your body, raising blood pressure. They can also:

  • Increase heart rate

  • Interfere with blood pressure medications

  • Cause palpitations

  • Safer alternatives:

  • Saline nasal spray

  • Steam inhalation

  • Nasal strips

  • Antihistamines (for allergy-related congestion)

  • 3. Certain Antacids
  • Common names: Alka-Seltzer, Bromo-Seltzer, some effervescent pain relievers
  • The risk: These products often contain high levels of sodium—as much as 1,000 mg per dose. For someone with high blood pressure, that’s a significant amount of salt that can cause fluid retention and pressure spikes.
  • Safer alternatives:

  • Standard calcium carbonate antacids (Tums)

  • H2 blockers (Pepcid, Zantac)

  • Proton pump inhibitors (Prilosec, Prevacid)

  • Always check the sodium content on any effervescent or soluble medication.
  • Prescription Medications That Can Raise Blood Pressure
  • 4. Corticosteroids
  • Common names: Prednisone, Methylprednisolone, Hydrocortisone
  • Used for: Asthma, allergies, autoimmune conditions, inflammation
  • The risk: Corticosteroids cause sodium and fluid retention, leading to increased blood pressure, especially with long-term use.
  • What to do: If you need steroids, your doctor will monitor your blood pressure closely. Never stop steroid medication abruptly—it must be tapered.
  • 5. Hormonal Medications
  • Common names: Birth control pills (especially those containing estrogen), hormone replacement therapy
  • The risk: Estrogen can increase blood pressure in some women, particularly those who smoke, are overweight, or have a history of high blood pressure.
  • What to do: Discuss alternatives with your doctor—progestin-only options may have less impact on blood pressure.
  • 6. Certain Antidepressants
  • Common names: Venlafaxine (Effexor), Desvenlafaxine (Pristiq), Monoamine oxidase inhibitors (MAOIs)
  • The risk: Some antidepressants can raise blood pressure by affecting norepinephrine levels.
  • What to do: Don’t stop antidepressants abruptly. Work with your doctor to find an option that balances mental health needs with blood pressure control.
  • 7. Immunosuppressants
  • Common names: Cyclosporine, Tacrolimus
  • Used for: Organ transplant recipients, autoimmune conditions
  • The risk: These medications can significantly raise blood pressure by constricting blood vessels and affecting kidney function.
  • What to do: Regular monitoring is essential. Your doctor will adjust medications as needed.
  • 8. Erythropoiesis-Stimulating Agents
  • Common names: Epoetin alfa (Epogen, Procrit), Darbepoetin alfa (Aranesp)
  • Used for: Anemia related to kidney disease or cancer treatment
  • The risk: These medications increase red blood cell production, which can thicken blood and raise blood pressure.
  • Supplements That Can Affect Blood Pressure
  • Even “natural” supplements can impact blood pressure:

  • Ephedra (ma huang) – Banned in the US, but still found in some products

  • Bitter orange (Citrus aurantium) – Often used in weight loss products; can raise BP

  • Ginseng – Can interfere with blood pressure medications

  • Licorice root – Can cause sodium retention and potassium loss

  • St. John’s wort – Can interact with blood pressure medications

  • Yohimbine – Can raise blood pressure significantly

  • Always tell your doctor about any supplements you take.
  • What to Do: A Practical Guide
  • Step 1: Make a List
  • Write down every medication, supplement, and over-the-counter product you take regularly or occasionally. Include:

  • Prescription drugs

  • Over-the-counter pain relievers

  • Cold and allergy medications

  • Antacids

  • Vitamins and supplements

  • Herbal products

  • Step 2: Review With Your Pharmacist
  • Pharmacists are medication experts. Take your list to your local pharmacy and ask:

  • “Could any of these affect my blood pressure?”

  • “Are there safer alternatives?”

  • “What should I avoid in the future?”

  • Step 3: Talk to Your Doctor
  • Share your list with your doctor. They may:

  • Adjust your blood pressure medication

  • Recommend alternatives

  • Monitor you more closely

  • Step 4: Read Labels
  • Before taking any new over-the-counter medication, read the label carefully:

  • Look for warnings for people with high blood pressure

  • Check sodium content

  • Note active ingredients you recognize from this list

  • Step 5: Ask Before You Take
  • Before taking anything new—even something “harmless”—ask your pharmacist or doctor: “Is this safe for someone with high blood pressure?”
  • Red Flags: When to Seek Help
  • If you experience any of these after starting a new medication, contact your doctor immediately:

  • Severe headache

  • Chest pain

  • Shortness of breath

  • Vision changes

  • Irregular heartbeat

  • Sudden swelling in feet or ankles

  • Blood pressure readings significantly higher than usual

  • The Bottom Line
  • Managing high blood pressure is a daily commitment—and it involves more than just taking your prescribed medication. Over-the-counter drugs, supplements, and even seemingly harmless cold remedies can silently undermine your efforts.
  • You are your own best advocate. Know what you’re putting into your body. Ask questions. Read labels. And always keep your healthcare team informed.
  • Your heart is worth it.