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Do Nasal Vasoconstrictors Raise BP?

October 30, 2018

Written by Vivian Lei

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In patients without a history of hypertension, use of intranasal vasoconstrictors did not significantly increase blood pressure compared to placebo.

Why does this matter?
Use of intranasal vasoconstrictors is common in epistaxis. However, there are warnings against use of these agents in patients with hypertension. Given that many clinicians are using these medications anyway, should we really be so concerned about their effects on hemodynamics? 

Rub your nose in this one
This was a single-center, double-blind, placebo-controlled, randomized trial performed at the Mayo Clinic Emergency Department (ED). Adult patients with no prior history of hypertension who were being discharged from the ED were randomized to 4 study arms: oxymetazoline 0.05%, phenylephrine 0.25%, lidocaine 1% with epinephrine 1:100,000, or bacteriostatic 0.9% sodium chloride (placebo). The medications were applied to a cotton pledget placed in the anterior naris for 15 minutes with a nose clip, and hemodynamic measurements were taken at 5 minute intervals for 30 minutes. This was a small study with only 68 total patients enrolled (63 completed the study and were included in analysis). Median age of participants was 33.5 years. There was no significant increase in mean arterial pressure, systolic blood pressure, diastolic blood pressure, or heart rate with administration of any study medication compared to saline. Further study is required in patients with hypertension as well as in patients presenting with epistaxis.

Effect of Intranasal Vasoconstrictors on Blood Pressure: A Randomized, Double-Blind, Placebo-Controlled Trial. J Emerg Med. 2018 Sep 5. pii: S0736-4679(18)30659-0. doi: 10.1016/j.jemermed.2018.07.004. [Epub ahead of print]

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Reviewed by Clay Smith