What is the first line decongestant recommended for patients who are hypertensive?

The recommended first-line decongestant for patients who are hypertensive is nasal oxymetazoline. This choice is considered appropriate because oxymetazoline, a topical nasal decongestant, acts locally within the nasal passages. This localized action minimizes systemic absorption and consequently reduces the risk of elevated blood pressure compared to systemic agents like oral pseudoephedrine or topical phenylephrine. These systemic agents can lead to vasoconstriction due to their sympathomimetic effects, which can exacerbate hypertension in vulnerable patients.

While intranasal corticosteroids can also provide relief from nasal congestion and are particularly beneficial for patients with allergic rhinitis, they are not classified as decongestants and may not offer immediate symptomatic relief in acute situations compared to oxymetazoline, making oxymetazoline a more suitable choice for immediate decongestion in hypertensive patients.