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Evidence Is Lacking for Link between Rhinitis and Hypertension

In a report asserting a relation between rhinitis and reclining systolic hypertension in men, Kony and colleagues (1) fail to mention oral medication use in the populations analyzed. Antihypertensives, including angiotensin-converting enzyme inhibitors, ß-blockers, and prazosin, can cause chronic rhinitis (2). Conversely, pseudoephedrine, a widely available over-the-counter preparation commonly taken as treatment for rhinitis, has been implicated in systolic blood pressure elevation (3, 4). Other medications can have similar effects including nonsteroidal antiinflammatory drugs (5). All the above drug classes could confound the study results.

In a study of 161 consecutive male patients younger than 40 years from my general internal medicine practice, I found no relation between rhinitis and reclining systolic blood pressure: 81 men noting nasal airflow obstruction did not differ from 80 men with clear nasal airflow (129 versus 130 mm Hg, respectively). Similarly, when 66 men with pollen allergy were compared with 95 men without pollen allergy, reclining systolic blood pressures were identical (129 mm Hg). With the exception of a slightly higher reclining pulse in those with pollen allergy (68 vs. 63 bpm, p < 0.05), no differences between each group were noted in other cardiovascular measurements including: semi-recumbent pulse, semirecumbent systolic or diastolic blood pressure, reclining diastolic blood pressure, or orthostatic blood pressure drop. Mean body mass index and age likewise were similar. The population was overwhelmingly healthy, white, and middle class.

The methodologic flaws noted earlier in the study of Kony and colleagues (1) and the failure to find similar results in a separate study suggest that the subject needs further scrutiny.

Alexander C. Chester

Georgetown University Medical Center Washington, D.C.

FOOTNOTES

Dr. Kony and colleagues were given the opportunity to respond but declined to do so.

REFERENCES

1. Kony S, Zureik M, Neukirch C, Leynaert B, Vervloet D, Neukirch F. Rhinitis is associated with increased systolic blood pressure in men: a population-based study. Am J Respir Crit Care Med 2003;167:538–543.[Abstract/Free Full Text]
2. Corren J. Allergic rhinitis: treating the adult. J Allergy Clin Immunol 2000;105:S610–S615.[Medline]
3. Chua SS, Benrimoj SI, Gordon RD, Williams G. A controlled clinical trial on the cardiovascular effects of single doses of pseudoephedrine in hypertensive patients. Br J Clin Pharmacol 1989;28:369–372.[Medline]
4. Beck RA, Mercado DL, Seguin SM, Andrade WP, Cushner HM. Cardiovascular effects of pseudoephedrine in medically controlled hypertensive patients. Arch Intern Med 1992;152:1242–1245.[Abstract]
5. Morgan T, Anderson A. The effect of nonsteroidal anti-inflammatory drugs on blood pressure in patients treated with different antihypertensive drugs. J Clin Hypertens 2003;5:53–57.

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