The Journal of Laryngology & Otology, 1 of 5.

MAIN ARTICLE
© JLO (1984) Limited, 2018
doi:10.1017/S0022215118000580

Allergic rhinitis and arterial blood pressure:

a population-based study

O SAKALLIOGLU, C POLAT, A AKYIGIT, H CETINER, S DUZER

ENT Clinic, Elazığ Training and Research Hospital, Elazığ, Turkey

Abstract
Objectives: To investigate the likelihood of allergic rhinitis and potential co-morbidities, and to assess whether
allergic rhinitis is associated with arterial blood pressure and hypertension.
Methods: In this population-based study, 369 adults with allergic rhinitis and asthma were assessed via a
questionnaire and immunoglobulin E levels. There were four groups: control (n = 90), allergic rhinitis (n = 99),
asthma (n = 87) and hypertension (n = 93). Arterial blood pressure was measured in all groups.
Results: There were no significant differences in systolic or diastolic blood pressure between males and females in
any group. Pairwise comparisons revealed no significant differences between: the control and allergic rhinitis
groups, the control and asthma groups, or the allergic rhinitis and asthma groups. The systolic and diastolic
blood pressure values of males and females were significantly higher in the hypertension group than the allergic
rhinitis group. There were no significant differences in systolic blood pressure or diastolic blood pressure for
seasonal and perennial allergic rhinitis patients.
Conclusion: Rhinitis was not associated with increased blood pressure. Allergic rhinitis can coincide with asthma
and hypertension. The findings do not support the need for blood pressure follow up in allergic rhinitis patients.

Key words: Allergic Rhinitis; Blood Pressure; Asthma; Hypertension

Introduction chronic hay fever share some similar pathophysiology

Allergic rhinitis affects approximately 10–30 per cent
of adults and up to 40 per cent of children each year.
Although allergic rhinitis is not a life-threatening
disease, it is a major cause of suffering and impaired
quality of life (QoL).1 The symptoms of allergic rhin-
itis (rhinorrhoea, nasal congestion and sneezing) are
annoying in themselves, but patients also experience
non-nasal symptoms that are troublesome, including
headache, thirst and disturbed sleep.2 Learning is
impaired in children, and some adults report a decrease
in productivity and concentration.3
Allergic rhinitis is often associated with co-morbid
asthma and, if not managed properly, exacerbates other
conditions, including acute and chronic sinusitis, recur-
rent nasal polyposis, otitis media, sleep apnoea, respira-
tory infections, and asthma.4 Asthma affects people of
all ages, from children to older adults, and its incidence
has seen a worldwide increase in recent years.5 There
is strong evidence that perennial rhinitis and asthma fre-
quently occur together.6 Asthma is a chronic disease that
can result in variable restriction in the physical, emo-
tional and social aspects of the patient’s life.7 Asthma
and rhinitis are often co-morbid conditions, and the
overall characteristics of the diseases and the treatment
options for the disorders are similar.4 Asthma and
with chronic inflammation. Thus, the presence of hay
fever may contribute to an increased risk of stroke, in a
similar fashion as asthma, through a combination of ele-
vated blood pressure (BP) and inflammation.8
In addition, population studies have demonstrated that
the prevalence of both hypertension and allergic dis-
eases continue to increase year on year.9 Because rhinitis
symptoms are known to be associated with snoring and
obstructive sleep apnoea (OSA), and snoring and OSA
are associated with hypertension, a link between rhinitis
and BP seems plausible.10–12 Kony et al. found an asso-
ciation between questionnaire-reported rhinitis and mea-
sured arterial systolic BP in 146 middle-aged males.13
However, Heinrich et al. found no association between
allergic rhinitis and measured BP.12
This study aimed to investigate the likelihood of
allergic rhinitis and potential co-morbidities, and to
assess whether rhinitis is associated with arterial BP
and hypertension.
Materials and methods
This study was conducted according to the Declaration
of Helsinki, and was approved by the ethical commit-
tee of Eskisehir Osmangazi University Faculty of
Medicine.

Accepted for publication 5 December 2017

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 2 O SAKALLIOGLU et al.
Participants
This study was designed as a population-based study.
The study population had consisted of 401 participants
aged 18–50 years. However, of the asthmatic patients,
nine had seasonal allergic rhinitis and five had peren-
nial allergic rhinitis; of the hypertensive patients, four
had seasonal allergic rhinitis and four had perennial
allergic rhinitis; and even in the control group, six of
the healthy volunteers had seasonal allergic rhinitis
and four had perennial allergic rhinitis. These indivi-
duals, who had more than one disease (asthma plus
allergic rhinitis, hypertension plus allergic rhinitis), or
controls with allergic rhinitis, were excluded from the
study.
A total of 369 participants with pure allergic rhinitis,
asthma or hypertension, or healthy controls with no
other diseases, were included in the study and analysis.
These individuals were divided into four groups, as
follows. The control group comprised 90 participants
(38 male, 52 female), with a mean age of 32.04 ±
8.58 years (range, 20–50 years). The allergic rhinitis
group consisted of 99 individuals (39 male, 60
female), with a mean age of 32.08 ± 11.35 years
(range, 18–50 years). The asthma group comprised
87 participants (30 male, 57 female), with a mean
age of 34.84 ± 9.30 years (range, 20–50 years). The
hypertension group consisted of 93 individuals (32
male, 61 female), with a mean age of 35.49 ± 11.67
years (range, 18–50 years).
Informed consent was obtained from all participants.
The patients’ demographics, and information on allergic
rhinitis and other co-morbidities, including asthma,
atopic eczema, laryngopharyngeal reflux, otitis media
with effusion, nasal polyposis, and hypertension, were
recorded.
Allergic rhinitis
The patients were asked if they had allergic rhinitis
related symptoms such as nasal discharge, nasal
itching, sneezing or nasal obstruction. A detailed
ENT examination was performed. The diagnosis of
allergic rhinitis was initially made based on symptoms
and clinical findings. Specific immunoglobulin E
levels were subsequently studied to confirm the allergic
rhinitis diagnosis. The arterial BP of patients with rhin-
itis was measured.
Patients who suffered from rhinitis symptoms while
being near to animals (such as cats, dogs or horses),
near feathers (including pillows, quilts or duvets) or
in dusty parts of the house were considered to have per-
ennial rhinitis. Patients who suffered with a runny or
stuffy nose or started sneezing when exposed to trees,
grass or flowers, or when the pollen count was high,
were considered to have seasonal rhinitis.12
Asthma
Patients who answered ‘yes’ to both the questions ‘Have
you ever had asthma?’ and ‘Was it confırmed by a
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doctor?’ were considered to suffer from asthma.13 Patients
were defined as having current asthma if they had
suffered at least 1 asthma attack or had taken asthma
medication in the previous 12 months.14
Hypertension
Patients were considered hypertensive if their systolic
BP was at least 140 mmHg and/or their diastolic BP
was at least 90 mmHg, and/or they reported using anti-
hypertensive medication.12,13 Both systolic and dia-
stolic BP were measured with a digital electronic
tensiometer (VitalScan 1 BP 1600; Braun, Kronberg,
Germany). Two independent measurements were
taken, with a 5-minute interval, while the patients
were in a supine position. The second values were
used for the statistical analysis.13
Statistical analysis
The software package SPSS® (version 16.0) was used
for statistical evaluation. Kruskal–Wallis variance ana-
lysis, Mann–Whitney U test, Mann–Whitney U test
with Bonferroni adjustment, and Spearman’s correl-
ation rho efficient tests were used to analyse the data.
A p-value of less than 0.05 was taken to indicate stat-
istical significance. Where the Mann–Whitney U test
with Bonferroni adjustment was used, an adjusted
p-value of less than 0.0125 was considered statistically
significant.
Results
In the allergic rhinitis group, 54 patients (54.5 per cent)
had seasonal allergic rhinitis and 45 patients (45.5 per
cent) had perennial allergic rhinitis.
The BP values of the four groups (control, allergic
rhinitis, asthma and hypertension) are shown in Table I.
There were no significant differences between males
and females in terms of systolic BP and diastolic BP
for any group (p < 0.05). In the allergic rhinitis group,
for the males, the mean systolic BP was 110.97 ±
18.86 mmHg and the mean diastolic BP was 67.87 ±
11.69 mmHg; for the females, the mean systolic BP
was 110.32 ± 14.92 mmHg and the mean diastolic BP
was 67.47 ± 11.09 mmHg.
The differences between groups in terms of both sys-
tolic BP and diastolic BP, for the males and the
females, was assessed using Kruskal–Wallis variance
analysis. The differences were statistically significant
( p < 0.05) (Table I).
To find the values causing the differences, pairwise
comparisons using a Mann–Whitney U test with
Bonferroni adjustment were performed (Table II). An
adjusted p-value of less than 0.0125 was considered
statistically significant. In the hypertension group, all
systolic BP and diastolic BP values of the males and
the females were significantly higher than those of
the allergic rhinitis group. With the exception of
males’ diastolic BP, females’ systolic BP and diastolic
BP, and males’ systolic BP values, were significantly
higher in the hypertension group than in the control
 ALLERGIC RHINITIS AND ARTERIAL BLOOD PRESSURE 3

TABLE I
BLOOD PRESSURE VALUES OF THE GROUPS
Groups Females Males Systolic BP Diastolic BP
p-value∗ p-value∗
n BP (mean ± SD; mmHg) n BP (mean ± SD; mmHg)
Systolic Diastolic Systolic Diastolic

Control 52 112.04 ± 17.21 67.04 ± 10.94 38 109.03 ± 14.31 68.39 ± 12.38 0.583 0.759
Allergic rhinitis 60 110.32 ± 14.92 67.47 ± 11.09 39 110.97 ± 18.86 67.87 ± 11.69 0.991 0.875
Asthma 57 113.98 ± 16.77 68.84 ± 12.15 30 117.20 ± 15.53 71.73 ± 9.89 0.437 0.106
Hypertension 61 130.49 ± 22.27 74.48 ± 13.14 32 125.88 ± 19.18 74.69 ± 9.58 0.355 0.691
P-value† <0.0001 0.009 <0.0001 0.042
∗
Mann–Whitney U test. †Kruskal–Wallis variance analysis. BP = blood pressure; SD = standard deviation

group. Females’ systolic BP values were also signifi-
cantly higher in the hypertension group than in the
asthma group (adjusted p < 0.0125). Pairwise compar-
isons revealed no significant differences between: the
control and allergic rhinitis groups, the control and
asthma groups, and the allergic rhinitis and asthma
groups.
In the allergic rhinitis group, the Mann–Whitney U
test was used to determine the differences in systolic
BP and diastolic BP values for the patients with
seasonal and perennial allergic rhinitis. There was no
significant difference for systolic BP ( p = 0.174,
z = −1.358) or diastolic BP ( p = 0.491, z = −0.689).
The relationship between group (control, allergic
rhinitis, asthma and hypertension), age, gender, allergic
rhinitis type (seasonal and perennial), systolic BP and
diastolic BP, was analysed using the Spearman’s cor-
relation rho efficient test, and a correlation matrix
was developed (Table III). The analysis of allergic rhin-
itis type was only performed for the allergic rhinitis
group. The findings revealed that both systolic BP
and diastolic BP values increased with patient age
( p < 0.05). As systolic BP increased, diastolic BP
also increased in all groups ( p < 0.05). In the allergic
rhinitis group, perennial allergic rhinitis was
detected more often in older patients, whereas sea-
sonal allergic rhinitis was more likely in younger
patients ( p < 0.05).
Of the patients with allergic rhinitis, one had nasal
polyposis, one had external ear canal eczema and one
had atopic eczema. Of the patients with asthma, nine
had seasonal allergic rhinitis and five had perennial
allergic rhinitis. Of the patients with hypertension,
four had seasonal allergic rhinitis and four had peren-
nial allergic rhinitis.
Discussion
Asthma and rhinitis commonly occur as co-morbid-
ities, and both diseases impair QoL.4,15 Affected indi-
viduals report problems with social and daily
activities, often experience difficulty sleeping at
night, suffer from daytime somnolence, and have
poorer mental health and well-being than patients
without rhinitis or asthma.16 Leynaert et al. found
that 78 per cent of asthmatics also had allergic rhinitis,
and individuals with both asthma and allergic rhinitis
experienced more physical limitations than patients
with allergic rhinitis alone.17 The authors concluded
that both asthma and allergic rhinitis were associated
with an impairment in QoL. We found that 14 asth-
matic patients also had allergic rhinitis.
There is strong evidence that perennial rhinitis and
asthma frequently occur together, but the nature of
the association is not well known.18 Leynaert et al.
observed that individuals with perennial rhinitis were
more likely than control subjects to have current

TABLE II
PAIRWISE COMPARISONS∗
Group comparisons Females Males
Systolic BP (mmHg) Diastolic BP (mmHg) Systolic BP (mmHg) Diastolic BP (mmHg)
† † †
z p z p z p z p†

Control vs allergic rhinitis −0.190 0.849 −0.117 0.907 −0.316 0.752 −0.092 0.927
Control vs asthma −0.957 0.339 −0.416 0.677 −2.022 0.043 −1.385 0.166
Control vs hypertension −4.672 <0.0001 −2.884 0.004 −3.875 <0.0001 −2.068 0.039
Allergic rhinitis vs asthma −1.267 0.205 −0.382 0.702 −1.570 0.117 −1.691 0.091
Allergic rhinitis vs hypertension −5.395 <0.0001 −2.872 0.004 −3.236 0.001 −2.527 0.012
Asthma vs hypertension −4.284 <0.0001 −2.436 0.015 −1.971 0.049 −0.968 0.333
∗
Conducted using the Mann–Whitney U test with Bonferroni adjustment. †Adjusted p < 0.0125 considered as statistically significant. BP =
blood pressure

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 4 O SAKALLIOGLU et al.
Variables Group
Group
–r
–p
Age
–r
–p
Gender
–r
–p
Seasonal or perennial allergic rhinitis
–r
–p
Systolic BP
–r
–p
Diastolic BP
–r
–p
∗
P-values represent the results of Spearman’s correlation rho efficient test. †Analysis was performed in allergic rhinitis group. BP = blood
pressure
asthma.14 They concluded that the strong association
between perennial rhinitis and asthma in non-atopic
subjects with normal immunoglobulin E levels is con-
sistent with the hypothesis that rhinitis is an independ-
ent risk factor for asthma. Leynaert et al. suggested that
patients with perennial and seasonal rhinitis are more
likely to have asthma than those patients with either
seasonal or perennial rhinitis alone, and that asthma
and rhinitis are associated co-morbidities in both aller-
gic and non-allergic rhinitis.4 In our study, nine asth-
matic patients had seasonal allergic rhinitis and five
had perennial allergic rhinitis.
A high prevalence of both rhinitis and hypertension
has been reported, with approximately 25 per cent of
the population living in industrialised countries.19
Rhinitis may be related to cardiovascular risk factors,
particularly hypertension, as rhinitis is associated
with snoring and obstructive sleep apnoea, and
snoring and OSA are associated with hypertension.20,21
Kony et al. found that hypertension was more frequent
in males with rhinitis (35.7 per cent) than in males
without rhinitis (15.6 per cent).13 However, Heinrich
et al. observed no statistically significant association
between rhinitis and BP in males with or without aller-
gic rhinitis.12 In our study, four hypertensive patients
had seasonal allergic rhinitis and four had perennial
allergic rhinitis.
In the present study, we investigated the BP values in
allergic rhinitis patients. The study consisted of patients
with allergic rhinitis, asthma and hypertension, and a
control group comprising healthy participants. In the
allergic rhinitis group, 54 patients (54.5 per cent) had
seasonal allergic rhinitis and 45 patients (45.5 per
cent) had perennial allergic rhinitis. There were no sig-
nificant differences in systolic BP and diastolic BP
between the males and the females for any group
( p < 0.05).
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TABLE III
CORRELATION MATRIX∗
Age Gender Seasonal or perennial allergic rhinitis† Systolic BP Diastolic BP
0.126 −0.065 0.340 0.205
0.015 0.212 <0.0001 <0.0001
−0.093 0.239 0.180 0.144
0.074 0.017 <0.0001 0.006
−0.155 −0.025 0.054
0.126 0.634 0.299
0.137 0.070
0.176 0.493
0.698
<0.0001
Pairwise comparisons revealed no significant differ-
ences between: the control and allergic rhinitis groups,
the control and asthma groups, or the allergic rhinitis
and asthma groups. The systolic BP and diastolic BP
values of the males and females were significantly
higher in the hypertension group than in the allergic
rhinitis group. With the exception of males’ diastolic
BP, females’ systolic BP and diastolic BP, and males’
systolic BP values were significantly higher in the
hypertension group than in the control group. Females’
systolic BP values were also significantly higher in the
hypertension group than in the asthma group.
Correlation analysis showed that both systolic BP
and diastolic BP values increased with patient age.
Furthermore, increased systolic BP was related to
increased diastolic BP in all groups. In the allergic rhin-
itis group, perennial allergic rhinitis was detected more
in older patients, whereas seasonal allergic rhinitis was
more likely in younger patients.
Corbo et al. detected an association between allergic
rhinitis and hypertension in males, but they found no
associations between systolic BP, snoring and rhinitis
in pre-menopausal females.22 The increase in systolic
BP between males with allergic rhinitis and without
allergic rhinitis was approximately 7 mmHg in the
Kony et al. study13 and only 3.5 mmHg in the Aung
et al. study.9 Kony et al. reported mean systolic BP
values of 130.6 ± 12.7 mmHg in males with rhinitis
and 123.5 ± 13.9 mmHg in males without rhinitis.13
In our study, males with allergic rhinitis had a mean
systolic BP of 110.97 ± 18.86 mmHg and a mean dia-
stolic BP of 67.87 ± 11.69 mmHg; in females, the
mean systolic BP was 110.32 ± 14.92 mmHg and the
mean diastolic BP was 67.47 ± 11.09 mmHg. In our
study, the systolic BP and diastolic BP values of the
allergic rhinitis group were at normal levels, but were
lower compared to those reported by Kony et al.13
 ALLERGIC RHINITIS AND ARTERIAL BLOOD PRESSURE
• This study aimed to investigate the likelihood
of allergic rhinitis and potential co-
morbidities
• This population-based study investigated
blood pressure (BP) values in allergic rhinitis
patients
• There were no significant differences in
systolic or diastolic BP between males and
females with allergic rhinitis
Chronic sinusitis is a common inflammatory disease of
the facial sinuses. Dales et al. found that males with
sinusitis were over 2 per cent more likely to have hyper-
tension, compared with 4 per cent for females.23 They
reported that sinusitis was associated with hypertension
in females only. Dogra et al. observed that asthmatics
were 43 per cent more likely to have heart disease and
36 per cent more likely to have high BP than non-asth-
matics.5 They concluded that asthmatics had increased
odds of cardiovascular disease compared to non-asth-
matics. A study of 3000 atopic patients showed a preva-
lence of 0.5 per cent for nasal polyps, whereas 300 non-
allergic patients showed a prevalence of 4.5 per cent.24
Of those patients with allergic rhinitis in our study,
one also had nasal polyps, one had external ear canal
eczema and one had atopic eczema. Iribarren et al. sug-
gested that asthma was independently associated with a
modest but significantly increased risk of coronary heart
disease among females.25 They detected that asthma was
associated with a 1.22-fold increased risk of coronary
heart disease among females. Matheson et al. observed
that of patients with a history of hay fever, 2.2 per cent
had suffered a stroke, and they concluded that a
history of hay fever seems to be a risk factor for stroke.8
Conclusion
Asthma and rhinitis commonly occur as co-morbid-
ities, and both diseases impair QoL. In this study,
there were no statistically significant differences in sys-
tolic or diastolic BP between males and females with
allergic rhinitis. We believe that regular checking of
arterial BP is not necessary in patients with allergic
rhinitis. We also found that some diseases, such as
asthma and hypertension, coincide with allergic rhin-
itis. Further studies with larger numbers of participants
are needed to investigate the impact of allergic rhinitis
severity and the potential co-morbidities.
Acknowledgement
The authors thank Prof Sadullah Sakallioglu (Department of
Practical Statistics, Faculty of Sciences and Letters,
Çukurova University, Adana, Turkey) for statistical advice.
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Author for correspondence:
Dr Sertac Duzer,
Department of Otorhinolaryngology,
Elazığ Training and Research Hospital,
23200 Elazığ, Turkey.
E-mail: duzersertac@yahoo.com
Dr S Duzer takes responsibility for the integrity of the content of
the paper
Competing interests: None declared