At what level of hypertension is it contraindicated to prescribe prednisone (corticosteroid)?

From the Research

Prednisone should be used with caution in patients with high blood pressure, but there is no absolute blood pressure threshold that universally prohibits its use, with systolic blood pressure exceeding 180 mmHg or diastolic pressure exceeding 120 mmHg being a concern, as indicated by the most recent study 1. When evaluating the risk of prescribing prednisone to patients with high blood pressure, it is essential to consider the severity of the condition requiring treatment and the patient's cardiovascular health.

• The decision to prescribe prednisone should be based on a thorough evaluation of the risk-benefit ratio for each patient.
• If prednisone is necessary, doctors may increase antihypertensive medications, prescribe the lowest effective dose for the shortest duration possible, recommend salt restriction, and monitor blood pressure frequently during treatment, as suggested by 2.
• Prednisone causes blood pressure elevation by promoting sodium retention, increasing fluid volume, and enhancing vascular sensitivity to constricting agents, which is a critical consideration in patients with existing hypertension, as noted in 3.
• Patients with existing hypertension should inform their healthcare provider about all medications they're taking and monitor their blood pressure regularly while on prednisone therapy, as emphasized by 4. The most recent study 1 provides guidance on the treatment of hypertension, which is essential in managing patients with high blood pressure who require prednisone therapy.
• First-line therapy for hypertension is lifestyle modification, including weight loss, healthy dietary pattern, physical activity, and moderation or elimination of alcohol consumption.
• The decision to initiate antihypertensive medication should be based on the level of blood pressure and the presence of high atherosclerotic cardiovascular disease risk.
• First-line drug therapy for hypertension consists of a thiazide or thiazide-like diuretic, an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker, and a calcium channel blocker, which should be titrated according to office and home blood pressure levels to achieve the target blood pressure, as recommended by 1.