How does Prednisone (corticosteroid) affect blood pressure in patients, particularly those with hypertension (high blood pressure) or cardiovascular disease?

From the FDA Drug Label

Average and large doses of hydrocortisone or cortisone can cause elevation of blood pressure, salt and water retention, and increased excretion of potassium. As sodium retention with resultant edema and potassium loss may occur in patients receiving corticosteroids, these agents should be used with caution in patients with congestive heart failure, hypertension, or renal insufficiency. The increased risk of diabetes mellitus, fluid retention and hypertension in elderly patients treated with corticosteroids should be considered.

Prednisone can cause an elevation of blood pressure due to sodium retention and fluid retention. Patients with hypertension or cardiovascular disease should be cautious when taking prednisone, as it may worsen their condition.

• Key points to consider:
  • Monitor blood pressure closely
  • Use lowest possible dose to control the condition
  • Gradually reduce dosage when possible
  • Consider alternative treatments if necessary 1, 1, 1

From the Research

Prednisone can elevate blood pressure in patients, particularly those with pre-existing hypertension or cardiovascular disease, due to its effects on sodium and fluid retention, as well as increased vascular sensitivity to hormones that constrict blood vessels. The relationship between prednisone and blood pressure is supported by several studies, including a 2020 population-based cohort study that found a cumulative dose of oral glucocorticoids was associated with increased incidence of hypertension 2. This study, which analyzed electronic health records from 389 practices in England, found that the incidence rate of hypertension increased with higher cumulative glucocorticoid prednisolone-equivalent dose.

Key Points to Consider

• The effect of prednisone on blood pressure is dose-dependent, with higher doses (typically above 20mg daily) and longer treatment durations posing greater risks 2.
• Blood pressure increases usually begin within days of starting therapy and may persist throughout treatment.
• Patients with hypertension or cardiovascular disease should have their blood pressure monitored regularly while on prednisone, ideally checking it daily during the first week of treatment and then weekly thereafter.
• If prednisone is medically necessary, physicians may need to adjust antihypertensive medications to counteract these effects.
• Lifestyle modifications like reducing sodium intake, maintaining physical activity, and limiting alcohol can help minimize blood pressure elevations.

Mechanism of Action

The exact mechanism by which prednisone affects blood pressure is complex and involves multiple pathways, including the activation of the mineralocorticoid receptor and the increase in vascular sensitivity to hormones that constrict blood vessels 3. Additionally, prednisone can cause sodium and fluid retention, which can also contribute to elevated blood pressure.

Clinical Implications

Given the potential for prednisone to elevate blood pressure, it is essential for healthcare providers to closely monitor patients' blood pressure while on this medication, particularly those with pre-existing hypertension or cardiovascular disease. By being aware of the potential risks and taking steps to mitigate them, healthcare providers can help minimize the adverse effects of prednisone on blood pressure and ensure the best possible outcomes for their patients.