From the FDA Drug Label
Cardio-Renal 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.
- Steroids are not contraindicated in patients with hypertension, but they should be used with caution due to the potential for sodium retention and edema.
- The decision to use steroids in patients with hypertension should be made on a case-by-case basis, weighing the potential benefits against the potential risks 1.
From the Research
Steroids are not absolutely contraindicated in patients with hypertension, but they should be used with caution as they can worsen blood pressure control. When prescribing steroids to hypertensive patients, the lowest effective dose should be used for the shortest duration possible. Common steroids like prednisone (typically 5-60 mg daily), dexamethasone (0.5-10 mg daily), or methylprednisolone (4-48 mg daily) can all raise blood pressure through mechanisms including sodium and water retention, increased vascular sensitivity to vasoconstrictors, and decreased vasodilator production 2. For hypertensive patients requiring steroids, blood pressure should be monitored more frequently, and antihypertensive medications may need adjustment. Non-steroidal alternatives should be considered when appropriate. Short courses of steroids (less than 2 weeks) generally pose less risk than long-term therapy. If long-term steroid therapy is necessary, consider steroid-sparing agents or local steroid applications (inhaled, topical, or intra-articular) which have less systemic effects on blood pressure.
Some key points to consider when using steroids in hypertensive patients include:
- Monitoring blood pressure regularly during steroid treatment
- Adjusting antihypertensive medications as needed
- Using the lowest effective dose of steroids for the shortest duration possible
- Considering non-steroidal alternatives when appropriate
- Educating patients about potential blood pressure effects and advising them to monitor their blood pressure at home during steroid treatment. According to a recent systematic review, prednisone was found to increase blood pressure and risk of hypertension in three studies 3. Therefore, it is essential to weigh the benefits and risks of steroid therapy in patients with hypertension and to closely monitor their blood pressure during treatment.