Do steroids raise blood pressure?

Steroids Do Raise Blood Pressure

Yes, steroids do raise blood pressure and are recognized as medication-induced causes of hypertension. 1 This effect can significantly impact morbidity and mortality, particularly with long-term use.

Mechanism and Evidence

Steroids raise blood pressure through multiple mechanisms:

• Increased cardiac output
• Expanded plasma and extracellular fluid volumes
• Increased exchangeable sodium
• Enhanced pressor responsiveness to catecholamines
• Possible "hypertensinogenic" mechanism distinct from classical mineralocorticoid or glucocorticoid effects 2

Research shows that both natural and synthetic glucocorticoids can cause hypertension:

• Synthetic steroids (prednisolone, methylprednisolone, triamcinolone, dexamethasone) raise blood pressure even without plasma volume expansion or sodium retention 3
• The hypertensive effect occurs rapidly, within 4-6 hours of administration 4
• Blood pressure increases can be substantial - studies show increases of 6-13 mmHg systolic and 7-11 mmHg diastolic with various synthetic steroids 3

Clinical Considerations

Risk Factors for Steroid-Induced Hypertension

The blood pressure effect of steroids varies considerably between individuals, with greater increases noted in:

• Elderly patients
• Those with higher baseline blood pressure
• Patients already on antihypertensive therapy
• Those with kidney disease 1

Timing of Blood Pressure Effects

Interestingly, hypertension can occur both during maximum steroid use and during steroid reduction:

• In one study of young asthma patients, diastolic blood pressures increased to 100-120 mmHg 1-8 weeks after corticosteroid reduction began 5
• This suggests the need for blood pressure monitoring not only during steroid therapy but also during the tapering period

Dose-Response Relationship

The hypertensive effect appears dose-dependent:

• Higher doses of prednisolone (0.75-1.0 mg/kg daily) are associated with more significant adverse effects 1
• Even lower doses can affect blood pressure in susceptible individuals

Management Approach

1. Screen all patients on steroids for hypertension

   • Regular blood pressure monitoring is essential during steroid therapy and during tapering

2. Consider steroid-sparing alternatives when possible

   • If steroids are required, use the minimum effective dose

3. Treat hypertension if it develops

   • If steroids are required or preferred, treat blood pressure to target regardless 1
   • Angiotensin-converting enzyme inhibitors may be particularly effective for steroid-induced hypertension 5
   • Diuretics may be less effective in some cases 5

4. Monitor during steroid tapering

   • Continue blood pressure monitoring during and after steroid reduction
   • Be aware that hypertension can paradoxically worsen during steroid tapering 5

Special Populations

Athletes

Athletes using anabolic steroids should be aware of potential negative impacts on blood pressure and lipoproteins 1. All athletes diagnosed with hypertension should be screened for steroid use, including:

• Prescription steroids for medical conditions
• Anabolic steroids
• Over-the-counter supplements that may contain steroid-like compounds

Transplant Recipients

In transplant recipients on immunosuppressive regimens:

• Steroid withdrawal is generally accompanied by reduction in blood pressure
• The benefit is greatest in previously hypertensive patients receiving relatively low doses of cyclosporine 6

In conclusion, steroids clearly raise blood pressure through multiple mechanisms, and this effect should be anticipated and monitored in all patients receiving steroid therapy.