Can hydrocortisone (cortisol) increase blood pressure, specifically causing hypertension?

From the Guidelines

Yes, hydrocortisone can increase blood pressure, and patients should be closely monitored for hypertension, especially when taking higher doses or for extended periods. As a corticosteroid medication, hydrocortisone can cause sodium and fluid retention in the body, which may lead to elevated blood pressure, especially in individuals with pre-existing hypertension, heart disease, or kidney problems 1. The blood pressure increase is typically dose-dependent, meaning higher doses (such as those used for severe inflammatory conditions) are more likely to cause significant blood pressure elevation than lower doses (like those in over-the-counter creams).

Key Considerations

• Patients with pre-existing hypertension, heart disease, or kidney problems should be particularly cautious when using hydrocortisone, as they are more susceptible to the blood pressure-elevating effects of the medication 1.
• Regular monitoring of blood pressure is essential for patients taking hydrocortisone, especially when initiating treatment or adjusting doses 1.
• If symptoms like headaches, dizziness, or visual changes occur while taking hydrocortisone, patients should contact their healthcare provider, as these could be signs of elevated blood pressure 1.
• The treating physician should ensure that the patient is adequately monitored for potential corticosteroid side effects, including hypertension, and conduct an assessment of health-related quality of life (HRQoL) while patients are receiving corticosteroids 1.

Management and Prevention

• To minimize the risk of hypertension, patients should be encouraged to maintain a healthy lifestyle, including a balanced diet, regular exercise, and stress management.
• Healthcare providers should closely monitor patients' blood pressure and adjust treatment plans as needed to prevent complications.
• In cases where hydrocortisone is necessary, the lowest effective dose should be used for the shortest duration possible to minimize the risk of side effects, including hypertension 1.

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

• Hydrocortisone can increase blood pressure, specifically causing hypertension, especially with average and large doses.
• Key factors to consider:
  • Dose: Average and large doses are more likely to cause elevation of blood pressure.
  • Electrolyte imbalance: Salt and water retention, and increased excretion of potassium may occur.
• Clinical decision: Monitor blood pressure and electrolyte levels in patients taking hydrocortisone, especially with average and large doses, and consider dietary salt restriction and potassium supplementation as necessary 2.

From the Research

Effects of Hydrocortisone on Blood Pressure

• Hydrocortisone can increase blood pressure, as evidenced by a study published in 1989, which found that oral hydrocortisone increased systolic blood pressure in healthy male volunteers 3.
• A 2016 randomized controlled trial found that a higher dose of hydrocortisone resulted in an increase in systolic and diastolic blood pressure in patients with secondary adrenal insufficiency 4.
• Another study published in 2014 found that hydrocortisone increased systolic blood pressure in both normal and endotoxemic rats, with the magnitude of the effect depending on the dose and pathophysiological conditions 5.

Mechanisms of Hydrocortisone-Induced Hypertension

• The increase in blood pressure caused by hydrocortisone may be due to an increase in cardiac output, as suggested by the 1989 study 3.
• Hydrocortisone may also enhance the pressor response to catecholamines, as found in a study published in 2006, which suggested that cortisol mediates cardiovascular tolerance to endotoxin and maintains vascular sensitivity to catecholamines 6.
• The 2016 study found that the higher dose of hydrocortisone led to decreases in serum aldosterone and plasma renin, and increased the ratio of plasma and urinary cortisol to cortisone, which may contribute to the increase in blood pressure 4.

Variability in Response to Hydrocortisone

• A case report published in 2023 found that hydrocortisone induced a decrease in blood pressure in a patient with anterior pituitary hypofunction, likely due to an allergic reaction 7.
• The response to hydrocortisone may vary depending on the individual and the underlying condition, as suggested by the different findings of the studies cited above 3, 4, 5, 7, 6.