Can Deflazacort (corticosteroid) cause elevated blood pressure in a patient with a history of hypertension, currently on CTD T AM (Chlorthalidone (diuretic) 12.5/40/5) and Telma (Telmisartan (angiotensin II receptor antagonist) 40) HS (hydrochlorothiazide (diuretic)), who had previously well-controlled blood pressure?

Deflazacort is Almost Certainly Causing Your Patient's Blood Pressure Elevation

Yes, deflazacort is the most likely cause of your patient's sudden blood pressure rise, and this is a well-established adverse effect of corticosteroids that requires immediate management adjustment.

Why Deflazacort is Responsible

Direct Mechanism of Blood Pressure Elevation

• Corticosteroids, including deflazacort, directly cause elevation of blood pressure through multiple mechanisms: sodium and water retention, increased potassium excretion, and increased calcium excretion 1
• The FDA label for deflazacort explicitly warns that it "can cause elevation of blood pressure, salt, and water retention, and increased excretion of potassium and calcium" 1
• This effect is dose-dependent, and your patient is on 12 mg daily (6 mg twice daily), which is a moderate immunosuppressive dose 1

Clinical Context Supporting This Diagnosis

• The temporal relationship is classic: previously well-controlled hypertension that suddenly became uncontrolled after starting deflazacort 2
• Steroids are among the "most important prescription drugs that affect blood pressure" alongside NSAIDs 2
• The JNC 7 guidelines specifically list corticosteroids as agents that may alter blood pressure and can cause "loss of control of previously well-controlled hypertension" 3

Immediate Management Steps

Monitor and Assess

• Check blood pressure regularly and assess for signs of volume overload (peripheral edema, weight gain, dyspnea) 1
• Monitor serum potassium levels immediately, as deflazacort increases potassium excretion 1
• Monitor serum electrolytes, renal function (creatinine, eGFR), and consider checking for hyperglycemia 4

Optimize Current Antihypertensive Regimen

• Your patient is on CTD T (chlorthalidone 12.5 mg/telmisartan 40 mg/amlodipine 5 mg) in the morning and telmisartan 40 mg at night 4
• First step: Increase chlorthalidone to 25 mg daily, as this is the preferred thiazide for resistant hypertension and provides superior 24-hour blood pressure control 3, 4
• Dietary salt restriction and potassium supplementation may be necessary given deflazacort's effects on electrolytes 1

Add Third-Line Agent if Needed

• If blood pressure remains uncontrolled after optimizing chlorthalidone, increase amlodipine from 5 mg to 10 mg daily 4
• The combination of telmisartan with hydrochlorothiazide (or chlorthalidone) provides greater blood pressure reduction than monotherapy, particularly effective for nighttime blood pressure control 5, 6, 7

Consider Spironolactone for Resistant Hypertension

• If blood pressure remains uncontrolled after 4 weeks on optimized three-drug therapy (chlorthalidone 25 mg + telmisartan 80 mg + amlodipine 10 mg), add spironolactone 25-50 mg daily 4
• Spironolactone is particularly rational here because it directly counteracts deflazacort's mineralocorticoid effects (sodium retention, potassium loss) 3, 4
• Spironolactone achieves blood pressure control in approximately 79% of patients with resistant hypertension 4

Critical Monitoring with Deflazacort

Cardiovascular Precautions

• Deflazacort should be used with caution in patients with congestive heart failure, hypertension, or renal insufficiency 1
• Monitor for signs of volume overload: weight gain, peripheral edema, shortness of breath 1

Electrolyte Management

• Check potassium within 1-2 weeks after any medication adjustment, as both deflazacort (decreases potassium) and potential spironolactone addition (increases potassium) affect levels 4, 1
• Consider potassium supplementation if levels drop below normal range 1

Regarding Myoril Maxx (Thiocolchicoside)

• Myoril Maxx (thiocolchicoside, a muscle relaxant) is not known to significantly affect blood pressure 2
• The blood pressure elevation is attributable to deflazacort, not the muscle relaxant 3, 2

Communication with Prescribing Provider

• Contact the provider who prescribed deflazacort to discuss whether the dose can be reduced or the duration shortened 1
• If deflazacort is essential for the underlying condition, accept that more intensive antihypertensive therapy will be required for the duration of steroid treatment 2
• The hypertensive effects of unavoidable medications like corticosteroids are "most commonly overcome by increasing the intensity of antihypertensive drug treatment" 2

Target Blood Pressure

• Aim for blood pressure <130/80 mmHg, which is the current guideline recommendation for most patients with hypertension 3, 4
• For patients <65 years, target 120-129/70-79 mmHg if well tolerated 4

Common Pitfall to Avoid

• Do not discontinue or reduce antihypertensive medications assuming the blood pressure rise is temporary—corticosteroid-induced hypertension persists as long as the steroid is continued 1, 2
• The blood pressure will likely remain elevated until deflazacort is discontinued or the antihypertensive regimen is intensified 3, 2