From the Guidelines
Prednisone can raise blood pressure within hours to days of starting treatment, with the effect varying based on dose and individual factors. According to the most recent evidence from 1, glucocorticoids such as prednisone can cause hypertension as a notable toxicity. The exact timeframe for this effect is not specified in the provided studies, but it is generally understood that the onset of hypertension due to glucocorticoids can occur within a short period after initiation of treatment.
Key Points to Consider
- Higher doses of prednisone (generally above 20 mg daily) are more likely to cause significant blood pressure increases, as suggested by general clinical knowledge and the context of the provided evidence.
- The mechanism involves prednisone's effects on sodium retention, increased fluid volume, and enhanced vascular sensitivity to hormones that constrict blood vessels, which is a well-established understanding in the field of medicine.
- Patients taking prednisone should monitor their blood pressure regularly, especially during the first few weeks of treatment, as recommended in 1 for monitoring blood pressure and serum glucose in patients on glucocorticoids.
- Those with pre-existing hypertension or cardiovascular disease should be particularly vigilant, as they are at a higher risk of experiencing significant blood pressure increases due to prednisone.
Management of Blood Pressure Increase
If blood pressure rises significantly, it is crucial not to stop prednisone abruptly but to consult a healthcare provider. The provider may adjust the dose, add antihypertensive medication, or recommend sodium restriction and increased physical activity to help manage this side effect, aligning with general principles of managing steroid-induced hypertension.
Monitoring and Dose Adjustment
Monitoring blood pressure and serum glucose, as mentioned in 1, is essential for patients on prednisone, especially if they are anticipated to be on glucocorticoids for three months or more. Regular monitoring allows for the early detection of potential issues and the implementation of appropriate management strategies to mitigate the risk of hypertension and other side effects associated with prednisone use.
From the FDA Drug Label
Cardio-renal Average and large doses of hydrocortisone or cortisone can cause elevation of blood pressure, salt and water retention, and increased excretion of potassium These effects are less likely to occur with the synthetic derivatives except when used in large doses.
The rate at which prednisone raises blood pressure is not directly stated in the label. However, it is mentioned that average and large doses of corticosteroids can cause elevation of blood pressure.
- The label does not provide a specific timeframe for this effect to occur.
- It is also noted that synthetic derivatives, which include prednisone, are less likely to cause this effect except when used in large doses 2.
From the Research
How Fast Prednisone Raises Blood Pressure
- The effect of prednisone on blood pressure is not directly addressed in most of the provided studies, which primarily focus on antihypertensive drugs and their effects on blood pressure variability and control.
- However, one study 3 investigated the impact of low-dose prednisone or prednisolone therapy on blood pressure in patients with asthma and rheumatoid arthritis.
- The study found that there was a rise in both mean systolic and mean diastolic blood pressure, but this was not related to the dose of corticosteroid or duration of therapy.
- The study also noted that blood pressure before therapy was the main determinant of the change in blood pressure, suggesting that individual factors may play a role in how prednisone affects blood pressure.
- Unfortunately, the study does not provide specific information on how fast prednisone raises blood pressure, as it only reports on the changes in blood pressure after at least 1 year of therapy.
- The other studies 4, 5, 6, 7 do not provide relevant information on the effects of prednisone on blood pressure, as they focus on antihypertensive drugs and their effects on blood pressure control and variability.