Does glucocorticoid (corticosteroid) therapy affect blood pressure (BP)?

From the Guidelines

Glucocorticoids can increase blood pressure, and patients on glucocorticoid therapy should have their blood pressure monitored regularly, particularly when starting treatment or changing doses. Glucocorticoids like prednisone, dexamethasone, and hydrocortisone often cause hypertension as a side effect, especially at higher doses and with longer treatment durations [ 1 ]. This effect is dose-dependent and typically occurs within days to weeks of starting therapy. The blood pressure elevation can be significant, with increases of 10-15 mmHg or more in some patients. Glucocorticoids raise blood pressure through multiple mechanisms, including increased sodium retention in the kidneys, enhanced vascular sensitivity to catecholamines, suppression of vasodilatory systems, and direct effects on blood vessel walls.

Some key points to consider when managing patients on glucocorticoid therapy include:

• Monitoring blood pressure regularly, especially when starting treatment or changing doses
• Adjusting antihypertensive medications for patients with pre-existing hypertension
• Managing hypertension with standard antihypertensive drugs while continuing glucocorticoid therapy if necessary
• Being aware that blood pressure typically returns to baseline after discontinuation of glucocorticoids, though this may take weeks depending on the duration of treatment [ 1 ].

It is essential to evaluate and treat comorbidities and risk factors for adverse effects, including hypertension, before starting glucocorticoid treatment [ 1 ]. During treatment, patients should be monitored for body weight, blood pressure, peripheral edema, cardiac insufficiency, serum lipids, blood and/or urine glucose, and ocular pressure, depending on individual patient risk, glucocorticoid dose, and duration [ 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. In general, dose selection for an elderly patient should be cautious, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal, or cardiac function, and of concomitant disease or other drug therapy In particular, the increased risk of diabetes mellitus, fluid retention and hypertension in elderly patients treated with corticosteroids should be considered.

Glucocorticoids, such as prednisone, can affect blood pressure (BP). The FDA drug label warns that average and large doses of glucocorticoids can cause elevation of blood pressure. Additionally, the label mentions that elderly patients treated with corticosteroids are at an increased risk of hypertension 2, 2.

From the Research

Glucocorticoids and Blood Pressure

• The relationship between glucocorticoids and blood pressure has been investigated in several studies 3, 4, 5.
• A population-based cohort study found that the incidence rate of hypertension increased with higher cumulative glucocorticoid prednisolone-equivalent dose 3.
• Another study found that recent glucocorticoid use was associated with a 17% increased hazard of hypertension, particularly at doses above 7.5mg 4.
• The Henan Rural Cohort Study found that serum glucocorticoids were associated with various blood pressure indices, including systolic blood pressure, pulse pressure, and mean arterial pressure 5.

Key Findings

• Cumulative dose of oral glucocorticoids was associated with increased incidence of hypertension 3.
• Recent glucocorticoid use was associated with incident hypertension in patients with rheumatoid arthritis 4.
• Serum deoxycortisol was positively correlated with systolic blood pressure, pulse pressure, mean arterial pressure, and other blood pressure indices 5.
• Monitoring of patients on long-term glucocorticoid therapy is essential to prevent and manage hypertension, but the overall monitoring provided is not satisfactory 6.

Implications

• Clinicians should consider cardiovascular risk when prescribing glucocorticoids and ensure blood pressure is regularly monitored and treated where necessary 4.
• Patients with chronic inflammatory diseases, diabetes mellitus, and other comorbidities should be closely monitored for hypertension when treated with glucocorticoids 3, 5.
• Further studies are needed to fully understand the relationship between glucocorticoids and blood pressure, but current evidence suggests a significant association 3, 4, 5.