Elevated Blood Pressure in DRESS Syndrome
The elevated blood pressure in DRESS syndrome is primarily caused by systemic corticosteroid therapy used to treat the condition, not by the syndrome itself. 1
Primary Mechanism: Corticosteroid Treatment
The main cause of hypertension in DRESS patients is iatrogenic:
- High-dose systemic corticosteroids (methylprednisolone 0.5-2 mg/kg IV or oral equivalent) are the standard treatment for DRESS syndrome and directly elevate blood pressure through multiple mechanisms 1
- Corticosteroids cause hypertension by increasing sodium retention, expanding blood volume, and enhancing vascular reactivity 1
- The prolonged steroid taper required for DRESS (minimum 4 weeks, often longer) maintains this hypertensive effect throughout the treatment course 1
Secondary Contributing Factors
Acute Kidney Injury
- Renal involvement is the second most common organ manifestation in DRESS syndrome after hepatic involvement 2
- Acute kidney injury occurs frequently, causing salt and water retention that exacerbates blood pressure elevation 3, 2
- Hematuria, proteinuria, and declining glomerular filtration rate are characteristic renal findings 3
Fluid Management Complications
- Patients with DRESS often require careful fluid administration for supportive care, including attention to fluid and electrolyte balance 1
- Overzealous fluid resuscitation in critically ill DRESS patients can contribute to volume expansion and hypertension 1
Clinical Context and Monitoring
The hypertension in DRESS is typically treatment-related rather than disease-related, which has important implications:
- Blood pressure elevation should be anticipated when initiating corticosteroid therapy 1
- Patients admitted to burn units or ICUs for severe DRESS (SJS/TEN overlap) require close hemodynamic monitoring 1
- Pre-existing hypertension may worsen significantly during DRESS treatment 1
Key Pitfall to Avoid
Do not attribute elevated blood pressure solely to the underlying DRESS pathophysiology—recognize that your treatment (corticosteroids) is the primary culprit and manage accordingly with standard antihypertensive therapy while continuing necessary immunosuppression 1
The combination of high-dose corticosteroids, acute kidney injury, and fluid management challenges creates a perfect storm for hypertension in DRESS patients, requiring vigilant blood pressure monitoring throughout the treatment course 1, 3, 2