Prednisone: Does it Increase Blood Pressure? Get the Facts

Prednisone is a corticosteroid used to treat various health problems, including infections, inflammation, allergic reactions, skin diseases, etc. 

High blood pressure is one of the side effects of prednisone.¹  While there is a possibility that prednisone can affect blood pressure levels, the relationship between prednisone use and hypertension is more complex. This article explores the impact of prednisone on blood pressure and examines what research has to say on the matter.

What is Prednisone?

Corticosteroids or steroids are hormones that your body produces. They have many functions, including controlling electrolyte homeostasis, metabolism, immune system, and stress response.² 

There are artificial corticosteroids prescribed to treat a wide range of diseases. Prednisone is a corticosteroid medication that reduces inflammation by suppressing your immune system. 

Prednisone treats many diseases affecting the immune system, endocrine system, joints, connective tissues, skin, allergies, eyes, respiratory system, gastrointestinal system, multiple sclerosis, and cancer.

Prednisone reduces inflammation by preventing certain types of white blood cells (polymorphonuclear leukocytes) from moving to areas with inflammation.³

Prednisone attaches to receptors on the surface of cells. Then enters the nucleus. Inside the nucleus, it binds to specific receptors and activates them, which leads to changes in how genes are expressed. This process helps reduce the production of proteins called proinflammatory cytokines that cause inflammation.

Prednisone is available in various forms, including tablets, delayed-release tablets, liquid solutions, and concentrated solutions. It is typically taken orally, with food, either once to four times a day or every other day, depending on your doctor's instructions.

To ensure the effectiveness of prednisone treatment, follow your doctor's instructions. It is crucial to consult your doctor or pharmacist before deviating from the prescribed dosage or duration.

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Does Prednisone Increase Blood Pressure?

Long-term prednisone use can cause serious side effects, including high blood pressure.⁴

The long-term and high-dose uses of prednisone can increase the possibility of experiencing side effects. Daily low doses of prednisone are less likely to cause side effects. A high dose of prednisone is more than 40mg/day.¹ 

A population-based cohort study investigated the effects of oral glucocorticoids on hypertension incidence in patients with chronic inflammatory diseases. The study looked at the data of more than seventy thousand patients. The hypertension incidence rate was 46.7 per 1000 person-years, meaning 46.7 cases developed hypertension in one year where the cohort was based. When the dose increased, the incidence rate increased as well. The study concluded that the blood pressure of patients using glucocorticoids should be monitored.⁵ 

Regular check-ups are crucial for mitigating the risks associated with prednisone and managing blood pressure effectively.

If you're taking prednisone and/or likely to suffer from high blood pressure, it is essential to consult a healthcare professional for personalized guidance. Your doctor will assess your medical history, evaluate the potential risks and benefits of prednisone treatment, and monitor blood pressure levels closely. 

Why and How Does Prednisone Raise Blood Pressure?

The impact of prednisone on blood pressure can vary based on individual factors such as lifestyle, medical history, and predisposition.⁶ However, two main reasons can account for the elevation in blood pressure commonly associated with prednisone use:

Fluid retention

Firstly, prednisone can disrupt fluid balance in the body. It promotes sodium and water retention, which increases extracellular fluid volume. 

Endogenously, adrenal glands secrete cortisol, which plays an important role in regulating nutrient metabolism, blood pressure, fluid and electrolyte balance, and the immune system. 

Adrenal glands secrete two types of corticosteroids: glucocorticoids and mineralocorticoids. Both have anti-inflammatory and immunosuppressive effects, but they have different actions as well.⁶ 

Prednisone is a glucocorticoid. Glucocorticoids act as cortisol, which regulates nutrient metabolism and the immune system. 

While mineralocorticoids act as aldosterone, a hormone adrenal glands produce. Aldosterone regulates sodium and water transport, thus, electrolyte and fluid homeostasis. Mineralocorticoids are used to treat diseases caused by impaired aldosterone production. They increase sodium and water reabsorption from the kidney, increasing blood pressure and volume. 

Glucocorticoids, including prednisone, show low mineralocorticoid activity. A high dose of glucocorticoid activates mineralocorticoid receptors, which increase sodium reabsorption, resulting in glucocorticoid-mediated hypertension. 

Weight gain

Secondly, prednisone often causes weight gain due to its impact on metabolism and appetite regulation.⁷

Corticosteroids affect brain regions that regulate appetite. A study investigated how prednisolone affects participants' responses to food stimuli. After an overnight fast, participants were injected with either 250 mg of prednisolone or a placebo.

Then, participants were shown pictures of food and objects while their brain scans were taken. The results showed that prednisolone made certain parts of the brain more active when looking at food, and this increased activity was associated with greater caloric intake. This suggests that prednisolone might make people want to eat more and could lead to weight gain when taken for a long time.

Excess weight gain can contribute to an increase in blood pressure. Individuals may notice weight gain, particularly in the face, abdomen, or upper back, and may also experience a redistribution of body fat.⁸

How Much Does Prednisone Raise Blood Pressure, and How Long Does It Take?

The extent to which prednisone raises blood pressure can vary based on several factors, including the medicine dosage (daily dose and cumulative dose), diet, overall health, and family history of hypertension.

Higher doses of prednisone, both in terms of daily dose and cumulative dose over time, are more likely to cause an increase in blood pressure. 

Your diet can also impact how much prednisone affects your blood pressure. A diet high in sodium (salt) can amplify the blood pressure-raising effects of the medication. You can adapt to a low-sodium diet. Monitoring your sodium intake while taking prednisone can help you prevent drug-related hypertension. 

Additionally, if you have a family history of hypertension (high blood pressure), you may be more susceptible to a rise in blood pressure while on prednisone. 

Regular blood pressure monitoring is necessary to assess changes and take appropriate measures to manage blood pressure effectively.

You should consult your doctor if you have any concerns or potential risks. Your doctor will guide you in managing your blood pressure while taking the medication. 

Other Common Side Effects of Prednisone

Like any medication, prednisone can have side effects that individuals should be aware of. Not every individual experiences all the side effects, but monitoring your responses to medication and recognizing the side effects when they occur is important.⁹ 

Possible side effects of prednisone may include, but are not limited to:¹⁰

Swollen hands, feet, and ankles (fluid retention)

Prednisone can cause fluid retention, leading to swelling in the hands, feet, and ankles. This fluid retention occurs due to prednisone's effects on sodium and water balance in the body.

High blood sugar (Hyperglycemia)

Prednisone can elevate blood sugar levels, especially in individuals with diabetes or those at risk of developing diabetes. 

The increase in blood sugar occurs due to prednisone's ability to increase insulin resistance and impair glucose metabolism. This effect is observed shortly after exposure to prednisone and can be more pronounced in postprandial glucose levels.

Frequent indigestion (Gastrointestinal discomfort)

Prednisone can disrupt the digestive system and lead to indigestion or gastrointestinal discomfort. This effect may be due to prednisone's impact on gastric acid secretion, gastric motility, and the integrity of the gastrointestinal lining.

Appetite changes

Prednisone can increase appetite, leading to increased hunger or changes in food preferences. This effect is thought to be mediated by prednisone's impact on the central nervous system and appetite-regulating hormones.

Trouble sleeping (Insomnia)

Insomnia or difficulty sleeping can occur as a side effect of prednisone. The exact cause of this side effect is unclear, but it may be related to prednisone's effects on the central nervous system, including alterations in neurotransmitter levels and circadian rhythm disruption.

Mood changes

Prednisone may cause mood swings, irritability, or emotional changes in some individuals. These mood changes can range from mild to severe and may be attributed to prednisone's impact on neurotransmitter systems and hormonal balance in the brain.

Acne

Skin issues, including acne breakouts, can occur due to prednisone use. Prednisone can increase sebum production, which can lead to acne. This effect is more commonly observed with higher doses and prolonged prednisone use.

Thin and fragile skin

Prolonged use of corticosteroids like prednisone can cause thinning and fragility of the skin. Prednisone inhibits collagen synthesis and alters the skin's structure, resulting in thinning of the dermis. This effect makes the skin more prone to tearing, bruising, and delayed wound healing.

Osteoporosis 

Corticosteroids can interfere with bone mineralization. There is a balance between bone formation and resorption (breaking down). Corticosteroids can favor bone resorption, resulting in decreased bone density and increasing the risk of fractures and osteoporosis. 

Headaches

Some individuals may experience headaches while taking prednisone. The exact mechanism for this side effect is not well understood but may be related to prednisone's effects on blood vessels, inflammation, and central nervous system function.

If you encounter any of these side effects or others not mentioned, it is essential to speak with your healthcare provider. They can evaluate your situation, assess the impact of side effects, and determine if switching to an alternative medication is necessary.

What to Do to Prevent High Blood Sugar When Taking Prednisone?

Corticosteroid therapy can cause drug-induced diabetes mellitus. Lifestyle changes can be beneficial in preventing high blood sugar when taking prednisone. Here are some general recommendations to consider:¹¹

Exercise

Regular physical activity helps regulate blood sugar levels and improves insulin sensitivity. A combination of 150 minutes of aerobic exercise and two days of strength training weekly is recommended by the World Health Organization (WHO). 

Maintain a healthy weight

Weight management is crucial for blood sugar control. Adopting a healthy and balanced diet and a regular exercise routine can help you achieve weight loss goals and maintain a healthy body weight.

Quit smoking and limit alcohol intake

According to the Centers for Disease Control and Prevention (CDC), smokers are more likely to develop type 2 diabetes than non-smokers. Smoking can lead to other diseases, which makes diabetes management more challenging. Excessive alcohol consumption can disrupt blood sugar levels, too. Quitting smoking and limiting alcohol intake can improve your blood sugar control.

Optimal sleep cycles

Establish regular sleep patterns and aim for adequate sleep duration. Poor sleep quality and inadequate sleep can affect blood sugar regulation and insulin sensitivity.

Stay hydrated

The majority of your body consists of water. Dehydration causes your body to function sub-optimally. Stay hydrated by drinking before feeling thirsty. Proper hydration supports overall health, including healthy blood sugar levels. 

Follow a balanced diet

Focus on a balanced diet. Choose nutrient-dense foods, including whole grains, lean proteins, fruits, vegetables, and healthy fats. Remember, nutrition should be personalized to your individual needs and requirements. Seeking professional help is always a good idea to find a proper nutrition plan.  

Monitor carbohydrate intake

Carbohydrates constitute a majority of your energy source. Therefore, you choose it wisely. Opt for complex carbohydrates with a low glycemic index and high fiber that slowly increase blood sugar levels. It is also important to balance carbohydrate intake with protein and healthy fats.

Regularly monitor blood sugar levels

Checking your blood sugar levels regularly can help to determine spikes and abnormalities in blood sugar levels. Monitoring allows you to track changes and consult your doctor when adjustments in your diet or medication are necessary. 

Visit your doctor frequently

Regularly consult your doctor to discuss your blood sugar management while taking prednisone. 

Remember to consult your healthcare professional for personalized advice on managing blood sugar levels while taking prednisone, as they can provide tailored recommendations based on your needs and medical history.

Alternative Treatments to Prednisone that Won't Raise Blood Pressure 

Alternative medications change based on the condition prednisone is prescribed to treat. 

Some prednisone alternatives are:

Methylprednisolone is a corticosteroid used to relieve inflammation and treat various conditions such as rheumatoid arthritis, allergies, asthma, and certain types of cancer. It is taken orally in tablet form.¹²

Dexamethasone is a corticosteroid that has potent anti-inflammatory effects. It is commonly used to treat severe inflammation, certain cancers, and autoimmune disorders.¹³

Hydrocortisone is a corticosteroid used to treat various health problems, including skin conditions, piles, mouth ulcers, painful joints, and adrenal gland conditions. Different forms of hydrocortisone, such as creams, ointments, suppositories, tablets, and injections, are available depending on the specific health issue.¹⁴

Remember, seeking professional guidance from a qualified doctor is crucial to finding the proper medication for your medical condition. 

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