Cardiovascular risk

Description: hypertension caused by cortisone is usually mild and isn't accompanied by symptoms. Your physician can make a diagnosis after the measuring your blood pressure during checkups and treatment. Furthermore, patients undergoing long-term treatment with corticosteroids have an increased risk of cardiovascular problems.

Frequency: Hypertension is diagnoses in approximately 10% of patients treated with corticosteroids, many of them after several months of treatment. This frequency is higher than that within similar groups of people that have not been treated with corticosteroids. Major cardiovascular complications such as heart failure and angina pectoris are very rare.

Subjects at risk: the risk factors of steroid-induced hypertension are not well known. Older patients and those with a family history of hypertension seem more often affected. Furthermore, the risk is low for doses of cortisone that are less than 15-20 mg per day. Salt intake seems to not be influential in the development of hypertension caused by cortisone treatment.

Long-term versus short-term treatment: Hypertension may appear form the earliest days of treatment with corticosteroids. However, most cases (along with major cardiovascular complications) occur after several weeks or months of treatment.

Prevention/treatment: The dose and the duration of treatment should be kept to a minimum to prevent hypertension and any further issues. Regular exercise and a healthy diet can limit the risk of these complications taking place. Your doctor may prescribe medication such as an anti-hypertensive if diet and exercise do not help the patient.

Screening: regular measurement of blood pressure (either by your doctor or by yourself at the pharmacy) is recommended.

Reversibility: steroid-induced hypertension regresses or disappears upon reduction of discontinuation of treatment.

Useful references
  • Jackson SH et al. Does long-term low-dose corticosteroid therapy cause hypertension? Clin Sci (Lond). 1981
  • Huscher D et al. Dose-related patterns of glucocorticoid-induced side effects. Ann Rheum Dis. 2009
  • Gudbjornsson B et al. Prevalence of long term steroid treatment and the frequency of decision making to prevent steroid induced osteoporosis in daily clinical practice. Ann Rheum Dis. 2002
  • Souverein PC et al. Use of oral glucocorticoids and risk of cardiovascular and cerebrovascular disease in a population based case-control study. Heart. 2004
  • Wei L et al. Taking glucocorticoids by prescription is associated with subsequent cardiovascular disease. Ann Intern Med. 2004
  • Whitworth JA. Mechanisms of glucocorticoid-induced hypertension. Kidney Int. 1987
  • Fardet L et al. Effet à court terme des apports sodés sur la pression artérielle des patients recevant une corticothérapie systémique : étude prospective, randomisée, croisée . Rev Med Interne. 2009

lastest update : August 02 2017