Does prednisone raise your heart rate and blood pressure

Dear Dr. Gott: What are some of the side effects of prednisone or an overdose of it? My elderly dad (age 82) is fairly healthy. He came down with a cold a few months ago. He saw his doctor, who prescribed prednisone, two pills by mouth four times a day for five days. After taking it for four days, he became delirious and nearly lost consciousness. He went back to the doctor who simply said, “Oh, yeah.”

My father seems to be tired a lot, has very little energy and is short of breath. He is seeing a heart specialist, who diagnosed him with a fibrillating heart. He never had heart problems before the prednisone. Could the medication have caused his heart problem?

Dear Reader: Prednisone is an oral corticosteroid and is not an appropriate treatment option for trivial colds. It can, however, be given for severe bronchitis, pneumonia, asthma, arthritis and other inflammatory conditions.

Because you do not give specifics about the dosage of your father’s prednisone, I can only give general information. Prednisone comes in 1, 2.5, 5, 10, 20 and 50 mg forms; therefore, your father could have been taking anywhere from 8 to 400 mg of the drug daily. While I highly doubt he was taking anything higher than 40 mg a day, I cannot be sure.

Prednisone has many side effects, including muscle weakness, potassium loss, high-blood pressure, thin skin, headache, seizure, adrenal unresponsiveness, glaucoma, congestive heart failure and more. Of these, both low potassium and high-blood pressure can be associated with heart rhythm abnormalities such as your father’s atrial fibrillation. This is NOT to say that his symptoms and difficulties are due to the prednisone, but they may be the result of one of the side effects.

Atrial fibrillation simply means that the heart is not beating normally. He has appropriately seen a cardiologist – the best resource in this situation. While you did not mention it, I assume that your father is on treatment to reduce his cholesterol (if it is too high), and lower his blood pressure and using an anticoagulant, such as warfarin or aspirin, to reduce the chance of clots, heart attack and stroke.

I cannot say if your father’s heart problems are directly related to the prednisone. It could be a coincidence that his problems happened shortly after he took it. Speak to his cardiologist about the possibility.

I should also mention that prednisone can cause the adrenal glands, which produce natural corticosteroids, to slow or stop production, leading to symptoms of adrenal failure. To prevent this frightening, uncomfortable and potentially serious consequence, prednisone taken for more than three or four days should be tapered off slowly until the medication is stopped or a maintenance dose can be reached (such as for fibromyalgia, lupus and others).

To give you related information, I am sending you a copy of my Health Report “Coronary Artery Disease.” Other readers who would like a copy should send a self-addressed, stamped number 10 envelope and $2 to Newsletter, PO Box 167, Wickliffe, OH 44092. Be sure to mention the title.

Doctor Gott, a retired physician, writes for United Media.

Prednisone is a commonly prescribed medication used to reduce discomfort and inflammation associated with a wide variety of health problems such as osteoarthritis, rheumatoid arthritis, inflammatory bowel disease, allergic reactions, asthma, chronic obstructive pulmonary disease (COPD), and other autoimmune diseases. 

It belongs to a group of medications called corticosteroids, also called steroids. Prednisone is the synthetic form of corticosteroids that are naturally present in the body. 

Please continue reading to learn more about the effects of prednisone on blood pressure. Also, find out why it may be important for you to regularly monitor your blood pressure while taking prednisone or steroid therapy with other corticosteroids.

Can prednisone raise blood pressure?

Yes, one of the possible side effects of prednisone is elevated blood pressure. The increase in blood pressure occurs due to two reasons - fluid retention and weight gain. 

Prednisone affects certain receptors on the kidneys, leading to sodium and water retention. When the body retains excessive sodium and fluid, it increases the total volume of blood, leading to high blood pressure. 

Another way in which prednisone can increase blood pressure is through weight gain. Prednisone mimics the natural hormone cortisol made by the adrenal glands in the body; cortisol is known to affect metabolism and appetite. Similarly, prednisone causes increased appetite, which leads to excess calorie intake and weight gain. People who are overweight or obese have a considerably higher risk of developing high blood pressure. Conversely, healthy weight loss can help control blood pressure.

Other side effects of prednisone besides fluid accumulation and weight gain include elevated blood sugar, sleep problems, skin thinning, mood swings, bone loss, suppression of the immune system, weakness, tiredness, and heartburn, among others.

How can I lower high blood pressure caused by prednisone?

Some people can develop hypertension (high blood pressure) due to fluid retention and weight gain caused by prednisone. People who already have hypertension may have worsening blood pressure control when taking prednisone or other corticosteroids. There are several ways to manage elevated blood pressure caused by prednisone.

Prednisone dosing

Doctors typically prescribe a low dose of prednisone for the shortest possible duration to minimize the side effects of this medication. However, sometimes higher doses of prednisone or other corticosteroid drugs are necessary, and fluid retention and weight gain damage are unavoidable. 

Lifestyle changes

Your healthcare provider may recommend monitoring blood pressure regularly to check your body’s response to prednisone. If you have significant weight gain or disruption of fluid balance and develop high blood pressure on prednisone, lifestyle changes can be employed to manage it. 

A low sodium diet and low cholesterol diet is recommended to manage blood pressure and help maintain a healthy weight—opt-out of eating processed foods that contain extra salt. 

Your aim should be to eat a balanced diet that includes fruits, vegetables, whole grains, lean proteins, and healthy fats. Such a diet can help reduce fluid retention, aid weight loss, and, ultimately, can help manage high blood pressure. These dietary changes are especially effective when combined with regular cardio and weight-bearing exercise.

Blood pressure medications

You may need to start taking a blood pressure medication if your blood pressure is consistently high despite lifestyle and dietary modifications. If you already take medications to control high blood pressure, their dosages may need to be adjusted by your doctor. You should follow professional medical advice from your healthcare provider to help manage high blood pressure.

Can you take prednisone with high blood pressure medications?

Yes, as mentioned above, your doctor may prescribe medications to treat high blood pressure while taking prednisone. For example, diuretics or water pills can help to reduce fluid retention and lower your blood pressure.

What should you not take with prednisone?

It is important to give your doctor a complete list of your medications, including prescription drugs, over-the-counter medicines, supplements, and herbal products to reduce the risk of drug interactions. A combination of prednisone and certain other medications can increase the risk of serious side effects. Your doctor may adjust the dose of your medicines or choose a different medication for you if there are known interactions or avoidable side effects.

If you are taking blood pressure medication or a diuretic to control prednisone-induced hypertension, you should talk to your doctor about potential dose adjustments of your blood pressure medicine while tapering off (slowly reducing the dose) prednisone.  During this tapering process off prednisone, your doctor will monitor your blood pressure while keep an eye out for symptoms of high or low blood pressure, such as headache, dizziness, fainting, blurred vision, and feeling cold and clammy. 

Wrapping Up: Prednisone and Blood Pressure

Corticosteroid drugs, including prednisone, are highly effective in treating many conditions such as allergies, arthritis, asthma, and autoimmune disorders. But these drugs carry a risk of side effects such as high blood sugar, reduced bone mass, and high blood pressure while on this medication. The risk is higher when you are on high doses of prednisone for an extended time.

You should discuss with your healthcare provider regarding different approaches to better manage the risks of taking prednisone, especially if you have to be on this therapy long-term. Keep in mind that even though side effects of steroids are unavoidable, your healthcare team can help you manage them. For example, if you develop high blood pressure on prednisone, as discussed above, your doctor may advise lifestyle changes or prescribe medications to manage blood pressure.

References:

1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=e9d6774e-45f6-419f-b388-8dfb4dd34944
2. https://medlineplus.gov/druginfo/meds/a601102.html

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