Cumulative Doses of Oral Steroids Linked to Increased Blood Pressure
March 23, 2020

Cumulative doses of oral steroids in patients with chronic inflammatory diseases are associated with increased hypertension, according to a study published in the Canadian Medical Association Journal.

“The cumulative effect of oral steroid doses on hypertension is substantial, and given that these are commonly prescribed medications, the related health burden could be high,” said Mar Pujades-Rodriguez, MD, Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom.

For the study, the researchers analysed electronic health records from 389 practices in England (1998-2017) of adults aged 18 years and older with 1 of 6 chronic inflammatory diseases (inflammatory bowel disease, systemic lupus erythematosus, polymyalgia rheumatica, giant cell arteritis, rheumatoid arthritis, or vasculitis), but with no previous hypertension.

The researchers defined glucocorticoid exposure status using all drug prescriptions for oral glucocorticoids issued in primary care. Glucocorticoid doses were extracted from the directions given (ie, once daily), product strength (ie, 5 mg), and prescribed quantity. Dosages were then converted into prednisolone-equivalent doses to account for differences in potency of different types of glucocorticoids.

Among 71,642 patients in the cohort, 24,896 (34.8%) developed hypertension during a median follow-up of 6.6 years. The incidence rate of hypertension was 46.7 per 1000 person-years.

Incidence rates increased with higher cumulative glucocorticoid prednisolone-equivalent dose, from 44.4 per 1000 person-years in periods of nonuse to 45.3 per 1000 person-years for periods with between >0.0 mg and 959.9 mg (hazard ratio [HR] = 1.14; 95% confidence interval [CI], 1.09-1.19), to 49.3 per 1000 person-years for periods with 960 mg to 3,054.9 mg (HR = 1.20; 95% CI, 1.14-1.27), and to 55.6 per 1000 person-years for periods with ≥3,055 mg (HR = 1.30; 95% CI, 1.25-1.35). Cumulative effects were seen for the 6 diseases studied, but dose-response effects were not found for daily dose.

“Cumulative dose of oral glucocorticoids was associated with increased incidence of hypertension, suggesting that blood pressure should be monitored closely in patients routinely treated with these drugs,” the authors concluded. “Given that glucocorticoids are widely prescribed, the associated health burden could be high.”

Reference: https://www.cmaj.ca/content/192/12/E295

SOURCE: Canadian Medical Association Journal