Synthetic Glucocorticoids and Early Variations of Blood Pressure: A Population-Based Cohort Study

Context: Endogenous glucocorticoids are known to increase blood pressure, but very little is known about the early effects of synthetic glucocorticoids (eg, prednisone, dexamethasone) on blood pressure. Objective: To assess longitudinal variations of blood pressure before and after initiation of systemic glucocorticoid therapy. Design, Setting, and Patients: Adult patients prescribed synthetic glucocorticoid therapy for at least 3 months and registered between 2004 and 2012 in The Health Improvement Network (THIN) primary care database. Main Outcome Measure: Systolic and diastolic blood pressure as measured in primary care. Results: Among the 16 351 patients prescribed antihypertensive drug within the year before glucocorticoid initiation (women, 57.1%; age [mean +/- SD], 72.0 +/- 11.4 y), the mean (SD) blood pressure within the year before glucocorticoid initiation was 140 (18)/78 (9) mm Hg. It was 139 (19)/77 (11), 139 (19)/77 (10), and 139 (19)/77 (11) mm Hg during the first, second, and third months of exposure, respectively. We did not find any evidence of the effects of glucocorticoids on blood pressure in these patients. Among the 6914 patients not prescribed antihypertensive drug within the year before glucocorticoid initiation (women, 64.9%; age, 60.0 +/- 17.8 y), the figures were 133 (17)/78 (10), 135 (20)/79 (11), 133 (19)/78 (11), and 133 (19)/78 (11) mm Hg before exposure and during the first, second, and third months of exposure, respectively. In this group of patients, glucocorticoid exposure was associated with a slight (<1 mmHg; P = .03) increase of systolic but not diastolic (P = .52) blood pressure. However, in 4% of people or fewer, extreme increases or decreases (ie, >= 30 mm Hg for systolic blood pressure) in blood pressure were observed after glucocorticoid initiation. Prednisone/prednisolone use was associated with a higher risk of extreme increase in systolic blood pressure than the other synthetic glucocorticoids (odds ratio, 4.9 [95% confidence interval, 1.9-12.6]; P = .001). Conclusion: Contrary to what is usually thought, the increase of blood pressure during the first months of exposure to synthetic glucocorticoids seems clinically nonsignificant.