Glucocorticoid-induced hypertension in the elderly relation to serum calcium and family history of essential hypertension

Abstract

To explore the syndrome of glucocorticoid-induced hypertension in the elderly, we analyzed the clinical findings from 35 patients aged more than 65 years (12 men, 23 women) who received glucocorticoid therapy. Resting blood pressures (BP) were less than 140/90 mm Hg before glucocorticoid therapy, and patients were apparently disease-free apart from the condition for which glucocorticoid therapy was prescribed. Glucocorticoid-induced hypertension is defined as systolic BP more than 160 mm Hg and/or diastolic BP more than 95 mm Hg after glucocorticoid administration. Glucocorticoid-induced hypertension was seen in 13 patients (37.1%); all patients with hypertension [steroid (glucocorticoid)-induced hypertension (SH(+)) group] received more than 20 mg of prednisolone daily, and BP rose rapidly within a week of commencing glucocorticoid administration. The SH(+) group did not differ significantly in terms of age, heart rate, blood count, plasma biochemistry, plasma renin activity, plasma aldosterone, routine urinalysis, or urinary electrolytes from patients who did not show hypertension [SH(-) group]. However, serum total calcium concentrations were significantly lower in the SH(+) group both before and after 2 weeks of glucocorticoid therapy than in the SH(-) group. Furthermore, the SH(+) group showed a significantly higher percentage of patients with a positive family history of essential hypertension than the SH(-) group. In conclusion, although the detailed mechanisms are as yet uncertain, glucocorticoid-induced hypertension occurs often in elderly patients, and is more common in patients with total serum calcium concentrations lower than the normal range, and/or in those with positive family history of essential hypertension.

Safety and tolerability of high doses of glucocorticoides

“…Th e data show that hypertensive eff ect is dose-dependent and high blood pressure occurs in 80% of patients during corticosteroid therapy [14,15,16]. In our study, hypertension occurred in 28% of patients aft er the administration of prednisone and dexamethasone.…”

Glucocorticoid Use and Risk of Atrial Fibrillation or Flutter

“…17,18 The positive predictive value of atrial fibrillation or flutter has been reported to be as high as 97% in the NRP. 19 We also obtained data from the NRP with regard to hospital procedure codes of cardioversions (treatment code BFFA0 in the Danish treatment classification) within the year after diagnosis of atrial fibrillation or flutter.…”

The Wrath of Steroids in Elderly Patients with Pulmonary Diseases

“…A retrospective meta-analysis reported a significant relationship for hypertension incidence with OR 2.2 (95 % CI 1.4-3.8) [55] among corticosteroid users. Risk may be dose dependent [10], and appears to develop early after initiation of corticosteroids [56].…”