High Blood Pressure
Steroids may cause increases in blood pressure. Blood pressure should be checked at every visit, but it is not necessary to limit salt intake unless it has been recommended by your cardiologist.
About Blood Pressure
Blood pressure is the measure of how much pressure it takes the left ventricle of the heart to squeeze the blood out (this is the top number, or systolic pressure) and the pressure inside the left ventricle of the heart when the heart is relaxed (this is the bottom number, or diastolic pressure).
Normal blood pressure changes throughout life, and is based on sex, age, and height. Most health care providers use the blood pressure reference provided by the National Institute of Health (NIH) to see if blood pressure is normal. As a general rule, 120/80 is the top limit for a normal blood pressure.
Hypertension is the medical term for high blood pressure.
High Blood Pressure Causes
Large blood volume
One of the causes of high blood pressure is having a large blood volume (the amount of blood and fluid in the body’s circulatory system which is pumped by the heart). This is why people with high blood pressure are put on diuretics, or water pills to decrease blood volume. Diuretics cause increased urination, which gets rid of fluid in the body. This decreases the blood volume, giving the heart less blood to pump, requiring less pressure to pump, thus lowering the blood pressure. Blood volume can be increased by a diet high in salt – salt in the gut attracts water, and more water entering the body systems increases the blood volume. This is why people with high blood pressure are encouraged to decrease or limit their salt intake.
While people taking steroids rarely develop hypertension, it has been shown that approximately 20% of patients treated with steroids will develop glucocorticoid-induced hypertension[i]. What is less clear is why. A recent review article[ii] suggests that there are several interactions that occur between the steroids and glucocorticoid receptors in body tissues (central nervous system, blood vessels, kidney, fat, and liver).
There is little evidence showing that increased salt and water in the body cause glucocorticoid-induced hypertension[iii]. In fact, studies have been done, giving patients who take glucocorticoids, spironolactone (which blocks the body from holding salt/sodium and water) to see if there was less hypertension; there was no reduction in the incidence of hypertension[iv]. Absorbing too much salt/sodium does not seem to cause or effect glucocorticoid-induced hypertension[v].
Managing Factors That Cause High Blood Pressure
As stated above, people who take steroids may be at increased risk for developing high blood pressure. Given this fact, it is important to manage other factors, which may also cause high blood pressure. These include:
The larger the body, the larger the area that the heart needs to pump blood, which requires more pressure – more body, more pressure! Maintaining a healthy weight is the best way to prevent high blood pressure and many other problems.
Most Americans eat too much salt. However, unless your health care provider has told you that you have high blood pressure, it is not necessary to limit your salt intake or count the milligrams of salt eaten per day. Eating an appropriate amount of salt is a good idea for everyone. An appropriate salt intake is 1500 mg daily for a child (less than 2300 mg is the daily recommended salt intake for adults) – which is easily achieved without counting.
- Avoid adding too much salt during cooking.
- Take the salt shaker off the table, so no more salt is added before eating.
- Fast foods, processed meats, and chips generally have high calories and high salt content – don’t overdo these types of foods!
- Be sure to talk to your nutritionist and/or health care provider for suggestions about healthy eating.
- Get the whole family involved.
- Eating less salt is a good idea for everyone, and it is certainly easier to institute a change if everyone is doing it!
[i] Mantero F, Boscaro M (1992) Glucocorticoid-dependent hypertension. J Steroid Biochem Mol Biol 43:409–413
[ii] Goodwin JE, Geller DS. Glucocorticoid-induced hypertension. Pediatr Nephrol (2012) 27:1059-1066.
[iii] Zhang Y, Whitworth JA. The role of nitric oxide: redox Imbalance in glucocorticoid-induced hypertension. Pp.129-146. NOVA Publishers.
[iv] Mangos GJ, Whitworth JA, Williamson PM, Kelly JJ (2003) Glucocorticoids and the kidney. Nephrology (Carlton) 8:267–273
[v] Li M,Wen C, Fraser T,Whitworth JA (1999) Adrenocorticotrophininduced hypertension: effects of mineralocorticoid and glucocorticoid receptor antagonism. J Hypertens 17:419–426