Key takeaways:
Prednisone is an oral corticosteroid medication. It treats several inflammatory conditions, autoimmune disorders, and some cancers.
High blood pressure is a possible side effect of prednisone. But the likelihood of it happening often depends on your dose and how long you take it for. It’s usually not an issue if you’re just taking it for a few days.
There are a few ways to help manage high blood pressure from prednisone, like exercising, eating less salt, and avoiding tobacco products.
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Prednisone is a common prescription medication that fights inflammation throughout the body. It's useful for a variety of health conditions, ranging from autoimmune disorders and skin conditions to certain types of cancer.
Whether you take prednisone for a few days or for the long-haul, it can cause several side effects. What’s more, some prednisone side effects are thought to be dose-related and linked to how long you’ve been taking it. One of these side effects is high blood pressure (hypertension).
What is prednisone?
Prednisone is an oral corticosteroid medication. It’s available as a tablet or liquid that’s taken by mouth once a day. It's commonly used short term (less than 30 days), but it can also be taken long-term in some situations. It can treat health conditions like:
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Corticosteroids like prednisone are human-made (synthetic) medications that mimic the natural stress hormone cortisol. Cortisol helps your body control inflammation, manage electrolytes like sodium (salt), and regulate its immune system.
Prednisone works by mimicking cortisol’s effects, which is what makes it useful for treating a variety of health conditions. But this also means it can cause side effects in different areas of the body.
Does prednisone increase blood pressure?
Yes. It's possible your blood pressure could go up while taking prednisone. This is more likely to happen if you’ve been taking higher doses for a long period of time.
For example, in a large review, more than 30% of people who took long-term oral corticosteroids (including prednisone) reported having high blood pressure. However, it’s less likely to happen if you just take prednisone for a few days.
Your healthcare provider may suggest regularly checking your blood pressure while taking prednisone. This will likely be the case if you also have a history of high blood pressure or diabetes.
Why does prednisone raise blood pressure?
Experts aren’t completely sure of all the ways prednisone raises blood pressure. Generally, prednisone is thought to increase blood pressure by acting like cortisol in your body.
This behavior can affect your body’s ability to balance water, salt, and other electrolytes. As a result, prednisone can cause salt and fluid levels to build up. This is known as fluid retention (edema). Fluid retention can cause or worsen high blood pressure.
Higher cortisol levels can also affect the way your body breaks down and stores sugar and fats. It may also make you feel more hungry, which may lead to weight gain. This can also raise your blood pressure.
How much will my blood pressure go up while taking prednisone?
It depends. The degree of blood pressure changes from prednisone varies from person to person. It depends on several factors, like your diet, kidney health, and if you have a history of high blood pressure. Your prednisone dose also plays a role. High blood pressure is less likely to happen when lower doses of prednisone are used.
It’s a good idea to know what blood pressure reading is normal for you and to check it regularly to monitor for changes. Your healthcare provider can tell you more about your target blood pressure readings.
Can blood pressure changes from prednisone be prevented?
You can manage blood pressure changes from prednisone in a few ways. These are some tips for managing or preventing high blood pressure while taking prednisone:
Prioritize regular exercise to help manage weight gain.
Eat a healthy, low salt diet (about 2,300 mg of salt per day), like the DASH diet. This can help lower salt intake, which can help lower fluid buildup.
Avoid alcohol and tobacco. Alcohol may contribute to weight gain, and tobacco can raise blood pressure.
Take a shorter course and/or a lower dose of prednisone, if possible. Speak with your healthcare provider about how long you should take prednisone for.
Look out for swelling in your hands, feet, or ankles. Let your healthcare provider know if this happens — they may recommend taking a water pill (diuretic) while you’re taking prednisone.
Check your blood pressure regularly.
While these strategies may help, you may still experience high blood pressure while taking prednisone. In some cases, you may need to start taking a blood pressure medication to help lower your blood pressure, or adjust the dose of your blood pressure medication(s) if you’re already taking them.
Speak with your healthcare provider about how to best manage your blood pressure while taking prednisone.
If my blood pressure goes up while taking prednisone, will it go back down?
Yes, it should. If your high blood pressure was caused by fluid retention, your blood pressure should gradually improve after you stop taking prednisone. But if your high blood pressure is due to weight gain or another cause, you may need to make changes unrelated to prednisone to see improvements in your blood pressure.
What other side effects are common with prednisone?
In addition to high blood pressure, other common prednisone side effects include:
High blood sugar
Swelling
Indigestion
Appetite changes
Sweating or hot flashes
Trouble sleeping
Mood changes or irritability
Headache
Talk to your healthcare provider if you experience bothersome side effects from prednisone. In some cases, it may be possible to switch to a different medication. Switching could be especially helpful if you need long-term treatment.
Are there any corticosteroids that don’t cause high blood pressure?
All corticosteroids, including prednisone, can cause your body to hold onto extra salt and fluid. This phenomenon is called the mineralocorticoid effect. But some corticosteroids do this less than others.
The corticosteroids with the strongest mineralocorticoid effects are fludrocortisone and hydrocortisone (Solu-Cortef). They tend to cause the greatest amount of fluid buildup, and possibly have the highest risk of causing high blood pressure.
Common corticosteroids that have the weakest mineralocorticoid effects are dexamethasone and methylprednisolone (Medrol). These medications tend to cause less fluid buildup.
Along the spectrum of mineralocorticoid effects, prednisone stacks up in about the middle between strongest and weakest.
The bottom line
High blood pressure is one possible side effect of prednisone, especially when taken for a long period of time or at higher doses. You can help manage or prevent high blood pressure from prednisone by focusing on healthy lifestyle behaviors. This includes exercising regularly, eating a low salt diet, and avoiding alcohol. Shorter treatment courses and lower doses of prednisone are less likely to cause high blood pressure.
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References
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Hunter, R. W., et al. (2014). Glucocorticoids and renal Na+ transport: Implications for hypertension and salt sensitivity. The Journal of Physiology.
Liu, D., et al. (2013). A practical guide to the monitoring and management of the complications of systemic corticosteroid therapy. Allergy, Asthma, & Clinical Immunology.
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