title: Synthetic Glucocorticoids and Early Variations of Blood Pressure: A Population-Based Cohort Study.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  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 mm Hg; 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).
  
  
  CONCLUSIONS
  Contrary to what is usually thought, the increase of blood pressure during the first months of exposure to synthetic glucocorticoids seems clinically nonsignificant.
authors.affiliation: University College London (L.F., I.N., I.P.), Department of Primary Care and Population Health, London WC1E 6BT, United Kingdom; Department of Dermatology (L.F.), Henri Mondor Hospital, 94010 Créteil, France; and EpiDermE (L.F.), Université Paris-Est Créteil Val-de-Marne, 94010 Créteil, France.
authors.forename: Laurence
authors.initials: L
authors.lastname: Fardet
authors.affiliation: University College London (L.F., I.N., I.P.), Department of Primary Care and Population Health, London WC1E 6BT, United Kingdom; Department of Dermatology (L.F.), Henri Mondor Hospital, 94010 Créteil, France; and EpiDermE (L.F.), Université Paris-Est Créteil Val-de-Marne, 94010 Créteil, France.
authors.forename: Irwin
authors.initials: I
authors.lastname: Nazareth
authors.affiliation: University College London (L.F., I.N., I.P.), Department of Primary Care and Population Health, London WC1E 6BT, United Kingdom; Department of Dermatology (L.F.), Henri Mondor Hospital, 94010 Créteil, France; and EpiDermE (L.F.), Université Paris-Est Créteil Val-de-Marne, 94010 Créteil, France.
authors.forename: Irene
authors.initials: I
authors.lastname: Petersen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure / Q000187:drug effects*; D015331:Cohort Studies; D003907:Dexamethasone / Q000627:therapeutic use; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D006973:Hypertension / Q000453:epidemiology / Q000503:physiopathology; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011241:Prednisone / Q000627:therapeutic use; D011320:Primary Health Care / Q000706:statistics & numerical data; D013997:Time Factors
chemical_list: D005938:Glucocorticoids; D003907:Dexamethasone; D011241:Prednisone