Avatar universal

Steroids Lower my Blood Pressure

Me: 46 year old male, hypertension diagnosed and treatment commenced at age 43 although elevated blood pressure was noted in 20's but not significant enough to warrant treatment. Otherwise healthy, a little excess weight but not obese. Frequent exerciser, [very] healthy eater, never smoked and occasional alcohol consumer.

I have been battling what I call stubborn hypertension although my doc doesn't feel I meet the definition of resistant hypertension because my BP is not constantly above 160/100 and/or I am not on 4 medications. Despite this, no matter what BP medication I take I cannot seem to get BP down from hovering in the 145/90 range. Steady dosage increases had no appreciable effect and neither did switching to different medications.

So, on a recent trip to urgent care for an unrelated problem (insect sting near an eye) BP was noted at 160/99. It refused to come down the whole time I was there. The staff were concerned that my BP was not effectively being controlled and I agreed and promised that I would be following up (yet again) with my doctor. However, for the insect sting they administered an injection of dexamethasone (a corticosteroid).

The following day I felt much better and when I took my blood pressure in the morning (pre medication) I was staggered to see that it was lower than I had ever seen it - 110/67. Thinking this was a BP machine issue I repeated the test with the same results. I changed batteries and used mains power. Each time it was low. Eventually I got my wife to lend her arm since she has rock solid BP and hers was normal. Had I eaten something different, I thought? No, there was no reason for this drop other than the steroid injection but this didn't make sense since steroids typically induce an increase in BP in most people.

After approximately 48 hours of consistently lower BP following that injection things slowly returned to the normal elevated 145/9 region.

So. mindful of the "steroid effect", I decided a few weeks later to conduct an experiment using some of the unused steroid pills I was also prescribed for that sting. Low and behold I got the same result - a dramatic drop which lasted 48 hours followed by a return to higher values after that.

I brought my finding to the attention of my doctor wasn't too happy with my DIY science experiment and she doesn't seem to want to offer any opinion on the findings stating that steroids are not a treatment for hypertension (which I know). I have repeated that experiment one more time since and obtained the same identical results.

Does anybody have any experience with this or has anybody noticed a similar coincidental finding? Since my doctor wants to distance herself from this apparent correlation and repeats the line that I have primary hypertension and these findings are incidental can anybody offer a suggestion? I know that aldosteronism (for which I have not been tested) has a particular variant that responds to steroids but are there any other conditions that could influence these results in this way?  

Much obliged
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Avatar universal
I am a 56 year old male and have some insight to this scenario.
In my 20's i had high BP and it was investigated and recommended to just watch. Fast forward some years , i just ignored it. Anyhow in my mid 40's i knew the BP was going up and i still just ignored it. Eventually it hit crisis point and i could not walk up the stairs at home and had zero exercise tolerance. I went to the ER and they freaked. It was 280 over 160 and the hr was 155. They were thinking i was on coke! ( which i was not of course) Anyhow they admitted me and started treatment slowly and cautiously. They were happy to get it below 180 and all the tests showed collapsed EF to 15%. I left hospital 10 days later and had 10 tablets to take. This went up over the next few months to 12 tablets, but it was resistant at 170/90 to 185/ 95. I sought a new BP expert and he did some tests and changed the medications! After 3 weeks he introduced a medication called Aldactone. Its for an adrenal gland issue. Just like your injection, my BP dropped like a stone to around 100/70 with the new medication. This opened up the door to the likely hood of an Adrenal issue.  Conns syndrome is the name of it. Its was investigated and the results were inconclusive. I stopped the med for  14 days to enable some further  tests to be done, however the BP was straight back up to 180.
This particular Adrenal issue is hard to detect and only a few places do proper testing. You should have it investigated yourself. There is an expert on it in Kings in London and he has some on line commentary that you should review. His name is Maurice Brown, you should look him up and learn a bit about it. It may not be your issue, but early onset high BP, and especially resistance to meds are primary indicators, so go get tests. Blood tests are usual, Renin tests and a 24 hour urine collection are part of it. They can do CT imaging, however the tumours (Non Cancerous) are often too small to detect, so  a special pet scan is required as the best means of detection. I am not a doctor but advise you to look into this to reassure yourself. (Just to say my EF recovered over time)
Let me know your updates
Helpful - 1
Hi and thanks indeed for describing your experience. I’m very glad to hear that things have improved for you because that sounded like a rough time you had back then.

Since I made the original post I have had some more blood tests. These have revealed normal aldosterone level, a somewhat low but within range renin level. My cortisol level was high (29.9 with the range being 4 - 22). Also out of range was DHEA-S at 687 (reference range 70 - 495).  

I speak with my doc soon about these but at face value it would appear that hyperaldosteronism can be ruled out as all the relevant values fall within range and the ratio is center range.

I suppose my issue must somehow be related to these elevated stress hormones be it directly or indirectly and maybe the problem is still at an adrenal gland (or both) or maybe higher up the HPA axis.

But the question I’d really like to know is just what did the dexamethasone do exactly, what did it disrupt or enhance to have the dramatic blood pressure lowering effect? There is nothing online that supports dexamethasone as a blood pressure lowering agent and, on the contrary, it seems to be that those with hypertension find the condition is exacerbated by taking the steroid. If I could get an answer in this I might be able to figure out (or narrow down) what part of the system is malfunctioning.  

I would think that the steroid use has played some role.  Odd your cortisol is elevated for adrenal numbers are within normal.  I'd have guessed that your aldosterone level would have been elevated as well. I'm not sure if you are going to get a specific answer but your cardiologist will best be able to direct you.  I'm following your story so update when you can.
Hi Specialmom. Thanks for your input and interest.

As an update it appears that I have reached the limit of usefulness with my doctor. I had self-referred to a cardiologist who, after putting me through a variety of cardiac tests (ECG, Echo, 14-days wearing a heart monitor) politely informed me I had wasted my money because there were no observable heart issues whatsoever. However, he did not (or maybe could not) answer my question about how dexamethasone might induce a fall in BP in some subjects.

Since seeing the cardiologist I have had some tests done with my own doctor (as detailed above). As I reported,  DHEA-S levels were significantly elevated as was cortisol. Aldosterone and a range of other tested hormones was normal.

However, even with this new high-cortisol finding my doctor could not offer an explanation on the apparent relationship between dexamethasone and my blood pressure so the medication I am taking for hypertension has little to no appreciable effect. (although that might not be a strictly accurate statement because I have not actually completely ceased the therapy, but I do know that dosage changes have had no effect and some of my lowest blood pressure readings have been seen at or beyond the end of the dosing cycle). All my doctor would say on the subject was that “I respond in the opposite way to most people”. As an engineer I find this an utterly frustrating and unhelpful response to a curious problem.

I have got an appointment to see an endocrinologist which I had to insist on with my doctor to get the referral. This is in a few weeks. I am hoping they can examine and explain this interaction of how dexamethasone is acting on the HPA axis which in turn is modifying cortisol production. Cushing’s (elevated cortisol due to a malfunction of the adrenal gland itself or HPA-axis system component) has been ruled out, I am told. But either way dexamethasone seems to dramatically reduce my blood pressure where all traditional BP meds have failed and this is completely the opposite response most people (especially hyptertensives) where we see an increase in BP.

I will keep you posted. Thanks again…..

Avatar universal
Hi Sara and Paxiled, thanks both for your replies.

Sara: Thanks for the verification on steroids and yes I do appear to present with the opposite of what one might expect. I’m getting some additional diagnostics in the coming days so I’ll return with the results of those in maybe a couple of weeks time.

paxiled: yes, as Sara stated I seem to have the opposite response/reaction, in fact I didn’t know that anxiety was a potential side effect but I have to say after that 8mg shot of dexamethasone in the first instance, the following day I felt super relaxed - odd indeed! I did ask my doc if the steroid might have inadvertently highlighted an inflammatory condition I was otherwise unaware of but, like I said, she really didn’t offer an opinion either way.  

The condition I think might potentially be looking at and certainly worthy of further investigation, is adosteronism. I spoke to the Aldosterone association and I certainly fit the profile and it seems that doctors might be too willing to treat hypertension in the primary sense as opposed to looking at secondary causes such as aldosteronism which is a  hormonal malfunction.

Anyways I’ll return in a little while with updates.  If anyone else reads this and had a similar experience I’d appreciate your input.

Much obliged….
Helpful - 0
Just to say, most people don't get anxious from steroids.  Because they are stimulating and humans who aren't anxious love stimulation (see coffee, sugar, amphetamines, etc.), if you don't get anxious but do get stimulated it can make you feel great, especially if you're getting older and don't quite have the testosterone and youthful energy you once did.  Doesn't make it good for you, it's not, but again, getting anxious is a side effect that most don't get.  Bummer when you do, though, and not easy on those of us who have anxiety problems to begin with.  Hope it works out for you.
Avatar universal
This is odd.  Steroids often cause anxiety; it's basically adrenaline.  So you're right, if anything, it should raise bp.  What you might do is find a specialist rather than your regular doc and see if there are any inflammatory conditions that elevate BP, as steroids are used to lower inflammation.  You can't of course take them regularly, as they are horrid to your immune system and can destroy connective tissue.  It would also be beneficial to pay close attention to your blood tests and see if any of your electrolytes are out of balance.  Make sure you hydrate sufficiently when you exercise.  I have no expertise to offer, but again, if there are inflammatory conditions that contribute to high BP, could be it.  Could even be something you're eating or not eating.  
Helpful - 0
15695260 tn?1549593113
Hello and welcome to the forum. We appreciate how well you articulated your question and that you have come here to ask it.  We're sorry as it seems you are unhappy with your doctor. As a consumer in healthcare, you should always feel free to find another that has a more suitable style to what you like in a care provider.  Corticosteriods are more known for elevating blood pressure than lowering it. Taking a corticosteriod causes the body holds on to sodium and loses potassium. This change in electrolyte balance can cause fluid retention, bloating and weight gain. When you are retaining water, it increases the total volume of fluid that is being pushed through your blood vessels by your heart and this can cause increases in your blood pressure.  
You may be having a more rare reaction with the lowering of your blood pressure.  It does seem to be correlated with your  careful observation.  

Have you considered going to a specialist like a cardiologist?

Helpful - 0
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