In the Journals

Greater cumulative glucocorticoids dose confers risk for hypertension

High cumulative use of oral glucocorticoids was associated with excess incidence of hypertension, according to research published in the Canadian Medical Association Journal.

In a cohort of 71,642 patients (mean age, 51 years; 38% men; 86% white) diagnosed with one of six chronic inflammatory diseases — inflammatory bowel disease, rheumatoid arthritis, polymyalgia rheumatica, giant cell arteritis, vasculitis or systemic lupus erythematosus — 34.8% developed hypertension during a median follow-up of 6.6 years.

Researchers found that compared with periods of nonuse, patients with the following cumulative doses had elevated risk for hypertension:

  • a 14% increase for periods with doses between 0 mg and 959.9 mg (HR = 1.14; 95% CI, 1.09-1.19);
  • a 20% increase for periods with doses between 960 mg and 3,054.9 mg (HR = 1.2; 95% CI, 1.14-1.27); and
  • a 30% increase for periods with doses of at least 3,055 mg (HR = 1.3; 95% CI, 1.25-1.35).

In contrast, evidence of a dose-response relationship for hypertension associated with prescribed oral daily glucocorticoids was found only in patients with vasculitis receiving at least 7.5 mg daily (HR = 1.49; 95% CI, 1.17-1.9). No other effects were observed for daily dosing.

“The difference in effect between current daily and cumulative dose could be explained by delays in diagnosis of hypertension (ie, more than 1 in 4 patients with incident hypertension had three or more measurements of high blood pressure but no recorded diagnosis of hypertension) or by a need for a higher dose or longer exposure to glucocorticoid therapy for hypertension to be clinically evident.” Teumzghi F. Mebrahtu, PhD, statistical epidemiologist at the Leeds Institute of Medical Research at St. James’s, U.K., and colleagues wrote. “This could also explain the inverse dose–response relationship found for polymyalgia rheumatica.”

Researchers studied electronic health records from 389 U.K.-based practices from 1998 to 2017 of adults diagnosed with any of the six chronic inflammatory diseases and no prior hypertension. According to the study, glucocorticoids dose was cumulated from 1 year before the start of follow-up and hypertension was defined as earliest diagnosis of hypertension, or at least three high systolic or diastolic BP measures, recorded within 12 months during follow-up.

“The findings of this study indicate that the effect of oral glucocorticoid cumulative dose on hypertension is substantial,” the researchers wrote. “We suggest that blood pressure be closely monitored for early identification and management of hypertension in patients with diseases treated with long-term glucocorticoids. Given that glucocorticoids are widely prescribed, the associated health burden could be high.” – by Scott Buzby

Disclosures: One author reports she received consultant fees from Chugai, GlaxoSmithKline, Regeneron, Roche and Sanofi. The other authors report no relevant financial disclosures.

High cumulative use of oral glucocorticoids was associated with excess incidence of hypertension, according to research published in the Canadian Medical Association Journal.

In a cohort of 71,642 patients (mean age, 51 years; 38% men; 86% white) diagnosed with one of six chronic inflammatory diseases — inflammatory bowel disease, rheumatoid arthritis, polymyalgia rheumatica, giant cell arteritis, vasculitis or systemic lupus erythematosus — 34.8% developed hypertension during a median follow-up of 6.6 years.

Researchers found that compared with periods of nonuse, patients with the following cumulative doses had elevated risk for hypertension:

  • a 14% increase for periods with doses between 0 mg and 959.9 mg (HR = 1.14; 95% CI, 1.09-1.19);
  • a 20% increase for periods with doses between 960 mg and 3,054.9 mg (HR = 1.2; 95% CI, 1.14-1.27); and
  • a 30% increase for periods with doses of at least 3,055 mg (HR = 1.3; 95% CI, 1.25-1.35).

In contrast, evidence of a dose-response relationship for hypertension associated with prescribed oral daily glucocorticoids was found only in patients with vasculitis receiving at least 7.5 mg daily (HR = 1.49; 95% CI, 1.17-1.9). No other effects were observed for daily dosing.

“The difference in effect between current daily and cumulative dose could be explained by delays in diagnosis of hypertension (ie, more than 1 in 4 patients with incident hypertension had three or more measurements of high blood pressure but no recorded diagnosis of hypertension) or by a need for a higher dose or longer exposure to glucocorticoid therapy for hypertension to be clinically evident.” Teumzghi F. Mebrahtu, PhD, statistical epidemiologist at the Leeds Institute of Medical Research at St. James’s, U.K., and colleagues wrote. “This could also explain the inverse dose–response relationship found for polymyalgia rheumatica.”

Researchers studied electronic health records from 389 U.K.-based practices from 1998 to 2017 of adults diagnosed with any of the six chronic inflammatory diseases and no prior hypertension. According to the study, glucocorticoids dose was cumulated from 1 year before the start of follow-up and hypertension was defined as earliest diagnosis of hypertension, or at least three high systolic or diastolic BP measures, recorded within 12 months during follow-up.

“The findings of this study indicate that the effect of oral glucocorticoid cumulative dose on hypertension is substantial,” the researchers wrote. “We suggest that blood pressure be closely monitored for early identification and management of hypertension in patients with diseases treated with long-term glucocorticoids. Given that glucocorticoids are widely prescribed, the associated health burden could be high.” – by Scott Buzby

Disclosures: One author reports she received consultant fees from Chugai, GlaxoSmithKline, Regeneron, Roche and Sanofi. The other authors report no relevant financial disclosures.