PMG Steroid dose- Hypertension

Hello nut her, sorry to hear you're having problems already. I'm sorry I have no medical training so I cannot offer any correct advice. One thing I will say is that prior to my diagnosis my blood pressure went through the roof. I was told that was because of the pain, inflamation and all the ibuprofen I was taking. Following diagnosis and whilst on the 15, and 12.5 doses of prednisone my blood pressure remained higher than usual and I was told this was because of the prednisone and that when the dosages went lower they expected my blood pressure to lower as well. I am now on 10 mgs and my blood pressure is still on the high side, the surgery are keeping an eye on this and have said that if I go too far above boarder line I may have to take blood pressure tablets. Is there any reason why they can't give you blood pressure tablets. That way you may be able to take the higher dose of prednisone. 

The issue re the 10mgs. Not working, perhaps you tapered down to quickly. Normal tapering should be, 15 mgs 6 weeks, 12.5 6 weeks 10 mgs, well I was on that level for 6 months. Good luck, christina 

I developed hypertension - I'm on medication and no problems.

It sounds as if you were started on a low dose and worked up - that really is not the best way to go about it. Best is to start at 15mg, maybe 20mg, get the symptoms under control and then reduce. That is the only real way to control the symptoms, until the inflammation is dealt with you will have symptoms and it is very obvious that the underlying autoimmune disorder that causes the symptoms is still very active - and possibly becoming more active. If the markers are still high then there is still considerable inflammation - you can't really separate inflammation and symptoms.

What you describe sounds rather similar to my experience in that I had palpitations after the PMR started. It was, however, definitely not pred since I had 5 years of PMR and palpitations pre-pred. It got worse after starting pred although the degree of the problem wasn't obvious. I was eventually diagnosed with atrial fibrillation and the cardiologist is confident it was the PMR that caused the a/f rather than the pred. It may therefore for you be coincidence or an additional problem. But using medication to control your BP will allow you to deal with the inflammation, once it is under control you can then reduce the pred and the hypertension problem may then also recede - certainly that is how it has worked for me and now I am down to 4mg pred I have also reduced the BP medication.

Before you dismiss the concept of using a drug to control side effects - I don't like that either, adjusting the other medication is preferable. but in the case of PMR there is little option. Either you control the BP or you have to accept the PMR symptoms since only pred controls it reliably. Unless you are taking enough pred to control the pain and stiffness then you might as well not take any - otherwise you have all the disadvantages with none of the benefits. Use of medication is always a balancing of benefits and downsides. There are RA drugs that may allow a lower dose of pred - but they potentially have worse side effects than BP meds which are of long standing and very well tolerated, plus there is a wide selection to choose from where the side effects are well known.

Hello nuther, good, as a medical professional you are better placed to understand the weird and not so wonderful PMR. I just had a thought though, obviously you'll know better, but if they controlled the blood pressure problem with medication then perhaps you could up the preds because as you know the normal starting dose is 15 mgs, and perhaps the 10 mgs you started off with is not working so well as it simply is not enough to control the inflamation and it's now the inflamation is getting the better of the 10 mgs. Sorry, I feel as if I'm teaching my granny to suck eggs! But it was Just a thought. Regards, christina.

I'm not sure I understand what the fuss is about. I also developed hypertension on Pred and for someone who had very low blood pressure to begin with, that was quite a feat.  It was quite refreshing not to have to remember to stand up slowly!

I was assured by my consultant that it would come down as the dose reduced (I was on 40mg at the time, just having been diagnosed with GCA) and in the meantime I was given one of the milder BP tabs, mainly because I was retaining far too much fluid.

Sure enough, it came down slowly over the next few weeks and I have not been troubled by it since, even though I have twice had to revert to 40mgs and twice to 30mgs (I think.  It's all a bit distant now).

If you have a large amount of inflammation charging wildly around your systems, surely that's as bad as taking a little more Pred, one more tab, and managing the whole thing?