Hypertension during reduction of long-term steroid therapy in young subjects with asthma

Corticosteroids can induce hypertension, which reportedly remits as the drug is withdrawn. We studied nine patients with steroid-requiring asthma, aged 9 to 16 years, who had elevated blood pressures during corticosteroid treatment. Unlike in previous studies, all nine patients developed hypertension during corticosteroid reduction. Diastolic blood pressures were 50 to 84 mm Hg during maximum corticosteroid therapy (1 to 4 mg/kg/day); these values were in the normal range for seven of the nine patients and in the high normal range for the other two patients. Maximum diastolic pressures were 100 to 120 mm Hg, 1 to 8 weeks after corticosteroid reduction was started. Hypertension occurred at 0% to 70% of their maximum corticosteroid dose. Corticosteroid reduction was the only medication change. Renal causes of hypertension were excluded. Six patients had levels of renin and aldosterone measured before onset of treatment. All six patients had elevated levels of renin, and five patients had elevated levels of aldosterone. Blood pressure elevations were resistant to diuretic therapy but responded rapidly to angiotensin-converting enzyme inhibitors. Caretakers of subjects with asthma need to be aware that hypertension may occur both during maximum corticosteroid use and during corticosteroid reduction.