Hypertension corticosteroid induced

Corticosteroid-induced ocular hypertension appears to relate not only to the individual patient but to the specific steroid used. In general, dexamethasone 0.1%, betamethasone 0.1%, and prednisolone acetate appear more likely to induce significant lOP elevations than do fluorometholone alcohol and medrysone. Clinical studies with rimexolone and LE indicate that they have less potential to elevate lOP than does dexamethasone phosphate or prednisolone acetate. 

The first point is that treatment with steroids is generally palliative rather than curative, and only in a very few diseases, such as leukemia and nephrotic syndrome, do corticosteroids alter prognosis. One must also consider which is worse, the disease to be treated or possible induced hypercortisolism. The patient s age can be an important factor, since such adverse effects as hypertension are more apt to occur in old and infirm individuals, especially in those with underlying cardiovascular disease. Glucocorticoids should be used with caution during pregnancy. If steroids are to be employed, prednisone or prednisolone should be used, since they cross the placenta poorly. 

Ciclosporin-induced encephalopathy was precipitated by diltiazem in a 76-year-old white woman with corticosteroid-resistant aplastic anemia and thrombocjdope-nia, type 2 diabetes, and coronary artery disease, who was taking diltiazem for hypertension (28). She became comatose after 13 days of therapy with ciclosporin, and clinical examination and electroencephalography showed diffuse encephalopathy of moderate severity. Ciclosporin was withdrawn and she regained consciousness after 36 hours. 

Amphetamines have also been associated with a syndrome of acute kidney injury and rhabdomyolysis. Several series have described patients following intravenous injection of methamphetamine or phenmetrazine who presented with hyperactivity, fever, chills, sweats, abdominal cramps, diarrhea, and hypotension [177,178]. The patients have developed acute kidney injury which is usually oliguric and associated with classic rhabdomyolysis, similar to cases of cocaine-induced rhabdomyolysis. Several patients have had disseminated intravascular coagulation and liver function abnormalities as well. Methamphetamine abuse has also been associated with accelerated hypertension, unexplained chronic renal failure, acute lead poisoning (a common reagent used in its production utilizes lead acetate) and at least one case of biopsy proven interstitial nephritis the latter patient responded to intravenous corticosteroids but whether the nephritis was truly due to amphetamines remains unproven [179]. 

Corticosteroids, CSA, TAC, and impaired kidney graft function may cause post-transplant hypertension. The primary mechanism of CI-associated hypertension in heart transplant recipients may be related to the Cl-induced stimulation of intact renal sympathetic nerves and the absence of reflex cardiac inhibition of the sympathetic nervous system, but a number of other mechanisms, including decreased prostacyclin and nitric oxide production, also have been proposed. " In addition to the propensity to cause peripheral vasoconstriction, CIs promote sodium retention, resulting in extracellular fluid volume expansion. TAC appears to have less potential to induce hypertension following transplantation than CSA. Most classes of antihypertensive medications effectively reduce blood pressure in transplant patients (see Chap. 13). ... 

Calcium-channel blockers for the treatment of hypertension Calcium products Cephalosporins Cerebroactive medications Chlamydial infections treatment of Cholinergic drugs uses in medicine Cholinergic-receptor-blocking agents uses of Cirrhosis treatment of Congestive heart failure treatment of Constipation drug-induced Corticosteroids uses for Crohn s disease treatment of Cytokines their actions... 

CARDIOVASCULAR SYSTEM The most striking cardiovascular effects of corticosteroids result from mineralocorticoid-induced changes in renal Na+ excretion, as is evident in primary aldosteronism. The resultant hypertension can lead to a diverse group of adverse effects on the cardiovascular system (see Chapter 32). Consistent with the known actions of mineralocorticoids in the kidney, restriction of dietary Na can lower the blood pressure considerably in mineralocorticoid excess. 

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