Original article| Volume 45, 102401, October 2020

The effects of high-dose corticosteroids for multiple sclerosis relapse on blood pressure: A pilot study


      • Corticosteroids are known to cause hypertension with long-term use.
      • Short pulse, high dose corticosteroids are used for relapse treatment in multiple sclerosis and there has been limited investigation of the impact of this treatment on blood pressure.
      • In our study group, there was a blunting in the normal nocturnal dip in blood pressure and evidence of nocturnal hypertension.
      • Subjects with a personal or family history of hypertension had higher daytime systolic blood pressure readings.
      • In light of these findings, clinicians may consider more monitoring for patients requiring high dose corticosteroids who have a history of hypertension.



      Multiple sclerosis (MS) relapses are often treated with short pulses of high dose corticosteroids. Previous literature demonstrates corticosteroids can increase blood pressure (BP). There are few studies regarding effects of high dose, pulse corticosteroids on BP when treating MS relapses.


      To investigate the effect of high dose pulse corticosteroids for MS relapses on BP and determine factors that may influence development of acute hypertension.


      In this open-label pilot study, adult patients with a diagnosis of MS were enrolled if determined to be having a relapse that would meet criteria for corticosteroid treatment. BP was monitored sequentially over the course of their corticosteroid treatment and correlations were made with demographic data, including past medical and family history.


      22 subjects contributed data. Higher daytime BP was noted in subjects with a past personal (p = 0.007) or family history of hypertension (p = 0.037). Nighttime BP recordings did not show the normal 10% drop and nocturnal diastolic BP was within a hypertensive range during corticosteroid treatment.


      MS patients may be at risk of increased BP when treated with corticosteroids for relapses. Those with a past or family history of hypertension may be at higher risk and may warrant more frequent monitoring.


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        • Bloomfield D.
        • Park A.
        Night time blood pressure dip.
        World J. Cardiol. 2015; 7: 373-376
        • Burton J.
        • O'Connor P.
        • Hohol M.
        • Beyene J
        Oral versus intravenous steroids for treatment of relapses in multiple sclerosis (review).
        Cochrane Database Syst. Rev. 2012; 12
        • Chibane S.
        • Feldman-Billard S.
        • Rossignol I.
        • Kassaei R.
        • Mihoubi-Mantout F.
        • Héron E
        Tolérance à court terme d'un traitement de trois jours par bolus de méthylprednisolone: étude prospective chez 146 patients.
        Rev. Med. Internet. 2005; 26: 20-26
        • Fan H.Q.
        • Li Y.
        • Thijs L.
        • Hansen T.W.
        • Boggia J.
        • Kikuya M.
        • et al.
        Prognostic value of isolated nocturnal hypertension on ambulatory measurement in 8711 individuals from 10 populations.
        J. Hypertens. 2010; 28: 2036-2045
        • Fardet L.
        • Flahault A.
        • Kettaneh A.
        • Tiev K.P.
        • Généreau T.
        • Tolédano C.
        • et al.
        Corticosteroid-induced clinical adverse events: frequency, risk factors and patient's opinion.
        Br. J. Dermatol. 2007; 157: 142-148
        • Group Optic Neuritis Study
        Multiple sclerosis risk after optic neuritis: final optic neuritis treatment trial follow-up.
        Arch. Neurol. 2008; 65 (2008/06/11): 727-732
        • Hoffmann-La Roche L
        Lemtrada product monograph.
        Toxicology. 2019; : 1-55
        • Holmøy T.
        • Fevang B.
        • Olsen D.B.
        • Spigset O.
        • Bø L
        Adverse events with fatal outcome associated with alemtuzumab treatment in multiple sclerosis.
        BMC Res. Notes. 2019; 12: 1-5
        • Iqbal P.
        • Stevenson L.
        Cardiovascular outcomes in patients with normal and abnormal 24-hour ambulatory blood pressure monitoring.
        Int. J. Hypertens. 2011; 2011
        • Ivarsen P.
        • Jensen L.W.
        • Pedersen E.B
        Circadian blood pressure rhythm and atrial natriuretic peptide in prednisolone-induced blood pressure elevation.
        Scand. J. Clin. Lab. Invest. [Internet]. 1995 Jan 1; 55: 655-662
        • Li Y.
        • Wang J.G.
        Isolated nocturnal hypertension: a disease masked in the dark.
        Hypertension. 2013; 61: 278-283
        • McDougall A.J.
        • McLeod J.G.
        Autonomic nervous system function in multiple sclerosis.
        J. Neurol. Sci. 2003; 215: 79-85
        • Miskiewicz P.
        • Milczarek-Banach J.
        • Bednarczuk T.
        • Opolski G.
        • Glowczynska R
        Blood pressure profile and N-terminal-proBNP dynamics in response to intravenous methylprednisolone pulse therapy of severe graves’ orbitopathy.
        Int. J. Mol. Sci. 2018; 19
        • Morrow S.A.
        • Rana R.
        • Lee D.
        • Paul T.
        • Mahon J.L
        Posterior Reversible Encephalopathy Syndrome due to High Dose Corticosteroids for an MS Relapse.
        Case Rep. Neurol. Med. 2015; 2015: 1-4
        • Polman C.H.
        • Reingold S.C.
        • Banwell B.
        • Clanet M.
        • Cohen J.A.
        • Filippi M.
        • et al.
        Diagnostic criteria for multiple sclerosis: 2010 Revisions to the McDonald criteria.
        Ann. Neurol. 2011; 69: 292-302
        • Racosta J.M.
        • Kimpinski K.
        • Morrow S.A.
        • Kremenchutzky M
        Autonomic dysfunction in multiple sclerosis.
        Auton Neurosci Basic Clin [Internet]. 2015; 193: 1-6
        • Repovic B.P.
        Management of multiple sclerosis relapses.
        Contin. (Minneap. Minn.). 2019; 25: 655-669
        • Shaygannejad V.
        • Ashtari F.
        • Alinaghian M.
        • Norouzi R.
        • Salari M.
        • Fatehi F
        Short-term safety of pulse steroid therapy in multiple sclerosis relapses.
        Clin. Neuropharmacol. 2013; 36: 1-3