2mg prednisone and low blood pressure

Hey, Susie -- Your post is timely for me. I've got a potpourri of health concerns, and the biggest one is hypertension. When I was put on 15 mg prednisone in June, I was told to keep an eye on my BP and also blood glucose. The latter shot up like a rocket, but as of this beautiful day I'm not seeing an increase in BP that parallels the level of prednisone in my body over the course of the day. And I've been checking like six times a day, wondering if it would go up 3 to 6 hours after taking prednisone and then down. Prednisone has given me back my lost energy, and I am the best kind of hyper most of the day.

I take torsemide in the AM, and Ibersartan and Niphedipine in the PM, and if I get readings in the 130's systolic, I'm happy.

That said, I've had some crazy low readings--like a 99/40 and a couple of 108/44's--since I started prednisone. Everything is relative, but this is surprisingly low for me. But I've had a smattering of 140s/150s too, which is "normal" for me.

Thing is, the absence of PMR pain stiffness since I started prednisone, plus the buzz, has allowed and inspired me to up my diet and exercise game. My sense is that my improving health has had a good effect on my BP. I've been pulling 125s the last couple of days, which is bloody perfect for me (without meds I'm in the 180s, 200s). Early morning 112s. And this is a week after I cut my torsemide dose in half to see if it made any difference (it did not).

But the biggest difference has been my heart rate. Over the winter, when things were bad, my heart rate rarely went under 70, and was often 80, at rest. My "normal" resting pulse, historically (I'm 73) has been around 60. Well, in the last couple of weeks, my resting pulse, taken when I take my BP, has been 50 to 55. Which doesn't jibe At All with my prednisone buzz and abundance of energy. I'm really happy about it though.

To answer your question, if I had a question about BP, I'd go to my cardiologist. We discussed my PMR and the prednisone, and he is of course hoping I can minimize it. But he is a wise sole, and a great believer that no movement and constant pain is as bad for heart health as anything.

BTW, my difficult winter involved a flare up of a pinched never root. L4-L5. Four months of nerve pain along with the PMR pain, ew. Symptoms present in left leg, from SI joint on down. I'm waiting to see what pain/dysfunction returns in my left leg/hips as I taper.

Blood pressure medications often need adjustments higher or lower depending on how much prednisone we take. Make sure your cardiologist or whoever is managing your blood pressure medications is aware that you are lowering your prednisone dose which might be causing your blood pressure to be low.
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Prednisone usually causes higher blood pressure. Monitoring your blood pressure before and a few hours after taking your prednisone dose is important.

Your BASELINE blood pressure is whatever it was BEFORE starting prednisone. Your blood pressure might be normal or it could already be high but your baseline is what it was before starting prednisone.

After prednisone is started, a person's blood pressure will probably be higher than their baseline.

The higher the prednisone dose ... the higher the blood pressure.

A higher blood pressure will require more blood pressure medications to keep the blood pressure within a normal range.

As we decrease our prednisone dose, --- the dose of a person's blood pressure medications also might need to be adjusted lower.

Chances are your adrenals are being sluggish to get moving again and produce a natural cortisol response to keep your blood pressure steady. As @dadcue wrote, you may not need a full dose of your BP medication at this time. Or the PMR is not under control then you may need to raise the Prednisone; but in either case some expert advice from your rheumatologist would be a good idea.

I've had high blood pressure ever since I reached adulthood. Had it under control on several occasions but always needed an adjustment at some point so it wasn't getting too low or high. Over the last 12 months it's been bouncing all over the place due to pred (way too high) and a toxic reaction to methotrexate (way too low). Stopped the methotrexate and have now been able to increase the BP meds to get it under control again.

My BP was high before pmr . My pcp has called my BP 'labile', it fluctuates. For the most part it has been stable until recently.
I think physicians would be reluctant to alter a medication another Dr. ordered. Pcp ordered losartan, rheum ordered prednisone, cardiologist ordered metoprolol and flecanide. I see rheum Aug 12. Right now I think I should go back to the plan I was told the last time I saw rheum which was to alternate 3 and 2mg. No further tapering plan was mentioned.
I get this overwhelming notion that I need to be like everybody else and be off the prednisone.

@dadcue
Agreed, I spoke with my cardiologist after I started taking prednisone and he gave me advice on how to monitor my BP and adjust my meds when necessary. I'm on olmesartan and he prescribed 5mg pills to make adjustments easier. I've had crazy high readings and crazy low readings, but I made the adjustments and kept my cardiologist informed through the patient portal.

I am finding it a little difficult to comprehend how a decision is made whether at the low prednisone doses to regulate prednisone or BP meds. I thought my pcp or rheum would order a cortisol but was told the cortisol test result would just be unreliable.
Also, apparently there is a difference as to whether or not you had hypertension before pmr or if hypertension was a result of taking prednisone.
I will message rheum tomorrow.
Thanks to everyone for the input on this topic.

My BP has been pretty normal taking 25mg losartan a day until I reduced my prednisone dose to 6mg. Last week I was sweating a lot and got somewhat dehydrated. I started feeling a little confused and dizzy. My blood pressure was low so I drank water and ate some salted peanuts and felt better. This was a good reminder to me to always carry water and something to eat. I've been checking my BP several times a day now and it seems to be stabilizing in the normal range. I'm not recommending stopping blood pressure medication, but I did until I talk to my Dr. this week.

@pmrsuzie
I've had seriously high BP for 20 years, so home monitoring is second nature to me. Every time a med changes, or I gain weight, or lose weight, or get strange pain in my shoulders (statin-induced myalgia--I've had all the whacko can't-raise-my-arms problems!).

My cardiologist goes by my home readings when considering changes--the one reading they get in the office is not enough (and can be high due to nerves).

So the decision to alter BP meds is directly based on my recent home BP readings.

Plenty of fluids and adding some saltier foods should help.
Unfortunately, I walk a thin line with salt - it can trigger a Meniere's attack. I avoid adding salt to most everything.

@pmrsuzie I'd check for cortisol testing again. I've heard of many people having it tested at the 2 mg pred level or even a bit higher, and getting valid results. At that level your adrenals should be starting to fire again. Only heard that the test for cortisol wasn't worthwhile at doses of 7 mg and higher, as that's still high enough to close down natural production.