ModerateSelective beta-adrenergic blockers×Systemic glucocorticoid
Updated · Methodology
Mechanism
Methylprednisolone causes sodium and water retention via mineralocorticoid effect, reducing the antihypertensive effect of the beta-blocker.
Symptoms
Gradual blood pressure rise 2–4 weeks after starting the glucocorticoid. In heart failure: oedema, weight gain.
Management
For short methylprednisolone courses (up to 7 days), no adjustment. For prolonged systemic therapy, increase bisoprolol or add a diuretic (hydrochlorothiazide, indapamide) with blood pressure monitoring every 2 weeks.
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Sources
- FDA: Bisoprolol tablet (Micro Labs Limited) – Prescribing Information (2016)– ; DailyMed setid c3ee566c-74c4-45f4-a947-526a7313e326