“Hypertension” is the fancy word for high blood pressure. Blood pressure is the measure of how much pressure it takes the left ventricle of the heart to squeeze the blood out (the top number, or systolic pressure) and the pressure inside the left ventricle of the heart when the heart is relaxed (the bottom number, or diastolic pressure).

“Normal blood pressure” changes throughout life, and is based on sex, age, and height. Most health care providers use the blood pressure reference provided by the National Institute of Health (NIH) to see if a child’s blood pressure is normal, and, as a general rule, 120/80 is the top limit for a normal blood pressure.

High Blood Pressure Causes

One of the causes of high blood pressure is having a large blood volume (the amount of blood and fluid in the body’s circulatory system which is pumped by the heart). This is why people with high blood pressure are put on “diuretics,” or water pills to decrease blood volume. Diuretics cause increased urination, which gets rid of fluid in the body, which decreases the blood volume, giving the heart less blood to pump, requiring less pressure to pump, thus lowering the “blood pressure.” Blood volume can be increased by a diet high in salt – salt in the gut attracts water, and more water entering the body systems increases the blood volume. This is why people with high blood pressure are encouraged to decrease or limit their salt intake.

 

Steroids & Salt Intake

Recently, the issue of whether it is necessary for children who take “glucocorticoids” (prednisone or deflazacort) to limit their sodium/salt intake has come up. It is well known that taking steroids (prednisone or deflazacort) can cause glucocorticoid-induced hypertension. After consulting with five major programs (Columbus, Cincinnati, Iowa City, Seattle, and Baltimore), we have developed the following suggestions. (As always, if you have questions specific to your child, please ask your health care provider.)

 

While children taking glucocorticoids rarely develop hypertension, it has been shown that approximately 20% of patients treated with glucocorticoids will develop glucocorticoid-induced hypertension[i]. What is less clear is why. A recent review article [ii] suggests that there are several interactions that occur between the glucocorticoids and glucocorticoid receptors in body tissues (central nervous system, blood vessels, kidney, fat, and liver).

There is little evidence showing that increased salt and water in the body cause glucocorticoid-induced hypertension [iii]. In fact, studies have been done, giving patients who take glucocorticoids, spirololactone (which blocks the body from holding salt/sodium and water) to see if there was less hypertension; there was no reduction in the incidence of hypertension [iv]. Absorbing too much salt/sodium does not seem to cause or effect glucocorticoid-induced hypertension [v].

Given these findings, is it really necessary to limit your child’s salt intake?

Managing Factors That Cause High Blood Pressure

As stated above, children who take glucocorticoids may be at increased risk for developing high blood pressure. Given this fact, it is important to manage other factors, which may also cause high blood pressure. These include:

 

  • Weight 
    The larger the body, the larger the area that the heart needs to pump blood, which requires more pressure – more body, more pressure!  Keeping your child at a healthy weight is the very best way to prevent high blood pressure and many other problems.

 

  • Salt
    Most Americans eat too much salt. Unless your health care provider has told you that your child has high blood pressure, it is not necessary to limit your child’s salt intake or count the milligrams of salt eaten per day. Eating an “appropriate” amount of salt is a good idea for everyone. An appropriate salt intake is 1500mg daily for a child – which is easily achieved without counting.

    Here are some helpful tips:

     

    • Avoid adding too much salt during cooking
    • Take the salt shaker off the table, so no more salt is added before eating
    • Fast foods, processed meats, and chips generally have high calories and high salt content - don’t overdo these types of foods!
    • Be sure to talk to your nutritionist and/or health care provider for suggestions about healthy eating.

 

  • Get the whole family involved
    Eating less salt is a good idea for everyone, and it is certainly easier to institute a change if everyone is doing it!

I hope this helps address the Salt, Steroids and Duchenne issue. As with most things, moderation is key!

 

 

References

[i] Mantero F, Boscaro M (1992) Glucocorticoid-dependent hypertension.  J Steroid Biochem Mol Biol 43:409413

[ii] Goodwin JE, Geller DS. Glucocorticoid-induced hypertension. Pediatr Nephrol (2012) 27:1059-1066.

[iii]  Zhang Y, Whitworth JA. The role of nitric oxide: redox Imbalance in glucocorticoid-induced hypertension.  Pp.129-146.  NOVA Publishers.

[iv] Mangos GJ, Whitworth JA, Williamson PM, Kelly JJ (2003) Glucocorticoids and the kidney. Nephrology (Carlton) 8:267273

[v] Li M,Wen C, Fraser T,Whitworth JA (1999) Adrenocorticotrophininduced hypertension: effects of mineralocorticoid and glucocorticoid receptor antagonism. J Hypertens 17:419426

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Comment by Kathi Kinnett on October 31, 2013 at 9:36pm
The weight gain on steroids is related to the steroids and inactivity - not salt and water retention. The recommended exercises are non-weight bearing (swimming, hydrotherapy, and horse therapy - which always sounded the best to me!). The best thing is to help manage weight is to keep them as safely active as possible and monitor calories. It is hard ~
Comment by Cathy Rozema on October 31, 2013 at 6:35pm

I have had my son on a sodium reduced diet for a few years now, after he had bouts with kidney stones. He had these after becoming dehydrated one year at summer camp. We are still struggling with his weight, and I feel that is has more to do with the deflazacort and lack of physical activity than with his sodium intake. Sodium is hidden in many different places, and though it has taken us a while  to reduce his intake, it is now part of our daily lives. I have learned to read labels more closely when I go grocery shopping, and try to buy sodium reduced items where available. Fast food is the most difficult to deal with, but we don't often eat out at these places, but when we do, it is few and far between. My son's weight wasn't always an issue, it was stable for many years, but I have found the weight gain to be increasing since he has become dependant on his power wheelchair. He can't walk any longer since he fell and broke his hip, and was non weight bearing for several weeks. Since then his weight has been on a steady increase. I am also looking for any suggestions on how to deal with this, keeping in mind that this is an 18 year old boy, any thoughts on this?

Comment by Keith & Jill VE on August 16, 2013 at 9:44am

Thank you for this information!  In today's world, it is amazingly difficult to find foods (especially restaurants!) with low sodium.

While I understand the impact sodium has on blood pressure, what role does sodium play in regards to weight gain while on deflazacort?  We are assuming that our son's weight gain is related to our lack of discipline around sodium intake, but could the weight gain be more directly related to steroids or lack of ability to get enough physical activity?

Thoughts?

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