Can Cortisone Shots Raise Blood Pressure?

Cortisone shots can raise blood pressure, though for most people the increase is modest and temporary. A study tracking patients after glucocorticoid injections found that average systolic blood pressure rose by about 4 to 5 mmHg in the first week before drifting back to normal within three weeks. That average, however, hides a wide range of individual responses, and a small percentage of people experience sharp spikes that deserve attention. The effect depends on the type of steroid used, how much is injected, where it goes, and whether you already have cardiovascular risk factors.

How a Local Injection Becomes a Whole-Body Event

A cortisone shot is usually framed as a local treatment: the steroid goes straight into a joint, a tendon sheath, or the epidural space around the spine, and it works on inflammation right there. That framing is accurate as far as it goes, but it leaves out the fact that the drug does not stay put. The steroid absorbs into the bloodstream, sometimes in meaningful amounts, and once it is circulating it can act on tissues far from the injection site.

Research on intra-articular injections shows that steroid compounds reach detectable blood levels quickly. After lumbar facet joint injections of triamcinolone acetonide, for example, peak drug concentrations in the blood appeared within 24 hours.¹ The body’s own cortisol production reacts to this influx: serum cortisol drops within hours, usually bottoming out at one to two days, and can take one to four weeks to recover, sometimes longer depending on the formulation and dose.² That suppression of the body’s own cortisol is itself evidence that the injected steroid is active throughout the system, not just at the injection site.

How much steroid gets absorbed varies a lot from person to person. A review of the evidence on locally injected glucocorticoids concluded that individual variability in systemic absorption is significant, and that both intra-articular and epidural injections can produce systemic effects lasting weeks.³ Complications associated with this absorption include blood sugar spikes, loss of bone density, and, relevant here, changes in blood pressure.

Why Corticosteroids Push Blood Pressure Up

Once a steroid is circulating, it can raise blood pressure through at least two major pathways that work on different parts of the cardiovascular system.

The first involves the kidneys. Corticosteroids can activate receptors in the kidney that tell it to hold on to sodium. When you retain more sodium, you retain more water along with it, and that expands blood volume. More volume pressing against the same vessel walls equals higher pressure. The principal mechanism behind glucocorticoid-induced hypertension is this overstimulation of kidney receptors, leading to sodium retention, volume expansion, and ultimately a rise in blood pressure.⁴ The body’s stress hormone system can amplify this by increasing the production of hormones that further encourage sodium retention in the kidneys.⁵

The second pathway involves the blood vessels themselves. Corticosteroids make blood vessel walls more responsive to the body’s own tightening signals, particularly stress hormones like norepinephrine. Normally your vessels have a certain baseline tone: they constrict and relax in response to signals from the nervous system and circulating hormones. Glucocorticoids amplify those constriction signals, so vessels squeeze tighter and vascular resistance goes up.⁶ Combined with increased blood volume from sodium retention, this creates a double push on blood pressure.

These mechanisms explain why the effect is not instant. The kidney needs time to accumulate extra sodium and water, and the vascular sensitivity ramps up gradually. That is consistent with the clinical pattern, where blood pressure tends to peak a few days after the injection rather than minutes later.

How Much Does Blood Pressure Actually Rise?

The honest answer is that it depends enormously on who you are. The population-level average looks small, but averages can be misleading when a small fraction of people have large responses.

A study that tracked patients after intra-articular and epidural glucocorticoid injections found that mean systolic blood pressure went from about 123 mmHg at baseline to 127 mmHg on day one and 128 mmHg on day seven, then returned to baseline by day 21.⁷ A 4 to 5 point rise in systolic pressure is not dramatic for someone with normal readings, and it resolves on its own within about three weeks.

But a larger population-based study of nearly 7,000 patients who were not already on blood pressure medication painted a more complex picture. On average, glucocorticoid use was associated with a systolic blood pressure increase of less than 1 mmHg. Yet in up to 4% of people, extreme swings of 30 mmHg or more in systolic blood pressure were observed after starting glucocorticoids.⁸ A jump of 30 points is clinically significant: if your systolic pressure is normally 130, a spike to 160 puts you in hypertensive territory. The same study found that the risk of an extreme systolic increase was nearly five times higher with prednisone or prednisolone compared to other synthetic glucocorticoids.

The takeaway from these studies together is that the average effect is small, but the distribution has a long tail. Most people barely notice anything. A handful experience a jump that could matter, especially if their blood pressure is already borderline or elevated.

Which Steroid Formulations Matter

Not all cortisone shots are created equal. “Cortisone shot” is a casual term that covers a range of different steroid compounds, and they differ in how long they stay in the body and how strongly they affect blood pressure.

Triamcinolone acetonide is one of the most commonly injected formulations. It is a relatively insoluble compound, which means it forms a depot at the injection site and releases slowly. That slow release is good for prolonged local anti-inflammatory effect, but it also means the drug seeps into the bloodstream over a longer window. Methylprednisolone acetate is another common choice with similar depot characteristics. Betamethasone preparations tend to be somewhat more soluble and are sometimes preferred for smaller joints.

The population-based study mentioned earlier specifically singled out prednisone and prednisolone as carrying a higher risk of extreme blood pressure spikes compared to other glucocorticoids.⁸ These are typically oral formulations rather than injected ones, but the finding highlights that the specific compound matters, not just whether you are getting “a steroid.” When a doctor chooses an injectable formulation, factors like which joint is being treated, how long the effect needs to last, and your cardiovascular risk profile all play into the decision.

The dose matters too. Higher doses mean more drug absorbing systemically, and more systemic drug means a stronger push on the kidneys and blood vessels. The number of joints injected at the same session amplifies exposure in the same way. Getting one knee injected is one thing; getting both knees and a shoulder done on the same day triples the total steroid load entering your system.³

Who Needs to Be Most Careful

If your blood pressure is already well controlled and you are getting a single injection into one joint, the odds of a clinically meaningful blood pressure rise are low. But certain groups should pay closer attention.

People with existing hypertension are the most obvious concern. If you are already on blood pressure medication, a steroid injection adds a temporary force pushing in the wrong direction. Corticosteroids can also interfere with the effectiveness of antihypertensive drugs, meaning your usual medication may not hold your pressure as well as it normally does for a week or two after the shot.⁹

People with diabetes face a compound problem. Glucocorticoid injections cause transient blood sugar elevations that can last several days, and high blood sugar itself can drive up blood pressure through fluid shifts and vascular effects. Research on intra-articular injections in diabetic patients with knee osteoarthritis has documented these transient glucose spikes.² If you have diabetes, your doctor may want you to monitor your blood sugar more frequently for several days after the injection and may adjust your insulin or oral medications temporarily.

Older adults and people with kidney disease may also be more sensitive to the sodium-retaining effects of corticosteroids, since their kidneys are already less efficient at handling sodium. Anyone with heart failure should be especially cautious, because even a small increase in fluid volume can worsen symptoms.

How Long the Blood Pressure Effect Lasts

The clinical data suggests that the blood pressure bump from a single injection is self-limiting. The study that tracked systolic pressure after glucocorticoid injections found it returned to baseline by about three weeks.⁷ That timeline lines up with what we know about how long the injected steroid suppresses the body’s own cortisol, which also takes one to four weeks to normalize.²

The peak effect on blood pressure seems to happen within the first week. Most people who are going to experience a significant rise will see it in the first few days, and it gradually fades from there. This is why some clinicians recommend checking blood pressure about a week after an injection if you are in a higher-risk group, rather than only at the time of the injection itself.

Repeated injections are a different story. If you are getting cortisone shots every few months for a chronic condition, each injection restarts the cycle of systemic absorption and sodium retention. Over time, there is a question of whether the cumulative exposure has a longer-lasting effect on blood pressure. The evidence here is thinner, but the review literature on locally injected glucocorticoids cautions that the number of injections is an important consideration in estimating risks.³

Practical Steps Before and After the Shot

None of this means you should refuse a cortisone injection if your doctor recommends one. For most people, the pain relief is significant and the blood pressure effect is minor and temporary. But there are reasonable steps to take, especially if you have risk factors.

Tell your doctor: If you have high blood pressure, diabetes, heart failure, or kidney disease, make sure the provider doing the injection knows. This is not always the same doctor managing your other conditions, and the information does not always transfer automatically.
Monitor at home: If you already own a blood pressure cuff, checking your readings for a week or two after the injection gives you useful data. A modest rise that resolves on its own is expected. A rise above 180/120 or one accompanied by symptoms like severe headache, chest pain, or visual changes warrants urgent medical attention.
Watch your salt: Since the mechanism involves sodium retention, keeping sodium intake moderate in the week after an injection makes physiological sense, even though no large trial has tested this specific strategy.
Space out injections: If you need multiple joints treated, doing them on separate visits rather than all at once reduces the total steroid hitting your bloodstream at any one time.
Review your medications: If you take antihypertensives, ask whether a temporary dose adjustment might be warranted. Some doctors prefer to simply monitor rather than change medications for a transient effect, but the conversation is worth having.

Epidural Versus Joint Injections

Epidural steroid injections, commonly used for back pain and sciatica, deserve separate mention because they tend to deliver larger doses of steroid into a highly vascular space. The epidural space has a rich blood supply, and steroid absorption can be faster and more complete than from a knee or shoulder joint. The study that measured blood pressure changes after glucocorticoid injections included both epidural and intra-articular patients, and both groups showed the systolic increase in the first week.⁷

Some clinicians regard epidural injections as carrying a somewhat higher risk of systemic side effects than peripheral joint injections, both because of the dose and because of the absorption characteristics. The review on systemic absorption explicitly noted that both intra-articular and epidural injections can have systemic effects for weeks, and listed complications including Cushing-like features, bone density loss, infection, and blood sugar elevation.³ Blood pressure elevation was not always singled out in every review, but it follows from the same mechanisms of sodium retention and vascular sensitization that apply to any route of glucocorticoid absorption.

When Injections Overlap With Oral Steroids

Some patients receiving cortisone shots are also taking oral corticosteroids like prednisone for conditions such as rheumatoid arthritis, asthma, or inflammatory bowel disease. This overlap stacks the systemic steroid load and increases the likelihood and magnitude of blood pressure effects. The review on locally injected glucocorticoids specifically flagged concurrent oral steroid use as an important risk factor.³

Similarly, a wide range of other medications can independently push blood pressure up or interfere with antihypertensive drugs.⁹ Common examples include nonsteroidal anti-inflammatory drugs (the over-the-counter painkillers many people with joint problems are already taking), certain antidepressants, and decongestants. If you are taking any of these alongside a cortisone injection, the combined effect on blood pressure can be more than either would produce alone. This is one more reason a full medication list matters before the injection.

For people already on long-term oral steroids, the calculus around a cortisone shot shifts. The injection adds to an existing systemic glucocorticoid load rather than introducing one from scratch. In those cases, the blood pressure monitoring window may need to be longer, and the threshold for adjusting antihypertensive therapy may be lower. Your rheumatologist or internist should be in the loop, not just the orthopedist or pain specialist giving the shot.