Moderate
Amlodipine × methylprednisolone
Calcium channel blockers (dihydropyridines)×Systemic glucocorticoid
Mechanism
Similar to amlodipine + prednisolone. Methylprednisolone causes sodium retention via mineralocorticoid effect, reducing amlodipine's antihypertensive action.
Symptoms
Gradual blood pressure rise 2–4 weeks after starting the glucocorticoid. In heart failure: oedema, weight gain.
Management
For short methylprednisolone courses, no adjustment. For prolonged systemic therapy, increase amlodipine or add a diuretic (hydrochlorothiazide, indapamide) with blood pressure monitoring every 2 weeks.