Blood Pressure Management in Acute Ulcerative Colitis Patients on Prednisone and Upadacitinib

Rationale for Antihypertensive Selection

The European Society of Gastrointestinal Endoscopy recommends that patients with acute ulcerative colitis on prednisone and upadacitinib who develop hypertension should be treated with calcium channel blockers or thiazide diuretics as first-line antihypertensive agents, due to their lack of significant drug interactions with JAK inhibitors 1, 2, 3
The American Gastroenterological Association suggests that upadacitinib requires blood pressure monitoring for the first 3 months after treatment initiation, then every 6 months, with patients having preexisting hypertension needing weekly home monitoring for the first month 3

The American College of Cardiology recommends amlodipine 5-10 mg daily as a long-acting calcium channel blocker with once-daily dosing, with no significant drug interactions with upadacitinib or prednisone 3
The European Society of Cardiology suggests hydrochlorothiazide 12.5-25 mg daily as a thiazide diuretic, though monitoring for electrolyte disturbances is necessary given the risk of hypokalemia in acute colitis 1, 4

The American Heart Association recommends weekly home blood pressure monitoring for the first month after starting upadacitinib in patients with preexisting hypertension, then every 3 months for the first 3 months of upadacitinib therapy, and every 6 months thereafter during maintenance therapy 3
The National Institute for Health and Care Excellence suggests monitoring serum potassium closely if using thiazide diuretics, as both the diuretic and active colitis increase hypokalemia risk 1, 4

The British Society of Gastroenterology recommends intravenous fluid and electrolyte replacement to correct dehydration, which may improve blood pressure control, and thromboprophylaxis with subcutaneous low-molecular-weight heparin is mandatory in all hospitalized acute severe UC patients unless contraindicated 1, 2, 4
The American Gastroenterological Association suggests that joint gastroenterologist and colorectal surgeon management is required for acute severe UC, ensuring coordinated decision-making about both the colitis and its complications 1, 2