A5980 Plasma cortisol secretion and left ventricular changes in essential hypertension

Abstract

Objectives: Cushing syndrome and subclinical hypercortisolism are associated with changes in left ventricular (LV) structure. No data are available on the relationship between cortisol production and LV mass and geometry in essential hypertension (EH). Methods: In 103 EH patients, we evaluated clinical characteristics, general biochemistries, the circadian level of plasma cortisol (8 AM, 5 PM, and 11 PM) together with the area under the curve (C-AUC), 24-h urinary cortisol excretion, and the response of plasma cortisol to an overnight suppression test with 1 mg of dexamethasone (DMT). Echocardiography was performed with a standard technique. Results: LV hypertrophy (LVH) was detected in 34 of 103 EH patients. Patients with LVH were significantly older, had longer duration of hypertension, and greater BMI, systolic BP, plasma triglycerides, and post-DMT plasma cortisol (P = 0.004) than patients without LVH. No differences were detected in circadian plasma cortisol profile nor urinary cortisol excretion between patients with or without LVH. Eccentric LVH was present in 13 EH patients who showed greater post-DMT plasma cortisol levels than patients with other types of LV geometry. In a logistic regression, LVH was associated independently with BMI and post-DMT plasma cortisol (P = 0.045). LV mass index (LVMI) was significantly and directly related to age, duration of hypertension, BMI, systolic blood pressure, plasma glucose and triglycerides, HOMA-index, and post-DMT plasma cortisol (r = 0.349, P = 0.002), whereas a borderline relationship was found with C-AUC (r = 0.201, P = 0.053). In multivariate models, LVMI was independently associated with post-DMT cortisol and C-AUC. Conclusion: Subtle changes in the regulation of plasma cortisol secretion contribute to LV changes in patients with EH.