Abstract P251: Out-of-clinic Cortisol Secretion Is Increased In Masked Uncontrolled Hypertension

Abstract

Introduction: Masked uncontrolled hypertension (MUCH) in treated patients is defined as controlled office BP but uncontrolled out-of-clinic ambulatory BP (ABP). In contrast, patients with true controlled hypertensive (CHTN) have controlled BP by both office BP and out-of-clinic ABP. Previously, we have shown that patients with MUCH have increased out-of-clinic catecholamines/metanephrines (indicative of SNS activity) and aldosterone levels (indicative of RAAS activity). The current study tested the hypothesis that MUCH patients have higher cortisol levels (corticotropin-glucocorticoid axis) compared to patients with true CHTN. Methods: 222 patients with controlled office BP at ≥3 clinic visits were recruited. Patients taking glucocorticoid-containing medications were excluded. All patients were evaluated by automated office BP. Out-of-clinic ABP monitoring and 24-hour-urinary cortisol, cortisone, aldosterone, catecholamines and metanephrines levels were also measured. 115 patients had MUCH and remaining 75 patients had true CHTN. Results: MUCH patients had significantly higher out-of-clinic levels of 24-hour-urinary cortisol, catecholamines, metanephrines and aldosterone compared to true CHTN. Further, in correlation matrix analysis higher urinary cortisol was associated with higher catecholamines, metanephrines and aldosterone in MUCH patients.BP. Conclusions: Patients with MUCH had higher out-of-clinic urinary cortisol levels compared to patients with true CHTN. These findings suggest that patients with MUCH have higher out-of-clinic cortisol, aldosterone secretion and SNS tone that may contribute to their higher out-of-clinic BP.