Effect of cortisol on achieving target blood pressure levels in patients with resistant hypertension and chronic kidney disease

Abstract

Background. Resistant hypertension is defined as failure to achieve the target blood pressure (BP), despite treatment with at least three antihypertensive drugs that include a diuretic, and is associated with a poor prognosis. This is caused by organ damage from long-term exposure to high blood pressure, and is also linked to diabetes mellitus, chronic kidney disease and obesity. The purpose of the work is to evaluate biological markers associated with failure to achieve the target level of blood pressure in patients taking 3 or more antihypertensive drugs, depending on the presence of chronic kidney disease. Materials and methods. The study included 1146 patients with resistant hypertension who took 3 or more antihypertensive drugs. They were examined using both instrumental and laboratory methods with the measurement of office blood pressure upon admission to the hospital and upon discharge, evaluation of biochemical blood parameters, levels of creatinine, blood lipids, renin, blood aldosterone, cortisol. Results. The average age of the patients was 57.90±0.37 years. There were more women than men— 62.7 versus 36.7%. The body mass index was 31.00±0.19kg/m2. The average office systolic/diastolic BP upon admission to the hospital was 174.60±0.64/100.50±0.38 mmHg. 22.4% of patients had glomerular filtration rate (GFR) <60ml/min/1.73m2. In the subgroup with GFR ≥60ml/min/1.73m2, the achievement of the target BP was 44.76%, which is significantly higher than in patients with GFR <60ml/min/1.73m2 (12.56%, p<0.05). Blood cortisol level in the subgroups with failure to reach the target level of office blood pressure was 127.72±4.20 μg/dl (with GFR<60 ml/min/1.73m2) and 163.71±15.20 μg/dl (GFR ≥60ml/min/1.73m2), which was significantly higher compared to the patients with the target BP level: 6.02±0.90 μg/dl (with GFR <60ml/min/1.73m2; p<0.05) and 47.84±4.40 μg/dl (in the subgroup with GFR ≥60ml/min/1.73m2; p<0.05). Conclusions. In patients with resistant hypertension, elevated blood cortisol content, regardless of GFR, was associated with failure to achieve the target level of office blood pressure.