INFLUENCE OF CORTISOL ON BLOOD PRESSURE AND TARGET ORGAN DAMAGES IN HYPERTENSIVE PATIENTS WITHOUT CORTISOL EXCESS

Abstract

Objective: Patients with overt and subclinical Cushing's syndrome frequently develop hypertension, metabolism disorders and atherosclerotic lesions. The aim of the present study was to test the association between cortisol and these parameters in hypertensive patients without cortisol excess. Design and method: Patients treated with corticosteroids or having Cushing's syndrome were excluded. The cohort included 623 hypertensive patients (mean age 50.3 ± 15.4 years, 50.9% of men, median 24-hours blood pressure (BP) 146/88 mmHg) with an extended work-up. Cortisol secretion was assessed by plasma cortisol at 8:00 am and 4:00 pm and by 24-hours urinary free cortisol (UFC) eventually normalized to urine creatinine (UFC/U creat). With respect to aetiologies, 517 patients had essential hypertension; the other etiologies being primary aldosteronism (80 patients), renal artery stenosis (13 patients), renal parenchymal disease (6 patients) and others (7 patients) Results: Patients with primary aldosteronism had higher values of 24-h UFC (p < 0.001, panel A) and UFC / urinary creatinine (p = 0.003, panel B) than patients with primary hypertension but not different plasma cortisol at 8:00 am (p = 0.195, panel C) and at 4:00 pm (p = 0.679, panel D).Patients with primary aldosteronism have higher levels of cortisol in comparison to those with primary hypertension (p < 0.001). plasma cortisol at 4:00 pm, 24-hours UFC, and UFC/U creat were statistically and positively correlated with daytime, nighttime and 24 hours systolic BP. Plasma cortisol at 8:00 am was not associated with BP. The best correlations were observed in the subgroup of men older than 50 years (coefficients of correlation between 0.23 and 0.28). This observation was similar after adjustment for plasma aldosterone. Metabolic parameters were only weakly associated with cortisol. Arterial stiffness (peripheral and central pulse pressure, pulse wave velocity), plasma NT-proBNP and microalbuminuria were significantly correlated with 24-hours UFC, UFC / U creat and plasma cortisol at 4:00 pm.Conclusions: Cortisol is associated with BP, aortic stiffness and microalbuminuria in hypertensive patients without cortisol excess. Overall, our results emphasize the potential role of cortisol pathway within normal values in the pathophysiology of high BP and suggest that drugs targeting cortisol excess could be efficient in selected hypertensive patients.