Journal of Hypertension | 2021
Impact of cortisol on blood pressure and hypertension-mediated organ damage in hypertensive patients.
Abstract
OBJECTIVES\nPatients 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 blood pressure (BP), organ damage, and metabolic parameters in hypertensive patients without hypercortisolism.\n\n\nMETHODS\nAfter exclusion of patients treated with corticosteroids or with Cushing s syndrome, the cohort included 623 hypertensive patients (mean\u200a±\u200aSD age 50.3\u200a±\u200a15.4\u200ayears, 50.9% men, median 24-h BP 146/88\u200ammHg) with an extended work-up (lipid profile, hypertension-mediated organ damage). Cortisol secretion was assessed by plasma cortisol at 0800 and 1600 h, and by 24-h urinary free cortisol (24\u200ah UFC) normalized if required to urine creatinine (UFC/U creat).\n\n\nRESULTS\nPlasma cortisol at 1600 h, 24\u200ah-UFC, and UFC/U creat were significantly and positively correlated with daytime, night-time, and 24-h SBP; plasma cortisol at 0800 h was not associated with BP. The strongest correlations were observed in the subgroup of aged more than 50\u200ayears (correlation coefficients between 0.23 and 0.28). These correlations remained after adjustment on plasma aldosterone. Metabolic parameters were weakly associated with cortisol. Arterial stiffness (central pulse pressure and pulse wave velocity), plasma NT-proBNP, and microalbuminuria were significantly correlated with 24\u200ah UFC, UFC/U creat, and plasma cortisol at 1600\u200ah.\n\n\nCONCLUSION\nCortisol influences weakly the level of BP independently from plasma aldosterone in hypertensive patients, particularly in older patients, and that there was weak association with HMOD. It may, therefore, be of interest to test specific treatments targeting cortisol excess in selected hypertensive patients.