Endocrine Abstracts

JOINT255824

Background: Patients with adrenal insufficiency (AI) have an increased risk of cardiovascular diseases, largely attributed to supraphysiological hormone replacement therapy.

Objective: This study evaluated 24-hour blood pressure (BP) profiles in patients with primary (PAI) and secondary AI (SAI) based on ESC/ESH hypertension thresholds and dipping status. BP profiles were correlated with glucocorticoid (GC) and mineralocorticoid (MC) replacement, cumulative GC dose/week (calculated from daily GC dose and frequency of dose adjustments), plasma steroid profiles, salivary cortisol (SC) day profiles, urinary cortisol as well as routine clinical and biochemical parameters.

Methods and results: We analysed 246 patients (76% PAI; mean age 50±15 years; 69% female). 52% of the subjects either had a preexisting diagnosis of arterial hypertension (22%) or exhibited pathologically elevated blood pressure on 24-h BP measurement (30%). Among patients on antihypertensive treatment (n=53, 22%), 60% had elevated 24 h-BP, compared to 41% of untreated patients (n=187) (P=0.01). The prevalence of elevated 24 h-BP was higher among SAI compared to PAI (58% vs. 41%, P=0.02). Nighttime hypertension was more frequent than daytime hypertension (48% vs. 35%), even in patients without previously diagnosed hypertension (42% vs. 30%). One-third were non-dippers, regardless of antihypertensive therapy. No significant differences in GC or MC dose regimens or GC preparations were observed between patients with elevated or normal 24 h-BP. However, both 24-hour diastolic BP and extent of nocturnal dipping positively correlated with cumulative GC dose/week (r=0.2, P<0.01; r=0.14, P=0.03). Inverse dippers were more frequent with evening GC use (20% vs. 6%, P=0.02). Morning SC levels were significantly higher in patients with elevated 24 h-BP, particularly in patients on short-acting GC and in patients with quantifiable steroid precursors. Logistic regression analyses identified AI etiology, glomerular filtration rate (GFR), body weight, and the frequency of GC dose adjustments as significant predictors of elevated 24-hour BP in the entire cohort. Except for AI etiology, these factors remained significant predictors in subgroups of patients not on antihypertensive treatment and in those with PAI.

Conclusion: Of the subjects, 52% either had a preexisting diagnosis of arterial hypertension or exhibited elevated 24-h BP levels. Frequency of GC dose adjustments was a consistent predictor of hypertension, implying a negative impact of recurrent cortisol spikes on BP regulation. The higher morning SC levels observed in hypertensive patients on short-acting GC and in those with quantifiable steroid precursors suggest that delayed cortisol metabolism and/or residual adrenal function may additionally contribute to increased blood pressure.