Association Between Aldosterone and Hypertension Among Patients With Overt and Subclinical Hypercortisolism

Kosuke Inoue; Hirofumi Horikoshi; Masao Omura; Yuya Tsurutani; Jun Saito; Tetsuo Nishikawa

doi:10.1210/jendso/bvac167

Association Between Aldosterone and Hypertension Among Patients With Overt and Subclinical Hypercortisolism

J Endocr Soc. 2022 Oct 31;7(1):bvac167. doi: 10.1210/jendso/bvac167. eCollection 2022 Nov 17.

Authors

Kosuke Inoue^{1

2}, Hirofumi Horikoshi², Masao Omura², Yuya Tsurutani², Jun Saito², Tetsuo Nishikawa²

Affiliations

¹ Department of Social Epidemiology, Graduate School of Medicine, Kyoto University, Kyoto 606-8315, Japan.
² Endocrinology and Diabetes Center, Yokohama Rosai Hospital, Yokohama 222-0036, Japan.

Abstract

Introduction: Hypertension is one of the most common clinical features of patients with overt and subclinical hypercortisolism. Although previous studies have shown the coexistence of autonomous cortisol and aldosterone secretion, it is unclear whether aldosterone plays a role in hypertension among patients with hypercortisolism. Therefore, we examined the associations of plasma aldosterone concentrations (PACs) with hypertension among patients with overt and subclinical hypercortisolism.

Methods: This single-center retrospective cohort study included patients with adrenal tumor and serum cortisol levels after 1-mg dexamethasone suppression test >1.8 µg/dL (50 nmol/L). Using multivariable regression models adjusting for baseline characteristics, we investigated the association of PACs with systolic blood pressure and postoperative improvement of hypertension after the adrenalectomy.

Results: Among 89 patients enrolled in this study (median age, 51 years), 21 showed clinical signs of Cushing syndrome (overt hypercortisolism) and 68 did not show clinical presentations (subclinical hypercortisolism). We found that higher PACs were significantly associated with elevated systolic blood pressure among patients with subclinical hypercortisolism (adjusted difference [95% CI] = +0.59 [0.19-0.99], P = 0.008) but not among those with overt hypercortisolism. Among 33 patients with subclinical hypercortisolism and hypertension who underwent adrenalectomy, the postoperative improvement of hypertension was significantly associated with higher PACs at baseline (adjusted risk difference [95% CI] = +1.45% [0.35-2.55], P = 0.01).

Conclusion: These findings indicate that aldosterone may contribute to hypertension among patients with subclinical hypercortisolism. Further multi-institutional and population-based studies are required to validate our findings and examine the clinical effectiveness of the intervention targeting aldosterone for such patients.

Keywords: adrenalectomy; aldosterone; hypertension; subclinical hypercortisolism.