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

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...

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Autores principales: Inoue, Kosuke, Horikoshi, Hirofumi, Omura, Masao, Tsurutani, Yuya, Saito, Jun, Nishikawa, Tetsuo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9683494/
https://www.ncbi.nlm.nih.gov/pubmed/36438547
http://dx.doi.org/10.1210/jendso/bvac167
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author Inoue, Kosuke
Horikoshi, Hirofumi
Omura, Masao
Tsurutani, Yuya
Saito, Jun
Nishikawa, Tetsuo
author_facet Inoue, Kosuke
Horikoshi, Hirofumi
Omura, Masao
Tsurutani, Yuya
Saito, Jun
Nishikawa, Tetsuo
author_sort Inoue, Kosuke
collection PubMed
description 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.
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spelling pubmed-96834942022-11-25 Association Between Aldosterone and Hypertension Among Patients With Overt and Subclinical Hypercortisolism Inoue, Kosuke Horikoshi, Hirofumi Omura, Masao Tsurutani, Yuya Saito, Jun Nishikawa, Tetsuo J Endocr Soc Clinical Research Article 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. Oxford University Press 2022-10-31 /pmc/articles/PMC9683494/ /pubmed/36438547 http://dx.doi.org/10.1210/jendso/bvac167 Text en © The Author(s) 2022. Published by Oxford University Press on behalf of the Endocrine Society. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (https://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Clinical Research Article
Inoue, Kosuke
Horikoshi, Hirofumi
Omura, Masao
Tsurutani, Yuya
Saito, Jun
Nishikawa, Tetsuo
Association Between Aldosterone and Hypertension Among Patients With Overt and Subclinical Hypercortisolism
title Association Between Aldosterone and Hypertension Among Patients With Overt and Subclinical Hypercortisolism
title_full Association Between Aldosterone and Hypertension Among Patients With Overt and Subclinical Hypercortisolism
title_fullStr Association Between Aldosterone and Hypertension Among Patients With Overt and Subclinical Hypercortisolism
title_full_unstemmed Association Between Aldosterone and Hypertension Among Patients With Overt and Subclinical Hypercortisolism
title_short Association Between Aldosterone and Hypertension Among Patients With Overt and Subclinical Hypercortisolism
title_sort association between aldosterone and hypertension among patients with overt and subclinical hypercortisolism
topic Clinical Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9683494/
https://www.ncbi.nlm.nih.gov/pubmed/36438547
http://dx.doi.org/10.1210/jendso/bvac167
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