P45 - ECE_2394 - Hypertension in adrenal insufficiency: prevalence, disease specific factors and insights into regulation of the renin-angiotensin-aldosterone system
TL;DR
While classical risk factors appear dominant, the observed associations with GC replacement and cortisol profiles indicate unphysiological steroid exposure under conventional treatment contributes to BP elevations.
Abstract
Retrospective analyses consistently show higher cardiovascular (CV) mortality and morbidity in patients with adrenal insufficiency (AI) compared to controls. However, factors driving the increased CV risk remain poorly understood. Assess the prevalence of hypertension (HT) by 24-hour blood pressure (24h-BP) measurements and associations with disease-related parameters in patients from our multicentric AI registry. We measured 24h-BP in 281 patients (71% primary AI (PAI), 68% female, mean age 50 ± 14 years, 24% under antihypertensive treatment). HT was diagnosed according to ESC/ESH thresholds. Results were correlated with hormone replacement regimens, salivary- and urinary cortisol, key effectors of the renin-angiotensin-aldosterone system (RAAS) (Angiotensin I/II, Aldosterone, angiotensin-converting-enzyme activity (ACE-Q)) and routine clinical and biochemical parameters. 24h-BP was elevated in 59% of all patients (PAI 57% vs SAI 74%, P = .006) and in 52% of patients without antihypertensive treatment (PAI 52% vs SAI 53%, P = 0.88). Nighttime-HT was more prevalent than daytime-HT (48% vs 38%) regardless of antihypertensive therapy and 33% of the cohort were non-dippers. Logistic regression in patients not receiving antihypertensive therapy showed significant associations of male sex, BMI, and renal function with 24h-HT, and of higher glucocorticoid (GC) doses with daytime-HT. In the subgroup with available RAAS data, evening GC intake and ACE-Q were additionally associated with 24h-HT and nighttime-HT. Linear regression in patients with 24h-HT demonstrated associations between mean systolic BP and higher 24h urinary cortisol, salivary cortisol AUC, and GC replacement dose. Nighttime hypertension and non-dipping are frequent in our cohort. While classical risk factors appear dominant, the observed associations with GC replacement and cortisol profiles indicate unphysiological steroid exposure under conventional treatment contributes to BP elevations.