Hypertension Unit, Division of Internal Medicine, Department of Medicine, University of Udine, Udine, Italy (G.B., C.C., A.D.P., L.B., A.V., L.A.S.).
Department of Cardiology, Medical University of Graz, Austria (N.D.V.).
Hypertension. 2022 Jul;79(7):1435-1444. doi: 10.1161/HYPERTENSIONAHA.122.19472. Epub 2022 May 10.
Left ventricular (LV) abnormalities were reported in patients with overt and subclinical Cushing syndrome. The aim of this study was to investigate the relationships of daily plasma cortisol profile and cortisol response to an overnight suppression test with cardiac changes in patients with hypertension.
In a cross-sectional study, we included 136 nondiabetic, patients with essential hypertension who were free of cardiovascular and renal complications. Plasma cortisol was measured at 8 am, 3 pm, and 12 am and at 8 am after overnight suppression with 1 mg dexamethasone (dexamethasone suppression test [DST]). Echocardiography was performed with standard B-mode and tissue-Doppler imaging.
LV hypertrophy was present in 30% and LV diastolic dysfunction in 51% of patients who were older and had significantly higher body mass index, systolic blood pressure, duration of hypertension, and 12 am and DST cortisol. LV mass index and relative wall thickness increased progressively across tertiles of DST cortisol, together with progressive worsening of diastolic function. LV mass index was directly related to age, systolic blood pressure, duration of hypertension, and 12 am and DST cortisol, and inversely to creatinine clearance. Multivariate regression analysis showed independent correlation of LV mass index with body mass index, systolic blood pressure, and 12 am and DST cortisol. Logistic regression showed that DST cortisol independently predicted LV hypertrophy.
Midnight and DST plasma cortisol levels are independent determinants of LV mass and geometry in patients with essential hypertension suggesting that even minor changes in regulation of cortisol secretion could contribute to cardiac abnormalities in these patients.
显性和亚临床库欣综合征患者存在左心室（LV）异常。本研究旨在探讨高血压患者中，日常血浆皮质醇谱和皮质醇对 overnight suppression test 的反应与心脏变化的关系。
在一项横断面研究中，我们纳入了 136 名无心血管和肾脏并发症的非糖尿病原发性高血压患者。在 8 点、3 点和 12 点以及使用 1mg 地塞米松 overnight suppression 后 8 点（地塞米松抑制试验 [DST]）测量血浆皮质醇。使用标准 B 模式和组织多普勒成像进行超声心动图检查。
30%的患者存在 LV 肥厚，51%的患者存在 LV 舒张功能障碍，这些患者年龄较大，体重指数、收缩压、高血压病程以及 12 点和 DST 皮质醇显著较高。LV 质量指数和相对壁厚度随 DST 皮质醇三分位的升高而逐渐增加，同时舒张功能逐渐恶化。LV 质量指数与年龄、收缩压、高血压病程以及 12 点和 DST 皮质醇直接相关，与肌酐清除率呈负相关。多元回归分析显示，LV 质量指数与体重指数、收缩压和 12 点及 DST 皮质醇独立相关。Logistic 回归显示，DST 皮质醇独立预测 LV 肥厚。
午夜和 DST 血浆皮质醇水平是原发性高血压患者 LV 质量和几何形状的独立决定因素，这表明即使皮质醇分泌调节的微小变化也可能导致这些患者的心脏异常。
