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Effects of Hydrocortisone on the Regulation of Blood Pressure: Results From a Randomized Controlled Trial
- Source :
- The Journal of Clinical Endocrinology & Metabolism. 101:3691-3699
- Publication Year :
- 2016
- Publisher :
- The Endocrine Society, 2016.
-
Abstract
- Cardiovascular risk is increased in patients with secondary adrenal insufficiency, which may be ascribed to an unfavorable metabolic profile consequent to a relatively high hydrocortisone replacement dose.We determined the effects of a higher versus a lower glucocorticoid replacement dose on blood pressure (BP), the renin-angiotensin-aldosterone system, 11β-hydroxysteroid dehydrogenase enzyme activity and circulating (nor)metanephrines.Forty-seven patients with secondary adrenal insufficiency from the University Medical Center Groningen participated in this randomized double-blind crossover study.Patients randomly received 0.2-0.3 mg hydrocortisone/kg body weight followed by 0.4-0.6 mg hydrocortisone/kg body weight, or vice versa, each during 10 weeks.BP and regulating hormones were measured.The higher hydrocortisone dose resulted in an increase in systolic BP of 5 (12) mm Hg (P = .011), diastolic BP of 2 (9) mm Hg (P = .050), and a median [interquartile range] drop in plasma potassium of -0.1 [-0.3; 0.1] nmol/liter (P = .048). The higher hydrocortisone dose led to decreases in serum aldosterone of -28 [-101; 9] pmol/liter (P = .020) and plasma renin of -1.3 [-4.5; 1.2 ] pg/mL (P = .051), and increased the ratio of plasma and urinary cortisol to cortisone (including their metabolites) (P.001 for all). Furthermore, on the higher dose, plasma and urinary normetanephrine decreased by -0.101 [-0.242; 0.029] nmol/liter (P.001) and -1.48 [-4.06; 0.29] μmol/mol creatinine (P.001) respectively.A higher dose of hydrocortisone increased systolic and diastolic BP and was accompanied by changes in the renin-angiotensin-aldosterone system, 11β-hydroxysteroid dehydrogenase enzyme activity, and circulating normetanephrine. This demonstrates that hydrocortisone dose even within the physiological range affects several pathways involved in BP regulation.
- Subjects :
- Adult
medicine.medical_specialty
Hydrocortisone
Hormone Replacement Therapy
Endocrinology, Diabetes and Metabolism
Urinary system
Clinical Biochemistry
Blood Pressure
030209 endocrinology & metabolism
Context (language use)
030204 cardiovascular system & hematology
Biochemistry
law.invention
Renin-Angiotensin System
Young Adult
03 medical and health sciences
0302 clinical medicine
Endocrinology
Randomized controlled trial
law
Internal medicine
medicine
Humans
Glucocorticoids
Aged
Cross-Over Studies
business.industry
Biochemistry (medical)
Middle Aged
Crossover study
Normetanephrine
Treatment Outcome
Blood pressure
11-beta-Hydroxysteroid Dehydrogenases
Cortisone
business
Glucocorticoid
Adrenal Insufficiency
medicine.drug
Subjects
Details
- ISSN :
- 19457197 and 0021972X
- Volume :
- 101
- Database :
- OpenAIRE
- Journal :
- The Journal of Clinical Endocrinology & Metabolism
- Accession number :
- edsair.doi.dedup.....0a9c26d1587b9488194838bef4cf1ad8