Hypercortisolism and arterial hypertension a possible role for vasosuprin

Background: A possible role of vasopressin in the development of arterial hypertension in patients with hypercortisolism was investigated. Methods: Four groups of subjects of both sexes were included. In all of them plasma vasopressin was determined. Twenty-four patients with Cushing's disease (13 hypertensive and 11 still normotensive) were studied during the active period of the disease and after correction of hypercortisolism. A second group included 14 patients with Addison's disease receiving specific hormone replacement. Thirty-two subjects with uncomplicated, untreated essential hypertension and a group of eight control healthy normotensive volunteers were also enrolled. Results: Baseline vasopressin (pg/mL) was higher (p < 0.05) in hypertensive patients with Cushing's disease (3.2 ± 0.63) compared with all groups: normotensive patients with Cushing's disease (1.6 ± 0.75), patients with Addison's disease (1.9 ± 0.29), essential hypertensive patients (1.4 ± 0.21) and control normotensive volunteers (1.4 ± 0.20). Treatment reduced plasma cortisol, mean arterial pressure (MAP) and vasopressin in patients with Cushing's disease. On examining those patients in detail, only 13 had no relapse of the disease after surgical treatment, and vasopressin and MAP were significantly reduced only in the seven who were previously hypertensive. Conclusions: Our data show that in normotensive patients with Cushing's disease, plasma vasopressin is lower than in patients with hypertension. Moreover, after an effective surgical treatment, plasma vasopressin is lowered concurrently with lowering of MAP only in patients who were hypertensive. Patients with Addison's disease receiving specific hormone replacement have low/normal plasma cortisol and normal vasopressin levels. Our observations suggest that vasopressin may have a role in the genesis or in development of hypertension associated with high levels of plasma cortisol.