Prevalence of hypercortisolism in hypertension and its link to carotid atherosclerosis markers

Objectives: The prevalence of hypercortisolism in hypertension and its association with cardiometabolic risk in hypertensive patients remains unknown. This study investigates the prevalence of hypercortisolism and the relationship between cortisol secretion and cardiometabolic parameters in hypertensive patients. Methods: In 106 non-diabetic and non-obese hypertensive patients (aged 37-70 years; 53 females), cortisol after a 1 mg dexamethasone suppression test (F-1mgDST), carotid intima-media thickness (cIMT), blood pressure dipping pattern (DP), carotid stenosis (CS), fasting glucose (FG), and glycated haemoglobin (HbA1c) were evaluated. Hypercortisolism was defined as F-1mgDST >1.8 μg/dL (50 nmol/L). Results: Hypercortisolism was identified in 8 patients (7.5%). Compared to those without, patients with hypercortisolism were older (56.9 vs 63.0 years, p=0.04), had higher FG (95.3 vs. 103.8 mg/dL, p=0.03), HbA1c (5.4% vs. 5.6%, p=0.001), more frequently altered DP (22.0% vs. 62.5%, p=0.026), pathological cIMT (>1 mm; 7% vs. 66.7%, p=0.001), and frequently required ≥2 antihypertensive drugs (14.3% vs. 50.0%, p=0.027). Pathological cIMT levels were associated with F-1mgDST levels (OR 14.00, 95%CI 2.70-72.48, p<0.002) after adjusting for age, sex, BMI, smoking status and presence of IFG/IGT. The optimal F-1mgDST cut-off for predicting increased cIMT was identified as 1.14 μg/dL (31.4 nmol/L). This F-1mgDST threshold predicted the risk of cIMT >1 mm (OR 15.57, 95% CI 2.88-84.29, p=0.001), after adjustment for age, sex, BMI, smoking, and presence of impaired glucose metabolism. Conclusions: Hypercortisolism was detected in 7.5% of non-diabetic and non-obese hypertensive patients and was associated with early vascular damage. Hypercortisolism may worsen the cardiometabolic risk in hypertension.