Cardiac Changes and Cortisol in Essential Hypertension

Objective: This study aimed to examine the relationships between 24-hour urinary cortisol levels (24h-UFC) and alterations in left ventricular (LV) structure and function in patients with essential hypertension. Methods: A prospective cohort study was conducted at the Hypertension Center of the University of Hong Kong-Shenzhen Hospital, including 315 patients with essential hypertension. Baseline 24h-UFC levels were measured, and echocardiographic assessments were performed to evaluate left ventricular mass (LVM), left ventricular ejection fraction (LVEF), and the E/e’ ratio (early diastolic trans-mitral flow velocity to early diastolic mitral annular velocity). Patients were divided into tertiles based on their 24h-UFC levels for comparative analysis. Statistical analyses were employed to examine the relationships between UFC levels and changes in cardiac parameters over the follow-up period. Results: Higher baseline 24h-UFC levels were significantly associated with greater increases in LVM and E/e’ during follow-up, indicating adverse LV remodeling and diastolic dysfunction. This correlation remained significant after adjusting for confounding factors such as age, gender, baseline systolic and diastolic blood pressure, heart rate, and their changes. Patients in the highest 24h-UFC tertile exhibited an increase in left ventricular hypertrophy (LVH) prevalence, whereas those in the lower tertiles showed a reduction. Conclusion: Elevated 24h-UFC levels are independently associated with adverse changes in LV structure and diastolic function in patients with essential hypertension. Novelty and Relevance What Is New? This is the first study to elucidate the association between longitudinal changes in left ventricular structure and function and 24-hour urinary free cortisol (24h-UFC) in essential hypertension. What Is Relevant? This cohort study indicates that higher baseline 24h-UFC levels are significantly associated with greater increases in left ventricular mass (LVM) and the E/e’ ratio during the follow-up period, suggesting adverse left ventricular (LV) remodeling and diastolic dysfunction. Clinical/Pathophysiological Implications? This study provides novel insights into the role of cortisol in cardiovascular remodeling in hypertensive patients and may have significant implications for understanding the mechanisms underlying hypertensive heart disease.