Circadian blood pressure dipping patterns, hypertension, and cortisol metabolism across the weight spectrum

Q: What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Hypertension and circadian blood pressure dipping patterns across the weight spectrum (n=426). Intervention: BMI ≥30 kg/m2 and cortisol metabolism (urinary/serum F/E ratio) vs. BMI 18.5-29.9 kg/m2 and dipping BP pattern (≥10% nocturnal BP fall). Primary outcome: Nondipping blood pressure pattern (<10% nocturnal BP fall) and 24-h mean systolic blood pressure associations with cortisol metabolism (r = 0.46 (urinary F/E ratio with 24-h mean SBP in nondippers with BMI 18.5-29.9 kg/m2), p=0.004).

Q: What does this research mean for the field?

Cortisol metabolism biomarkers show limited association with blood pressure variation in individuals with obesity, but urinary cortisol-to-cortisone ratio is positively associated with 24-hour systolic blood pressure in normal-to-overweight individuals with a nondipping pattern. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To examine associations between 24-hour ambulatory blood pressure patterns, hypertension, and cortisol metabolism across different body mass index classifications.

Morten Kallehauge; Claus Bogh Juhl; Dorte Glintborg; Marianne S. Andersen; René Støving; Charlotte Røn Stolberg

doi:10.1097/hjh.0000000000004484

November 6, 2026Journal of Hypertension

Circadian blood pressure dipping patterns, hypertension, and cortisol metabolism across the weight spectrum

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Key result

Obesity (BMI ≥30 vs 18.5-29.9 kg/m2) had more BP nondipping (66.6% vs 50.5%, P=0.004), while urinary cortisol/cortisone ratio correlated with 24-h SBP in non-obese nondippers (r=0.46, P<0.001).

Why the study?

Alterations in cortisol metabolism have been linked to hypertension and nondipping patterns, motivating an examination of associations between 24-h BP patterns, hypertension, and cortisol levels across the weight spectrum.

Key Points

To examine associations between 24-hour ambulatory blood pressure patterns, hypertension, and cortisol metabolism across different body mass index classifications.
Cross-sectional study evaluating 426 participants, including 97 individuals with BMI 18.5–29.9 kg/m² and 329 individuals with BMI ≥30 kg/m².
Measured 24-hour ambulatory blood pressure monitoring profiles alongside 24-hour urinary cortisol/cortisone ratio, serum corticosteroid-binding globulin, and serum cortisol/cortisone ratio.
Participants with BMI 18.5–29.9 kg/m² had lower 24-hour mean systolic blood pressure (119 ± 11 vs. 131 ± 12 mmHg, P < 0.001) and a lower prevalence of nondipping patterns (50.5% vs. 66.6%, P = 0.004) than those with BMI ≥30 kg/m².
No significant difference was observed in cortisol metabolism between dippers and nondippers overall, though female sex, obesity, normotension, and antihypertensive therapy independently associated with lower urinary cortisol/cortisone ratios.
Among nondippers with BMI 18.5–29.9 kg/m², the urinary cortisol/cortisone ratio correlated positively with 24-hour mean systolic blood pressure (r = 0.46, P < 0.001).

Study Design

Type

Cross-Sectional (n=426)

Structured PICO

P

Population

426 participants (329 with BMI ≥30 kg/m2, mean age 43.9 years; 97 with BMI 18.5-29.9 kg/m2, mean age 47.6 years) evaluated with 24-h ambulatory BP monitoring and cortisol assays.

E

Exposure

24-h ambulatory blood pressure monitoring and assessments of 24-h urinary cortisol/cortisone ratio (F/E ratio), serum corticosteroid-binding globulin, and serum F/E ratio

C

Comparator

Comparison between BMI groups (BMI ≥30 kg/m2 vs. BMI 18.5-29.9 kg/m2) and blood pressure dipping patterns (dippers defined by ≥10% nocturnal BP fall, nondippers as <10% BP fall, and risers as a nocturnal BP increase)

O

Outcome

Associations between 24-h blood pressure patterns (dippers, nondippers, risers, 24-h mean SBP), hypertension, and cortisol metabolism (24-h urinary cortisol/cortisone ratio, serum corticosteroid-binding globulin, and serum cortisol/cortisone ratio)surrogate

Main Result

Effect estimate: r = 0.46 (urinary F/E ratio with 24-h mean SBP in nondippers with BMI 18.5-29.9 kg/m2)

Absolute Event Rate: 66.6% vs 50.5%

p-value: p=0.004

Associations between cortisol biomarkers and blood pressure variation are limited in individuals with obesity (BMI ≥30 kg/m2), but urinary cortisol/cortisone ratio positively correlates with 24-h systolic blood pressure in non-obese nondippers.

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Implication

Obesity links to more nondipping without cortisol differences; leaves open whether cortisol metabolism influences BP variation in non-obese nondippers.

Abstract

BACKGROUND: Blood pressure (BP) exhibits a circadian rhythm with a nocturnal decline, dipping. Alterations in cortisol metabolism have been linked to hypertension and nondipping patterns. This study aimed to examine associations between 24-h BP patterns, hypertension, and cortisol levels. METHODS: In this cross-sectional study, 426 participants (329 with BMI ≥30 kg/m2; 97 with BMI 18.5-29.9 kg/m2) underwent 24-h ambulatory BP monitoring and assessments of 24-h urinary cortisol/cortisone ratio (F/E ratio), serum corticosteroid-binding globulin, and serum F/E ratio. Dippers were defined by at least 10% nocturnal BP fall; nondippers as less than 10% BP fall; and risers as a nocturnal BP increase. RESULTS: Participants with BMI 18.5-29.9 kg/m2 (BMI 24.8 ± 2.7 kg/m2) compared to participants with BMI at least 30 kg/m2 (BMI 40.9 ± 6.8 kg/m2), were older (47.6 ± 8.2 vs. 43.9 ± 10.9, P = 0.002), had lower 24-h mean SBP (119 ± 11 vs. 131 ± 12 mmHg, P < 0.001), and were less frequently nondippers (50.5 vs. 66.6%, P = 0.004). No significant difference was observed in cortisol metabolism when comparing nondippers and dippers (sex-stratified). In a multivariable regression analysis, female sex, BMI at least 30 kg/m2, being normotensive, or receiving antihypertensive treatment were all significantly associated with a lower 24-h urinary F/E ratio. Among nondippers with BMI 18.5-29.9 kg/m2, urinary F/E ratio was positively associated with 24-h mean SBP (r = 0.46, P < 0.001). CONCLUSION: Associations between cortisol biomarkers and BP variation were limited in participants with BMI at least 30 kg/m2, but appeared stronger in individuals with BMI 18.5-29.9 kg/m2 with nondipping BP.

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Cite This Study

Kallehauge et al. (2026) conducted a cross-sectional in Hypertension and circadian blood pressure dipping patterns across the weight spectrum (n=426). BMI ≥30 kg/m2 and cortisol metabolism (urinary/serum F/E ratio) vs. BMI 18.5-29.9 kg/m2 and dipping BP pattern (≥10% nocturnal BP fall) was evaluated on Nondipping blood pressure pattern (<10% nocturnal BP fall) and 24-h mean systolic blood pressure associations with cortisol metabolism (r = 0.46 (urinary F/E ratio with 24-h mean SBP in nondippers with BMI 18.5-29.9 kg/m2), p=0.004). Obesity (BMI ≥30 vs 18.5-29.9 kg/m2) had more BP nondipping (66.6% vs 50.5%, P=0.004), while urinary cortisol/cortisone ratio correlated with 24-h SBP in non-obese nondippers (r=0.46, P<0.001).

synapsesocial.com/papers/6aefbd5d50d2071ffda4bd2b https://doi.org/10.1097/hjh.0000000000004484

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Circadian blood pressure dipping patterns, hypertension, and cortisol metabolism across the weight spectrum

Key Points

Study Design

Structured PICO

Main Result

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Circadian blood pressure dipping patterns, hypertension, and cortisol metabolism across the weight spectrum

Key Points

Study Design

Structured PICO

Main Result

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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