Background:Left ventricular (LV) abnormalities were reported in patients with overt and subclinical Cushing syndrome. The aim of this study was to investigate the relationships of daily plasma cortisol profile and cortisol response to an overnight suppression test with cardiac changes in patients with hypertension.Methods:In a cross-sectional study, we included 136 nondiabetic, patients with essential hypertension who were free of cardiovascular and renal complications. Plasma cortisol was measured at 8 am, 3 pm, and 12 am and at 8 am after overnight suppression with 1 mg dexamethasone (dexamethasone suppression test [DST]). Echocardiography was performed with standard B-mode and tissue-Doppler imaging.Results:LV hypertrophy was present in 30% and LV diastolic dysfunction in 51% of patients who were older and had significantly higher body mass index, systolic blood pressure, duration of hypertension, and 12 am and DST cortisol. LV mass index and relative wall thickness increased progressively across tertiles of DST cortisol, together with progressive worsening of diastolic function. LV mass index was directly related to age, systolic blood pressure, duration of hypertension, and 12 am and DST cortisol, and inversely to creatinine clearance. Multivariate regression analysis showed independent correlation of LV mass index with body mass index, systolic blood pressure, and 12 am and DST cortisol. Logistic regression showed that DST cortisol independently predicted LV hypertrophy.Conclusions:Midnight and DST plasma cortisol levels are independent determinants of LV mass and geometry in patients with essential hypertension suggesting that even minor changes in regulation of cortisol secretion could contribute to cardiac abnormalities in these patients.

中文翻译：

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皮质醇分泌调节的差异导致原发性高血压患者左心室异常

背景：在明显和亚临床库欣综合征患者中报告了左心室 (LV) 异常。本研究的目的是调查每日血浆皮质醇分布和皮质醇对夜间抑制试验的反应与高血压患者心脏变化之间的关系。方法：在一项横断面研究中，我们纳入了 136 名非糖尿病、原发性高血压患者，他们没有心血管和肾脏并发症。在上午 8点、下午 3点、上午 12点和上午 8点测量血浆皮质醇。用 1 mg 地塞米松抑制过夜后（地塞米松抑制试验 [DST]）。超声心动图采用标准 B 型和组织多普勒成像进行。结果：30% 的老年患者存在 LV 肥大，51% 的患者存在 LV 舒张功能障碍，并且体重指数、收缩压、高血压病程显着升高和上午 12点和 DST 皮质醇。LV 质量指数和相对壁厚在 DST 皮质醇的三分位数中逐渐增加，同时舒张功能逐渐恶化。LV 质量指数与年龄、收缩压、高血压持续时间和凌晨 12点直接相关和 DST 皮质醇，与肌酐清除率相反。多变量回归分析显示 LV 质量指数与体重指数、收缩压、上午 12点和 DST 皮质醇的独立相关性。Logistic 回归显示 DST 皮质醇独立预测 LV 肥大。结论：午夜和 DST 血浆皮质醇水平是原发性高血压患者 LV 质量和几何形状的独立决定因素，这表明即使皮质醇分泌调节的微小变化也可能导致这些患者的心脏异常.