Cortisol and hypertension.
1. In humans, the hypertensive effects of adrenocorticotropic hormone (ACTH) infusion are reproduced by intravenous or oral cortisol. Oral cortisol increases blood pressure in a dose-dependent fashion. At a dose of 80-200 mg/day, the peak increases in systolic pressure are of the order of 15 mmHg. Increases in blood pressure are apparent within 24 h. 2. Cortisol-induced hypertension is accompanied by a significant sodium retention and volume expansion. Co-administration of the type I (mineralocorticoid) receptor antagonist spironolactone does not prevent the onset of cortisol-induced hypertension. Thus, sodium retention is not the primary mechanism of cortisol-induced hypertension. 3. Direct and indirect measures of sympathetic activity are unchanged or suppressed during cortisol administration, suggesting that cortisol-induced hypertension is not mediated by increased sympathetic tone. 4. Preliminary evidence in humans suggests that suppression of the nitric oxide system may play a role in cortisol-induced hypertension. 5. These potential mechanisms of cortisol action may be relevant in a number of clinical contexts, including Cushing's syndrome, apparent mineralocorticoid excess, the hypertension of liquorice abuse and chronic renal failure. There is also preliminary evidence suggesting a role for cortisol in essential hypertension.
Kelly
J J
JJ
Department of Medicine, St George Hospital, University of New South Wales, Sydney, Australia. jkelly@s056.aone.net.au
Mangos
G
G
Williamson
P M
PM
Whitworth
J A
JA
D000324:Adrenocorticotropic Hormone / Q000494:pharmacology; D000818:Animals; D002302:Cardiac Output / Q000187:drug effects; D003480:Cushing Syndrome / Q000209:etiology; D004837:Epinephrine / Q000378:metabolism; D006801:Humans; D006854:Hydrocortisone / Q000494:pharmacology*; D006973:Hypertension / Q000139:chemically induced*; D009131:Muscle, Smooth, Vascular / Q000502:physiology; D009638:Norepinephrine / Q000378:metabolism; D012964:Sodium / Q000378:metabolism
D000324:Adrenocorticotropic Hormone; D012964:Sodium; D006854:Hydrocortisone; D009638:Norepinephrine; D004837:Epinephrine