Urinary cortisol to cortisone metabolites ratio in prednisone-treated and spontaneously hypertensive patients.
OBJECTIVE
Prednisone and its active metabolite prednisolone, both substrates for 11beta-hydroxysteroid dehydrogenase type 2 (11beta-HSD2), may represent a pharmacological challenge for the enzyme. The aim of the present work was to define the possible role of abnormal cortisol/cortisone handling, as revealed by an urinary tetrahydrocortisol + allotetrahydrocortisol (THFs)/tetrahydrocortisone (THE) ratio between 1.5 and 3.0, by measuring urinary cortisol and cortisone metabolites in: normotensive individuals (n = 100) who received 7-8 mg/day of oral prednisone and were then followed for development of hypertension; essential hypertensive (EH) participants from primary care (n = 103); and EH hypertensive patients referred to the Hypertension Unit (n = 141).


RESULTS
About one-third (14 out of 47, 30%) of glucorticoid-treated patients who developed hypertension showed a THFs/THE ratio >1.5, which was seen in 3% (n = 3) and 14% (n = 19) of primary and tertiary care hypertensive patients, respectively. A THFs/THE ratio >1.5 was associated with a 3.8-fold incremental risk of hypertension after glucocorticoid therapy, regardless of duration and intensity of prednisone therapy.


CONCLUSIONS
A number of EH patients and glucocorticoid-treated participants shared a similar phenotype, characterized by both arterial hypertension and elevated urinary THFs/THE ratio. Such a phenotype is more common in severely, rather than in mildly, hypertensive patients.
Olivieri
Oliviero
O
Unit of Internal Medicine, Department of Clinical and Experimental Medicine, University of Verona, Italy. oliviero.olivieri@univr.it
Pizzolo
Francesca
F
Ravagnani
Viviana
V
Moretti
Lorenzo
L
Carletto
Antonio
A
Faccini
Giovanni
G
Pasini
Francesco
F
Friso
Simonetta
S
Corrocher
Roberto
R
D000328:Adult; D000368:Aged; D003348:Cortisone / Q000652:urine*; D005260:Female; D005938:Glucocorticoids / Q000009:adverse effects*; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism / Q000652:urine*; D006973:Hypertension / Q000139:chemically induced* / Q000652:urine; D008297:Male; D008875:Middle Aged; D010641:Phenotype; D011241:Prednisone / Q000009:adverse effects*; D012307:Risk Factors
D005938:Glucocorticoids; D003348:Cortisone; D011241:Prednisone; D006854:Hydrocortisone