11-Beta Dehydrogenase Type 2 Activity Is Not Reduced in Treatment Resistant Hypertension.
OBJECTIVE
Decreased renal 11-beta dehydrogenase type 2 (11β-HSD2) activity, as reflected by an increased urinary free cortisol to cortisone ratio (UFF/UFE), is associated with having hypertension (HTN). The current study was conducted to determine if reduced 11β-HSD2 activity is also associated with having resistant HTN.


METHODS
We evaluated 55 consecutive patients with RHTN, defined as blood pressure (BP) ≥140/90 mm Hg despite using ≥3 antihypertensive medications including a diuretic, and 38 patients whose BP was controlled on ≤3 medications to serve as a non-RHTN comparator group. All patients underwent biochemical evaluation, including measurement of 24-hour urinary UFF/UFE.


RESULTS
The 2 study groups had similar demographic characteristics. Systolic, diastolic BP, and number of antihypertensive medications were greater in patients with uncontrolled RHTN vs. the control group (167.5 ± 28.2/91.2 ± 18.8 vs. 126.6 ± 11.4/77.8 ± 8.65 mm Hg and 4.31 ± 1.23 vs. 2.74 ± 0.6, respectively). The 24-hour UFF was 13.6 ± 11.8 vs. 14.3 ± 10.7 µg/24 h and UFE was 64.9 ± 36.3 vs. 76.1 ± 44 µg/24 h such that the UFF/UFE was 0.22 ± 0.16 vs. 0.19 ± 0.09 in RHTN vs. the control group. This ratio was not associated to age, race, gender, and body mass index.


CONCLUSIONS
An elevated UFF/UFE was not present in this large cohort of patients with uncontrolled RHTN. This suggests that reduced conversion of cortisol to cortisone does not contribute to the development of RHTN.
Vascular Biology and Hypertension Program, Cardiovascular Disease, Department of Medicine, University of Birmingham at Alabama, Birmingham, Alabama, USA.
Lama
L
Ghazi
Vascular Biology and Hypertension Program, Cardiovascular Disease, Department of Medicine, University of Birmingham at Alabama, Birmingham, Alabama, USA.
Tanja
T
Dudenbostel
Vascular Biology and Hypertension Program, Cardiovascular Disease, Department of Medicine, University of Birmingham at Alabama, Birmingham, Alabama, USA.
Maria El
ME
Hachem
Vascular Biology and Hypertension Program, Cardiovascular Disease, Department of Medicine, University of Birmingham at Alabama, Birmingham, Alabama, USA.
Mohammed
M
Siddiqui
Center for Clinical and Translational Science, University of Birmingham at Alabama, Birmingham, Alabama, USA.
Chee Paul
CP
Lin
Vascular Biology and Hypertension Program, Cardiovascular Disease, Department of Medicine, University of Birmingham at Alabama, Birmingham, Alabama, USA.
Suzanne
S
Oparil
Vascular Biology and Hypertension Program, Cardiovascular Disease, Department of Medicine, University of Birmingham at Alabama, Birmingham, Alabama, USA.
David A
DA
Calhoun
D043209:11-beta-Hydroxysteroid Dehydrogenase Type 2 / Q000378:metabolism*; D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D015415:Biomarkers / Q000652:urine; D001794:Blood Pressure / Q000187:drug effects; D003348:Cortisone / Q000652:urine; D003430:Cross-Sectional Studies; D004351:Drug Resistance; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000652:urine; D006973:Hypertension / Q000175:diagnosis / Q000188:drug therapy / Q000201:enzymology* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
D000959:Antihypertensive Agents; D015415:Biomarkers; D043209:11-beta-Hydroxysteroid Dehydrogenase Type 2; C468387:HSD11B2 protein, human; D003348:Cortisone; D006854:Hydrocortisone
11-beta dehydrogenase type 2; blood pressure; cortisol/ cortisone ratio; hypertension; resistant hypertension.