To assess the influence of an altered aldosterone, renin, angiotensin (ARA), cortisol and thyroid hormone pattern on the clinical course of high blood pressure subjects and the effect of medical treatment on this pattern.Design and method:
We have studied a group of 110 patients with controlled essential hypertension examined in the last two years; the subjects have been hypertensive for at least 3 years; the HBP duration ranged from 3 to 33 years (average duration 9.6 years). We recorded family history of cardiovascular diseases, smoking status, socio-professional stress, comorbidities, clinical course, medication and blood test results for the endocrine and enzymatic pattern of the subjects (plasma cortisol, TSH, aldosterone, renin and angiotensin converting enzyme). All patients have also been explored by standard echocardiography, ECG and had the usual blood tests performed (e.g. glycaemia, lipid profile, serum creatinine etc.)Results:
Group characteristics: mean age 57.3 +/− 12.7 years, males 56.4%, smokers 33.6%, obesity 41.8%, dyslipidemia 48.2%, IHD 33.6%, type 2 DM 23.6%, HF 28.2%, cerebrovascular disease 13.6%, atrial fibrillation 8.2%. Main blood test results: cortisol 19.2 +/− 7.4 μg/dl; TSH 2.8 +/− 1.7 mIU/l; aldosterone 17.5 +/− 7.9 ng/dl; renin 62.7 +/− 31.4 μIU/ml; ACE 30.6 +/− 15.6 IU/l. Cortisol and TSH pattern were frequently altered in subjects with socio-professional stress or by medication. Clinical course was mainly influenced by associated cardiovascular pathology and other major comorbidities (e.g. DM). Neither the ARA pattern was significantly influenced by ACEI and ARB treatment, nor did high ARA pattern change the clinical course of the controlled high blood pressure patients. We found a relatively important correlation between high ARA values and the presence of family history for cardiovascular events together with young age at the moment of hypertension diagnosis.Conclusions:
The enzymatic and endocrine pattern is frequently altered in essential hypertension. Despite this, patients can achieve good blood pressure control through medical treatment according to guidelines. Family history of cardiovascular events and young age at the diagnosis of hypertension have an impact on ARA pattern, which might be considered for tailoring treatment.