Pharmaceutical & Non-Pharmaceutical Cortisol Decrease in Patients with Hypertension

Hypertension is a prevalent medical condition in society. Cortisol, an endocrine hormone, is shown to increase blood pressure. This study uses PubMed to review the findings on how decreasing cortisol affects blood pressure in hypertensive patients. After a literature search, 136 records were screened, and seven studies were included in the review. Pharmaceutical remedies were found in studies involving glucocorticoid antagonists mifepristone and relacorilant, looking at patients who have Cushing’s syndrome. These studies show a significant decrease in blood pressure but many patients withdrew from the study due to adverse effects. Non-cushing syndrome hypertensive patients were seen in a study involving beta blockers atenolol and nebivolol. Atenolol had a significant decrease in cortisol levels, both drugs reported a decrease in blood pressure and ACTH. The non-pharmaceutical studies involve relaxation training, forest therapy, qigong, and aromatherapy. All these studies show a common problem: the inability to control the variables to isolate cortisol effects. Some studies saw decreases in epinephrine and norepinephrine, and others in aldosterone. This makes it increasingly difficult to draw conclusions about the effect of decreasing cortisol in hypertensive patients. Further research on the impact of micro doses of mifepristone and relacorilant on non-cushings patients is needed to see if reducing cortisol can effectively lower blood pressure.   

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Article Contents 

20 min

Introduction Literature Review Methodology Results Discussion Conclusions & Future Directions References

Introduction

The heart is an intricate and vital organ since it is part of many organ systems that allow the body to function correctly. From endocrine hormone movement to something as simple as nutrient and oxygen distribution, the heart keeps the body alive. The heart involves two pumps, the ventricles, moving the blood in series. Blood pressure is the pressure of blood as it flows through the blood vessels. This pressure is required to ensure the blood reaches target tissues. Systolic blood pressure is known as the pressure of blood after the ventricles contract, and diastolic blood pressure is the pressure of blood after relaxation of the ventricle muscles. Hypertension is the incidence of elevated blood pressure over a period of time (Oparil et al., 2018). 48.1% of adults in the United States have hypertension or are taking medicine to treat hypertension. In 2021, hypertension contributed to 691,095 deaths in the United States (Centers for Disease Control and Prevention, 2023). The American Heart Association states that hypertension can lead to heart attacks, heart failure, kidney damage, strokes, and vision loss. A greater understanding of specific mechanisms that lead to hypertension is crucial for knowledge that may treat and prevent hypertension-related fatalities.

Hypertension is more specifically defined as a systolic blood pressure greater than 130 mmHg or a diastolic blood pressure greater than 80 mmHg (Centers for Disease Control and Prevention, 2023). Hypertension can lead to blood clots, which can travel to the brain and lead to a stroke. According to the American Heart Association, the clots can also travel to the coronary arteries and lead to a heart attack. Hypertension can occur mainly through two routes, one being the increased volume of blood traveling through the blood vessels. This can be done by impaired endocrine responses or by increased sodium intake in the diet (Denton et al., 1995). The second route is by arterial over-contraction, which increases the pressure by decreasing the space in which the blood volume can travel through (Brenner et al., 2000, Qiao et al., 2014). This may occur through the sympathetic system or other endocrine hormones (Furuhashi et al., 2000). The renin-angiotensin-aldosterone system is an endocrine system that can cause hyperten