A new cause of high blood pressure has been identified. Research led by scientists at the University of Birmingham suggests that this could lead to major changes in managing the disease.
High blood pressure, also known as hypertension, affects around 1 in 4 adults. There is no identifiable cause for the condition and it often goes unnoticed. If left untreated, it can increase the risk of heart attack and stroke.
In around 10% of the patients suffering from hypertension, primary aldosteronism or Conn syndrome, in which there is the overproduction of adrenal hormone aldosterone, is the cause of disease. The risk of cardiovascular diseases in such patients is higher than those without this syndrome.
New findings suggest that in many patients with Conn syndrome, there is an overproduction of stress hormone cortisol, in addition to production of aldosterone.
Professor Wiebke Arlt, Director of the Institute of Metabolism and Systems Research (IMSR) at the University of Birmingham, said "Our findings show that the adrenal glands of many patients with Conn syndrome also produce too much cortisol, which finally explains puzzling results of previous studies in Conn patients."
"These previous studies had found increased rates of type 2 diabetes, osteoporosis and depression in Conn patients -- problems typically caused by overproduction of cortisol, also termed Cushing syndrome, and not by too much aldosterone." Arlt added.
This new cause of hypertension caused by the combined overproduction of aldosterone and cortisol is named as Connshing syndrome.
Current treatment of Conn syndrom only targets the adverse effects of aldosterone. This leaves the cortisol excess untreated.
Katharina Lang, second author of the study and an academic clinical lecturer at IMSR sais, "These findings are very likely to change clinical practice. Patients will now need to undergo more detailed assessment to clarify whether they suffer from Conn or Connshing syndrome."
"Previously, patients with Conn syndrome were never assessed for the overproduction of other hormones but this will now change thanks to the results of this study. Also, researchers now will need to investigate whether treating the Connshing patients with an additional drug, which counteracts the cortisol excess, will improve their health outcomes." Lang added.
The study is published in JCI Insight.
- Wiebke Arlt et al. Steroid metabolome analysis reveals prevalent glucocorticoid excess in primary aldosteronism. JCI Insight; (2017) doi.org/10.1172/jci.insight.93136
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