Abstract 4371513: Stage 2 heart failure is associated with 24 hour urinary cortisol levels in patients with resistant hypertension

Resistant hypertension (RHTN), defined as blood pressure (BP) above goal despite using ≥3 antihypertensive agents. Patients with resistant hypertension are at an increased risk of heart failure compared with those with more easily controlled hypertension. Early biomarkers for the prevention of symptomatic heart failure (stage 3 and 4) are needed. There has not been an evaluation of biomarkers in stage 2 heart failure (HF) in patients with Resistant Hypertension (RHTN) there have not been any investigations into biomarkers. We conducted a cross-sectional analysis of patients referred to the Hypertension Clinic at the University of Alabama at Birmingham. In this study we analyzed data of patients with RHTN and stage 2 HF defined by structural changes assessed by cardiac MRI who had no history of HF, and compared it with patients with hypertension (HTN). We evaluated demographics, body mass index, and blood pressure levels. Patients also underwent biochemical evaluation of serum/plasma, 24-hr urine collection, and cardiac MRI assessment. Patients with RHTN and stage 2 HF had significantly higher 24-hr urinary cortisol levels (118.6 ±66.5 vs 86.7±31.5 mcg, p<0.0022), higher BNP and ANP levels (41 ± 74.2 vs 19.4 ± 18.2, p = 0.007) (82.4 ± 54 vs 54.6 ± 32.6, p = 0.012). Among the pertinent cardiac MRI measurements the most significant were the left ventricular mass (LVM) (169.5 ± 46.25 vs 125.6 ± 29.75, p < 0.001), the LVM end diastolic (LVM ED) (162.4 ± 44.4 vs 120.8 ± 27.1, p < 0.001), the LVM end systolic (LVM ES) ( 177.3 ± 49.7 vs 130.5 ± 32.8, p < 0.001), the LVM posterior wall (LVPW) (10.3 ± 2.6 vs 8.1 ± 1.4, p< 0.001), and IVS (12.5 ± 2.5 vs 10.1± 1.4, p< 0.001). There was no difference in age, BMI, serum creatinine, urinary sodium, and urinary potassium. When analyzed by gender or race there was no difference between groups. In summary, cortisol may play a role in the development of HF in patients with RHTN. Further studies are needed to elucidate underlying mechanisms.