Remission of hypertension after surgical cure of Cushing's syndrome

• Published in: Clinical endocrinology (Oxford) Vol. 92; no. 2; pp. 124 - 130
• Main Authors: Jha, Smita, Sinaii, Ninet, McGlotten, Raven N., Nieman, Lynnette K.
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01-02-2020
• Subjects: Adenoma; Adrenocorticotropic hormone; Adult; Antihypertensive Agents - therapeutic use; Antihypertensives; Blood pressure; Blood Pressure - physiology; Body mass index; cardiovascular; Cardiovascular diseases; Cushing syndrome; Cushing Syndrome - complications; Cushing Syndrome - metabolism; Cushing Syndrome - physiopathology; Cushing Syndrome - surgery; Female; Humans; Hydrocortisone - blood; Hydrocortisone - urine; hypercortisolaemia glucocorticoids; Hypertension; Hypertension - drug therapy; Hypertension - etiology; Hypertension - metabolism; Hypertension - surgery; Male; Middle Aged; Nervous system diseases; Pituitary; postoperative; predictors; Remission; Remission (Medicine); Remission Induction; Retrospective Studies; Weight Loss - physiology; Withholding Treatment; postoperative; predictors; blood pressure; cardiovascular; hypercortisolaemia glucocorticoids
• ISSN: 0300-0664; 1365-2265
• DOI: 10.1111/cen.14129

Context
Hypertension associated with Cushing's syndrome (CS) increases cardiovascular risk. The time‐course of improvement after cure is unclear.
Objective
To describe the time‐course and predictors of blood pressure (BP) normalization during one year after surgical cure of CS.
Design
Retrospective chart review of 75 hypertensive adults cured of CS (72 with ACTH‐dependent CS; 3 with adrenal adenoma). Hypertension was defined as current use of antihypertensives, a systolic BP >130 mm Hg, or diastolic BP >80 mm Hg.
Main Outcome Measure(s)
Remission of hypertension: BP ≤130/80 mm Hg and no antihypertensive medications. Improvement in hypertension: BP >130/80 mm Hg and decreased number or dose of medications, or blood pressure ≤130/80 with continued use of medications at constant dose.
Results
At postoperative discharge, 17 (23%, P < .001), 51 (68%, P < .001) and 7 (9%) patients had remission, improvement in hypertension or no change. Twenty‐nine had no follow‐up. Others achieved remission at 3 (n = 5), 6 (n = 6), or 12‐months (n = 5). At the last evaluation, 33/75 (44%) had remission, 36/75 (48%) had improved hypertension and 6 were unchanged. Patients with improvement discontinued a median of one medication (P < .001). At 12‐months, 27/42 (64%) patients had normal BP (P < .002). Longer estimated duration of CS (P = .0106), younger age (P = .0022), and lower baseline body mass index (P = .0413) predicted hypertension remission.
Conclusions
About 80% of CS patients experienced BP normalization or improvement within 10 days of cure, but about half failed to normalize BP by one year. BP should be monitored after cure, and antihypertensive medications adjusted to avoid unwanted cardiovascular effects.