RESPONSE OF HYPERTENSION TO CONVENTIONAL ANTIHYPERTENSIVE TREATMENT AND/OR STEROIDOGENESIS INHIBITORS IN CUSHINGS-SYNDROME

Objectives. To evaluate the effect of conventional antihypertensive drugs and/or inhibitors of steroid production in the management of hypertension in Cushing's syndrome. Design. A retrospective open clinical study with pre- post-treatment assessment. Setting. A university hospital, where patients were initially admitted and then followed-up in an ambulatory clinic over a period of 6 years. Subjects. Forty consecutive hypertensive patients with Cushing's syndrome. Interventions. Patients were divided into two groups according to the different management of hypertension. The first group (group 1) of 28 patients included those treated with antihypertensive drugs at full dose (diuretics, calcium antagonists, angiotensin converting enzyme [ACE] inhibitors, as single agents or in combination). The second group (group 2) of 12 patients received ketoconazole alone. Main outcome measures. Blood pressure variations compared to pre-treatment levels. Results. Blood pressure normalization was obtained in four of the 28 patients of group 1. In 12 of the remaining patients, ketoconazole, an inhibitor of steroid production, was subsequently added and this normalized blood pressure in all but the one in whom cortisol was not decreased. In the 12 patients of group 2, ketoconazole alone lowered blood pressure within normal limits in all but one who had longstanding hypertension. Conclusions. In hypertensive patients with Cushing's syndrome, conventional antihypertensive therapy is mostly ineffective. Blood pressure response is satisfactory only after the restoration of normal cortisol levels, indicating the need for a specific treatment for hypertension in this disorder.