Association Between Longitudinal Changes in Left Ventricular Structure and Function and 24-Hour Urinary Free Cortisol in Essential Hypertension

Abstract

This study aimed to investigate the associations between 24-hour urinary cortisol levels (24 h-UFC) and alterations in left ventricular (LV) structure and function in patients with essential hypertension. A prospective cohort study was conducted, including 315 patients with essential hypertension who underwent baseline 24 h-UFC measurement and echocardiographic evaluation of left ventricular mass (LVM), left ventricular ejection fraction (LVEF), and the E/e′ ratio. Over a mean follow-up period of 28.54 ± 14.21 months, patients were grouped into tertiles based on baseline 24 h-UFC levels. Higher baseline 24 h-UFC levels were significantly associated with greater increases in LVM and E/e′, reflecting adverse LV remodeling and diastolic dysfunction. These associations persisted after adjusting for potential confounders, including age, gender, baseline blood pressure, and their changes during follow-up. Moreover, patients in the highest 24 h-UFC tertile showed an increased prevalence of LV hypertrophy, contrasting with a reduction observed in the lower tertiles. These findings underscore the independent role of elevated 24 h-UFC levels in driving adverse cardiac structural and functional changes in essential hypertension.