Evidence for altered hypothalamus–pituitary–adrenal axis functioning in systemic hypertension: Blunted cortisol response to awakening and lower negative feedback sensitivity

Wirtz, Petra H.; von Känel, Roland; Emini, Luljeta; Ruedisueli, Katharina; Groessbauer, Sara; Maercker, Andreas; Ehlert, Ulrike

doi:10.1016/j.psyneuen.2007.02.006

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Volume 32, Issue 5 , Pages 430-436, June 2007

Evidence for altered hypothalamus–pituitary–adrenal axis functioning in systemic hypertension: Blunted cortisol response to awakening and lower negative feedback sensitivity

Petra H. Wirtz
- Department of Clinical Psychology and Psychotherapy, Psychological Institute, University of Zurich, Binzmuhlestrasse 14/Box 26, CH-8050 Zurich, Switzerland
- Corresponding author. Tel.: +41446357367; fax: +41446357359.
Roland von Känel
- Department of General Internal Medicine, University Hospital Berne, Switzerland
Luljeta Emini
- Department of Clinical Psychology and Psychotherapy, Psychological Institute, University of Zurich, Binzmuhlestrasse 14/Box 26, CH-8050 Zurich, Switzerland
Katharina Ruedisueli
- Department of Clinical Psychology and Psychotherapy, Psychological Institute, University of Zurich, Binzmuhlestrasse 14/Box 26, CH-8050 Zurich, Switzerland
Sara Groessbauer
- Department of Clinical Psychology and Psychotherapy, Psychological Institute, University of Zurich, Binzmuhlestrasse 14/Box 26, CH-8050 Zurich, Switzerland
Andreas Maercker
- Department of Psychopatholgy, Psychological Institute, University of Zurich, Switzerland
Ulrike Ehlert
- Department of Clinical Psychology and Psychotherapy, Psychological Institute, University of Zurich, Binzmuhlestrasse 14/Box 26, CH-8050 Zurich, Switzerland

Received 14 November 2006; received in revised form 29 January 2007; accepted 18 February 2007.

Summary

Background: Hypothalamus–pituitary–adrenal (HPA) axis functioning in systemic hypertension is not fully understood. We explored HPA axis activity and feedback sensitivity to oral administration of dexamethasone in systemic hypertension via assessment of the cortisol awakening response (CAR) and the circadian cortisol profile.

Methods: The CAR and circadian cortisol profile were assessed in 20 unmedicated and otherwise healthy middle-aged hypertensive men and in 22 normotensive male controls. Salivary free cortisol measures for the CAR were obtained immediately after awakening and 15, 30, 45, and 60min thereafter. Circadian cortisol secretion was sampled at 08:00, 11:00, 15:00, and 20:00h. Assessment of the CAR was repeated on the next day after administration of 0.5mg dexamethasone at 23:00h on the previous night.

Results: Hypertensives had a significantly lower CAR (p<0.02) and significantly reduced suppression of the CAR after dexamethasone administration (p<0.01) than normotensive controls. There were no significant differences in cortisol levels at awakening and in circadian cortisol profiles between hypertensives and normotensives.

Conclusion: We found evidence for altered HPA axis activity in men with systemic hypertension evident with the CAR. Hypertensives showed relative attenuation in the CAR and in the HPA axis feedback sensitivity following dexamethasone suppression. Such alterations in HPA axis regulation might contribute to the atherosclerotic risk in hypertensive individuals.

Keywords: Hypertension, HPA axis, Salivary cortisol, Morning cortisol, Dexamethasone