Normal ambulatory blood pressure in young adults with 21-hydroxylase enzyme deficiency undergoing glucocorticoid replacement therapy

Arch Endocrinol Metab. 2023 Jan 18;67(1):64-72. doi: 10.20945/2359-3997000000504. Epub 2022 Aug 4.

Abstract

Objective: Herein, we compared ambulatory blood pressure (ABP) between young adults with congenital adrenal hyperplasia (CAH) due to 21-hydroxylase enzyme (21OHase) deficiency and a control group. Additionally, we analyzed correlations between the glucocorticoid dose and androgen levels and ABP parameters.

Subjects and methods: This case-control study included 18 patients (6 males and 12 females) and 19 controls (8 males and 11 females) matched by age (18-31 years). ABP monitoring was used to estimate blood pressure (BP) over a 24-h period.

Results: No difference was noted between patients and controls in terms of systolic BP (males, 115.5 ± 5.6 vs. 117.0 ± 9.3, P = 0.733; and females, 106.4 ± 7.9 vs. 108.4 ± 7.6, P = 0.556, respectively) and diastolic BP during 24 h (males, 62.8 ± 7.5 vs. 66.2 ± 5.6, P = 0.349; and females, 62.7 ± 4.9 vs. 62.3 ± 4.9, P = 0.818, respectively). Systolic and diastolic BP and pulse pressure during daytime and nocturnal periods were similar between patients and controls. Furthermore, no differences were detected in the percentage of load and impaired nocturnal dipping of systolic and diastolic BP between patients and controls during the 24-h period. Additionally, the glucocorticoid dose (varying between r = -0.24 to 0.13, P > 0.05) and androgens levels (varying between r = 0.01 to 0.14, P > 0.05) were not associated with ABP parameters.

Conclusion: No signs of an elevated risk for hypertension were observed based on ABP monitoring in young adults with CAH attributed to 21OHase deficiency undergoing glucocorticoid replacement therapy.

Keywords: Cardiovascular risk; congenital adrenal hyperplasia; hydrocortisone; hypertension.

MeSH terms

  • Adolescent
  • Adrenal Hyperplasia, Congenital* / complications
  • Adrenal Hyperplasia, Congenital* / drug therapy
  • Adult
  • Blood Pressure / physiology
  • Blood Pressure Monitoring, Ambulatory
  • Case-Control Studies
  • Female
  • Glucocorticoids* / therapeutic use
  • Humans
  • Hypertension
  • Male
  • Steroid 21-Hydroxylase
  • Young Adult

Substances

  • Glucocorticoids
  • Steroid 21-Hydroxylase

Supplementary concepts

  • Congenital adrenal hyperplasia due to 21 hydroxylase deficiency

Grants and funding

this work was supported by the São Paulo Research Foundation (Fapesp – 2011/23460-1; 2012/16778-8; 2014/20186-4 and 2017/00657-0) and the Brazilian Federal Agency for Support and Evaluation of Graduate Education (Capes/PNPD – 88887.360763/2019-00).