Work

EP51 - ECE_3020 - Role of glucocorticoid receptor polymorphisms on blood pressure control and lipid profile in a group of patients with apparent essential hypertension

Year: 2026

Type: conference-abstract

Abstract: Objective four glucocorticoid receptor polymorphisms (GRp) have been linked with increased resistance (ER22/23EK, GR-9β) or sensitivity (N363S, BclI) to glucocorticoids (GC) conferring a better, or worse, metabolic and cardiovascular risk. The aim of the present study was to evaluate the biochemical and clinical impact of GRp in a group of patients with apparent essential hypertension. Methods in this cross-sectional study, we evaluated in 99 hypertensive patients (aged 37-70 years, 51 females): anthropometric variables; hypotalamus-pituitary-adrenal (HPA) axis parameters [(basal cortisol levels, cortisol after 1 mg-Dexamethasone suppression test, ACTH levels, urinary free cortisol (UFC)]; glycemic and lipidic profile; carotid intima-media thickness (cIMT) and presence of carotid stenosis; presence of uncontrolled blood pressure (UBP) defined as 24 h-mean BP at ambulatory blood pressure monitoring or mean office BP > 140/90 mmHg despite antihypertensive treatment; gene variants of ER22/23EK, GR-9β, N363S and BclI. Exclusion criteria were signs suggestive for secondary hypertension and presence of obesity or diabetes mellitus. Patients were defined as carriers of a resistant (RS) or sensitive (SN) phenotype based on the presence of at least one associated GRp. Thirteen patients who presented both types of GRp were excluded from statistical analysis to avoid phenotype overlapping. Results we found 32 RS (32.3%), 54 SN (54.5%) and 26 wild-type patients (26.3%). GR-9β was the most prevalent GRp in RS (32/32 cases) while BclI was the most prevalent among SN patients (52/54 cases). Comparing RS patients with non-RS patients, no differences were found in anthropometric variables, glycemic and lipidic profile, HPA axis parameters, number of antihypertensive drugs. We did not observe any difference in the prevalence of impaired fasting glucose/impaired glucose tolerance (IFG/IGT) and altered cIMT. RS patients showed a higher prevalence of carotid stenosis (36% vs 61%, P = .056) and UBP (34.3% vs 63.2%, P = .024) than non-RS patients. RS phenotype was associated with UBP (OR:5.6, P = .007) independently of age, sex, BMI, number of antihypertensive drugs, smoking status, prevalence of IFG/IGT, UFC. SN patients showed lower ACTH (30.4 vs 24.0 ng/L, P = .042) and higher HDL cholesterol (P = .043) than non-SN patients. We did not find any statistically significant difference in any other variables. After stratification for sex, we found that HDL cholesterol levels remained statistically significant in female SN patients (57.3 vs 66.3 mg/dL, P = .046) but not in male ones (50 vs 51.1 mg/dL, P = .77). Conclusions GR-9β polymorphism, associated with RS, could be linked with UBP independently from common cardiovascular risk factors. In female SN patients higher HDL cholesterol was observed, suggesting a sex-dependent effect of GC on cholesterol.

Source: European Journal of Endocrinology

DOI: 10.1093/ejendo/lvag096.660