Ninety-five percent of adults with Cushing’s syndrome have high blood pressure.

A recent U.S. study titled Hypertension in Patients with Cushing’s Syndrome, published in Springer’s Endocrine Hypertension journal, has found that high blood pressure in patients with Cushing’s Syndrome (CS) occurs in up to 95 percent of adult and in half of pediatric cases. These patients face major cardiovascular and mortality risks.

The U.S. National Endocrine and Metabolic Diseases Information Service (NEMDIS) describes CS, or hypercortisolism, as a “hormonal disorder caused by prolonged exposure of the body’s tissues to high levels of the hormone cortisol.” Cortisol is produced by the adrenal cortex that regulates carbohydrate metabolism, maintains blood pressure, and is produced in response to stress. NEMDIS says that the syndrome is quite rare and mostly affects adults aged 20 to 50. Also, “people who are obese and have type 2 diabetes, along with poorly controlled blood glucose and high blood pressure, have an increased risk of developing the disorder.”

According to Medscape, more than 99 percent of cases of CS are due to the administration of prolonged and/or excessive use of glucocorticoids in the form of medication. Glucocorticoids are used to treat many conditions including adrenal insufficiency, asthma, to suppress various allergic, inflammatory, and autoimmune disorders, to prevent acute transplant rejection and graft-versus-host disease, and even more recently in the treatment of heart failure.

CS can also be caused by diseases that result in excess adrenocorticotropic hormone (ACTH) or levels of the corticotrophin-releasing hormone (CRH) — a peptide hormone and neurotransmitter responsible for stimulating the pituitary synthesis of ACTH and involved in the body’s stress response.

Cushing’s disease causes CS in 70 percent of cases excluding glucocorticoid. Cushing’s disease occurs when a tumor in the pituitary gland produces large amounts of ACTH, causing the adrenal glands to produce elevated levels of cortisol. An easy way to distinguish Cushing’s syndrome from Cushing’s disease is that the measured ACTH levels are lower in the former.

The recent U.S. study found that in patients with exogenous CS (caused by external factors), the prevalence of hypertension was dose-dependent and about 20 percent lower than in those with endogenous CS. The authors recommended therapy aimed at normalizing blood pressure and removing the source of glucocorticoid excess. This may include surgery depending on the age of onset, duration, and degree of glucocorticoid excess, as well as other underlying hypertension risk factors such as obesity, sleep apnea, and insulin resistance. If necessary, glucocorticoid excess and its effects should be controlled with drugs.

In a study by State University of New York Medical Department, researchers also found that hypertension is a very common comorbidity in patients with Cushing’s disease/syndrome. They emphasized that “therapeutic strategies for Cushing’s-specific hypertension are necessary to decrease morbidity and mortality associated with this disease.”

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