Abstract Body: Background: Sustained physiological stress is an independent cardiovascular risk factor in young adults and may be key in the pathogenesis of masked hypertension (MHT). As stress-induced vascular changes may contribute to pre-clinical functional arterial remodelling and reduced compliance, this may facilitate the development of MHT in young adults, an approach not yet described.
Aim: In age, sex, ethnicity and socio-economic status (SES) matched-controls and MHT we 1) compared neuroendocrine (dehydroepiandrosterone (DHEA), adrenocorticotropin (ACTH), cortisol and functional-wave characteristics (pulse-wave-velocity (PWV), augmentation index (AIx), incident-and-reflected waves); 2) determined the relationship between these stress-parameters and functional wave characteristics.
Methods: We included 236 screened-to-be healthy South African young adults (25±5 years; 49% male; 50% Black) age, sex, ethnicity and SES matched controls (N=120) and MHT (N=116). Fasting blood samples were drawn and analysed for DHEA, ACTH, cortisol and cardiometabolic parameters. Carotid-femoral PWV, AIx and the incident-and-reflected arterial pulse waves were measured. Office-and 24H Ambulatory BP were measured and MHT defined by ISH guidelines.
Results: In MHT versus healthy controls: MAP, HbA1c, and medication usage, MHT’s had higher DHEA and cortisol levels (P<0.05) and lower PWV and wave-reflection parameters (all P<0.028) versus controls. In MHT, cortisol associated with PWV, AIx and the forward-wave (all P<0.04); ACTH associated with PWV, Aix and forward-wave (all P<0.037) and DHEA inversely associated with PWV and the backward wave (both P<0.034).
Conclusion: In MHT, higher levels of DHEA and cortisol were observed, which were associated with increased measures of arterial stiffness. A potential early neurohormonal influence on vascular function in MHT may indicate a stress-neuroendocrine linked pathophysiology.