High blood pressure and hormones

A form of secondary hypertension that is, high blood pressure with a known cause is hormone-related hypertension. Here, an over- or underproduction of various hormones leads to high blood pressure readings.

The main forms are:

pheochromocytoma, which is the cause in about 0.2 to 0.4 percent of all hypertension cases,
Cushing's syndrome this accounts for about 0.3 percent of patients with high blood pressure, and
Conn's syndrome, which accounts for about 12 percent and makes up the largest share of hormone-related high blood pressure.
thyroid overactivity/underactivity (see separate article)

Pheochromocytoma

A pheochromocytoma is usually a benign tumor of the adrenal medulla. In some cases it appears as an extra-adrenal pheochromocytoma (paraganglioma) outside the adrenal gland near the spine or the large blood vessels and then arises from part of the autonomic, i.e. involuntary, nervous system that runs along the spine (the sympathetic chain). The condition is rare (there are two to eight new cases per year per million people). It causes an overproduction of catecholamines such as adrenaline, noradrenaline and dopamine, which in turn cause the possible symptoms. High blood pressure occurs in most patients either continuously or in sudden attacks. Patients may also experience pounding headaches, sweating, palpitations and paleness.

Cushing's syndrome

In Cushing's syndrome there is a pathologically increased production of cortisol, a hormone from the adrenal glands. Most often a benign tumor of the pituitary gland (hypophysis) is the cause. This leads to an overproduction of the hormone ACTH, which in turn stimulates the adrenal glands and causes increased cortisol secretion.

In rarer cases, tumors of the adrenal gland directly produce too much cortisol. This affects the kidney's regulation of blood pressure and can therefore lead to high blood pressure. It can also cause a deficiency of potassium, which may impair circulatory function. Other important consequences of the hormone excess include the so-called moon face, central obesity, stretch marks on the skin (striae), development of diabetes, muscle wasting, increased susceptibility to infections, depressive moods and more.

Conn's syndrome

Conn's syndrome also called primary hyperaldosteronism is one of the most common causes of secondary hypertension. It is a disease of the adrenal glands that causes an overproduction of the hormone aldosterone. Aldosterone plays a key role in the body's water and salt balance. By affecting salt transport, aldosterone causes the excretion of potassium and the reabsorption of sodium and water. That means too little salt is excreted and the resulting increased fluid volume in the blood vessels leads to higher blood pressure.

There are two different causes that can lead to this condition: on the one hand, the adrenal glands can be enlarged (bilateral adrenal cortical hyperplasia) and therefore produce too much aldosterone. On the other hand, there can be benign tumors (adenomas) on the adrenal gland that also produce aldosterone and raise the level. The first cause is somewhat more common, accounting for about 60% of Conn's syndromes. It can often be treated well with medication. In both cases Conn's syndrome is considered treatable and, in the case of surgery, even curable.

There are also a few other, very rare causes of Conn's syndrome. If left untreated, Conn's syndrome often leads to serious complications and organ damage. The blood pressure caused by the syndrome more frequently and more severely leads to complications than other forms of high blood pressure.

High blood pressure during menopause

High blood pressure in women during menopause also has a hormonal background. Here the cause is not an overproduction, but a decrease in the production of the hormone estrogen. Up to menopause estrogen has a protective effect because it lowers blood pressure. Estrogen production falls during the climacteric and this protective effect is lost. At the same time, the level of the male hormone testosterone rises. This now promotes the development of abdominal fat in women just as in men and abdominal fat can itself release appetite-stimulating hormones, which can also raise blood pressure. Women can best counteract this themselves with plenty of exercise, a healthy low-salt diet, low alcohol intake and by avoiding nicotine.

The ESH (European Society of Hypertension) has included early menopause that is, the cessation of menstruation before the age of 45 without an explanatory treatment as a risk factor for developing high blood pressure. Affected women are advised to check their blood pressure regularly and, if high values are measured, to start treatment as soon as possible to prevent complications.
Regular monitoring is also recommended when hormone replacement therapy is given during menopause. The therapy does not necessarily have to raise blood pressure, but it is possible that it does. Therefore monitoring is advised, and if necessary an antihypertensive drug treatment; if blood pressure cannot be lowered with these measures, stopping hormone replacement therapy may be recommended (of course only in consultation with the treating physician).

Hormone therapies
If transgender people undergo gender-affirming hormone therapy, where hormones often have to be dosed much higher than, for example, in hormone replacement therapy during menopause, blood pressure monitoring is also recommended. Current data are not yet conclusive as to whether the therapy increases the risk of high blood pressure or other cardiovascular diseases. As a precaution, however, monitoring blood pressure values is advised.
This also applies to hormone therapies carried out for other reasons.

Acromegaly

Acromegaly is a disorder caused by a slowly growing tumor of the pituitary gland that leads to increased secretion of growth hormones. A noticeable effect is enlargement of the extremities (= body ends) that is, fingers, toes, nose, chin and cheekbones. If the disorder develops before the end of linear growth, it results in an unusually tall stature. The proportions, however, remain intact. Acromegaly not only causes excessive growth but also an increase in blood volume due to reduced water and sodium excretion. This can result in high blood pressure.

Sources

This article comes from BloodPressureDB – the leading app since 2011 that helps hundreds of thousands monitor their blood pressure every day. Our content is based on carefully researched, evidence-based data and is continuously updated (as of 04/2024).

Author Sabine Croci is a qualified medical assistant with many years of experience in internal medicine and cardiology practices as well as in outpatient care, and has led BloodPressureDB's specialist editorial team since 2015. Thanks to her extensive additional qualifications as a paramedic, first responder and in various therapy and emergency areas, she provides solid, practical and reliably reviewed information.