Hormone Imbalance and High Blood Pressure

What is Hormone Imbalance?

Hormones are chemicals synthesised in endocrine glands and pass through the bloodstream, directing tissues and organs on what to do. Many of our body's fundamental activities, such as metabolism and nd reproduction, are controlled by endocrine glands.⁵

Hormonal imbalances occur when there is either overproduction or underproduction of a hormone in the bloodstream. Due to their critical function in the body, even minor hormone abnormalities could lead to side effects.

Hormones are required to regulate most key bodily functions. Therefore a hormonal imbalance can have a wide range of consequences. Hormones aid in the regulation of metabolism, blood sugar, bodily growth, blood pressure, reproductive cycles and sexual function, as well as general growth and development, mood, and stress levels, amongst other things. Finally, they manage any abnormalities associated with the secretion of insulin, steroid, growth hormone, and adrenaline that might impact both men and women. Females are more prone to have oestrogen and progesterone imbalances, whereas men are more likely to have changes in levels of testosterone. ²

What is Hypertension?

High blood pressure, or hypertension, is commonly referred to as a silent killer and is categorised as the the increase in blood pressure exerted on the walls of arteries.

Hypertension can be caused by a hormonal imbalance. It is difficult to tell the difference between hormone-related hypertension and primary hypertension (i.e ‘normal hypertension’), which has no known cause. Treatment-resistant hypertension is the term used by doctors to describe hormone-related chronic high blood pressure. According to the Endocrine Society, hypertension can be one of the earliest signs of 15 distinct hormonal disorders. The mechanism of treatment-resistant hypertension is related to the functioning of the adrenal gland, a tiny gland located on top of the kidneys. This gland produces hormones that regulate the salt balance in the blood.⁸

According to researchers at the Queen Mary University of London, excessive synthesis of the steroid hormone 'aldosterone' causes salt to build up in the circulation. Subsequently, this causes a rise in blood pressure, as well as an increase in salt content in the blood. Even people on sensible diets accumulate salt, which raises blood pressure despite the use of diuretics and other traditional therapies.⁶  

Excess aldosterone secretion is caused by a variety of reasons. Some studies link it to an individual's genetics, while others link it to abnormal cell growth in the adrenal gland, which is similar to that of tumour growth. Although excess aldosterone is an uncommon cause of hypertension, the former president of Endocrine Society's recommends that healthcare practitioners should examine individuals with hypertension for excess aldosterone.⁸

Treatments for hypertension

Most individuals can be properly treated by making healthy lifestyle choices and taking regular medication. Blood pressure can be difficult to manage in one out of ten people. In these cases, the condition is known as 'resistant hypertension’, because their blood pressure is uncontrolled. These people are at the greatest risk of stroke and heart disease.⁶

High blood pressure can be controlled by using a variety of medications, with many people requiring several different medications. If you are under 55 years old, an ACE inhibitor or an angiotensin-2 receptor blocker is frequently recommended to reduce blood pressure by relaxing blood vessels.  Examples of these include lisinopril and valsartan.⁴ If you are 55 years of age or older, or of African or Caribbean descent, you will be prescribed a calcium channel blocker that reduces blood pressure by widening the blood vessels. An example of this is verapamil.⁴

Blood pressure medication may be required for the rest of your life. However, if your blood pressure remains under control for several years, your doctor may be able to reduce or discontinue your therapy. It is critical to take your treatment exactly as prescribed as it will not function as effectively if you skip doses.

Types and Causes of Endocrine Hypertension

What is Aldosterone?

The hormone aldosterone regulates sodium and potassium levels in the blood. Aldosterone is a mineralocorticoid hormone that regulates water and salt in the body. Aldosterone's major purpose is to influence salt and water reabsorption, and potassium excretion in the kidneys, as well as contribute to acid-base balance.  Aldosterone regulates the sodium gradient in the kidneys to either increase or decrease the amount of water reabsorbed to contribute to the extracellular fluid volume. Overall, aldosterone is a key player in the multifactorial regulation of salt, potassium, blood pressure, and acid-base balance.¹²

For two reasons, aldosterone is clinically significant. Aldosterone levels can rise or fall, and drugs that modify its action might influence blood pressure. Aldosterone levels that are excessively high (e.g. in Conn syndrome and renovascular hypertension) or too low (e.g. certain kinds of Addison's disease and congenital adrenal hyperplasia) can have severe consequences for the body.

Primary Aldosteronism

Primary aldosteronism (also known as Conn's syndrome) is a rare illness caused by one or both adrenal glands overproducing the aldosterone hormone. Because aldosterone produced in this situation exceeds the body's requirements, it is relatively independent of its typical chronic regulation, the renin-angiotensin II system. Excess sodium reabsorption in the kidney results in hypertension and renin-angiotensin II suppression. If potassium and hydrogen ions are lost in the urine and exchanged for sodium in the kidney, hypokalemia and metabolic alkalosis can occur. ¹¹

As a result, high blood pressure and low potassium levels in the blood are common symptoms of primary aldosteronism. High blood pressure, if left untreated, can lead to severe consequences, such as heart attack and stroke, whereas low potassium can cause cardiac rhythm disturbances.

Treatment-resistant Hypertension

Treatment-resistant hypertension is usually diagnosed through multiple tests. This diagnostic method includes ruling out all other causes of hypertension and excluding kidney diseases. The only method to distinguish between the various types of hypertension and arrive at a definitive diagnosis is to do appropriate laboratory testing for hormonal abnormalities. An MRI or CT scan of the adrenal glands may be recommended by your doctor to look for any abnormal growth.⁸  

Studies have shown that spironolactone (an aldosterone steroid blocker) controls resistant hypertension a lot better than medications approved for the treatment of hypertension. They have now demonstrated that spironolactone's effectiveness is linked to its capacity to overcome salt excess in resistant hypertension. They also discovered that a medication called ‘amiloride’ can effectively replace spironolactone, which could be an alternative medication for people who are not willing to take spironolactone.⁹

Menopause and Hypertension

Premenopausal women have lower blood pressure than men at the same age, however, women have a higher incidence of hypertension than men as they get older.¹

The hormone oestrogen drops dramatically in people who are going through menopause. This hormone has the capacity to lower blood pressure. To begin with, oestrogen has a vasodilative action, which means it aids blood flow by keeping blood arteries open. Second, oestrogen helps to maintain low cholesterol levels, which helps to avoid artery narrowing and hardening caused by cholesterol deposits or plaques. As a result, a woman who goes through menopause and has lower oestrogen levels is more likely to develop hypertension. ¹⁰

Weight gain is a possibility for women going through menopause. Weight gain increases the risk of high blood pressure, thus menopause may unintentionally increase this risk.³ Some recent studies have revealed that women who have gone through menopause are more sensitive to salt than women who have not yet gone through menopause. Salt sensitivity might indicate an overabundance of salt in the bloodstream. Excess salt raises blood pressure by increasing fluid retention. Since hypertension usually has no symptoms, the only way to determine if you have it is to check your blood pressure on a regular basis.⁷

Ways to Manage Endocrine Hypertension

Various ways in which endocrine hypertension can be managed.¹³

1. Surgery: Uncontrolled growth of cells in the adrenal gland, also known as pheochromocytomas, can only be treated with surgical resection.
2. Management before surgery: As part of the operation preparation, patients must undergo medical history inspection, physical examination, and heart evaluation.
3. Medical supervision: In the pre-operative period of surgical management of pheochromocytoma, appropriate and optimal pharmaceutical therapy to inhibit the effects of hormones released from the adrenal gland is critical. The main goals of therapy are normalising blood pressure and heart rate, restoring volume depletion, and preventing intraoperative hypertensive crises.
4. Medication: Phenoxybenzamine (Dibenzyline) is an alpha-receptor blocker that is non-selective, irreversible, and noncompetitive. This drug lowers blood pressure swings, eases vasoconstriction, and prevents hypertensive crises during surgery.

Conclusion

Hormonal imbalance which is either the overproduction or underproduction of hormones leads to various changes in bodily functions, and possibly harmful clinical consequences. One of the examples that we have explained in this article was how overproduction of aldosterone hormone from adrenal glands results in high blood pressure in individuals. Therefore, although there might be various causes for developing primary aldosteronism, for example, menopause in women, it is crucial that careful evaluation is carried out in each individual to properly treat and manage hypertension.