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Have hypertension. Get tired. Should I measure cortisol? What about diurnal effects?

Dec 2012
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Answered by

General & Family Physician
Practicing since : 2012
Answered : 1704 Questions
I have hypertension -- essential, meaning my doctor doesn't know what causes it either. I am 5'10" BMI 25.1, fat (via Tnata, for what that's worth) 21%. I eat a low-salt, essentially Dash diet, exercise 30 minutes or more per day, etc., etc. I've been super compliant with the nostrums supplied by my doctor -- beta blocker, calcium channel blocker, and ARB. My fasting blood sugar is 85. Haven't taken a postprandial or had an HBA1C lately.

I'm getting tired of this. They have no interest in attempting to find out more, so I've started my own research -- and in your answer please don't lecture me about continuing to take my prescribed medicine, I intend to.

With that intro my question: Should I measure cortisol. What should it be? What about diurnal effects? In other words lower in the morning, higher during the day, what?
Posted Sun, 29 Sep 2013 in Hypertension and Heart Disease
Answered by Dr. Nsah Bernard 1 hour later
Brief Answer:
Not necessary to measure cortisol

Detailed Answer:

Thanks for posting on XXXXXXX

Well I personally do not see the necessity of measuring serum cortisol. Measurements of serum cortisol are used primarily in determining if a patient is suffering from hypercortisolism (abnormal increase in cortisol levels) and hypocortisolism (abnormal decrease in cortisol). Many extraneous factors can affect the serum cortisol inclusing stress, time of day ( i.e morning: 7-28 microgram/dl, afternoon: 2-18, Stimulated with ACTH: >18, Suppressed with dexamethasone: <2), and exogenous glucocorticoids. This makes the interpretation of a single value hazardous, and emphasizes the need for provocative testing.
Now, since you apparently is not manifesting any symptoms of cortisol abnormality, there is truly no reason to measure cortisol.
If your question was trying to relate cortisol to hypertension, then let me clarify you. More than 80% of hypertension is essential (meaning nobody can readily identify a potential cause--not with the present scientific research) and the rest are secondary due to other causes such as hypercortisolism, kidney cancer, thyroid disorder etc. But believe me when I say you are not suffering from hypercortisolism or cushing's syndrome as there are characteristic symptoms that always come with it and hypertension mostly exist as a long term acquired condition.
I believe (from your statements) that you are already doing the right general measures of controlling high blood pressure and medications are just to help control the BP to optimum levels.

Hope this helps and wish you the best.
Dr. Nsah
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