New mechanisms for corticosteroid-induced hypertension.

A substantial proportion of patients with secondary hypertension have disorders of the adrenal cortex. Not surprisingly, corticosteroids were amongst the first putative pathogenic mediators to be investigated in essential hypertension. Despite this long history, there remains controversy about the mechanisms which promote abnormal adrenocortical secretion, the tissues and receptors which mediate corticosteroids' effects on blood pressure, and the relevance of corticosteroids in essential hypertension. Several recent advances relate to adrenocortical secretion in hypertension, but arguably the most significant progress has been in understanding factors which control tissue sensitivity to corticosteroids. It is from this latter perspective that it now seems most likely that the role, if any, of the adrenal cortex in essential hypertension will become apparent.