Table 5. Effect of medical therapy for hypercortisolism on hypertension.
| Study, year | Study Drug | Drug dose | Patient, n | Etiology of hypercortisolism, n | Hypertension at baseline, n (%) | Duration of follow-up, month | Hypertension at follow-up |
|---|---|---|---|---|---|---|---|
| Sonino et al., 1991 (75) | Ketoconazole | Range: 400–800 mg QD | 34 | CD: 28 | 21/34 (62%) | Range: 0.13–36; | Resolution: 33% |
| Mean: 564.3 mg QD | Adrenal CS: 4 | Mean: 8.1 | Improvement: 62% | ||||
| Median: 600 mg QD | Ectopic CS: 2 | Median: 5 | |||||
| Moncet et al., 2007 (76) | Ketoconazole | Range: 200–1200 mg QD | 54 | CD: 37 | 43/54 (80%) | Range: 0.5–156 | Resolution: 44% |
| Median: 600 mg QD | Adrenal CS: 5 | Mean: 9.6 | Improvement: 37% | ||||
| Ectopic CS: 1 | |||||||
| Unclear: 11 | |||||||
| Castinettiet et al., 2014 (77) | Ketoconazole | Range: 200–1200 mg QD | 174 | CD: 174 | 116/174 (67%) | Range:0.03–135 | Improvement: 42% |
| Mean: 774.6 mg QD | Mean:20.6 | ||||||
| Median: 600 mg QD | |||||||
| Verhelst et al., 1991 (78) | Metyrapone | Range: 500–4000 mg QD | 91 | CD: 57 | 74/91(81%) | Range: 0.25–140 | Improvement: 73% |
| Adrenal CS: 16 | |||||||
| Ectopic CS: 18 | |||||||
| Donadille et al., 2010 (79) | Mitotane | Mean: 3.3±1.2 g Lysodren equivalent daily | 23 | Ectopic CS: 23 | 19/23(83%) | Range: 3.6–408 | Resolution: 16% |
| Mean: 96.48 | Improvement: 47% | ||||||
| Fleseriu et al., prospective, open-label study, 2012 (80) | mifepristone | Range: 300–1200 mg daily | 50 | CD: 43 | 40/50 (80%) | 6 | Improvement: 53% |
| Adrenal CS: 3 | |||||||
| Ectopic CS: 4 | |||||||
| Colao et al., RCT, 2012 (81) | Pasireotide | Range: 600–900 BID | 162 | CD: 162 | 56/72 (78%) (missing blood pressure data in 90 subjects) | 12 | Mean SBP and DBP decreased by 6.1 and 3.7 mmHg |
| Feelders et al., prospective, open-label study, 2013 (20) | Pasireotide | Pasireotide: range: 100–250 mcg TID, if UFC not normalized: added: Cabergoline (day 28) range: 0.5–1.5 mg QOD, Ketoconazole (day 60) 200 mg TID | 17 | CD: 17 | Not reported | 2.6 | Mean SBP and DBP decreased by 12 and 8 mmHg |
| Cabergoline | |||||||
| Ketoconazole | |||||||
| Bertagna et al., prospective, open-label study, 2013 (82) | Osilodrostat (LCI699) | Range: 2–50 mg BID | 12 | CD: 12 | Not reported | 2.5 | At day 70: SBP decreased by 10 mmHg, DBP decreased by 6 mmHg |
| Fleseriu et al., prospective, open-label study, 2016 (83) | Osilodrostat (LCI699) | Range: 4–60 mg QD | 19 | CD: 19 | 13/19 (68%) | 5.5 | SBP decreased by 1.0 mmHg, DBP increased by 1.3 mmHg |
Selection criteria: publication year: 1990 or after; design: retrospective, prospective studies or randomized control trials; intervention: medical therapy as main therapy; outcome: hypertension prevalence data available at baseline and after treatment. mg, milligram; QD, once daily; CS, Cushing syndrome; CD, Cushing disease; g: gram; BID, twice daily; RCT, randomized control trial; SBP, systolic blood pressure; DBP, diastolic blood pressure; TID, thrice daily; UFC, urinary free cortisol; QOD, once every other day.