11β-hydroxysteroid dehydrogenase type-2 and type-1 (11β-HSD2 and 11β-HSD1) and 5β-reductase activities in the pathogenia of essential hypertension

Cortisol availability is modulated by several enzymes: 11 beta-HSD2, which transforms cortisol (F) to cortisone (E) and 11 beta-HSD1 which predominantly converts inactive E to active F. Additionally, the A-ring reductases (5 alpha- and 5 beta-reductase) inactivate cortisol (together with 3 alpha-HSD) to tetrahydrometabolites: 5 alpha THF, 5 beta THF, and THE. The aim was to assess 11 beta-HSD2, 11 beta-HSD1, and 5 beta-reductase activity in hypertensive patients. Free urinary F, E, THF, and THE were measured by HPLC-MS/MS in 102 essential hypertensive patients and 18 normotensive controls. 11 beta-HSD2 enzyme activity was estimated by the F/E ratio, the activity of 11 beta-HSD1 in compare to 11 beta-HSD2 was inferred by the (5 alpha THF + 5 beta THF)/THE ratio and 5 beta-reductase activity assessed using the E/THE ratio. Activity was considered altered when respective ratios exceeded the maximum value observed in the normotensive controls. A 15.7% of patients presented high F/E ratio suggesting a deficit of 11 beta-HSD2 activity. Of the remaining 86 hypertensive patients, two possessed high (5 alpha THF + 5 beta THF)/THE ratios and 12.8% had high E/THE ratios. We observed a high percentage of alterations in cortisol metabolism at pre-receptor level in hypertensive patients, previously misclassified as essential. 11 beta-HSD2 and 5 beta-reductase decreased activity and imbalance of 11 beta-HSDs should be considered in the future management of hypertensive patients.