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A prospective cohort study was conducted, including 315 patients with essential hypertension who underwent baseline 24\u00a0h\u2010UFC measurement and echocardiographic evaluation of left ventricular mass (LVM), left ventricular ejection fraction (LVEF), and the E\/e\u2032 ratio. Over a mean follow\u2010up period of 28.54 \u00b1\u00a014.21 months, patients were grouped into tertiles based on baseline 24\u00a0h\u2010UFC levels. Higher baseline 24\u00a0h\u2010UFC levels were significantly associated with greater increases in LVM and E\/e\u2032, reflecting adverse LV remodeling and diastolic dysfunction. These associations persisted after adjusting for potential confounders, including age, gender, baseline blood pressure, and their changes during follow\u2010up. Moreover, patients in the highest 24\u00a0h\u2010UFC tertile showed an increased prevalence of LV hypertrophy, contrasting with a reduction observed in the lower tertiles. These findings underscore the independent role of elevated 24\u00a0h\u2010UFC levels in driving adverse cardiac structural and functional changes in essential hypertension.<\/jats:p>","DOI":"10.1111\/jch.14979","type":"journal-article","created":{"date-parts":[[2025,2,26]],"date-time":"2025-02-26T00:11:13Z","timestamp":1740528673000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Association Between Longitudinal Changes in Left Ventricular Structure and Function and 24\u2010Hour Urinary Free Cortisol in Essential Hypertension"],"prefix":"10.1111","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1150-4146","authenticated-orcid":false,"given":"Gao\u2010Zhen","family":"Cao","sequence":"first","affiliation":[{"name":"The First School of Clinical Medicine Southern Medical University  Guangzhou China"},{"name":"Division of Cardiovascular Medicine Cardiac and Vascular Center The University of Hong 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