Changes in systolic blood pressure in dogs with pituitary dependent hyperadrenocorticism during the first year of trilostane treatment

Abstract

Background: Systemic hypertension (SH) is common in dogs and humans with hypercortisolism and can persist after treatment. Objectives: To evaluate changes in prevalence of SH and systolic blood pressure (SBP) in dogs with pituitary-dependent hyperadrenocorticism (PDH) during the first year of trilostane treatment, its relationship with disease control and selected laboratory variables, and their response to antihypertensive treatment. Animals: Fifty-one dogs with PDH treated with trilostane Q12h. Methods: Prospective case series study. Dogs were evaluated at diagnosis (T0) and 1, 3, 6, and 12 months (T12). Dogs were classified as nonhypertensive (SBP < 160 mm Hg) or hypertensive (SBP≥160 mm Hg) and subclassified according to target organ damage (TOD) risk. Hypertensive dogs were treated with benazepril and, if control of SH was not achieved, amlodipine was added. Results: Prevalence of SH decreased from T0 (36/51) to T12 (17/37; P = .01). Changes in SBP during the study were influenced by the risk of TOD at T0. In severely hypertensive (SBP ≥ 180 mm Hg) dogs, the decrease in SBP was more pronounced whereas in normotensive (SBP < 140 mm Hg) dogs SBP increased slightly (P = .00). Blood pressure was not associated with disease control. Antihypertensive treatment was needed in 31/51 dogs, and in 13/31 dogs additional SH control with amlodipine was required. One third of nonhypertensive dogs at T0 required treatment with benazepril because SH developed during follow-up. Conclusions and Clinical Importance: In dogs with PDH, SBP should be measured at every visit, regardless of disease control or SBP at diagnosis. More than 1 drug may be necessary to manage SH in affected dogs.

Survival of dogs with pituitary‐dependent hyperadrenocorticism treated twice daily with low doses of trilostane

“…However, the low median final trilostane dose, considering that monitoring was based on clinical signs, and the long median survival time achieved can be interpreted as a good clinical control as previously described by other authors using this treatment protocol 12 . Moreover, in a previous study of the same research group involving 51 of the dogs included in the present one, all dogs included shown a good clinical control of the disease at some point during the first year of treatment 19 …”

“…12 Moreover, in a previous study of the same research group involving 51 of the dogs included in the present one, all dogs included shown a good clinical control of the disease at some point during the first year of treatment. 19 In conclusion, low dose twice daily trilostane treatment provides a slightly longer survival time than previously reported in dogs with CS treated with once or twice daily higher trilostane doses. Older age, calcinosis cutis, a thin BCS (i.e.…”

“…18 In those dogs with clinical signs consistent with CS and post-ACTH cortisol concentrations below 5.5 μg/dl but an increased UCCR, frequency of administration was increased to three times daily. 18,19 In dogs presenting with poor appetite, trilostane treatment was temporarily discontinued. Final trilostane dose and frequency were also recorded.…”

“…Monitoring and dose adjustments were performed based on clinical signs and the results of the ACTH‐st and UCCR 18 . In those dogs with clinical signs consistent with CS and post‐ACTH cortisol concentrations below 5.5 μg/dl but an increased UCCR, frequency of administration was increased to three times daily 18,19 . In dogs presenting with poor appetite, trilostane treatment was temporarily discontinued.…”

Prevalence of Systemic Hypertension and Control of Systolic Blood Pressure in a Cohort of 14 Dogs with Adrenal-Dependent Hypercortisolism during the First Year of Trilostane Treatment or after Adrenalectomy

“…It is well documented that systemic hypertension (SH) is a common complication of CS, which may be present in approximately 70-85% of people [3][4][5][6] and 31-86% of dogs at the time of diagnosis [7][8][9][10][11][12][13][14][15]. There are also some factors that have been associated with SH in dogs with CS, such as lower potassium concentrations, thrombocytosis, higher cortisol concentrations, or higher urinary protein to creatinine ratio [7,[10][11][12][13]15].…”