Dose–response relationship between thyroid stimulating hormone and hypertension risk in euthyroid individuals

He, Wei; Li, Sheli; Wang, Bin; Mu, Kaida; Shao, Xiaorong; Yao, Qiuming; Li, Ling; Li, Qian; Zhang, Jinan

doi:10.1097/hjh.0000000000001826

Cited by 18 publications

(20 citation statements)

References 54 publications

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“…Since blood pressure is an independent risk factor for cardiovascular diseases, the elevated blood pressure may mediate or further aggravate the harm of SCH on cardiovascular health ( 9 , 10 , 14 ). Some observational studies including one our study have also suggested an obviously positive relationship between TSH level and hypertension risk among euthyroid individuals, which supports a possibly causal role of elevated TSH level in the development of hypertension ( 16 – 18 ). However, the relationship between thyroid dysfunction and hypertension is still controversial, and the causal relationship between SCH and hypertension has not been well established ( 9 , 19 , 20 ).…”

Section: Introductionsupporting

confidence: 76%

“…Secondly, the modest impact of TSH on blood pressure may conceal the effect of LT4 therapy. Previous studies including one our study have shown a statistically significant relationship between TSH and blood pressure although with less dramatic coefficient, suggesting that decreasing TSH level through LT4 therapy may only have a modest effect on blood pressure ( 16 – 18 ). At last, many SCH participants enrolled in these RCTs were normotensive, which could interfere the blood pressure-lowering effect of LT4 therapy.…”

Section: Discussionmentioning

confidence: 57%

“…Several cross-sectional studies suggested an obviously positive relationship between TSH level and hypertension among euthyroid individuals ( 16 – 18 ). Two prospective cohort studies also supported an association between TSH level and hypertension risk among euthyroid individuals ( 71 , 72 ).…”

Section: Discussionmentioning

confidence: 99%

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Effect of Levothyroxine on Blood Pressure in Patients With Subclinical Hypothyroidism: A Systematic Review and Meta-Analysis

Zhang

et al. 2018

Front. Endocrinol.

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Background: Patients with subclinical hypothyroidism (SCH) have elevated blood pressure, but the effect of levothyroxine (LT4) therapy on blood pressure among those patients is still unclear. This study aimed to assess whether LT4 therapy could reduce blood pressure in SCH patients through a systematic review and meta-analysis.Methods: PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science were searched. Randomized controlled trials (RCTs) assessing the effect of LT4 therapy on blood pressure or prospective follow-up studies comparing the blood pressure level before and after LT4 treatment were included, and the mean difference of systolic blood pressure (SBP) or diastolic blood pressure (DBP) was pooled using random-effect meta-analysis.Results: Twenty-nine studies including 10 RCTs and 19 prospective follow-up studies were eligible for the analysis. Meta-analysis of 10 RCTs suggested that LT4 therapy could significantly reduce SBP in SCH patients by 2.48 mmHg (95% CI −4.63 to −0.33, P = 0.024). No heterogeneity was observed among these 10 RCTs (I2 = 0%). Meta-analysis of the 19 prospective follow-up studies found that LT4 therapy significantly decreased SBP and DBP by 4.80 mmHg (95%CI −6.50 to −3.09, P < 0.001) and 2.74 mmHg (95%CI −4.06 to −1.43, P < 0.001), respectively.Conclusion: The findings suggest that LT4 replacement therapy can reduce blood pressure in SCH patients, which needs to be validated in more clinical trials with larger samples.

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Section: Introductionsupporting

confidence: 76%

Section: Discussionmentioning

confidence: 57%

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Effect of Levothyroxine on Blood Pressure in Patients With Subclinical Hypothyroidism: A Systematic Review and Meta-Analysis

Zhang

et al. 2018

Front. Endocrinol.

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“…Therefore, most clinical studies focused on the relationship between TSH and blood pressure levels . In 2018, the meta‐analysis of He et al showed the relationship of TSH with increased clinic systolic and diastolic blood pressures, but it could not explain the high heterogeneity in the results of analysis ( I 2 = 90%) . In addition, many recent clinical studies did not support the results .…”

Section: Introductionmentioning

confidence: 99%

Association of thyroid function with white coat hypertension and sustained hypertension

Cai

Peng

Chen

et al. 2019

J of Clinical Hypertension

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This study aimed to explore the relationship of thyroid-stimulating hormone (TSH), free triiodothyronine (FT3), and free thyroxine (FT4) levels with hypertension subtypes. 1056 euthyroid adults were included as research samples. They underwent measurement of clinic blood pressure and 24-hours ambulatory blood pressure monitoring. Then, they were divided into normotension (NT), white coat hypertension (WCH), masked hypertension (MHT), and sustained hypertension (SHT) groups. The 24-hours dynamic electrocardiogram was performed to analyze the heart rate variability (HRV), so as to reflect the cardiac autonomic function. The relationship between hypertension subtypes, thyroid function, and HRV was analyzed. The TSH concentration was significantly higher in the SHT group than in the NT group (P = 0.001). The FT3 concentration was higher in the SHT group than in the NT and MHT groups (P = 0.013, P = 0.008), while the FT4 concentration was significantly higher in the WCH group than in the NT group (P = 0.002). The changes in HRV were observed between the SHT, WCH, and MHT groups and the NT groups, as well as between the SHT and the MHT groups. The multiple linear regression analysis also showed that FT3, HRV (RMSSD and PNN50), and blood pressure levels linearly correlated with one another (P < 0.05). Meanwhile, the linear regression analysis showed a linear negative correlation between FT4 and HRV (SDANN) in the WCH + NT group (P = 0.001). Thyroid function was closely related to hypertension subtypes such as WCH probably due to the changes in the cardiac autonomic function. | 675 CAI et Al.

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“…is meta-analysis indicates that only subclinical hypothyroidism is associated with increased SBP and DBP, whereas subclinical hyperthyroidism is not. A recent publication by He et al [30] conducted another metaanalysis showing a dose-response relationship between serum TSH level and hypertension risk even in euthyroid individuals, suggesting individuals with higher normal TSH level are at higher risk of developing hypertension than those with lower normal TSH level. Reports from Japan [5] and Germany [6,31] demonstrated this phenomenon existed despite countries of different iodine supply in food (iodinereplete in Japan while iodine-deficient in Germany) as well as prevalence of hypertension (higher in Japan than Germany).…”

mentioning

confidence: 99%

Gender-Specific Differences on the Association of Hypertension with Subclinical Thyroid Dysfunction

Zhang

Huang

Meng

et al. 2019

International Journal of Endocrinology

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Objective. Both hypertension and subclinical thyroid dysfunction (STD) have high prevalence and clinical importance, but their relationship is still a matter of debate. We aimed to explore gender-specific difference on the association between hypertension and STD in Chinese. Methods. We recruited 13,380 ostensible healthy participants (8,237 men and 5,143 women). e associations between hypertension and STD were analyzed on a gender-based setting after dividing STD into subclinical hypothyroidism, subclinical hyperthyroidism and further subgrouped euthyroidism. Crude and adjusted odds ratios of STD for hypertension were analyzed by binary logistic regression. Results. An increasing trend of hypertension prevalence was found along with aging in both genders. Yet, higher male hypertension prevalence was found until 65 years, and then it intersected with female hypertension prevalence. Women had significantly higher propensity for STD than men. Yet, in elderly participants, this gender-specific difference became less obvious. We displayed detrimental effects for subclinical hypothyroidism in both genders after multiple-covariate adjustments, yet no such effects were shown for subclinical hyperthyroidism. Moreover, females with subclinical hypothyroidism were more likely to be associated with hypertension than males, and the corresponding odds ratios were 1.619 (P < 0.01) and 1.557 (P < 0.05), respectively. For systolic blood pressure, the adjusted odds ratios were 1.371 (P < 0.05) and 1.154 (P > 0.05), and for diastolic blood pressure, 1.604 (P < 0.01) and 1.564 (P < 0.01), respectively. Conclusion. We demonstrate that hypertension is associated with subclinical hypothyroidism, but not with subclinical hyperthyroidism. Moreover, females with subclinical hypothyroidism are more likely to be associated with hypertension than males.

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Dose–response relationship between thyroid stimulating hormone and hypertension risk in euthyroid individuals

Abstract: The current study provides strong evidence for the dose-response relationship between serum TSH level and hypertension risk in euthyroid individuals. Euthyroid individuals with higher normal TSH level are at higher risk of developing hypertension than those with lower normal TSH level.

Cited by 18 publications

References 54 publications

Effect of Levothyroxine on Blood Pressure in Patients With Subclinical Hypothyroidism: A Systematic Review and Meta-Analysis

Effect of Levothyroxine on Blood Pressure in Patients With Subclinical Hypothyroidism: A Systematic Review and Meta-Analysis

Association of thyroid function with white coat hypertension and sustained hypertension

Gender-Specific Differences on the Association of Hypertension with Subclinical Thyroid Dysfunction

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