Hypertension in acromegaly and in the normal population: prevalence and determinants

Vitale, Giovanni; Pivonello, Rosario; Auriemma, Renata S.; Guerra, Ermelinda; Milone, Francesco; Savastano, Silvia; Lombardi, Gaetano; Colao, Annamaria

doi:10.1111/j.1365-2265.2005.02370.x

Cited by 118 publications

(95 citation statements)

References 61 publications

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“…We considered 3 prospective studies (n=2976), 23,27,29 although regression coefficients used were derived from cross-sectional analyses within those studies, 14 cross-sectional studies (n=7798), 14,[24][25][26][29][30][31][32][33][34][35]37,42 and 3 case-control comparisons (n=930). 20,22,28 Overall, the analysis included 11 704 subjects. In these studies, information about ongoing antihypertensive therapy were not always provided, and hence the state of BP treatment was inconsistent across studies.…”

Section: Study Design and Subject Selectionmentioning

confidence: 99%

“…1 The complexity in understanding the vascular functions of IGF-1 is underscored by conflicting reports on the association between BP and IGF-1. These findings include (1) small studies (n=5) indicating that hypertensive patients had higher IGF-1 concentrations compared with normotensives (total n=250); [15][16][17][18][19] (2) a neutral 20,21 or positive relationship 22 between BP and IGF-1 in active acromegalic patients (n=305 and 21, respectively); (3) cross-sectional studies indicating a neutral relationship between BP and IGF-1 (total n=5263); 14,[23][24][25][26][27][28][29][30][31] and (4) cross-sectional studies (total n=5771), including Framingham and our own, 32 yielding significant inverse associations between BP and IGF-1. 20,28,[32][33][34][35][36][37][38][39][40] Prospective studies (n=2590) also indicate an inverse association with systolic BP in 544 young black men after 10 years 23 and a 44% reduced risk for incident hypertension in 2046 nondiabetic women over 4 years.…”

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confidence: 99%

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Revisiting the Relationship Between Blood Pressure and Insulin-Like Growth Factor-1

et al. 2014

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Abstract-Conflicting evidence exists on the relationship between blood pressure (BP) and insulin-like growth factor-1 (IGF-1). We reviewed available articles and pooled extrapolated regression coefficients for the association between BP and total IGF-1 as reported in the literature and included additional data from 912 individuals from the general population. We identified 20 studies including 11 704 subjects. We also measured total IGF-1, insulin-like binding protein-3, and BP in 912 black and white men and women from South Africa (aged 20-70 years). When plotting positive and negative weighed regression coefficients (29 data points) against IGF-1, we found a significant positive relationship (r=0.31; P<0.001; n=11 704) intercepting the 0 point at 191 ng/mL IGF-1, suggesting an inverse BP/IGF-1 relationship in low IGF-1 conditions, and a positive relationship in overtly high IGF-1 conditions. In conclusion, our findings suggest that the relationship between BP and IGF-1 is dependent on, or related to, IGF-1 concentrations, as an expression of direct or reverse causality. Low IGF-1 bioavailability (associated with aging and vascular deterioration), resistance to IGF-1, and the complex interplay between IGF-1 and other vasoactive hormones could mask the vasoprotective functions of IGF-1 in cross-sectional studies or could modify their functions in prospective studies.

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Section: Study Design and Subject Selectionmentioning

confidence: 99%

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confidence: 99%

Revisiting the Relationship Between Blood Pressure and Insulin-Like Growth Factor-1

et al. 2014

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“…Characteristically, LVH in acromegaly occurs in the absence of arterial hypertension, but is further aggravated by it: 9,19) In this study, the presence of hypertension, DM, and OSAS was found to be related to LVMI. These comorbidities frequently coexisting with acromegaly seem to contribute to the development of both LVH and LVDD.…”

Section: Discussionmentioning

confidence: 81%

Evaluation of Left Ventricular Diastolic Function According to New Criteria and Determinants in Acromegaly

et al. 2012

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SummaryLeft ventricular diastolic dysfunction (LVDD) develops in the early stages of acromegaly. The purpose of this study was to identify LVDD analyzing by new echocardiograpic criteria as well as to evaluate determinants of the LVDD in acromegaly. This cross-sectional study examined 42 patients with acromegaly; 16 in active disease (AA) and 26 cured/ well controlled (CA), and compared them with 30 healthy controls (CG). Ventricular systolic and diastolic functions were studied by conventional and tissue Doppler imaging based on the E/Em ratio and myocardial performance index (MPI). Other clinical parameters possibly contributing to LVDD in acromegaly were also investigated. The prevalence of LV hypertrophy (33%) and LVDD (35.7%) were increased in acromegaly, however, there were no differences between the AA and CA groups. Acromegalic patients had higher LV volumes and LV mass, and septal E/Em ratio compared to CG, whereas LV ejection fraction and MPI were not different. The presence of acromegaly (r = 0.29, P = 0.013), diabetes mellitus (DM) (r = 0.41, P < 0.001), hypertension (r = 0.35, P = 0.002), and sleep apnea (r = 0.56, P = 0.003) were found to be correlated with LVDD, whereas duration and activity of acromegaly were not. In regression analysis, advanced age (OR: 8.53, P = 0.006) and DM (OR: 25.9, P = 0.007) were found to be independent risk factors for LVDD. The risk of LVDD according to new criteria increases in acromegaly. However, it seems to be related to the presence of DM and advanced age and is independent of disease duration and activity. ( Cardiac involvement is known to be a major determinant of the shortened life expectancy in acromegalic patients. 1,2) Increased GH, directly and via insulin like growth factor 1 (IGF-1), induces myocardial hypertrophy and fibrosis in the absence of increased wall stress.3) Left ventricular hypertrophy (LVH) causes diastolic and more rarely systolic dysfunction and arrhythmias. Echocardiographic studies of acromegalic patients have suggested left ventricular diastolic dysfunction (LVDD) in the early stages of the disease while LV systolic function was preserved. 4) However, previous studies have evaluated diastolic function by old methods including the transmitral E/A ratio. This ratio is not sufficient to evaluate the diastolic function in patients with preserved systolic function. Pulsed-wave (pw) tissue Doppler imaging (TDI) allows quantitative measurements of the myocardial contraction and relaxation velocities of a selected myocardial segment.5) The Em velocity is considered as an index of ventricular relaxation, which is relatively independent from variation of the atrial pressure and its ratio to velocity peak of transmitral flow (E/Em) is related with the LV filling pressure. The E/Em ratio is recommended at the first step for evaluation of LVDD by echocardiography according to a new guideline. 6) Peak systolic mitral annular velocity (Sm) is used to evaluate LV systolic function. Another parameter used in the evaluation of cardiac function is the myo...

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“…A prevalência de hipertensão nos pacientes com acromegalia varia entre 18% e 60% em diferentes séries, e a sua incidência é mais alta do que a da população geral. Em estudo com 200 acromegálicos, a prevalência de hipertensão arterial atingiu 46% dos pacientes (48). Entretanto, a despeito da sua importância, a hipertensão arterial no contexto da acromegalia ainda não tem bem esclarecidos os seus mecanismos fi siopatológicos.…”

Section: Hipertensão Arterialunclassified

Distúrbios cardiovasculares na acromegalia

Fedrizzi

Czepielewski

2008

Arq Bras Endocrinol Metab

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A acromegalia acarreta uma série de distúrbios ao sistema cardiovascular, decorrentes da exposição crônica a níveis elevados de GH e IGF-1. Estes distúr-bios são os principais responsáveis pelo aumento da mortalidade de acromegáli-cos. Entre as várias formas de acometimento cardiovascular, destaca-se a miocardiopatia acromegálica, entidade caracterizada, inicialmente, pelo estado hiperdinâmico, seguido de hipertrofi a ventricular esquerda concêntrica e disfunção diastólica por défi cit de relaxamento, culminando com disfunção sistólica e, por vezes, insufi ciência cardíaca franca. Além disso, são também relevantes as arritmias, as valvulopatias, sobretudo mitral e aórtica, a cardiopatia isquêmica, a hipertensão e os distúrbios dos metabolismos glicêmico e lipídico. Nesta revisão são abordados os principais aspectos clínicos e prognósticos destas entidades, os efeitos do tratamento da acromegalia sobre elas e as repercussões correspondentes sobre a sobrevida dos pacientes. ABSTRACT Cardiovascular Disturbances in Acromegaly.Acromegaly causes a number of disorders in the cardiovascular system, resulting from chronic exposure to high levels of GH and IGF-1. Such disorders are the main responsible for increased mortality rates among acromegalic patients. Among several forms of cardiovascular impairment is acromegalic cardiomyopathy, an entity that is initially characterized by a hyperdynamic state, followed by concentric left ventricular hypertrophy and diastolic dysfunction due to relaxation defi cit, culminating in systolic dysfunction and sometimes heart failure. In addition, arrhythmias and heart valve diseases are also relevant, especially mitral and aortic, ischemic heart disease, hypertension, and glucose and lipid metabolism disorders. This review approaches the main clinical and prognostic aspects of these entities, the effects of acromegaly treatment on them, and the respective consequences on patient survival. (Arq Bras Endocrinol Metab 2008; 52/9:1416-1429)

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Hypertension in acromegaly and in the normal population: prevalence and determinants

Cited by 118 publications

References 61 publications

Revisiting the Relationship Between Blood Pressure and Insulin-Like Growth Factor-1

Revisiting the Relationship Between Blood Pressure and Insulin-Like Growth Factor-1

Evaluation of Left Ventricular Diastolic Function According to New Criteria and Determinants in Acromegaly

Distúrbios cardiovasculares na acromegalia

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