Increased blood pressure variability in pheochromocytoma compared to essential hypertension patients

Zelinka, Tomáš; Štrauch, Branislav; Petrák, Ondřej; Holaj, Robert; Vránková, Alice; Weisserová, Hana; Pacák, Karel; Widimský, Jiří

doi:10.1097/01.hjh.0000185714.60788.52

Cited by 48 publications

(29 citation statements)

References 27 publications

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“…Second, prevalence of diabetes in patients with pheochromocytoma found in this as well as in our earlier study 27 was higher (53 and 54%, respectively) than that in the studies published by other authors (34 and 43%, respectively). 30,31 Besides longer disease duration, it may be in a consequence of different patient's phenotype.…”

Section: Discussioncontrasting

confidence: 51%

“…[24][25][26] Finally, catecholamine overproduction in pheochromocytoma in often associated with exaggerated BP variability. 27 Higher 24-h systolic BP variability was proven as another possible risk factor leading to increased carotid intima-media thickening. 28 All these mechanisms may explain higher IMT in subjects with pheochromocytoma compared to subjects with essential hypertension, whereas no differences were found in parameters of the leftventricular geometry, which are primarily BP dependent.…”

Section: Discussionmentioning

confidence: 99%

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Increased carotid intima-media thickness in patients with pheochromocytoma in comparison to essential hypertension

et al. 2008

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Catecholamines due to various mechanisms may contribute to the accumulation of collagen fibers and extracellular matrix in the arterial wall. The aim of this study was to compare intima-media thickness (IMT) of the common carotid artery (CCA) and carotid bifurcation (CB) in patients with pheochromocytoma, essential hypertension and healthy controls. Carotid ultrasound studies were carried out in 30 patients with pheochromocytoma matched for age and gender with 80 patients with essential hypertension and 40 normotensive controls. Significantly higher IMT was found in patients with pheochromocytoma and essential hypertension compared to controls when measured in the CCA (0.931 ± 0.223, 0.825±0.146 and 0.738±0.113 mm; Po0.001; Po0.05), and only in patients with pheochromocytoma compared to controls in the region of CB (1.359 ± 0.593, 1.095 ± 0.311 and 0.968 ± 0.247 mm; Po0.001; P ¼ 0.13). Higher IMT in patients with pheochromocytoma compared to patients with essential hypertension was also statistically significant in both carotid regions (both Po0.01). This difference remained significant after adjustment for all relevant clinical and biochemical covariates in the CCA (P ¼ 0.014) but disappeared in the region of CB (P ¼ 0.079). In summary, patients with pheochromocytoma have increased common carotid IMT when compared to patients with essential hypertension. This finding could be caused by the deleterious effects of the excess of catecholamines on the vascular wall growth and thickening.

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Section: Discussioncontrasting

confidence: 51%

Section: Discussionmentioning

confidence: 99%

Increased carotid intima-media thickness in patients with pheochromocytoma in comparison to essential hypertension

et al. 2008

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“…It should be suspected in every hypertensive patient with headaches, palpitations, and sweating, typically occurring in an episodic way; not all pheochromocytomas show up with these typical symptoms, and this is the reason why there is often a delay between the initial symptoms and the final diagnosis, with an average delay of three years. Moreover, pheochromocytoma is characterized by increased blood pressure variability due to inconstant catecholamine release, which represents an additional independent risk factor beyond increased blood pressure itself for cardiovascular morbidity and mortality (Kikuya et al, 2000;Björklund et al, 2004;Zelinka et al, 2005).…”

Section: Pheochromocytomamentioning

confidence: 99%

Resistant Hypertension, Elevated Aldosterone/Renin Ratio and Reduced RGS2: A Pathogenetic Link Deserving Further Investigations?

Semplicini¹,

Stella²,

Ceolotto³

2012

Genetics and Pathophysiology of Essential Hypertension

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“…The prominent symptom is persistent or intermittent hypertension, reflecting the increased secretion of catecholamines epinephrine and norepinephrine. Increased blood pressure variability, the absence of the night-time BP decrease and inverted circadian BP rhythm are more common in phaeochromocytoma patients compared to essential hypertension [1]. Phaeochromocytoma is the underlying cause of hypertension in 0.1% of hypertensive patients [2].…”

Section: Introductionmentioning

confidence: 99%

“…The traditional antihypertensive preoperative medical preparation uses the non-selective α-adrenoceptor blocker phenoxybenzamine and a β-adrenoceptor blocker, propranolol [8]. Other agents, including selective α-adrenoceptor blockers, doxazosin and prazosin, and calcium channel antagonists have been used effectively [1]. Since the number of patients in the studies is often low, there are some controversies as to the best regimen [9].…”

Section: Introductionmentioning

confidence: 99%

Perioperative hypertension in phaeochromocytoma patients undergoing adrenalectomy

Šakić¹,

Kvolik²,

Grljusic

et al. 2007

Open Medicine

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AbstractThis study was designed to compare perioperative blood pressure (BP) management in hypertensive patients with phaeochromocytoma undergoing preoperative α-blockade and in patients with other suprarenal gland tumors. Perioperative hemodynamic data and immediate postoperative outcome in two groups undergoing adrenalectomy were compared. 483 medical charts from urologic patients with tumors were analyzed. In the hypertensive (n = 168) group, 20 patients with suprarenal gland tumors were identified (phaeochromocytoma n = 11, other tumors n = 9). Demographic data, intraoperative consumption of fentanyl and phentolamine, preoperative hospital stay and postoperative ICU stay were compared. Mean arterial pressure (MAP) was registered on the day before surgery, before anesthetic induction, during surgery, and upon admission in the intensive care unit (ICU). Although BP values did not differ significantly on the day before anesthesia, before induction and during operation, significantly more antihypertensive drugs were used for BP regulation in phaeochromocytoma patients versus the other tumor group. The phaeochromocytoma group required significantly more fentanyl during surgery (370±87 vs. 242±35 µg; p = 0.04). MAP upon ICU admission was significantly lower (85.1 vs. 97.4, p = 0.02) after adrenalectomy in phaeochromocytoma patients versus the other tumor group. The postoperative MAP decreased significantly in the phaeochromocytoma group (21.51 mmHg, p = 0.005), whereas significant differences according to preoperative values were not observed in the other tumor group (5.5 mmHg, p = 0.416). Prolonged preoperative hospital stay (24.6 vs. 10.0 days, p = 0.005) and ICU stay were registered in the phaeochromocytoma group. Pheochromocytoma patients had more pronounced perioperative BP oscillations, needed more antihypertensive drugs, analgesics and required prolonged hospital stay than patients with other adrenal tumors. Prolonged α-blockade may have contributed to these effects.

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Increased blood pressure variability in pheochromocytoma compared to essential hypertension patients

Cited by 48 publications

References 27 publications

Increased carotid intima-media thickness in patients with pheochromocytoma in comparison to essential hypertension

Increased carotid intima-media thickness in patients with pheochromocytoma in comparison to essential hypertension

Resistant Hypertension, Elevated Aldosterone/Renin Ratio and Reduced RGS2: A Pathogenetic Link Deserving Further Investigations?

Perioperative hypertension in phaeochromocytoma patients undergoing adrenalectomy

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