Relationship between systolic hypertension assessed by 24‐hour ambulatory blood pressure monitoring and aortic diameters in young women with Turner syndrome

Abstract

Objective: Patients with Turner syndrome (TS) are at high risk for cardiovascular morbidity and mortality due to aortic dilation. We evaluated the prevalence of hypertension and its risk factors and investigated the relationship between systolic hypertension and aortic diameter in young patients with TS. Design:Observational, cross-sectional study. Patients and measurements:Forty-two patients with TS (15-35 years) who had achieved final adult heights underwent 24-h ambulatory blood pressure monitoring (ABPM). Fasting glucose, insulin and lipid profiles were measured. The homeostasis model assessment of insulin resistance (HOMA-IR) was calculated. Echocardiography was performed to evaluate aortic diameters (aortic annulus, aortic root at the sinuses of Valsalva, sinotubular junction and ascending aorta), which were converted into Turner-specific z-scores.Results: Systolic and/or diastolic hypertension was identified in 71.4% (n = 30) of patients, as assessed by 24-hour ABPM. Twenty-eight patients (66.7%) were nondippers. Patients with systolic hypertension (n = 8, 19.0%) had a higher weight, waist circumference and HOMA-IR levels than those without hypertension (P < 0.05 for all).After adjusting for covariates, HOMA-IR was independently associated with systolic hypertension (odds ratio 10.1, P = 0.043). After adjusting for age and bicuspid aortic valve, systolic hypertension was independently related to increased aortic diameter at the aortic annulus (β = 1.064, P = 0.009) and sinotubular junction (β = 1.124, P = 0.016). Conclusions:Hypertension is highly prevalent and independently associated with IR in young patients with TS. The significant relationship between systolic hypertension and aortic diameters underscores the importance of BP and IR control. K E Y W O R D S ambulatory blood pressure monitoring, aortic diseases, hypertension, insulin resistance, Turner syndrome | 157 LEE Et aL.

Hypertension in Turner syndrome: a review of proposed mechanisms, management and new directions

“…From limited data describing the blood pressure phenotypes, higher prevalence of masked clinical arterial hypertension has been reported [72][73][74]. When comparing the ambulatory blood pressure measurements (ABPM) with clinic BP measurements of 23 girls with TS, five girls were found to be hypertensive from ABPM readings, but only one girl was found to be hypertensive according to a measurement taken in clinic [74].…”

Risk assessment for aortic dissection in Turner syndrome: The role of the aortic growth rate

“…While short stature and primary ovarian insufficiency are the commonest characteristics, there is a broad clinical spectrum including a complex cardiovascular phenotype which has been recognised as the most important factor contributing to the increased mortality rate seen in TS 1,3,4 . Common cardiovascular abnormalities include bicuspid aortic valve (BAV) and coarctation of the aorta (CoA) 5 ; hypertension and aortic dilatation are frequently reported in adult TS 6–9 . Both congenital and acquired cardiovascular disease contribute to a 100‐fold increased risk of aortic dissection (AoD) in this population 3,7 .…”

“…include bicuspid aortic valve (BAV) and coarctation of the aorta (CoA) 5 ; hypertension and aortic dilatation are frequently reported in adult TS. [6][7][8][9] Both congenital and acquired cardiovascular disease contribute to a 100-fold increased risk of aortic dissection (AoD) in this population. 3,7 Notably, AoD occurs at a younger age in TS women compared to the general female population-a mean age of 31 versus 68 years, respectively.…”