Twenty-four hour profile of blood pressure in patients with acromegaly. Correlation with demographic, clinical and hormonal features

Abstract

Cardiovascular events are frequently reported in patients with acromegaly and they are usually related to arterial hypertension. Aim of the present study was to assess the 24-hour profile of blood pressure (BP) and heart rate (HR) in patients with active acromegaly and to correlate them with clinical and hormonal data. Sixteen patients and 16 healthy, age and sex matched subjects underwent ambulatory blood pressure monitoring by means of a portable automatic device (SpaceLabs monitor 90207, Kontron) with measurements every 20 minutes for 24 hours. The presence of the nocturnal fall was assessed by the calculation of the night-day systolic and diastolic ratio. The mean 24-hour diastolic BP was significantly higher in acromegalic patients than in controls (79.1+/-11.5 mmHg vs 70.8+/-5.3 mmHg, p<0.05) and the circadian diastolic profile was flatten. In fact, 10/16 patients were defined as nondippers while this figure was 2/16 in the control group (62% vs 12%, p<0.01). Also the mean 24-hour systolic BP was higher in acromegalic patients than in controls (124.8+/-17.2 mmHg vs 114.1+/-8.6 mmHg, p<0.05). The circadian systolic profile paralleled that of diastolic and was flatten, without a significant nocturnal fall. Ten out of 16 patients were nondippers compared to 2/16 controls (62 vs 12%, p<0.01). No significant correlation was found between mean 24-hour BP, either diastolic or systolic, and demographic or hormonal characteristics of the patients. HR patterns did not differ between patients and controls and were characterized by a prominent nocturnal fall.

Impact of successful transsphenoidal surgery on cardiovascular risk factors in acromegaly

“…Taken together, these data argue for a significant relationship between insulin resistance and LVH in acromegaly, independent of BP. Hypertension is likely to act as an additional risk factor, as supported herein by the slight but significant correlation between 24-h DBP and LVMI observed before surgery, and by the greater LVMI reported by others in hypertensive patients with acromegaly compared with their normotensive counterparts (14).…”

Altered circadian blood pressure profile in patients with active acromegaly. Relationship with left ventricular mass and hormonal values

“…23 In addition, there are data to suggest that hypertensive patients who are salt sensitive are more likely to be non-dippers than patients who are salt resistant. 24 Our results are in contrast with those observed by Minniti et al, 7 who in only one out of seven acromegalics with hypertension observed the absence of the physiological night-time decrease of BP, but they are in agreement with those observed by Terzolo et al, 8 who in five out of seven defined as hypertensives by ABPM found a non-dipper, altered night-day ratio for BP. In essential hypertensives it was observed that the ratio of fasting insulin to glucose was higher in non-dippers.…”

“…5,6 There is no direct relationship between the degree of cardiomegaly and the level of circulating growth hormone (GH). 5,6 With only two exceptions 7,8 hypertension in acromegalyc patients was studied with sphygmomanometric methods and hence, there is scanty information on the circadian variations in blood pressure (BP) and heart rate (HR). Moreover, the available results are contradictory.…”

Serum- and Glucocorticoid-Regulated Kinase (SGK1) Gene and Blood Pressure

“…Acromegaly, which leads to enhanced release of IGF1, is a well-known cause of hypertension, and the IGF1 gene locus demonstrates linkage to blood pressure in twins. 25,26 Only a subpopulation of acromegalic patients develop hypertension. In view of the present data, it is tempting to speculate that the acromegalic patients who remain normotenEffect of the polymorphisms on blood pressure in the twin sample and the replication sample.…”