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

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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.

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References

  1. Balzer R., Mc Cullagh E.P. Hypertension in acromegaly. Am. J. Med. Sci. 37: 449, 1959.

    Article  Google Scholar 

  2. Molitch M.E. Clinical manifestations of acromegaly. Endocrin. Metab. Clin. North Am. 23: 597, 1992.

    Google Scholar 

  3. Pepine C.J., Aloia J. Hearth muscle disease in acromegaly. Am. J. Med. 48: 530, 1970.

    Article  PubMed  CAS  Google Scholar 

  4. Wright A.D., Hill D.M., Lowy C., Froser T.R. Mortality in acromegaly. Q. J. Med. 39: 1, 1970.

    PubMed  CAS  Google Scholar 

  5. Alexander L., Appleton D., Hall R., Ross W.H., Wilkinson R. Epidemiology of acromegaly in the Newcastle region. Clin. Endocrinol. (Oxf.) 12: 71, 1980.

    Article  CAS  Google Scholar 

  6. Bengtsson B.A., Eden S., Ernest I., Oden A, Sjogren B. Epidemiology and long term survival in acromegaly. Acta Med. Scandinava 223: 327, 1988.

    Article  CAS  Google Scholar 

  7. Bates A.S., Van’t Hoff W., Jones J. M., Clayton R.N. The effect of treatment on life expectancy in acromegaly. In: Wass J.A.M. (Ed.), Treating acromegaly. J. Endocrinol. Ltd, Bristol, 1994, p. 175.

    Google Scholar 

  8. Biglieri E., Watlington C.O., Forsham P.H. Sodium retention with human growth hormone and its subfractions. J. Clin. Endocrinol. Metab. 21: 361, 1961.

    Article  CAS  Google Scholar 

  9. Cain J.P., Williams G.H., Dluhy R.G. Plasma renin activity and aldosterone secretion in patients with acromegaly. J. Endocrinol. Invest. 34: 73, 1972.

    CAS  Google Scholar 

  10. Cuneo R.C., Salomon F., Wilmshurst P., Byrue C., Wiles C.M., Hesp R., Sonksen P.M. Cardiovascular effects of growth hormone treatment in growth-hormone deficient adults: stimulation of the renin-aldosterone system. Clin. Sci. 81: 587, 1991.

    PubMed  CAS  Google Scholar 

  11. Haak T., Schirmer U., Scheuermann E. Haemodynamic and renal responsiveness to human atrial natriuretic peptide (hANF) in active acromegaly. In: Mantero F., Takeda R., Scoggins B.A., Biglieri E.G., FUnder J.W. (Eds.), The adrenal and hypertension: Raven Press, New York, 1989, vol. 57, p. 391.

    Google Scholar 

  12. Deray G., Rieu M., Devynck M.A. et al. Evidence of an endogenous digitalis-like factor in the plasma of patients with acromegaly. N. Engl. J. Med. 316: 575, 1987.

    Article  PubMed  CAS  Google Scholar 

  13. Imai Y., Abe K., Sasaky S., Minai N., Nihei M., Murakata M., Murakoni O, Matsue K., Sekino H., Miura Y., Yoshinaga K. Altered circadian blood pressure rhythm in patients with Cushing’s Syndrome. Hypertension. 12: 11, 1988.

    Article  PubMed  CAS  Google Scholar 

  14. Piovesan A., Panarelli M., Terzolo M., Osella G., Matrella C., Paccotti P., Angeli A. 24-hour profiles of blood pressure and hearth rate in Cushing’s syndrome: relationship between cortisol and cardiovascular rhythmicities. Chronobiol. Int. 7: 263, 1990.

    Article  PubMed  CAS  Google Scholar 

  15. Statius van Eps R.G., Van den Meiracker A.H., Boomsma F. et al. Diurnal variation of blood pressure in patients with catecolamine-producing tumors. Am. J. Hypertens. 7: 492, 1994.

    Google Scholar 

  16. Meisel S.R., Mor-Avi V., Rosenthal T., Akselrod S. Spectral analysis of systolic blood pressure signal in secondary hypertension: a method for the identification of phaechromocytoma. J. Hypertens. 12: 269, 1994.

    Article  PubMed  CAS  Google Scholar 

  17. Veglio F., Pinna G., Melchio R., Rabbia F., Molino P., Torchio C., Chiandussi L. Twenty-four hour power spectral analysis by Maximum Entropy Method of blood pressure in primary hyperaldosteronism. Blood pressure. 2: 189, 1993.

    Article  PubMed  CAS  Google Scholar 

  18. White W.B., Malchoff C. Diurnal blood pressure variability in mineralocorti-coid excess syndrome. Am. J. Hypertens. 5: 414, 1992.

    Article  PubMed  CAS  Google Scholar 

  19. Fallo F., Barzon L., Casiglia E., Boscaro M., Sonino N. Effect of octreotide on 24-hour blood pressure in acromegaly. 79th Annual Meeting of the endocrine Society. June 11, 1997.

    Google Scholar 

  20. Coca A. Circadian rhythm and blood pressure control: physiological and pathophysiological factors. J. Hypertens. 12 (Suppl. 5): S13, 1994.

    Google Scholar 

  21. Parati G., Ravogli A., Frattola A., Groppelli A., Ulian L., Santucci C., Mancia G. Blood pressure variability:clinical implications and effects of antihypertensive treatment. J. Hypertens. 12 (Suppl. 5): S35, 1994.

    CAS  Google Scholar 

  22. O’Brien E., Sheridan J., O’Malley K. Dippers and non-dippers. Lancet. ii: 397, 1988.

    Article  Google Scholar 

  23. Shimada K., Kawamoto A., Matsubayashi K., Nishinaga A., Kimura S., Ozawa T. Diurnal blood pressure variations and silent cere-brovascular damage in elderly patients with hypertension. J. Hypertens. 10: 875, 1992.

    PubMed  CAS  Google Scholar 

  24. Palatini P., Penzo M., Raccioppa A., Zugno E., Guzzardi G., Anaclerio M., Pessina A.C. Clinical relevance of nighttime blood pressure and daytime blood pressure variabiIity. Arch. Intern. Med. 152: 1855, 1992.

    CAS  Google Scholar 

  25. O’Brien E., Sheridan J., Browne E. et al. Validation of the SpaceLabs 90202 ambulatory blood pressure recorder. J. Hypertens. 7 (Suppl. 6): S388, 1989.

    Google Scholar 

  26. Staessen J., Bulpitt C.J., O’Brien E., Cox J., Fargard R., Stanton A. The diurnal blood pressure profile. A population study. Am. J. Hypertens. 5: 386, 1992.

    Article  PubMed  CAS  Google Scholar 

  27. Staessen J., Fargard R., Lijnen P.J., et al. The mean and range of the ambulatory blood pressure in normotensive subjects from a meta-analysis of 23 studies. Am. J. Cardiol. 67: 723, 1991.

    Article  PubMed  CAS  Google Scholar 

  28. Ritche C.M., Atkinson A.B., Kennedy A.L. et al. Ascertainment and natural history of trated acromegaly in Northern Ireland. Ulster Med. J. 59: 52, 1990.

    Google Scholar 

  29. Hamwi G.J., Skillman T.G., Tufts K.C.J. Acromegaly. Am. J. Med. 29: 690, 1960.

    Article  PubMed  CAS  Google Scholar 

  30. Jonas E.A., Aloia J.F., Lane F.J. Evidence of subclinical heart muscle dysfunction in acromegaly. Chest 67: 190, 1975.

    Article  PubMed  CAS  Google Scholar 

  31. Martins J.B., Keber R.E., Sherman B.M., Mercus M.L., Ehrardt J.C. Cardiac size and function in acromegaly. Circulation 56: 865, 1977.

    Article  Google Scholar 

  32. Bruel A., Oxlund H. Biosynthetic growth hormone increases the collagen deposition rate in rat aorta and heart. Eur. J. Endocrinol. 132: 195, 1995.

    Article  PubMed  CAS  Google Scholar 

  33. Grant M.B., Wargovich T.J., Ellis E.A. et al. Localization of insulin-like growth factor I and inhibition of coronary smooth muscle cell growth by somatostatin analogues in human coronary smooth muscle cells. A potential treatment for restenosis? Circulation 89: 1511, 1994.

    Article  PubMed  CAS  Google Scholar 

  34. Khorsandi M., Fagin J.A., Fishbein M.C. et al. Effects of hypophisectomy on vascular insulin-like growth factor I gene expression after ballon denudation in rats. Atherosclerosis 93: 115, 1992.

    Article  PubMed  CAS  Google Scholar 

  35. Sarzani R., Paci V.M., Lanari A. et al. Induction of cardiac growth factors and growth factor receptors gene expression by growth hormone in normotensive and hypertensive rats. High Blood Pressure 5: 139, 1996.

    Article  Google Scholar 

  36. Davies A.B., Gould B. A., Cashman P.M.M. et al. Circadian rhythm of blood pressure in patients dependent on ventricular demand pace-makers. Br. Heart J. 52: 93, 1984.

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  37. Imai Y., Abe K., Munakata M., Sakuma H., Hashimoto J., Imai K., Sekino H., Yoshinaga K. Does ambulatory blood pressure monitoring improve the diagnosis of secondary hypertension? J. Hypertens. 8: S71, 1990.

    CAS  Google Scholar 

  38. Verdecchia P., Schillaci G., Boldrini F., Zampi I., Porcellati C. Variability between current definitions of normal ambulatory blood pressure. Hypertension 20: 555, 1992.

    Article  PubMed  CAS  Google Scholar 

  39. Schulte K. L., Liederwald K., Meyer-Sabellek W., Van Gemmeren D., Lenz T., Gotzen R. Relationships between ambulatory blood pressure, forearm vascular resistence and left ventricular mass in hypertensive and normotensive subjects. Am. J. Hypertens. 6: 786, 1993.

    PubMed  CAS  Google Scholar 

  40. Lie J.T., Grossman S.J. Pathology of the heart in acromegaly: anatomic findings in 27 autopsied patients. Am. Heart J. 100: 41, 1980.

    Article  PubMed  CAS  Google Scholar 

  41. Fazio S., Cittadini A., Cuocolo A., Merola B., Sabatini O., Nicolai E., Biondi D, Lombardi G, Saccà L. Impaired cardiac performance is a distinct feature of uncomplicated acromegaly. J. Clin. Endocrinol. Metab. 79: 441, 1994.

    PubMed  CAS  Google Scholar 

  42. Terzolo M., Avonto L., Matrella C., Pozzi R., Luceri S., Borretta G., Pecchio F., Ugliengo G., Magro G.P., Reimondo G., Uslenghi E., GrecoLucchina P., Angeli A. Doppler echocardiographic patterns in patients with acromegaly. J. Endocrinol. Invest. 18: 613, 1995.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Dipartimento di Scienze Cliniche e Biologiche, Medicina Interna, University of Torino, Azienda Ospedaliera S. Luigi, Regione Gorzole 10, 10043, Orbassano (TO), Italy

    M. Terzolo, C. Matrella, A. Boccuzzi, S. Luceri, M. Borriero, G. Reimondo, A. Pia, E. Rovero, P. Paccotti & A. Angeli

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  1. M. Terzolo
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  2. C. Matrella
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  3. A. Boccuzzi
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Terzolo, M., Matrella, C., Boccuzzi, A. et al. Twenty-four hour profile of blood pressure in patients with acromegaly. Correlation with demographic, clinical and hormonal features. J Endocrinol Invest 22, 48–54 (1999). https://doi.org/10.1007/BF03345478

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