Hypertension-related factors in patients with active and inactive acromegaly

Abstract

Introduction: There are several complications of the cardiovascular system caused by acromegaly, especially hypertension. Objectives: To evaluate hypertension characteristics in patients with cured/controlled acromegaly and with the active disease. Patients and methods: Cross-sectional study of the follow-up of forty-four patients with acromegaly submitted to clinical evaluation, laboratory tests and cardiac ultrasound. Patients with cured and controlled disease were evaluated as one group, and individuals with active disease as second one. Results: Forty-seven percent of the patients had active acromegaly, and these patients were younger and had lower blood pressure levels than subjects with controlled/cured disease. Hypertension was detected in 50% of patients. Subjects with active disease showed a positive correlation between IGF-1 and systolic and diastolic blood pressure levels (r = 0.48, p = 0.03; and r = 0.42, p = 0.07, respectively), and a positive correlation between IGF-1 and urinary albumin excretion (UAE) rates. In patients with active disease, IGF-1 was a predictor of systolic blood pressure, although it was not independent of UAE rate. For individuals with cured/controlled disease, waist circumference and triglycerides were the predictors associated with systolic and diastolic blood pressure. Conclusions: Our findings suggest that blood pressure levels in patients with active acromegaly are very similar, and depend on excess GH. However, once the disease becomes controlled and IGF-1 levels decrease, their blood pressure levels will depend on the other cardiovascular risk factors. Arq Bras Endocrinol Metab. 2011;55(7):468-74

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

“…We plotted (Figure, A) unweighed regression coefficients (r-values for correlation between mean or systolic BP and total IGF-1) against the reported mean total IGF-1 from previous studies, 14,20,[22][23][24][25][26][27][28][29][30][31][33][34][35][36][37]42 as well as the low, middle, and high IGF-1 groups from SAfrEIC and SABPA studies. A similar analysis weighed for study sample size is also presented (Figure, B).…”

“…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.…”

“…Regression coefficients for the relationship between blood pressure and total insulin-like growth factor-1 (IGF-1) extracted from different studies plotted against total IGF-1 concentration, with (A) unweighed regression analysis and (B) weighed according to sample size: (1) patients with active acromegaly aged 48±9 y; cross-sectional analysis of cases (n=21) 22 ; (2) patients with active acromegaly aged 46.8±14.9 y; cross-sectional analysis of cases at study entry (n=200) 20 ; (3) Sex, Age and Ethnicity on Insulin Sensitivity and Cardiovascular Function (SAfrEIC) study: black and white population aged 31.8±9.32 y; cross-sectional study (n=27), adjusted for age and sex; (4) Sympathetic Activity and Ambulatory Blood Pressure in Africans (SABPA) study: black and white population aged 36.1±11.3 y; cross-sectional study (n=30), adjusted for age and sex; (5) black men aged 27±3.7 y; cross-sectional analysis of year 2 of prospective study (n=544), adjusted for age, body mass index (BMI), physical activity, alcohol, and smoking 23 ; (6) healthy young Finnish men aged 25±5 y; cross-sectional study (n=846), adjusted for age 24 ; (7) 29 ; (23) hypertensive men and women and controls aged 50±10 y; cross-sectional analysis of cases and controls combined (n=157) 30 ; (24) SAfrEIC study: black and white population aged 47.6±11.8 y; cross-sectional study (n=215), adjusted for age and sex; (25) women with/without coronary heart disease aged 60 to 79 y; cross-sectional analysis of data from prospective study (n=500), adjusted for age 27 ; (26) women from the general population aged 25 to 64 y; cross-sectional analysis (n=195) 37 ; (27) men and women from the general population aged 45.5±19.4 y; crosssectional study (n=404), adjusted for age 34 ; (28) healthy men and women aged 46.8±15 y; cross-sectional analysis of controls at study entry (n=200) 20 ; (29) men and women from the general population aged 40±9 y (n=3496); cross-sectional analysis of first examination of prospective study, adjusted for sex and age.…”

“…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.…”

The ongoing challenge of discrepant growth hormone and insulin‐like growth factor I results in the evaluation of treated acromegalic patients: a systematic review and meta‐analysis

“…Elevated IGF-I levels have been shown to be more predictive than GH levels regarding decreased insulin sensitivity 27 as well as elevated blood pressure (both systolic and diastolic). 28 On the other hand, some advocate that the pattern of 'High GH' discrepancy may indicate recurrence of disease, as a number of these patients will increase the IGF-I levels and deteriorate biochemically over time. 29 In addition, in patients treated with SSAs, the evaluation of GHn during OGTT is questioned.…”