Prevalence of hypertension in acromegalic patients: clinical measurement versus 24-hour ambulatory blood pressure monitoring

Abstract

Ambulatory blood-pressure monitoring indicated a lower prevalence of hypertension in acromegalic patients then usually reported, suggesting that the role of hypertension in the pathogenesis of acromegalic cardiomyopathy is commonly overestimated. We propose that ambulatory blood-pressure monitoring should be routinely proposed in acromegalics with high or borderline clinical blood pressure values although it is not useful in patients defined normotensive according to repeated clinical measurement.

Relationship between blood pressure and glucose tolerance in acromegaly

“…No correlation was found between BP values and either patients BMI or IRI, GH and IGF-I levels. The lack of correlation between GH/IGF-I values and BP values is in agreement with most studies (Kraatz et al, 1990;Ezzat et al, 1994;Minniti et al, 1998b;Colao et al 2000), although higher GH values were found in hypertensive acromegalics in a single report (Ikeda et al, 1993). Neither did the appearent duration of disease, which has been reported to contribute to myocardial performance impairement in acromegalics (Colao et al, 1999), correlate with either BP values or glucose tolerance in this study.…”

“…The main advantages of 24-h ABPM over clinical measurement are to disclose high occasional BP values due to the`white-coat effect' and to provide additional information concerning nocturnal BP values (Mallion et al, 1999). Using 24-h BP values for the definition of systemic hypertension instead of clinical BP measurement (Staessen et al, 1993) may lead to significant differences in its appearent prevalence (Minniti et al, 1998b), and recent recommendations of JNC (1997) suggest to more clearly distinguish between diurnal BP values ± which circumvent the`white-coat effect' ± and nocturnal BP values. In the present series, the prevalence of high diurnal BP values was 47´0%, with a progressive increase from 30´8% in patients with NGT patients to 76´9% in patients with DM, a similar trend being observed for clinical and nocturnal BP values.…”

“…BP was recorded every 15 minutes from 06´00 h to 23´00 h and every 30 minutes for the rest of the time, using an A & Co (Tokyo, Japan) TM 2420 monitor (7th model) (Palatini et al, 1991). The recordings were collected and evaluated in the different centres, then verified by an expert and possible artefacts were excluded, as previously described (Minniti et al, 1998b). Mean diurnal, nocturnal and 24-h SBP and DBP values were obtained.…”

“…In addition, metabolic disorders ± including diabetes mellitus, impaired glucose tolerance, hyperinsulinaemia and/or insulin resistance ± are thought to contribute to increase BP values, but the relative physiopathological importance of such factors is largely unknown. The prevalence of systemic hypertension in acromegalic patients, as defined by clinical sphygmomanometric measurements, has been reported to range from 30 to 60% (Nabarro, 1987;Kraatz et al, 1990;Ezzat et al, 1994;Rajasoorya et al, 1994;Colao et al, 1999), although a significantly lower incidence has been found by 24-h ambulatory blood pressure monitoring (ABPM) according to Staessen's criteria (Staessen et al, 1993;Minniti et al, 1998b). On the other hand, abnormalities of glucose tolerance, including overt diabetes mellitus, are commonly observed in up to 50% and 30% of acromegalic patients, respectively (Ezzat et al, 1994;Colao et al 2000).…”

GH and IGF‐I excess control contributes to blood pressure control: results of an observational, retrospective, multicentre study in 105 hypertensive acromegalic patients on hypertensive treatment

“…4,5 Hypertension affects approximately one-third of patients with acromegaly, with values ranging from 17·5% to 57% in different series. [6][7][8][9][10][11][12][13][14][15][16] In a recent epidemiological study, hypertension was found in 39·1% of 1036 cases reported. 17 In a case-control study including 200 patients with acromegaly, Vitale et al .…”