Effect of medical therapy on 24-h blood pressure profile in acromegaly
C. Sardella, A. Nuzzo, C. Urbani, M. Lombardi, I. Scattina, L. Tomisti, E. Martino & F. Bogazzi
To investigate the blood pressure profile (BP) in active acromegaly and the effect of medical treatment of acromegaly on BP circadian rhythm, we studied 21 acromegalics before and after 360 months of treatment with somatostatin analogs (15/21) or pegvisomant (5/21) or both (5/21). Ambulatory 24-h BP was recorded. The 24-h mean BP (MBP), the mean systolic BP (SBP) and diastolic BP (DBP), the day-time (day) and night-time (night) MBP, SBP and DBP and the 24-h mean heart rate (HR) were evaluated. At baseline, 11 patients were normotensive (NT) and ten were treated with antihypertensive drugs. In hypertensive (HT), mean night BP was higher than in NT (P≤0.01). The BP circadian rhythm was abnormal in 62% of active acromegalics with no difference between the two groups. No correlation between BP and GH or IGF1 was found in HT acromegalics. After therapy, acromegaly was controlled (C) in 12 patients (6 NT and 6 HT) whereas in nine (5 NT and 4 HT) was not controlled (NC). After therapy, 24-h and night MBP and 24-h, day- and night DBP were lower (P≤0.05, P≤0.01) in HT and NC patients whereas SBP, MBP and DBP were increased (P≤0.05, P≤0.01) in NT and NC acromegalics. No difference before and after treatment was found in the C group although three patients reduced or discontinued the antihypertensive drugs after IGF1 normalization. After therapy, the BP circadian rhythm was disturbed in 47% of all patients and in 60% of NC. The 24-h mean HR was lower either in HT (P=NS) or NT (P≤0.05) after treatment regardless of disease control. Active acromegaly is associated with alterations of 24-h BP profile; control of acromegaly may reduce the risk to develop hypertension and is associated with improvement of several BP parameters.
Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.
Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.