Endocrine Abstracts (2009) 20 P293

Prevalence and peculiarity of arterial hypertension treatment in acromegaly patients

Galina Melnichenko, Abram Syirkin, Vyachelav Pronin, Alexey Svet, Ekaterina Chaplyigina, Evgeniy Gitel & Yuriy Poteshkin

I.M. Sechenov Moscow Medical Academy, Moscow, Russian Federation.

Occurrence of arterial hypertension (AH) in acromegaly (A) is the significant risk factor for sudden death. The study group included 232 patients with A aged 47–67 year (mean age 54). The duration of active phase of A was 7–17 years (median 11), GH levels were 23–19.2 ng/ml (mean 6.5), IGF-1 were 223–568 ng/ml (mean 354). AH was found in 186 patients (80.2%): 1st degree – 27%, 2nd – 32%, 3rd – 41%. Of 24-hour arterial blood pressure monitoring showed primary night increase of blood pressure (BP) in 45% patients. Mean levels of systolic and diastolic BP is strongly correlated with the duration of an active phase of A (r=0.57 and r=0.68) and GH level (r=0.51 and r=0.58) (P<0.0001). Remission in patients with an age of A onset <45 year leads to normalization of BP (P<0.005), but this was not found in patients with an onset of A > 45-year-old. (P=0.24). To estimate the efficiency and safety of cardioselective beta-adrenoblockers in patients with A, we created the study group included 19 patients with an onset of disease > 45-year-old (53-62-year-old (mean age 59-year-old)). All of them had high BP levels despite the remission of A and the management of antihypertensive therapy (ACE inhibitors – 95%; diuretics – 53%; dihydropyridine calcium-channel blockers – 37%). Criteria of exclusion was occurrence of coronary heart disease, heart failure, rhythm and conductivity disorders in the past. Of 13 patients received Bisoprolol and 6 patients – Nebivolol.

Results: In 32% patients treatment with beta-adrenoblockers led to severe conductivity disorders or sick sinus syndrome that is higher than prevalence of all recorded adverse reaction of Bisoprolol (11.2%).

Conclusion: Prevalence of AH in patients with A is 1.5-fold higher than in general population. The treatment of AH with beta-adrenoblockers in patients with myocardial dysfunction require caution, careful screening and ECG monitoring.

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