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 4767 year (mean age 54). The duration of active phase of A was 717 years (median 11), GH levels were 2319.2 ng/ml (mean 6.5), IGF-1 were 223568 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.
25 - 29 Apr 2009
European Society of Endocrinology