Impact of hypothyroidism on the daily blood pressure profile in hypertensive patients based on outpatient blood pressure monitoring results
Background. The purpose was to study characteristics of the daily blood pressure profile in hypertensive patients with concomitant hypothyroidism based on outpatient blood pressure monitoring results. Materials and methods. The study included 50 patients with hypertension and concomitant hypothyroidism. Depending on the serum level of thyroid-stimulating hormone (TSH), the patients were divided into two groups of 25 patients with compensated (Group 1) and decompensated hypothyroidism (Group 2). TSH level of 4.4 mIU/L was considered as the compensation criterion. The control group consisted of 30 patients with hypertension and excluded thyroid dysfunction. The main indicators of outpatient blood pressure monitoring, depending on the compensation of hypothyroidism, were compared. The daily systolic blood pressure index was estimated. Regression analysis was carried out to identify the relationship between clinical and anamnestic factors and indicators with the development of diastolic dysfunction by E/A ratio. Results. Based on the results of the outpatient blood pressure monitoring assessment, the patients with reduced thyroid function were found to have more significant changes in the daily blood pressure profile, whereas the average values of office blood pressure did not significantly differ between the groups. The patients with hypertension and concomitant hypothyroidism are characterized by an insufficient reduction in blood pressure at night, as evidenced by a greater proportion of patients with a daily index of less than 10 among these patients (p = 0.001). According to the results of ROC analysis, the duration of hormone replacement therapy > 6 years can predict a decrease in the daily systolic blood pressure index with a sensitivity of 82.1 % and specificity of 57.1 %. With a decrease in the daily index of ≤ 9.12 in patients with hypertension combined with hypothyroidism, diastolic dysfunction (E/A) is more likely to develop, as evidenced by the results of ROC analysis with a sensitivity of 86.4 % and a specificity of 46.2 %. Conclusions. Outpatient blood pressure monitoring is thus indicated in hypertensive patients with concomitant hypothyroidism to detect night hypertension and correct antihypertensive therapy. Based on these findings, antihypertensive therapy should be aimed not only at lowering blood pressure, but also on the normalization of the daily index.
Full Text:PDF (Українська)
Tseluyko VI. Reality of arterial hypertension treatment in Ukraine: the results of «СИСТЕМА 2» cohort study.Ukrainian journal of cardiology. 2018; 1: 13-19. (InUkrainian).
LutayMI. Efficiency of the combined treatment of arterial hypertension in Ukraine: results of the TRIUMF multicenter study. Ukrainian journal of cardiology. 2016; 4: 17-28. (InUkrainian)
Williams B, Mancia G, Spiering W, AgabitiRosei E, Azizi M, Burnier M, et al. Guidelines for the management of arterial hypertension. EurHeart J. 2018; 39(33): 3021-3104.
Zawadzki M J, Small A K, Gerin W. Ambulatory blood pressure variability: a conceptual review. Blood pressure monitoring. 2017; 22 (2): 53-58.
Myers MG. The relationship between automated office and a wake ambulatory blood pressure maybe differentatthresholdsfor diagnosis and target for therapy. CanadianJournalofCardiology. 2018; 34(1): 8-10.
Turner JR, Viera AJ, Shimbo D. Ambulatory blood pressure monitoring in clinical practice: a review. The American journal of medicine. 2015; 128(1): 14-20.
Banegas JR, Ruilope LM, delaSierra A, Vinyoles E, Gorostidi M, delaCruz JJ, et al. Relationship between Clinic and Ambulatory Blood-Pressure Measurement sand Mortality. N Engl J Med. 2018;378(16):1509-1520. doi: 10.1056/NEJMoa1712231.
Mitchenko OI,. Logvinenko AO, Romanov VYu. Diurnal profile of blood pressure and structural-functional state of myocardiumin patients with metabolic syndrome and thyroiddysfunction, treatment optimization. Ukrainian journal of cardiology. 2010; 4: 70-77. (In Ukrainian).
Wirtwein M, Gruchala M, Sobiczewski W. Diurnal blood pressure profile and coronary atherosclerosis extentare related to cardiovascular complications. Bloodpressure. 2017; 26(2): 81-86.
Garber JR, Cobin RH, Gharib H, Hennessey JV, Klein I, Mechanick JI, et al. Clinical practice guidelines for hypothyroidism in adults: cosponsored by the American Association of Clinical Endocrinologist sand the American Thyroid Association. Endocr Pract. 2012; 18(6): 988-1028.
Skarzhinskaya NS, Chesnikova AI, Safronenko VA. Arterial hypertension in patients with hypothyroidism, management strategies. Arterial Hypertension. 2016; 22(4): 401-413. . (In Russian).
Mancia G, Verdecchia P. Clinical value of ambulatory blood pressure: evidence and limits. Circulation research. 2015; 116(6): 1034-1045.
Piantanida E, Gallo D, Veronesi G, Pariani N, Masiello E, Premoli P, etal.Masked hypertension in newly diagnosed hypothyroidism: a pilot study.J Endocrinol Invest. 2016; 39(10): 1131-8. doi: 10.1007/s40618-016-0488-7.
Ateş İ, Altay M, Kaplan M, Arıkan MF, Özkayar N, Alagüney ME, et al. Is thyroid function associated with masked hypertension? Anatol J Cardiol. 2016;16(8):644. doi: 10.14744/AnatolJCardiol.2016.7197.
Tadic M, Cuspidi C, Pencic-Popovic B, Celic V, Mancia G.The influence of night-time hypertension on left ventricular mechanics. Int J Cardiol. 2017; 243: 443-448. doi: 10.1016/j.ijcard.2017.06.011.
Farah R, Makhoul N, Arraf Z, Khamisy-Farah R. Switching therapy to bed time for uncontrolled hypertension with a non dippin gpattern: a prospective randomized-controlled study. BloodPressMonit. 2013; 18(4): 227-31. doi: 10.1097/MBP.0b013e3283624aed
Demirel M, Gürsoy G, Yıldız M. Does Treatment of Either Hypothyroidy or Hyperthyroidy Affect Diurnal BloodP ressure. Archives of Iranian Medicine (AIM). 2017; 20(9): 572-580. doi: 0172009/AIM.005.
Copyright (c) 2020 EMERGENCY MEDICINE
This work is licensed under a Creative Commons Attribution 4.0 International License.
© Publishing House Zaslavsky, 1997-2020