DOI: https://doi.org/10.22141/2224-0586.8.103.2019.192373

Impact of hypothyroidism on the daily blood pressure profile in hypertensive patients based on outpatient blood pressure monitoring results

V.Y. Tseluyko, D.A. Korchagina

Abstract


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.


Keywords


blood pressure; arterial hypertension; hypothyroidism; antihypertensive therapy

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