Modifying influence of subclinical hypothyroidism on arterial hypertension: relationship to masked treatment failure, circadian blood pressure profile and target organs status
https://doi.org/10.14341/ket2015255-62
Abstract
Aim. The study aimed to investigate the modifying influence of subclinical hypothyroidism (SH) on arterial hypertension (AH), the prevalence of masked uncontrolled hypertension, circadian blood pressure (BP) profile and cardiovascular disorders. Materials and methods. We investigated twenty-four hours BP monitoring data and cardiovascular parameters in 101 hypertensive patients with normal thyroid function ( n = 45) or SH ( n = 56). Then, we observed 44 patients with AH and SH within six months; 24 of them received levothyroxine. Results. Patients with AH and SH had higher risk of masked uncontrolled hypertension (for TSH ≥ 5 mU/L, OR 1.9 [1.11, 3.26], p = 0.016); increased pulse BP, daily BP variability, non-dippers rate as well as more marked myocardial hypertrophy, arterial dysfunction and microcirculation deterioration ( p < 0.05 for all parameters). Levothyroxine therapy reduced the incidence of masked uncontrolled hypertension, ambulatory BP value, non-dippers rate and intensified microcirculation ( p < 0.05 for all parameters). Conclusion. SH is a risk factor for masked failure of antihypertensive therapy. SH impairs the profile of ambulatory BP and target organs damages in patients with AH. These disorders can be partly corrected by the use of levothyroxine.
About the Authors
T A Nekrasova
Nizhny Novgorod State Medical Academy, Russian Federation
L G Strongin
Nizhny Novgorod State Medical Academy, Russian Federation
E P Morozova
Nizhny Novgorod State Medical Academy, Russian Federation
E M Durigina
Nizhny Novgorod State Medical Academy, Russian Federation
L V Kasakova
Volga Region Medical Center, Nizhny Novgorod, Russian Federation
References
1. Бланкова З.Н., Серединина Е.М., Агеев Ф.Т. Влияние терапии левотироксином на клинический, гемодинамический и нейрогуморальный статус больных сердечной недостаточностью в сочетании с субклиническим гипотиреозом. // Журнал Сердечная Недостаточность. - 2011. - Т. 12. - №1 - C. 18-22. [Blankova ZN, Seredinina EM, Ageev FT. Vliyanie terapii levotiroksinom na klinicheskii, gemodinamicheskii i neirogumoral’nyi status bol’nykh serdechnoi nedostatochnost’yu v sochetanii s subklinicheskim gipotireozom. Zhurnal Serdechnaya Nedostatochnost’. 2011;12(1):18-22. (In Russ).]
2. Демидова Т.Ю., Галиева О.Р. К вопросу лечения субклинического гипотиреоза у больных ожирением. // Клиническая и экспериментальная тиреоидология. - 2008. - Т.4. - №1 - C. 48-52. [Demidova T, Galieva O. Treatment of subclinical hypothyroidism in obese patients. Clinical and experimental thyroidology. 2008;4(1):48-52. (In Russ).] doi: 10.14341/ket20084148-52.
3. Кравец Е.Б., Идрисова Е.М., Дамдиндорж Д., и др. Особенности суточного профиля артериального давления у больных с аутоиммунным тиреоидитом в фазе субклинического гипотиреоза. // Клиническая и экспериментальная тиреоидология. - 2008. - Т. 4. - №3 - С. 50-54. [Kravez EV, Idrisova EM, Damdindorsh D, et al. Daily rhythm of arterial pressure in patients with autoimmune thyroidite in a phase subclinical hypothyroidism. Clinical and experimental thyroidology. 2008;4(3):50-54. (In Russ).] doi: 10.14341/ket20084350-54.
4. Iqbal A, Figenschau Y, Jorde R. Blood pressure in relation to serum thyrotropin: The TROMSØ study. J Hum Hypertens. 2006;20(12): 932-936. doi: 10.1038/sj.jhh.1002091.
5. Ittermann T, Thamm M, Wallaschofski H, et al. Serum thyroid-stimulating hormone levels are associated with blood pressure in children and adolescents. J Clin Endocrinol Metab. 2012;97(3): 828-834. doi: 10.1210/jc.2011-2768.
6. Volzke H, Alte D, Dorr M, et al. The association between subclinical hyperthyroidism and blood pressure in a population-based study. J Hypertens. 2006;24(10):1947-1953. doi: 10.1097/01.hjh.0000244942.57417.8e.
7. Walsh JP, Bremner AP, Bulsara MK, et al. Subclinical thyroid dysfunction and blood pressure: A community-based study. Clin Endocrinol (Oxf). 2006;65(4):486-491. doi: 10.1111/j.1365-2265.2006.02619.x.
8. Килейников Д.В., Орлов Ю.А., Мазур В.В., и др. Влияние заместительной терапии на артериальную гипертензию и ремоделирование сердца у больных первичным гипотиреозом. // Клиническая и экспериментальная тиреоидология. - 2011. - Т. 7. - №1 - С. 41-44. [Kileinicov D, Orlov Y, Masur V, et al. Levothyroxine replacement therapy in patients with hypothyroidism, blood pressure and myocardial remodeling. Clinical and experimental thyroidology. 2011;7(1): 41-44. (In Russ).] doi: 10.14341/ket20117141-44.
9. Mancia G, Fagard R, Narkiewicz K, et al. 2013 ESH/ESC guidelines for the management of arterial hypertension: The task force for The management of arterial hypertension of the European society of hypertension (ESH) and of the European society of cardiology (ESC). J Hypertens. 2013;31(7):1281-1357. doi: 10.1097/01.hjh.0000431740.32696.cc.
10. Кобалава Ж.Д., Котовская Ю.В. Артериальная гипертония в XXI веке: достижения, проблемы, перспективы. - М.: “Бионика Медиа”; 2013. [Kobalava ZD, Kotovskaya YV. Arterial’naya gipertoniya v XXI veke: dostizheniya, problemy, perspektivy. Moscow: “Bionika Media”; 2013. (In Russ).]
11. Горбунов В.М. Суточное мониторирование артериального давления: современные аспекты. - М.: “Логосфера”; 2015. [Gorbunov VM. Sutochnoe monitorirovanie arterial’nogo davleniya: sovremennye aspekty. Moscow: “Logosfera”; 2015. (In Russ).]
12. Pickering TG, Davidson K, Gerin W, et al. Masked hypertension. Hypertension. 2002;40(6):795-796. doi: 10.1161/01.hyp.0000038733.08436.98.
13. Bobrie G, Clerson P, Cuchet A, et al. Prevalence and mechanism of masked hypertension: The ol’mesures survey. Arch Mal Coeur Vaiss. 2006;99(7-8):760-763.
14. Bombelli M, Sega R, Facchetti R, et al. Prevalence and clinical significance of a greater ambulatory versus office blood pressure (’reversed white coat’ condition) in a general population. J Hypertens. 2005;23(3):513-520.
15. Mancia G, Facchetti R, Bombelli M, et al. Long-term risk of mortality associated with selective and combined elevation in office, home, and ambulatory blood pressure. Hypertension. 2006;47(5):846-853. doi: 10.1161/01.HYP.0000215363.69793.bb.
16. Hansen TW, Jeppesen J, Rasmussen S, et al. Ambulatory blood pressure and mortality: A population-based study. Hypertension. 2005;45(4):499-504. doi: 10.1161/01.HYP.0000160402.39597.3b.
17. Pierdomenico SD, Cuccurullo F. Prognostic value of white-coat and masked hypertension diagnosed by ambulatory monitoring in initially untreated subjects: An updated meta analysis. Am J Hypertens. 2011;24(1):52-58. doi: 10.1038/ajh.2010.203.
18. Fagard RH, Cornelissen VA. Incidence of cardiovascular events in white-coat, masked and sustained hypertension versus true normotension: A meta-analysis. J Hypertens. 2007;25(11):2193-2198. doi: 10.1097/HJH.0b013e3282ef6185.
19. Фадеев В.В. Заболевания щитовидной железы в регионе легкого йодного дефицита: эпидемиология, диагностика, лечение. - М.: “Видар”; 2005. [Fadeyev VV. Zabolevaniya shchitovidnoi zhelezy v regione legkogo iodnogo defitsita: epidemiologiya, diagnostika, lechenie. Moscow: “Vidar”; 2005. (In Russ).]
20. Parati G, Faini A, Valentini M. Blood pressure variability: Its measurement and significance in hypertension. Curr Hypertens Rep. 2006;8(3):199-204. doi: 10.1007/s11906-006-0051-6.
21. Sachdeva A, Weder AB. Nocturnal sodium excretion, blood pressure dipping, and sodium sensitivity. Hypertension. 2006;48(4): 527-533. doi: 10.1161/01.HYP.0000240268.37379.7c.
22. Stergiou GS, Parati G. How to best assess blood pressure?: The ongoing debate on the clinical value of blood pressure average and variability. Hypertension. 2011;57(6):1041-1042. doi: 10.1161/hypertensionaha.111.172924.
23. Rothwell PM. Limitations of the usual blood-pressure hypothesis and importance of variability, instability, and episodic hypertension. The Lancet. 2010;375(9718):938-948. doi: 10.1016/s0140-6736(10)60309-1.
24. Pearce SHS, Brabant G, Duntas LH, et al. 2013 eta guideline: Management of subclinical hypothyroidism. Eur Thyroid J. 2013;2(4):215-228. doi: 10.1159/000356507.
25. Cooper DS, Biondi B. Subclinical thyroid disease. The Lancet. 2012;379(9821):1142-1154. doi: 10.1016/s0140-6736(11)60276-6.
26. Rodondi N, Den Elzen WPJ, Bauer DC, et al. Subclinical hypothyroidism and the risk of coronary heart disease and mortality. JAMA. 2010;304(12):1365. doi: 10.1001/jama.2010.1361.
27. Laurent S, Cockcroft J, Van Bortel L, et al. Expert consensus document on arterial stiffness: Methodological issues and clinical applications. Eur Heart J. 2006;27(21):2588-2605. doi: 10.1093/eurheartj/ehl254.
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For citations:
Nekrasova T.A., Strongin L.G., Morozova E.P., Durigina E.M., Kasakova L.V. Modifying influence of subclinical hypothyroidism on arterial hypertension: relationship to masked treatment failure, circadian blood pressure profile and target organs status. Clinical and experimental thyroidology. 2015;11(2):55-62. (In Russ.) https://doi.org/10.14341/ket2015255-62
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