Hypertension in acromegaly and in the normal population: prevalence and determinants

BACKGROUND: The GH/IGF-I axis has a relevant role to play in the cardiovascular system but its implication in the pathogenesis of hypertension in the normal population and in acromegaly is not yet clear. PATIENTS AND MEASUREMENTS: The aim of this retrospective and controlled study was to evaluate the prevalence and determinants of hypertension in 200 patients with acromegaly and 200 nonacromegalic subjects, matched for sex, age, body mass index (BMI) and smoking habits. RESULTS: Hypertension was found in 46% of patients and in 25% of controls (P < 0.0001), without any difference between men and women. Family history of hypertension occurred in 30% of hypertensive acromegalic patients and in 62% of hypertensive controls (P < 0.0001). In both groups, hypertensive subjects were older than normotensive subjects. Systolic (SBP) and diastolic blood pressures (DBP) in hypertensive acromegalic patients were lower and higher, respectively, than in hypertensive controls. The risk of hypertension increased with age and was higher in the patients than in the controls [hazard ratio (HR) 1.9; P = 0.0002]. Independent predictors of SBP were age and glucose in the acromegalic population, and BMI, age and glucose levels in the controls. Independent predictors of DBP were age and glucose in the patients, and BMI, age and IGF-I in the controls. CONCLUSIONS: In acromegaly, hypertension is more frequent than in the general population, involves predominantly DBP, and occurs earlier, is not related to gender, and is less frequently related to family history of hypertension and IGF-I levels. IGF-I may have a protective role for DBP in the general population.