Beta-Blocker Therapy on Blood Pressure in Subclinical Hyperthyroidism: A Retrospective Observational Study

Year 2023, Volume: 12 Issue: 3, 895 - 901, 26.09.2023

Aşkın Keskin Kaplan , Yılmaz Sezgin

https://doi.org/10.37989/gumussagbil.1324955

Abstract

This study aimed to investigate the effect of beta-blocker therapy on blood pressure in patients with subclinical hyperthyroidism and to elucidate the potential benefits of this treatment approach.
This retrospective observational cohort study included 56 hypertensive patients with subclinical hyperthyroidism who received beta-blocker therapy. Patient data, including demographic characteristics, thyroid function tests, and blood pressure measurements, were collected from medical records and evaluated using statistical analysis with SPSS Statistics software.
The cohort of hypertensive patients included 35 patients with uncontrolled blood pressure and 21 newly diagnosed patients, with a total average age of 55 and 73.2% of them being female. In newly diagnosed and uncontrolled hypertensive patients, TSH levels were below the average, and T3 levels were high (p<0.001). Significant reductions in systolic and diastolic blood pressure were observed in both groups after beta-blocker therapy (p<0.001). The most significant decrease in blood pressure in beta-blocker therapy occurred in newly diagnosed hypertensive patients, with an average decrease of 37.85 mmHg. Additionally, a significant reduction in the number of antihypertensive medications was observed in patients receiving beta-blocker therapy (p<0.001).
In conclusion, our study demonstrates the positive effects of beta-blocker therapy on blood pressure control in patients with subclinical hyperthyroidism. Particularly, the significant decrease in blood pressure in newly diagnosed hypertensive patients indicates the potential of beta-blockers as a preferred treatment option. This study highlights the necessity of a causal approach in treating hypertension with thyroid disorders. However, considering the limitations of the study design, further comprehensive research is needed to confirm these findings.

Keywords

Beta-blockers, Blood pressure, Hypertension, Subclinical hyperthyroidism, Thyroid function tests.

Supporting Institution

none

Subklinik Hipertiroidizmde Beta-Bloker Tedavisinin Kan Basıncına Etkisi: Retrospektif Bir Gözlemsel Çalışma

Abstract

Bu çalışma, subklinik hipertiroidizmi olan hastalarda beta-bloker tedavisinin kan basıncı üzerindeki etkisini araştırmayı ve bu tedavi yaklaşımının potansiyel faydalarını ortaya koymayı amaçlamıştır.
Bu retrospektif gözlemsel kohort çalışmaya subklinik hipertiroidizmi olan ve beta-bloker tedavisi alan 56 hipertansif hasta dahil edildi. Hastaların demografik özellikleri, tiroid fonksiyon testleri ve kan basıncı ölçümlerini içeren hasta verileri, tıbbi hasta kayıtlarından toplanarak SPSS Statistics yazılımı kullanılarak istatistiksel analizle değerlendirildi.
Çalışmaya dahil edilen kan basıncı kontrol altında olmayan 35 ve yeni teşhis konmuş 21, toplam 56 hipertansif hastanın kohortunda ortalama yaş 55 ve %73,2 si kadınlar hastalardan oluşmaktaydı. Yeni teşhis edilen ve kan basıncı kontrol altında olmayan hipertansif hastalarda, TSH düzeylerinin ortalamanın altında olduğu ve T3 düzeylerinin ise yüksek olduğu görüldü (p<0,001). Her iki grupta da beta-bloker tedavisi sonrasında sistolik ve diyastolik kan basıncında anlamlı düşüşler gözlenmiştir (p<0,001). Beta-bloker tedavisinde en büyük kan basıncı düşüşü, yeni teşhis edilen hipertansiyonlu hastalarda ortalama 37,85 mmHg azalma olarak ortaya çıkmıştır. Ek olarak, beta bloker tedavisi alan hastalarda antihipertansif ilaç kullanımı sayısında anlamlı azalma görülmüştür (p<0,001).
Sonuç olarak çalışmamızda, beta-bloker tedavisinin subklinik hipertiroidizmli hastalarda kan basıncı kontrolüne olumlu etkileri olduğunu gösterilmektedir. Özellikle yeni tanılı hipertansiyonlu hastalarda belirgin kan basıncı azalması, beta-blokerlerin tercih edilen bir tedavi seçeneği olarak potansiyelini göstermektedir. Bu çalışma, tiroid bozuklukları ile ilişkili hipertansiyon tedavisinde nedene yönelik bir yaklaşımın gerekliliğini vurgulamaktadır. Bununla birlikte, çalışmanın tasarım kısıtlamaları göz önüne alındığında, bu bulguların doğrulanması için daha kapsamlı araştırmalara ihtiyaç duyulmaktadır.

Keywords

Beta-bloker, Hipertansiyon, Kan basıncı, Subklinik hipertroidi, Tiroid fonksiyon testleri

References

• 1. World Health Organization, International Society of Hypertension Writing Group. (2003). “World Health Organization (WHO)/International Society of Hypertension (ISH) statement on management of hypertension”. Journal of Hypertension, 21 (11), 1983-1992. https://doi.org/10.1097/01.hjh.0000084751.37215.d2
• 2. Forouzanfar, M. H, Liu, P, Roth, G. A, Ng, M, Biryukov, S. and Marczak, L. (2017). “Global burden of hypertension and systolic blood pressure of at least 110 to 115 mm Hg, 1990-2015.” JAMA, 317 (2), 165-182. https://doi.org/10.1001/jama.2016.19043
• 3. Mills, K. T, Bundy, J. D, Kelly, T. N, Reed, J. E, Kearney, P. M. and Reynolds, K. (2016). “Global disparities of hypertension prevalence and control: a systematic analysis of population-based studies from 90 countries”. Circulation, 134 (6), 441-450. https://doi.org/10.1161/CIRCULATIONAHA.115.018912
• 4. Padwal, R, Straus, S. E. and McAlister, F. A. (2001). “Evidence based management of hypertension: cardiovascular risk factors and their effects on the decision to treat hypertension: evidence based review”. BMJ: British Medical Journal, 322 (7292), 977. https://doi.org/10.1136/bmj.322.7292.977
• 5. Berta, E, Lengyel, I, Halmi, S, Zrínyi, M, Erdei, A, Harangi, M, Páll, D, Nagy, E. V, and Bodor, M. (2019). "Hypertension in thyroid disorders". Frontiers in Endocrinology, 10, 482. https://doi.org/10.3389/fendo.2019.00482.
• 6. Prisant, L. M, Gujral, J. S, and Mulloy, A. L. (2006). “Hyperthyroidism: a secondary cause of isolated systolic hypertension”. The Journal of Clinical Hypertension, 8 (8), 596-599. https://doi.org/10.1111/j.1524-6175.2006.05180.x.
• 7. Rivas, A. M, Pena, C, Kopel, J, Dennis, J. A, and Nugent, K. (2021). “Hypertension and hyperthyroidism: association and pathogenesis”. The American Journal of the Medical Sciences, 361 (1), 3-7. https://doi.org/10.1016/j.amjms.2020.08.012.
• 8. Mazza, A, Beltramello, G, Armigliato, M, Montemurro, D, Zorzan, S, Zuin, M. and Rubello, D. (2011, September). “Arterial hypertension and thyroid disorders: what is important to know in clinical practice?” Annales d'endocrinologie, 72 (4), 296-303. https://doi.org/10.1016/j.ando.2011.05.004.
• 9. Sezgin, Y. and Akgun, A. E. (2018). “The evaluation of thyroid function tests in patients presenting to the family medicine clinics”. Journal of Clinical and Analytical Medicine, 9 (5), 439-441. https://doi.org/10.4328/JCAM.5812.
• 10. Cooper, D. S. (1987). “Subclinical hypothyroidism”. Jama, 258 (2), 246-247. https://doi.org/10.1001/jama.1987.03400020088037.
• 11. Bonow, R. O, Mann, D. L, Zipes, D. P. and Libby, P. (Eds.). (2011). Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. Elsevier Health Sciences.
• 12. Tsai, K. and Leung, A. M. (2021). “Subclinical hyperthyroidism: a review of the clinical literature”. Endocrine Practice, 27 (3), 254-260. https://doi.org/10.1016/j.eprac.2021.02.002.
• 13. Biondi, B. and Cooper, D. S. (2008). “The clinical significance of subclinical thyroid dysfunction”. Endocrine reviews, 29 (1), 76-131. doi:10.1210/er.2006-0043.
• 14. Bell, R. J, Rivera‐Woll, L, Davison, S. L, Topliss, D. J, Donath, S. and Davis, S. (2007). “Well‐being, health‐related quality of life and cardiovascular disease risk profile in women with subclinical thyroid disease–a community‐based study”. Clinical endocrinology, 66 (4), 548-556.https://doi.org/10.1111/j.1365-2265.2007.02771.x
• 15. Rodondi, N, Bauer, D. C, and Gussekloo, J. (2010). “Risk of coronary heart disease and mortality for adults with subclinical hypothyroidism”. Jama, 304 (22), 2481-2482. https://doi.org/10.1001/jama.2010.1361
• 16. Gencer, B, Collet, T. H, Virgini, V, Bauer, D. C, Gussekloo, J, Cappola, A. R. and Rodondi, N. (2012). “Subclinical thyroid dysfunction and the risk of heart failure events: an individual participant data analysis from 6 prospective cohorts”. Circulation, 126 (9), 1040-1049. https://doi.org/10.1161/CIRCULATIONAHA.112.096024
• 17. Schutte, A. E, Jafar, T. H, Poulter, N. R, Damasceno, A, Khan, N. A, Nilsson, P. M. and Tomaszewski, M. (2023). “Addressing global disparities in blood pressure control: perspectives of the International Society of Hypertension”. Cardiovascular research, 119 (2), 381-409. https://doi.org/10.1093/cvr/cvac130.
• 18. Ettehad, D, Emdin, C. A, Kiran, A, Anderson, S. G, Callender, T, Emberson, J. and Rahimi, K. (2016). “Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis”. The Lancet, 387 (10022), 957-967. https://doi.org/10.1016/S0140-6736(15)01225-8.
• 19. Walsh, J. P, Bremner, A. P, Bulsara, M. K, O’Leary, P, Leedman, P. J, Feddema, P. and Michelangeli, V. (2006). “Subclinical thyroid dysfunction and blood pressure: a community‐based study”. Clinical Endocrinology, 65 (4), 486-491. https://doi.org/10.1111/j.1365-2265.2006.02619.x.
• 20. Popławska-Kita, A, Siewko, K, Telejko, B, Modzelewska, A, Myśliwiec, J, Milewski, R. and Szelachowska, M. (2013). “The changes in the endothelial function and haemostatic and inflammatory parameters in subclinical and overt hyperthyroidism”. International journal of endocrinology, 2013, Article ID 981638. https://doi.org/10.1155/2013/981638.
• 21. Brandt, F, Green, A, Hegedüs, L. and Brix, T. H. (2011). “A critical review and meta-analysis of the association between overt hyperthyroidism and mortality”. European journal of endocrinology, 165 (4), 491-497. https://doi.org/10.1530/EJE-11-0299.
• 22. Kamiński, G. W, Makowski, K, Michalkiewicz, D, Kowal, J, Ruchala, M, Szczepanek, E. and Gielerak, G. (2012). “The influence of subclinical hyperthyroidism on blood pressure, heart rate variability and incidence of arrhythmia”. Thyroid, 22 (5), 454-60. https://doi.org/10.1089/thy.2010.0333.
• 23. Manolis, A. A, Manolis, T. A, Melita, H. and Manolis, A. S. (2020). “Subclinical thyroid dysfunction and cardiovascular consequences: An alarming wake-up call?”. Trends in cardiovascular medicine, 30 (2), 57-69. https://doi.org/10.1016/j.tcm.2019.02.011.
• 24. Cappola, A. R. and Ladenson, P. W. (2003). “Hypothyroidism and atherosclerosis”. The Journal of Clinical Endocrinology & Metabolism, 88 (6), 2438-2444. doi:10.1210/jc.2003-030398.
• 25. Purohit, P. and Mathur, R. (2013). “Hypertension Association with Serum Lipoproteins, Insulin, Insulin Resistance and C–Peptide: Unexplored Forte of Cardiovascular Risk in Hypothyroidism”. North American Journal of Medical Sciences, 5 (3), 195. https://doi.org/10.4103/1947-2714.109187.
• 26. Mayer Jr, O, Šimon, J, Filipovský, J, Plášková, M. and Pikner, R. (2006). Hypothyroidism in coronary heart disease and its relation to selected risk factors. Vascular health and risk management, 2(4), 499-506. https://doi.org/10.2147/vhrm.s24499.
• 27. Mancia, G, De Backer, G, Dominiczak, A, Cifkova, R, Fagard, R, Germano, G. and Zanchetti, A. (2007). “2007 ESH-ESC practice guidelines for the management of arterial hypertension: ESH-ESC task force on the management of arterial hypertension”. Journal of hypertension, 25 (9), 1751-1762. https://doi.org/10.1097/HJH.0b013e3282f0580f.
• 28. Imazio, M, Andreis, A, Agosti, A, Piroli, F, Avondo, S, Casula, M. and De Ferrari, G. M. (2021). “Usefulness of beta-blockers to control symptoms in patients with pericarditis”. The American Journal of Cardiology, 146, 115-119. https://doi.org/10.1016/j.amjcard.2021.01.032.
• 29. Mancia, G, Kjeldsen, S. E, Kreutz, R, Pathak, A, Grassi, G. and Esler, M. (2022). “Individualized beta-blocker treatment for high blood pressure dictated by medical comorbidities: indications beyond the 2018 European Society of Cardiology/European Society of Hypertension Guidelines”. Hypertension, 79 (6), 1153-1166. https://doi.org/10.1161/HYPERTENSIONAHA.122.19020.