RESUMEN
Hypertension is a major feature of Cushing's disease, with the attendant increase in the rate of cardiovascular events. The circadian blood pressure profile also impacts cardiovascular risk and a few studies have shown that patients with Cushing's syndrome do not present the expected nocturnal blood pressure decrease and, further, that this alteration persists in short-range disease remission. These studies were performed by conventional discontinuous ambulatory pressure monitoring, a technique not devoid of limitations. Aim of our study was the assessment of blood pressure and heart rate profile by beat-to-beat noninvasive monitoring in twelve patients with active Cushing's disease (9 women and 3 men, age 33.3+/-2.36 years) and the assessment of its possible changes at short- (<1 year) and long-term (2-3 years) follow-up after curative surgery. No nocturnal blood pressure dipping (i.e., decrease by 10% of daytime values) was observed in 50% of patients both during active hypercortisolism and within 1 year from surgery. Recovery of blood pressure dipping profile was detected at long-term follow-up in a minority of patients. Daytime heart rate was higher in patients with active Cushing's disease and decreased over time after cure. In conclusion, patients with Cushing's disease present absent nocturnal blood pressure dipping and abnormal heart rate values which do not resolve after short-term remission of hypercortisolism and show only partial improvement in the long run. These findings identify additional cardiovascular risk factors for patients cured of Cushing's disease.
Asunto(s)
Presión Sanguínea/fisiología , Ritmo Circadiano/fisiología , Hipersecreción de la Hormona Adrenocorticotrópica Pituitaria (HACT)/fisiopatología , Hipersecreción de la Hormona Adrenocorticotrópica Pituitaria (HACT)/cirugía , Adulto , Antihipertensivos/uso terapéutico , Monitoreo Ambulatorio de la Presión Arterial , Diástole , Femenino , Frecuencia Cardíaca , Humanos , Masculino , Persona de Mediana Edad , Hipersecreción de la Hormona Adrenocorticotrópica Pituitaria (HACT)/tratamiento farmacológico , Cuidados Posoperatorios , Sístole , Factores de TiempoRESUMEN
Today's approach to the treatment of patients with arterial hypertension is no longer based solely on reducing high pressure values but forms part of a broader context designed to reduce the overall cardiovascular risk. The very decision of whether to begin anti-hypertensive treatment or not depends both on the degree of hypertension and on the presence or otherwis of other risk factors, organ damage or associated pathological conditions. The present paper summarises recent indications provided by the guidelines issued in 2003 by the European Society of Hypertension and the European Society of Cardiology. The criteria for planning anti-hypertensive treatment in patients with a different level of cardiovascular risk are the subject of particularly concentrated discussion and the approach to the hypertens patient in special clinical conditions such as ageing, diabetes mellitus, the presence of renal, cerebrovascular or coronary pathology and pregnancy will be treated separately.