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Circadian blood pressure profile in patients with active Cushing's disease and after long-term cure
F Pecori Giraldi1, P M Toja, M De Martin
1Chair of Endocrinology, University of Milan, Ospedale San Luca, Instituto Auxologico Italiano IRCCS, Milan, Italy.
Insights
Patients with Cushing's disease often lack normal nocturnal blood pressure dipping, a cardiovascular risk factor that persists even after short-term remission. Long-term follow-up shows only partial improvement in blood pressure and heart rate abnormalities.
Area of Science:
- Endocrinology
- Cardiovascular Medicine
- Hypertension Research
Background:
- Cushing's disease frequently causes hypertension and increases cardiovascular event risk.
- Abnormal circadian blood pressure profiles, specifically absent nocturnal dipping, are observed in Cushing's syndrome and persist post-remission.
- Previous studies utilized conventional monitoring, limiting detailed analysis of blood pressure and heart rate dynamics.
Purpose of the Study:
- To assess blood pressure and heart rate profiles using beat-to-beat noninvasive monitoring in active Cushing's disease.
- To evaluate changes in these profiles at short-term (<1 year) and long-term (2-3 years) follow-up after curative surgery.
- To identify persistent cardiovascular risk factors in Cushing's disease patients.
Main Methods:
- Beat-to-beat noninvasive monitoring of blood pressure and heart rate.
- Study included twelve patients with active Cushing's disease (9 women, 3 men; age 33.3±2.36 years).
- Follow-up assessments were conducted at short-term (<1 year) and long-term (2-3 years) post-surgery.
Main Results:
- 50% of patients exhibited absent nocturnal blood pressure dipping during active hypercortisolism and within 1 year post-surgery.
- Recovery of blood pressure dipping was observed in a minority of patients at long-term follow-up.
- Daytime heart rate was elevated in active Cushing's disease, decreasing post-cure, with only partial long-term improvement.
Conclusions:
- Cushing's disease patients exhibit absent nocturnal blood pressure dipping and abnormal heart rate values.
- These cardiovascular abnormalities persist in short-term remission and show only partial improvement long-term.
- These findings highlight persistent cardiovascular risks in patients treated for Cushing's disease.
Abstract:
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.
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