Hypertension in Acromegaly in Relationship to Biochemical Control and Mortality: Global ACROSTUDY Outcomes
Por:
Vila, G, Luger, A, van der Lely, AJ, Neggers, SJCMM, Webb, SM, Biller, BMK, Valluri, S, Hey-Hadavi, J
Publicada:
30 nov 2020
Resumen:
Context
Hypertension is a major cardiovascular risk factor related to increased mortality in acromegaly. Surgical cure of acromegaly is associated with improvement in blood pressure levels, however little is known about the effect of pegvisomant (PEGV) treatment in patients with hypertension. This analysis evaluates outcomes in patients with hypertension and acromegaly included in ACROSTUDY.
Methods
ACROSTUDY is a global non-interventional surveillance study of long-term treatment with PEGV, monitoring its safety and efficacy. The cohort was retrospectively divided in two subgroups: patients with and without hypertension. Stepwise logistic regression and Kaplan-Meyer analyses were performed for testing predictors of mortality.
Results
The total cohort included 2,090 patients with acromegaly treated with PEGV who were followed for a median of 6.8 years (range up to 12.1 years). In ACROSTUDY there were 1,344 patients with hypertension (52.3% males). This subgroup was older, had a higher BMI, and higher prevalence of diabetes, hyperlipidemia, and cardiovascular disease (CVD) when compared to patients without hypertension. During ACROSTUDY, 68 deaths were reported in the hypertension cohort, vs 10 in the cohort without hypertension. Both CVD (p<0.0001) and anterior pituitary deficiencies (p=0.0105) at study entry independently predicted mortality in patients with acromegaly and hypertension; Kaplan-Meier analysis confirmed that CVD significantly impairs survival.
Conclusions
Hypertension is common in patients with acromegaly and significantly increases mortality, especially when there is concomitant CVD. These data suggest that treatment goals should extend beyond IGF-I normalization, and include optimisation of substitution of pituitary deficiencies and scrutinous screening and treatment of CVD.
Filiaciones:
Vila, G:
Med Univ Vienna, Dept Internal Med 3, Div Endocrinol & Metab, Vienna, Austria
Luger, A:
Med Univ Vienna, Dept Internal Med 3, Div Endocrinol & Metab, Vienna, Austria
van der Lely, AJ:
Erasmus MC, Pituitary Ctr Rotterdam, Dept Internal Med, Endocrinol Sect, Rotterdam, Netherlands
Neggers, SJCMM:
Erasmus MC, Pituitary Ctr Rotterdam, Dept Internal Med, Endocrinol Sect, Rotterdam, Netherlands
Webb, SM:
Univ Autonoma Barcelona, Ctr Invest Biomed Enfermedades Raras GIBER ER Uni, Hosp St Pau, IIB St Pau,Dept Med, Barcelona, Spain
Univ Autonoma Barcelona, Ctr Invest Biomed Enfermedades Raras GIBER ER Uni, Hosp St Pau, Serv Endocrinol,Dept Med, Barcelona, Spain
Biller, BMK:
Massachusetts Gen Hosp, Neuroendocrine Unit, Boston, MA 02114 USA
Valluri, S:
Pfizer Inc, Global Biometr & Data Management, New York, NY USA
Hey-Hadavi, J:
Pfizer Inc, Endocrine Care, New York, NY USA
Green Published, gold
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