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Ahmad AM, Hopkins MT, Weston PJ, Fraser WD, Vora JP
Clin
Endocrinol (Oxf). 2002 Apr; 56(4):431-7.
The purpose of this study was to
evaluate the effects of growth hormone replacement (GHR) on ambulatory blood
pressure (ABP) in patients with adult growth hormone deficiency (AGHD).
Increased prevalence of hypertension and cardiovascular mortality has been
reported in hypopituitary patients who had been treated with conventional
pituitary hormones. There is evidence that growth hormone plays a role in the
regulation of cardiovascular structure and function. The impact of GHR on blood
pressure is uncertain as reported data from other studies is contradictory.
Twenty two patients, who had undergone surgery for the removal of a
pituitary adenoma and had severe AGHD, were recruited for the study. The study
group was evenly split between male and female patients and the average age was
49 years. Twenty one of the patients required pituitary hormone replacement and
were receiving optimal doses at recruitment. That treatment was not altered
during the study. None of the patients had received GH therapy prior to
recruitment nor were they hypertensive.
This was a 12 month open
treatment design study. Patients were admitted to a clinical facility, prior to
commencement of GH replacement, to establish baseline measures, and again at the
end of the 12 month study period. A 24 hour APB profile was established for each
patient by recording BP and heart rate every 15 minutes during the day and every
30 minutes at night. Body composition was established by measuring body mass
index (BMI), waist-hip ratio (WHR) and total body water (TBW). Hormone assays
measured serum GH and IGF-1 levels. Patients were instructed on the
self-administration of GH by subcutaneous injection and commenced on a low-dose
regimen. The initial dose of GH was adjusted every 4 weeks as necessary to
achieve normalization of IGF-1 levels. During the study, patients kept a diary
of daily activities and sleep patterns.
At 3 months, normalization of
IGF-1 levels had been achieved in all patients. A significant increase was
observed in TBW after 12 months of GHR, with no significant change in BMI or
WHR. There were significant changes in the 24 hour mean ambulatory blood
pressure and heart rate prior to and after GHR. Both daytime and nighttime
systolic and diastolic blood pressure decreased significantly while heart rate
increased with GHR.
The researchers concluded the growth hormone
replacement results in decreased systolic and diastolic blood pressure with an
increase in heart rate. Potentially, this reduction in systolic and diastolic
blood pressure, if sustained, may have an impact in reducing cardiovascular risk
in treated AGHD patients.
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