Hypertension in Acromegaly in Relationship to Biochemical Control and Mortality: Global ACROSTUDY Outcomes
ContextHypertension 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 an...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2020-11-01
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| Series: | Frontiers in Endocrinology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fendo.2020.577173/full |
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| author | Greisa Vila Anton Luger Aart Jan van der Lely Sebastian J. C. M. M. Neggers Susan M. Webb Beverly M. K. Biller Srinivas Valluri Judith Hey-Hadavi |
| author_facet | Greisa Vila Anton Luger Aart Jan van der Lely Sebastian J. C. M. M. Neggers Susan M. Webb Beverly M. K. Biller Srinivas Valluri Judith Hey-Hadavi |
| author_sort | Greisa Vila |
| collection | DOAJ |
| description | ContextHypertension 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.MethodsACROSTUDY 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.ResultsThe 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.ConclusionsHypertension 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. |
| first_indexed | 2024-12-19T07:57:48Z |
| format | Article |
| id | doaj.art-67bdf8f844374ea1a8b1de1c2ec9e0d9 |
| institution | Directory Open Access Journal |
| issn | 1664-2392 |
| language | English |
| last_indexed | 2024-12-19T07:57:48Z |
| publishDate | 2020-11-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Endocrinology |
| spelling | doaj.art-67bdf8f844374ea1a8b1de1c2ec9e0d92022-12-21T20:29:57ZengFrontiers Media S.A.Frontiers in Endocrinology1664-23922020-11-011110.3389/fendo.2020.577173577173Hypertension in Acromegaly in Relationship to Biochemical Control and Mortality: Global ACROSTUDY OutcomesGreisa Vila0Anton Luger1Aart Jan van der Lely2Sebastian J. C. M. M. Neggers3Susan M. Webb4Beverly M. K. Biller5Srinivas Valluri6Judith Hey-Hadavi7Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Vienna, AustriaDivision of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Vienna, AustriaPituitary Center Rotterdam, Endocrinology Section, Department of Internal Medicine, Erasmus University Medical Centre, Rotterdam, NetherlandsPituitary Center Rotterdam, Endocrinology Section, Department of Internal Medicine, Erasmus University Medical Centre, Rotterdam, NetherlandsIIB-Sant Pau and Service of Endocrinology, Department of Medicine, Centro de Investigacion Biomedica en Enfermedades Raras (CIBER-ER Unidad 747), Hospital Sant Pau, Universitat Autonoma de Barcelona, Barcelona, SpainNeuroendocrine Unit, Massachusetts General Hospital, Boston, MA, United StatesGlobal Biometrics & Data Management, Pfizer Inc, New York, NY, United StatesEndocrine Care, Pfizer Inc, New York, NY, United StatesContextHypertension 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.MethodsACROSTUDY 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.ResultsThe 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.ConclusionsHypertension 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.https://www.frontiersin.org/articles/10.3389/fendo.2020.577173/fullhypertensionacromegalypegvisomantprognosismortalitycardiovascular disease |
| spellingShingle | Greisa Vila Anton Luger Aart Jan van der Lely Sebastian J. C. M. M. Neggers Susan M. Webb Beverly M. K. Biller Srinivas Valluri Judith Hey-Hadavi Hypertension in Acromegaly in Relationship to Biochemical Control and Mortality: Global ACROSTUDY Outcomes Frontiers in Endocrinology hypertension acromegaly pegvisomant prognosis mortality cardiovascular disease |
| title | Hypertension in Acromegaly in Relationship to Biochemical Control and Mortality: Global ACROSTUDY Outcomes |
| title_full | Hypertension in Acromegaly in Relationship to Biochemical Control and Mortality: Global ACROSTUDY Outcomes |
| title_fullStr | Hypertension in Acromegaly in Relationship to Biochemical Control and Mortality: Global ACROSTUDY Outcomes |
| title_full_unstemmed | Hypertension in Acromegaly in Relationship to Biochemical Control and Mortality: Global ACROSTUDY Outcomes |
| title_short | Hypertension in Acromegaly in Relationship to Biochemical Control and Mortality: Global ACROSTUDY Outcomes |
| title_sort | hypertension in acromegaly in relationship to biochemical control and mortality global acrostudy outcomes |
| topic | hypertension acromegaly pegvisomant prognosis mortality cardiovascular disease |
| url | https://www.frontiersin.org/articles/10.3389/fendo.2020.577173/full |
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