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ARTERIAL HYPERTENSION: Hormone Treatments

ARTERIAL HYPERTENSION: Hormone Treatments. Thierry Hertoghe, MD. Aging =>  Systolic BP. Systolic BP (mmHg). Fig. : Effect of age on systolic blood-pressure. Clean group. The Ns for each decade from 30-80 were 82, 151, 184, 119, 103 and 35. Nondipping Hypertension.

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ARTERIAL HYPERTENSION: Hormone Treatments

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  1. ARTERIALHYPERTENSION: Hormone Treatments Thierry Hertoghe, MD

  2. Aging =>  Systolic BP Systolic BP (mmHg) Fig. : Effect of age on systolic blood-pressure. Clean group. The Ns for each decade from 30-80 were 82, 151, 184, 119, 103 and 35.

  3. Nondipping Hypertension = lack of nocturnal fall of the blood pressure (nondipping) • closely associated • target organ damage • worsened cardiovascular outcome than in patients with essential hypertension with dipping pattern Cumu-lativeSurvival Dippers 24-hour hypertensives Nondippers https://www.google.be/search?q=Nondipping+hypertension&source=lnms&tbm=isch&sa=X&ved=0ahUKEwjQ3pW27vDbAhUOyqQKHbXSDpkQ_AUICigB&biw=1050&bih=871#imgrc=Hmdshsr1ktMrxM:&spf=1530000074810

  4. Masked Hypertension = association of • normal office blood pressure (BP) • high ambulatory or home BP => associated •  target organ damage •  adverse cardiovascular events as in patients with true hypertension True hyper-tension Maskedhyper-tension Normal BP White coat hyper-tension Cardio-vascular events (Relative Risk) Piantanida E, Gallo D, Veronesi G, Pariani N, Masiello E, Premoli P, Sassi L, Lai A, Tanda ML, Ferrario M, Bartalena L. Masked hypertension in newly diagnosed hypothyroidism: a pilot study. J Endocrinol Invest. 2016 Oct;39(10):1131-8. https://www.quora.com/Is-it-possible-to-still-have-high-blood-pressure-and-be-at-high-risk-of-stroke-because-of-it-even-if-you-get-normal-readings-at-the-doctors-office-Could-your-BP-temporarily-spike-for-a-few-minutes-at-a-time

  5. Nr 1 Treatment for Arterial hypertension:Thyroid

  6. ARTERIAL HYPERTENSION: Mechanism in hypothyroidism Myxoedema Healthy artery • Accumulation of mucopolysacchardies • hardening of the arteries • pinched AT e.g. 15/10

  7. Overt & subclinicalhypothyroidism=> Stifferarteries Brachial-ankle pulse wave velocity 76 postmenopausal patients With arterial hypertension 40 + euthyroidism +12%: 14.35 m/sec 52 + subclinical hypothyroidism) +7%: 13.75 m/sec Elastic artery Stiff arteries 24 + clinical hypothyroidism 12.85 m/sec in the patients with SCHT (14.35 (12.5; 15.5) m/sec) and in those with CHT (13.75 (13.05; 15.25) m/sec) was also statistically significantly higher than in the control group (12.85 (12; 13.9) m/sec) (p < 0.05). Riabtseva OIu, Orlova IaA, Blankova ZN, Chazova TE, Ageev FT. The vascular wall in postmenopausal women with hypothyroidism and hypertension. Ter Arkh. 2013;85(10):64-9.

  8. Hypothyroidism =>  systolic & diastolic BP  Healthy euthyroid subjects 100 recently diagnosed hypothyroid patients • Sign.  systolic & diastolic BP • Sign.  mean 24-h systolic BP • Sign.  24-h pulse pressure Kotsis V, Alevizaki M, Stabouli S, Pitiriga V, Rizos Z, Sion M, Zakopoulos N. Hypertension and hypothyroidism: results from an ambulatory blood pressure monitoring study. J Hypertens. 2007 May;25(5):993-9.

  9. Hypothyroidism =>  Blood pressure ARTERIAL HYPERTENSION in thyroid deficiency : esp. DIASTOLIC (Tseng, 1989; Menof, 1950

  10. =33,3% highest TSH levels of the population • Atherosclero-sis (arterial stiffness) (Dagre 2005) • Hypertension(Gumeniak 2005) • cholesterol in auto-immun. thyr.(Michalo-poulou 1998) •  CRP, homocysteine (Gursoy2006) • Aggravation of coronary heart disease (Auer 2003)  Progressive  thyroid deficit & disease Subjects « above »   2.5% Serum TSH (miU/mL) Systolic/diastol. hyper-tension (Iqbal 2006), Glucose, TG (Waterhouse 2007)  Serum TSH levels within the ref. range =>  disease risk  coronary disease death in women (Asvold 2008) Highest quartile Narrowing of arteries (Yun 2007) Normal 95% TSH ref. range insulin sensitive T4 levels Subjects in« normal » range Middle high quartile Health levels TSH >2.1 Metabolic syndrome feature:  insulin resistance in euthyroid subjects with serum T4 within the lowest tertile (vs upper tertile) TSH >2 (Roos A, Bakker SJ, Links TP, Gans RO, Wolffenbuttel BH. Thyroid function is associated with components of the metabolic syndrome in euthyroid subjects. J Clin Endocrinol Metab. 2007 Feb;92(2):491-6. ) TSH >1.53 TSH >1.3. Average TSH of a population: 1.3-1.5 miU/mL Healthy thyroid? TSH > 0.4 Subjects « below »   Also: sign.  triglycerides, total & LDL cholesterol (inverse associations w/T4) Progressive  thyroid excess & disease 2.5% Lowest quartile = 25% highest TSH levels Aggravation of thyroid deficiency = 25% lowest TSH levels

  11. Subclinical hypothyroidism:diastolic BP &  diastolic non-dipping BP 49 patients with subclinical hypothyroidism & without hypertension  50 healthy controls Sign.  diastolic, daytime&nighttimediastolic BP’s (p = 0.001) Sign.  nighttime systolic blood pressure (p= 0.01) 49% of subclincally hypothyroid patients => diastolic non-dipping=> Sign.  frequency of diastolic non-dipping(24 of the 49 patients vsq 26% (13/50) of healthy controls, p = 0.01) => subclinical hypothyroidism => indep. assoc. w/ diastolic non-dipping (RR: 1.18 % CI 1.16-8.05, p = 0.024). . Polat Canbolat I, Belen E, Bayyigit A, Helvaci A, Kilickesmez K. Evaluation of Daily Blood Pressure Alteration in Subclinical Hypothyroidism. Acta Cardiol Sin. 2017 Sep;33(5):489-494.

  12. Clinical & SubclinicalHypothyroidism=> 3.3x  risk of Masked Hypertension • 64 hypothyroid patients • 38 subclinical • 26 overt  50 euthyroid subjects sign. 3.3x risk of masked hypertension in (overt & subclinical) hypothyroid patients Vs euthyroid subjects (3.29, 1.08-10.08; p = 0.02) Piantanida E, Gallo D, Veronesi G, Pariani N, Masiello E, Premoli P, Sassi L, Lai A, Tanda ML, Ferrario M, Bartalena L. Masked hypertension in newly diagnosed hypothyroidism: a pilot study. J Endocrinol Invest. 2016 Oct;39(10):1131-8.

  13. Piantanida E, Gallo D, Veronesi G, Pariani N, Masiello E, Premoli P, Sassi L, Lai A, Tanda ML, Ferrario M, Bartalena L. Masked hypertension in newly diagnosed hypothyroidism: a pilot study. J Endocrinol Invest. 2016 Oct;39(10):1131-8. • Inal S, Karakoç MA, Kan E, Ebinç FA, Törüner FB, Aslan M. The effect of overt and subclinical hypothyroidism on the development of non-dipper blood pressure. Endokrynol Pol. 2012;63(2):97-103 • Duan Y, Wang X, Peng W, Feng Y, Tang W, Wu X, Mao X, Bo R, Li W, Chen J, Qin Y, Liu C, Liu C. Gender-specific associations between subclinical hypothyroidism and blood pressure in Chinese adults. Endocrine. 2010 (2009 Oct 14: Epub ahead of print) • Kileĭnikov DV, Makusheva MV, Volkov VS. Pathogenesis of arterial hypertension in patients with primary hypothyroidism] Klin Med (Mosk). 2009;87(5):30-2 • Velkoska Nakova V, Krstevska B, Bosevski M, Dimitrovski Ch, Serafimoski V. Dyslipidaemia and hypertension in patients with subclinical hypothyroidism. Prilozi. 2009 Dec;30(2):93-102 • Guasti L, Marino F, Cosentino M, Cimpanelli M, Rasini E, Piantanida E, Vanoli P, De Palma D, Crespi C, Klersy C, Maroni L, Loraschi A, Colombo C, Simoni C, Bartalena L, Lecchini S, Grandi AM, Venco A. Pain perception, blood pressure levels, and peripheral benzodiazepine receptors in patients followed for differentiated thyroid carcinoma: a longitudinal study in hypothyroidism and during hormone treatment. Clin J Pain. 2007 Jul-Aug;23(6):518-23 • Kotsis V, Alevizaki M, Stabouli S, Pitiriga V, Rizos Z, Sion M, Zakopoulos N. Hypertension and hypothyroidism: results from an ambulatory blood pressure monitoring study. J Hypertens. 2007 May;25(5):993-9 • Biondi B, Klein I. Hypothyroidism as a risk factor for cardiovascular disease. Endocrine. 2004 Jun;24(1):1-13 • Streeten DH, Anderson GH Jr, Howland T, Chiang R, Smulyan H. Effects of thyroid function on blood pressure. Recognition of hypothyroid hypertension. Hypertension. 1988 Jan;11(1):78-83 • Fommei E, Iervasi G. The role of thyroid hormone in blood pressure homeostasis: evidence from short-term hypothyroidism in humans. J Clin Endocrinol Metab. 2002 May;87(5):1996-2000 • Saito I, Ito K, Saruta T. Hypothyroidism as a cause of hypertension. Hypertension. 1983 Jan-Feb;5(1):112-5 Arterial hypertension: the association with lower thyroid hormone levels

  14. Subjects « above »   2.5% 3.7 pg/mL= 5.7 pmol/L T3 UPPER LIMIT 5.7 pmol/L Blood Free T3 level (pg/mL)  serum Free T3 levelswith the reference range associatedwithcardiovasculardisease 3.1 95% 2.8 Subjects in« normal » free T3 range 2.4 2.3 •  Adverse cardiovascular events (Rays J 2003) •  Severity of coronary artery athero-sclerosis (Auer J 2003) 1.8 pg/mL = 2.8 pmol/L T3 LOWER LIMIT  left ventricular dysfunction & hyper-trophy (Zoccali C 2006) Slow coronary flow (Evrengul H 2006) Levels of progressive  in risk of disease Subjects « below »   2.5% 0.7 -1.8 ng/dL 9- 23 pmol/L

  15. Thyroidtreatmentmay High Blood Pressure

  16. Arterial hypertension Rheumatism : Hormone treatment The nr 1 hormone therapy is with thyroid, esp. desiccated thyroid (more prolonged action) Calcitonin + ? PTH + ? GH, IGF-1 ± The actual most reliable: dessiccated (Erfa, Armlour,..) Thyroid ++ E2 + P+T ++ T++ In case of hypothyroidism Compounded: Often -40% action

  17. Arterial hypertension Rheumatism : Hormone treatment For Thyroidtherapy: desiccatedthyroid Calcitonin + ? PTH + ? GH, IGF-1 ± Thyroid ++ E2 + P+T ++ T++ Tip 1: Privilegedesiccatedthyroidbecause of itssofter, more progressivev& more stable effects) • T3 alone (ups & downs of activity) or • Synhtetic T3-T4 combinations (peakactivity at the end of the morning), whereactivitypeakslevelscould =>  BP

  18. Euthyroid Hypothyroid Normalization of Diastolic HT Diastolic HT

  19. Hypothyroidism =>  Blood pressure ARTERIAL HYPERTENSION in thyroid deficiency : esp. DIASTOLIC (Tseng, 1989; Menof, 1950) => OFTEN NORMALIZED BY THYROID TREATMENT (Fuller, 1966) => PREVENTION : quite efficient !? (Barnes B, in hypothyroidism, 1976, Ed Harper & Row, p. 147-54)

  20. Thyroid therapy =>  Systolic Hypertension THYROID TREATMENT 15 hypothyroid patients with systolic hypertension 53 % (8) not improved PRIOR Thyroid THerapy PATIENTS w/ SYSTOLIC HYPER-TENSION (mm Hg) 15 NOT IMPROVED 8 47 % (7) improved Hyper-tensed hypo-thyroid patients 7 53 % hyper-tensed patients IMPROVED (1) 7 % 40 % (6) cured 7% (1) improved 40 % CURED (6) normotensed figure :Under thyroid treatment an improvement in systolic blood pressure was noticed in 7 on 15 hypothyroid patients w/ systolic arterial hypertension.6 of the 7 improved patients were considered as cured. (Fuller H et al, Postgrad Med, 1966, 40 : 425-8) Fuller H, Jr, Spittell JA, Jr, McConahey WM, Schirger A. Myxedema and hypertension. Postgrad Med. 1966;40:425–8.

  21. Thyroid therapy =>  Diastolic Hypertension DIASTOLIC HYPERTENSION & THYROID TREATMENT 88 hypothyroid patients with diastolic hypertension 12.5 % (11) not improved Thyroid THerapy THYROID TREATMENT PRIOR 87.5 % (77) improved 88 PATIENTS w/ DIASTOLIC HYPERTENSION (mm Hg) 77 = 87.5 % hypertensed hypothyroid patients NOT IMPROVED 11= 12.5 % 29 % (22) cured 71% (55) improved IMPROVED (55) 71 % hypertensed patients CURED (22)normotensed 29 % Figure: The younger the patient, the shorter the duration of hypertension, & the higher the blood cholesterol concentration, the more likely it is that the hypothyroid systolic & diastolic hypertensed patient will become normotensive figure : evolution under thyroid treatments of the diastolic blood pressure in 88 hypothyroid patients with diastolic arterial hypertension. 87.5 % (77) patients improved; amongst which 29 % (22) were considered as cured. (Fuller H et al, Postgrad Med, 1966, 40 : 425-8) Fuller H, Jr, Spittell JA, Jr, McConahey WM, Schirger A. Myxedema and hypertension. Postgrad Med. 1966;40:425–8.

  22. L-Thyroxine => cures nocturnal non-dipping BP in subclinical, not overt, hypothyroidism  9 healthy controls 80 patients with subclinical or clinical hypothyroidism Loss of nocturnal dipping BP THYROXINE TREATMENT 30 patients with clinical hypothyroidism 7 patients with subclinical hypothyroidism  Nighttime dipping BP (p= 0.003 to 0.007) No sign. effect on nocturnal dipping BP Nath M, Gupta B, Rai M, Singh SK. Reversal of nocturnal non-dipping of blood pressure after Levothyroxine therapy in patients with subclinical hypothyroidism. Diabetes MetabSyndr. 2017 Dec;11 Suppl 2:S997-S1000.

  23. Clinical & SubclinicalHypothyroidism=> 3.3x  risk of Masked Hypertension • 64 hypothyroid patients • 38 subclinical • 26 overt  50 euthyroid subjects sign. 3.3x risk of masked hypertension in (overt & subclinical) hypothyroid patients Vs euthyroid subjects (3.29, 1.08-10.08; p = 0.02) • Thyroid therapy => After restoration of euthyroidism: • => BP profile improvement, esp. in patients with subclinical hypothyroidism • 2.3x(-58%)  prevalence of masked hypertension (from 25 to 10.7 %) • 2.9x (-68%)  prevalence of true hypertension(from 10.7 to 3.4 %) Piantanida E, Gallo D, Veronesi G, Pariani N, Masiello E, Premoli P, Sassi L, Lai A, Tanda ML, Ferrario M, Bartalena L. Masked hypertension in newly diagnosed hypothyroidism: a pilot study. J Endocrinol Invest. 2016 Oct;39(10):1131-8.

  24. Arterial hypertension: the improvement with thyroid treatment • Nath M, Gupta B, Rai M, Singh SK. Reversal of nocturnal non-dipping of blood pressure after Levothyroxine therapy in patients with subclinical hypothyroidism. Diabetes Metab Syndr. 2017 Dec;11 Suppl 2:S997-S1000. • Piantanida E, Gallo D, Veronesi G, Pariani N, Masiello E, Premoli P, Sassi L, Lai A, Tanda ML, Ferrario M, Bartalena L. Masked hypertension in newly diagnosed hypothyroidism: a pilot study. J Endocrinol Invest. 2016 Oct;39(10):1131-8. • Fuller H Jr, Spittell JA Jr, McConahey WM, Schirger A. Myxedema and hypertension. Postgrad Med. 1966 Oct;40(4):425-8 • Gasiorowski W, Plazinska MT. Arterial hypertension associated with hyper and hypothyroidism. Pol Tyg Lek. 1992 Nov 2-9;47(44-45):1009-10

  25. Nr 2 Treatment for Arterial hypertension:Transdermal Estrogen + ProgesteroneTherapies

  26. Female hormone replacementmay High Blood Pressure

  27. ARTERIAL HYPERTENSION: Mechanism in Estrogen Deficiency  Estrogens =>  relaxation of arterial smooth muscle cells => lack of vasodilatation Estrogens = vasodilators e.g. Blood pressure of 160/80 mmHg

  28. Arterial hypertension: the association with lower estrogen levels Harrison-Bernard LM, Schulman IH, Raij L. Postovariectomy hypertension is linked to increased renal AT1 receptor and salt sensitivity. Hypertension. 2003 Dec;42(6):1157-63 Clark JT, Chakraborty-Chatterjee M, Hamblin M, Wyss JM, Fentie IH. Estrogen depletion differentially affects blood pressure depending on age in Long-Evans rats. Endocrine. 2004 Nov;25(2):173-86 Peng N, Clark JT, Wei CC, Wyss JM. Estrogen depletion increases blood pressure and hypothalamic norepinephrine in middle-aged spontaneously hypertensive rats. Hypertension. 2003 May;41(5):1164-7

  29. Arterial hypertension Rheumatism : Hormone treatment Estrogen => transdermal is the first choice (Bio-identical, prolonged action) The actualmost reliable: (O)Estrogel In case of ovarian deficiency Calcitonin + ? PTH + ? GH, IGF-1 ± Thyroid ++ E2 + P+T ++ T++ Compounded: Cheaper, but Oftenneed to 2x the dose for same action

  30. Arterial hypertension Rheumatism : Hormone treatment Estrogen therapy in women is should be assoc. w/ Progesterone=> oral, vaginal or transdermal (Bio-identical, prolonged action) Calcitonin + ? PTH + ? GH, IGF-1 ± Thyroid ++ E2 + P+T ++ T++ The actualmost reliable oral/vaginal Prometrium-Utrogestan Compounded: 10% liposomal cream In case of ovarian deficiency Progesterone liposomal gel

  31. Transdermal Estradiol therapy…=> Blood Pressure

  32. ARTERIAL HYPERTENSION transdermal E2 =>systolic & diastolic BP & cardiac rhythm (Del Rio, 1994) 100 µg transdermal E2 patches => sign. BP - diastolic - systolic (Pang SC et al, FertilSteril, 1993, 59: 76-82)

  33. Arterial hypertension: the improvement with estrogen treatment • Harrison-Bernard LM, Schulman IH, Raij L. Postovariectomy hypertension is linked to increased renal AT1 receptor and salt sensitivity. Hypertension. 2003 Dec;42(6):1157-63 • Clark JT, Chakraborty-Chatterjee M, Hamblin M, Wyss JM, Fentie IH. Estrogen depletion differentially affects blood pressure depending on age in Long-Evans rats. Endocrine. 2004 Nov;25(2):173-86 • Peng N, Clark JT, Wei CC, Wyss JM. Estrogen depletion increases blood pressure and hypothalamic norepinephrine in middle-aged spontaneously hypertensive rats. Hypertension. 2003 May;41(5):1164-7

  34. Arterial hypertension: the improvement with estrogen & progesterone treatment • Junge W, El-Samalouti V, Gerlinger C, Schaefers M. Effects of menopausal hormone therapy on hemostatic parameters, blood pressure, and body weight: open-label comparison of randomized treatment with estradiol plus drospirenone versus estradiol plus norethisterone acetate. Eur J Obstet Gynecol Reprod Biol. 2009 Dec;147(2):195-200 • Ichikawa A, Sumino H, Ogawa T, Ichikawa S, Nitta K. Effects of long-term transdermal hormone replacement therapy on the renin-angiotensin- aldosterone system, plasma bradykinin levels and blood pressure in normotensive postmenopausal women. Geriatr Gerontol Int. 2008 Dec;8(4):259-64 • Kaya C, Cengiz SD, Cengiz B, Akgun G. Long-term effects of low-dose 17beta-estradiol plus dydrogesterone on 24-h ambulatory blood pressure in healthy postmenopausal women: a 1-year, randomized, prospective study. Gynecol Endocrinol. 2007 Oct;23 Suppl 1:62-7 • Preston RA, Norris PM, Alonso AB, Ni P, Hanes V, Karara AH. Randomized, placebo-controlled trial of the effects of drospirenone-estradiol on blood pressure and potassium balance in hypertensive postmenopausal women receiving hydrochlorothiazide. Menopause. 2007 May-Jun;14(3 Pt 1):408-14 • Gerhard M, Walsh BW, Tawakol A, Haley EA, Creager SJ, Seely EW, Ganz P, Creager MA. Estradiol therapy combined with progesterone and endothelium-dependent vasodilation in postmenopausal women. Circulation. 1998 Sep 22;98(12):1158-63 • Kornhauser C, Malacara JM, Garay ME, Perez-Luque EL. The effect of hormone replacement therapy on blood pressure and cardiovascular risk factors in menopausal women with moderate hypertension. J Hum Hypertens. 1997 Jul;11(7):405-11

  35. Nr 3 Treatment for Arterial hypertension:Testosterone

  36. Arteries= Tubes of mainlysmooth muscle cells Testosterone = Hormone of muscle cells, includingsmooth muscle cells

  37.         Men with mild hypertension =>  serum total testosterone 49 men older than 40 years 24 hypertensive patientsBP> 140/90mmHg, criteria for mild hypertension 25 healthy subjects: normal systemic BP Signif. -33%  serum testosterone in the hypertensive men at first visit than those in the N group (230 vs.343 ng/dL, p<0.001). Ishikura F, Asanuma T, Beppu S. Low testosterone levels in patients with mild hypertension recovered after antidepressant therapy in a male climacterium clinic. Hypertens Res. 2008 Feb;31(2):243-8.

  38.         Low testosterone levels in men +mild hypertension partially recovered after antidepressant therapy SUBJECTS:49 males > 40 years The systemic blood pressure(sBP) • 24 hypertensive patientsBP> 140/90mmHg, criteria for mild hypertension: (HT group) at first visit. • the other 25 patients: normal systemic BP (N group). FINDINGS: • Signi. -33%  serum testosterone in the hypertensive men at first visit than those in the N group (230 vs.343 ng/dL, p<0.001). Afterantidepressant therapy • Unchanged IIEF5 scores, SDS scores = lower in both groups. • Sign. -16%  mean systemic blood pressure in the hypertensive (from 112 to 94 mmHg) • concomitant with the disappearance of nonspecific complaints & the increase of testosterone levels. • In the N group, neither mBP nor testosterone levels changed. => Psychotherapy can ameliorate mild systemichypertension in climacteric men with low testosterone levels. Mental stress might suppress the hypothalamic-pituitary-gonadal axis to decrease testosterone levels. Ishikura F, Asanuma T, Beppu S. Low testosterone levels in patients with mild hypertension recovered after antidepressant therapy in a male climacterium clinic. Hypertens Res. 2008 Feb;31(2):243-8.

  39. Hypertensive men:  serum LH, Testosterone Men + Arterial Hypertension : -  plasma testosterone (free & total) : - 30 % (13 patients w/AHT  w/controls) (Hughes GS et al, Atherosclerosis, 1990, 84 (2-3): 229 - 37) -  plasma LH & testosterone (Tuev AV et al, Res Med Zh, 1992, 3: 10-3) -  plasma testo (free & total) (Phillips GB et al, J Hypertens, 1993, 11(7): 699-702) !! Antihypertensive drugs (beta-blockers, reserpine, prazosine, …) •  plasma testosterone (Zanozdra NS et al, Klin Med Mosk, 1990, 68 (7): 89-92; Gumbatov, Kardiologiia, 1992, 32(3): 37-40) 

  40. Testosteronetreatmentmay High Blood Pressure

  41. Arterial hypertension Rheumatism : Hormone treatment • Testosteronetherapy • start preferablywithtransdermalliposomalcream of testosterone • Softer • more stable testosteronelevels Compounded testosterone liposomal gel 10 % (men) 0.5% (womern) Testosterone liposomal gel

  42. Testosterone’s =>arteries: Mechanism Testosterone = vasodilator

  43. ARTERIAL HYPERTENSION: Mechanism in Testosterone Deficiency  Testosterone =>  parasympathetic nervous activity =>  relaxation of arterial smooth muscle cells => lack of vasodilatation Testosterone = vasodilator e.g. Blood pressure of 160/80 mmHg

  44. Nr 4 Treatment for Arterial hypertension:Growth hormone (& IGF-1) Therapies

  45. GH deficiency => Arterial hypertension

  46. ARTERIAL HYPERTENSION: Mechanism in Growth Hormone Deficiency  Growth hormone =>  Distensibility of the arteries Growth hormone =>  Tissue elasticity e.g. blood pressure of 160/90 mmHg

  47.  serum IGF-1 => systolic &  diastolic AT (Landin-Wilhelmsen 1994) Note : GH-therapy in young adults => NO effect on blood pressure (Bengtssen BA et al, J Clin Endocrinol Metab, 1993, 76: 309-17; Beshyah SA et al, J Intern Med, 1995, 237 (1): 35-42)

  48. Pathologic alterations that maycontribute to orare associated w/ elevated BP in aging •  Arterial stiffness •  sympathetic nervous system activity •  Baroreceptor sensitivity •   &   adrenergic responsiveness •  Endothelial cell-derived relaxing factor fn •  Sodium sensitivity •  Plasma renin activity •  insulin resistance (Supiano MA, 1996, Hypertension in Geriatric Medicine, 3th edition, Eds Springer-Verlag, NY)

  49. GH & IGF-1treatmentsmay High Blood Pressure

  50. Arterial hypertension GH THERAPY ! Avoid inducing with GH =>vthyroid excess TIP 1: Start at lower dose then carefully increase to moderately high dose = > REMAIN slightly SUBOPTIMAL until the BP is normalized:l 0.1 – 0.25 mg/day of GH Emergency & severe heart weakness 0.3 mg/day GH daily permanently + 20-30 mg/day of hydrocortisone or + 4-5 mg/day of methylprednisolone TIP 2: GH works better than IGF-1 to reduce the blood pressure thanks to its • greater elasticity-enhancing effects • greater weight-reducing effects. 50

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