Demirel Mutlu, Gürsoy Gül, Yıldız Mehmet
Department of Internal Medicine, Ministry of Health, Yıldırım Beyazıt Hospital, Ankara, Turkey.
Department of Internal Medicine, Kafkas University, Kars, Turkey.
Arch Iran Med. 2017 Sep;20(9):572-580.
Thyroid hormone has well recognized effects on the cardiovascular system. The purpose of this study was to define the influence of treatment of either hypothyroidism and hyperthyroidism on the values and circadial variations of arterial blood pressure measured by ambulatory blood pressure monitoring.
The study was carried out on 30 hypothyroidic and 30 hyperthyroidic patients without hypertension and 46 healthy participants. First, all the parameters of the groups, then blood pressure values obtained by ambulatory blood pressure monitoring before and after treatment (thyroid hormone replacement with levothyroxine and antithyroid treatment either with propylthyrouracil or metimazole) were compared. For statistical examinations, Shapiro-Wilk, one-way analysis of variance, Kruskal Wallis, post-hoc Tukey, and Wilcoxon Sign tests were used.
In the hypothyroid group, 24-hour mean and diastolic blood pressure, daytime diastolic blood pressure, nighttime mean, systolic and diastolic blood pressures were higher than the control group (P < 0.05). After treatment, 24-hour, daytime and nighttime systolic and diastolic blood pressures diminished. Mean blood pressures diminished only in daytime and nighttime. In the hyperthyroid group, 24-hour average and daytime systolic, mean blood pressures, and all nighttime blood pressure values were higher than the control group (P < 0.05). After treatment, 24-hour and daytime systolic, mean blood pressures, all nighttime pressures diminished (P < 0.05).
Throughout 24 hours, in hypothyroidic patients especially higher diastolic and in hyperthyroidics especially higher systolic blood pressures were exhibited than euthyroid subjects. After treatment of these diseases, ambulatory blood pressure values decreased. Early control of thyroid dysfunctions may help to protect cardiovascular system from hazardous effects of thyroid dysfunctions and lower mortality and morbidity in these patients.
甲状腺激素对心血管系统的影响已得到充分认识。本研究的目的是确定甲状腺功能减退和甲状腺功能亢进的治疗对通过动态血压监测测量的动脉血压值及昼夜变化的影响。
本研究对30例无高血压的甲状腺功能减退患者、30例甲状腺功能亢进患者及46名健康参与者进行。首先,比较各组的所有参数,然后比较治疗前后(用左甲状腺素替代甲状腺激素以及用丙硫氧嘧啶或甲巯咪唑进行抗甲状腺治疗)通过动态血压监测获得的血压值。统计检验采用夏皮罗-威尔克检验、单因素方差分析、克鲁斯卡尔-沃利斯检验、事后 Tukey 检验和威尔科克森符号检验。
甲状腺功能减退组的24小时平均血压和舒张压、日间舒张压、夜间平均血压、收缩压和舒张压均高于对照组(P<0.05)。治疗后,24小时、日间和夜间的收缩压和舒张压均降低。平均血压仅在日间和夜间降低。甲状腺功能亢进组的24小时平均血压、日间收缩压、平均血压以及所有夜间血压值均高于对照组(P<0.05)。治疗后,24小时和日间的收缩压、平均血压以及所有夜间血压均降低(P<0.05)。
在24小时内,甲状腺功能减退患者尤其是舒张压较高,而甲状腺功能亢进患者尤其是收缩压较高,均高于甲状腺功能正常的受试者。治疗这些疾病后,动态血压值降低。早期控制甲状腺功能障碍可能有助于保护心血管系统免受甲状腺功能障碍的有害影响,并降低这些患者的死亡率和发病率。