From the Departments of Internal Medicine and Public Health, Texas Tech University Health Sciences Center, Lubbock.
South Med J. 2020 Dec;113(12):607-611. doi: 10.14423/SMJ.0000000000001186.
Hypertension can cause significant morbidity and reduced life expectancy. Most patients with hypertension have primary hypertension; however, 10% to 15% have secondary hypertension. Endocrine disorders as a secondary cause occur in approximately 10% of patients with secondary hypertension, and thyroid disorders account for approximately 1% of all patients with hypertension. The identification of patients with hyperthyroidism has important benefits for these particular patients. The objective of this study was to examine the occurrence of high blood pressure in patients with hyperthyroidism.
We reviewed the clinical information available from 414 new patients referred to an endocrinology clinic in west Texas for evaluation of hyperthyroidism. The final cohort included 96 patients who had both thyroid laboratory tests and blood pressure measurements at the time of their clinic visit. We also examined this relationship in a nationally representative sample of US adults (National Health and Nutrition Examination Survey 2007-2012), which included thyroid test results and at least one blood pressure measurement (N = 8837).
Sixty-five of these clinic patients had elevated blood pressure based on criteria suggested by the American College of Cardiology/American Heart Association. These patients had similar thyroid hormone levels as patients who did not have hypertension but tended to be older. Ordinary least squares regression analysis of the National Health and Nutrition Examination Survey 2007-2012 data demonstrated a significant positive association between free T3 levels and systolic blood pressure, adjusting for age, sex, and the use of levothyroxine.
These findings from a specialty clinic and a national sample suggest that clinicians should consider the possibility of hyperthyroidism in patients with hypertension, even in older patients.
高血压可导致严重的发病率和预期寿命缩短。大多数高血压患者为原发性高血压；然而，10%-15%的患者为继发性高血压。作为继发性病因的内分泌疾病约占继发性高血压患者的 10%，甲状腺疾病约占所有高血压患者的 1%。识别甲状腺功能亢进症患者对这些特定患者有重要意义。本研究旨在探讨甲状腺功能亢进症患者高血压的发生情况。
我们回顾了 414 例新患者的临床信息，这些患者因甲状腺功能亢进症在德克萨斯州西部的内分泌科就诊。最终队列包括 96 例在就诊时同时进行甲状腺实验室检查和血压测量的患者。我们还在美国成年人（国家健康和营养调查 2007-2012 年）的全国代表性样本中检查了这种关系，该样本包括甲状腺检测结果和至少一次血压测量（N=8837）。
根据美国心脏病学会/美国心脏协会提出的标准，这些门诊患者中有 65 例血压升高。这些患者的甲状腺激素水平与没有高血压的患者相似，但年龄较大。对 2007-2012 年国家健康和营养调查数据进行普通最小二乘法回归分析表明，在调整年龄、性别和左甲状腺素使用后，游离 T3 水平与收缩压之间存在显著正相关。
来自专科诊所和全国样本的这些发现表明，临床医生应考虑高血压患者存在甲状腺功能亢进症的可能性，即使是老年患者。
