Blood pressure and Turner syndrome.
BACKGROUND
Elevated blood pressure (BP) is an important predictor of morbidity and mortality from cardiovascular disease. Patients with Turner syndrome (TS) have a higher morbidity and mortality in middle age than the normal population. As BP in childhood or early adulthood is predictive of BP later in adult life, we assessed manual and 24 h ambulatory BP in patients with TS to determine whether the BP pattern is altered at an early stage in these patients who are known to be at risk of cardiovascular disease.


METHODS
We studied manual and 24 h ambulatory BP profiles in 75 girls with Turner syndrome, age range 5.4-22.4 years. A monitor with an oscillometric device (SpaceLabs model 90207) and an appropriate sized cuff was used. BP was measured during the day-time (0800-2000 h) and the night-time periods (2200-0800 h). The BP measured were compared with population standards. The effect of different growth promoting agents on BP was also evaluated.


RESULTS
Mean manual and 24 h ambulatory BP measurements were 118/77 mmHg (range 95/60-140/102) and 115/70 mmHg (range 93/57-154/99), respectively. There was minimal difference between the two methods with a positive bias of 2.4 mmHg for diastolic BP and a negative bias of 2.1 mmHg for systolic BP. The mean standard deviation scores (SDS) corresponding to the mean BP recordings were 24 h systolic + 0. 81 (range - 1.26 to + 4.45), 24 h diastolic + 0.43 (range - 0.85 to + 3.42), day-time systolic + 1.08 (range - 0.95 to + 4.72), day-time diastolic + 0.70 (range - 0.94 to + 3.71), night-time systolic + 0. 22 (range -2.2 to + 3.64) and night-time diastolic - 0.18 (range -2. 0 to + 2.43). The SDS for both the mean 24 h and day-time systolic and diastolic BP were shifted to the right of the normal distribution. 57% of the girls had less than the normal 10% reduction in nocturnal systolic blood pressure. 17% had diastolic and 21% had systolic blood pressure above the 95th percentile for age and sex. There was no significant difference in the BP SDS between girls on no treatment and those receiving treatment.


CONCLUSIONS
Over 50% of girls with Turner syndrome have an abnormal BP circadian rhythm, which is similar to adult patients with secondary hypertension. Patients with Turner syndrome have higher blood pressure measurements compared to published population standards, as evidenced by the shift to the right of both the systolic and diastolic BP SDS. These findings suggest that girls with Turner syndrome should be carefully monitored in childhood and adulthood for blood pressure and other cardiovascular risk factors.
Nathwani
N C
NC
The London Centre for Paediatric Endocrinology, University College London, London, UK. n.nathwani@ucl.ac.uk
Unwin
R
R
Brook
C G
CG
Hindmarsh
P C
PC
D000293:Adolescent; D000328:Adult; D045930:Anabolic Agents / Q000627:therapeutic use; D000704:Analysis of Variance; D018660:Blood Pressure Monitoring, Ambulatory; D002648:Child; D002675:Child, Preschool; D002940:Circadian Rhythm; D003430:Cross-Sectional Studies; D004359:Drug Therapy, Combination; D004967:Estrogens / Q000627:therapeutic use; D005260:Female; D013006:Growth Hormone / Q000627:therapeutic use; D006801:Humans; D006973:Hypertension / Q000175:diagnosis*; D010074:Oxandrolone / Q000627:therapeutic use; D011374:Progesterone / Q000627:therapeutic use; D014424:Turner Syndrome / Q000188:drug therapy / Q000503:physiopathology*
D045930:Anabolic Agents; D004967:Estrogens; D011374:Progesterone; D010074:Oxandrolone; D013006:Growth Hormone