title: Arterial hypertension and thyroid disorders: what is important to know in clinical practice?
abstract: This review describes the pathogenic mechanisms of blood pressure (BP) regulation and long-term control in thyroid disorders. Variations from the euthyroid status affect virtually all physiological systems but the effects on the cardiovascular system are particularly pronounced. Thyroid disorders induce several hemodynamic changes leading to elevated BP as a consequence of their interaction with endothelial function, vascular reactivity, renal hemodynamic and renin-angiotensin system. However, in thyroid disorders, the regulation of BP and the development and maintenance of variable forms of arterial hypertension (HT) are different. Hyperthyroidism results in an increased endothelium-dependent responsiveness secondary to the shear stress induced by the hyperdynamic circulation, and contributes to reduce vascular resistance. Conversely, hypothyroidism is accompanied by a marked decrease in sensitivity to sympathetic agonists with an increase of peripheral vascular resistance and arterial stiffness. Furthermore in animal models, hypothyroidism reduces the endothelium-dependent and nitric oxide-dependent vasodilatation. HT due to thyroid disorders is usually reversible with achievement of euthyroidism, but in some cases pharmacological treatment for BP control is required. In hyperthyroidism, β-blockers are the first-choice treatment to control BP but when they are contraindicated or not tolerated, ACE-inhibitors or calcium-channel blockers (CCB) are recommended. Hypothyroidism is a typical low rennin HT form showing a better antihypertensive response to CCB and diuretics; indeed in hypothyroidism a low-sodium diet seems further to improve BP control. Randomized clinical trials to compare the efficacy on BP control of the antihypertensive treatment in thyroid disorders are needed.
authors.affiliation: Department of Internal Medicine, Santa Maria della Misericordia Hospital, via Tre Martiri 140, 45100 Rovigo, Italy. Electronic address: mazza.alberto@azisanrovigo.it.
authors.forename: A
authors.initials: A
authors.lastname: Mazza
authors.affiliation: Unit of Internal Medicine, General Hospital of Bassano, Vicenza, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Beltramello
authors.affiliation: Department of Internal Medicine, Santa Maria della Misericordia Hospital, via Tre Martiri 140, 45100 Rovigo, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Armigliato
authors.affiliation: Unit of Internal Medicine, General Hospital of Adria, Rovigo, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Montemurro
authors.affiliation: Department of Internal Medicine, Santa Maria della Misericordia Hospital, via Tre Martiri 140, 45100 Rovigo, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Zorzan
authors.affiliation: Department of Internal Medicine, Santa Maria della Misericordia Hospital, via Tre Martiri 140, 45100 Rovigo, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Zuin
authors.affiliation: Department of Nuclear Medicine, Radiology, Medical Physics, Santa Maria della Misericordia Hospital, Rovigo, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Rampin
authors.affiliation: Department of Nuclear Medicine, Radiology, Medical Physics, Santa Maria della Misericordia Hospital, Rovigo, Italy.
authors.forename: M C
authors.initials: MC
authors.lastname: Marzola
authors.affiliation: Department of Nuclear Medicine, Radiology, Medical Physics, Santa Maria della Misericordia Hospital, Rovigo, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Grassetto
authors.affiliation: Department of Nuclear Medicine, Hammersmith Hospital, London, UK.
authors.forename: A
authors.initials: A
authors.lastname: Al-Nahhas
authors.affiliation: Department of Nuclear Medicine, Radiology, Medical Physics, Santa Maria della Misericordia Hospital, Rovigo, Italy. Electronic address: domenico.rubello@libero.it.
authors.forename: D
authors.initials: D
authors.lastname: Rubello
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000450:Aldosterone / Q000502:physiology; D000818:Animals; D000959:Antihypertensive Agents / Q000627:therapeutic use; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D004730:Endothelium, Vascular / Q000503:physiopathology; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology; D006980:Hyperthyroidism / Q000150:complications / Q000503:physiopathology; D007037:Hypothyroidism / Q000150:complications / Q000503:physiopathology; D007668:Kidney / Q000098:blood supply; D012084:Renin-Angiotensin System / Q000502:physiology; D013959:Thyroid Diseases / Q000150:complications* / Q000503:physiopathology
chemical_list: D000319:Adrenergic beta-Antagonists; D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers; D000450:Aldosterone