Blood Pressure Profile, Catecholamine Phenotype, and Target Organ Damage in Pheochromocytoma/Paraganglioma
Abstrakt
CONTEXT: Impaired diurnal blood pressure (BP) variability is related to higher cardiovascular risk. OBJECTIVE: To assess diurnal variability of BP and its relation to target organ damage (TOD) and catecholamine phenotype in a consecutive sample of pheochromocytoma/paraganglioma (PPGL).
DESIGN: We included 179 patients with PPGL (96 females). All patients underwent 24h ambulatory blood pressure monitoring (SpaceLabs 90207) to determine dipping status.
Differences in plasma metanephrine or urine adrenaline were used to distinguish catecholamine biochemical phenotype. To evaluate TOD, renal functions, presence of left ventricle hypertrophy (LVH) and, in the subgroup (N=111) carotid-femoral PWV, were assessed.
Structural equation modeling was used to find the relationship among nocturnal dipping, catecholamine phenotype and TOD parameters. RESULTS: According to the nocturnal dipping, patients were divided into the three groups -dippers (28 %), non-dippers (40 %) and reverse dippers (32 %).
Reverse dippers were older (P<0.05), with a higher proportion of noradrenergic phenotype (P<0.05), a higher prevalence of diabetes mellitus (P<0.05), sustained arterial hypertension (P<0.01) and its duration (P<0.05) as opposed to the other groups. All parameters of TOD were more pronounced only in reverse dippers, in comparison with non-dippers and dippers.
The presence of noradrenergic biochemical phenotype (=absence of adrenaline production) was associated with reverse dipping and TOD (LVH and PWV). CONCLUSIONS: Only patients with reverse dipping had more significant TOD compared to other groups.
The noradrenergic biochemical phenotype plays an important role not only in impaired diurnal BP variability, but also, independently from dipping status, in more pronounced TOD of heart and vessels.