Abstract
Data on short-term blood pressure variability (BPV), which is a well-established cardiovascular prognostic tool, in pheochromocytoma and paraganglioma (PPGL) patients is still lack and conflicting. We retrospectively evaluated 23 PPGL patients referred to our unit from 2010 to 2019 to analyze 24 h ambulatory blood pressure monitoring (24-h ABPM)-derived markers of short-term BPV, before and after surgical treatment. PPGL diagnosis was assessed according to guidelines and confirmed by histologic examination. The 24-h ABPM-derived markers of short-term BPV included: circadian pressure rhythm; standard deviation (SD) and weighted SD (wSD) of 24-h, daytime, and night-time systolic and diastolic blood pressure (BP); average real variability (ARV) of 24-h, daytime, and night-time systolic and diastolic BP. 7 males and 16 females of 53 ± 18 years old were evaluated. After surgical resection of PPGL we found a significant decrease in 24-h systolic BP ARV (8.8 ± 1.6 vs. 7.6 ± 1.3 mmHg, p < 0.001), in 24-h diastolic BP ARV (7.5 ± 1.6 vs. 6.9 ± 1.4 mmHg, p = 0.031), and in wSD of 24-h diastolic BP (9.7 ± 2.0 vs 8.8 ± 2.1 mmHg, p = 0.050) comparing to baseline measurements. Moreover, baseline 24-h urinary metanephrines significantly correlated with wSD of both 24-h systolic and diastolic BP. Our study highlights as PPGL patients, after proper treatment, show a significant decrease in some short-term BPV markers, which might represent a further cardiovascular risk factor.
Highlights
Pheochromocytoma (PHEO) and paraganglioma (PGL), known together as pheochromocytoma and paraganglioma (PPGL), are rare and mostly benign neuroendocrine tumors, arising from chromaffin-cells of adrenal medulla and Cancers 2019, 11, 658; doi:10.3390/cancers11050658 www.mdpi.com/journal/cancersCancers 2019, 11, 658 paraganglia of the sympathetic and parasympathetic nervous system, respectively [1]
As higher cardiovascular mortality has been reported in PPGL subjects [19], increased blood pressure variability (BPV) might be a contributor for enhanced cardiovascular morbidity and mortality in this rare disease, besides the known risk factors, such as hypertension, arrhythmias, and altered glucose metabolism [20]
We showed significant changes in average real variability (ARV) of 24-h systolic and diastolic blood pressure (BP) and 24-h diastolic BP weighted SD (wSD) in patients affected by PPGL after successful surgical tumor excision
Summary
Pheochromocytoma (PHEO) and paraganglioma (PGL), known together as PPGL, are rare and mostly benign neuroendocrine tumors, arising from chromaffin-cells of adrenal medulla and Cancers 2019, 11, 658; doi:10.3390/cancers11050658 www.mdpi.com/journal/cancersCancers 2019, 11, 658 paraganglia of the sympathetic and parasympathetic nervous system, respectively [1]. Office blood pressure (BP) values remain the gold standard for the diagnosis of hypertension, the measurement of BP variability (BPV) in addition to office BP, has been demonstrated to have physiopathological and prognostic importance [7,8]. Several studies have shown that higher 24-h BPV, assessed by 24-h ambulatory blood pressure monitoring (24-h ABPM), independently of mean office BP values, is clinically important, as this might increase cardiovascular events, mortality, and hypertension-mediated organ damage [9,10,11,12,13,14]. As higher cardiovascular mortality has been reported in PPGL subjects [19], increased BPV might be a contributor for enhanced cardiovascular morbidity and mortality in this rare disease, besides the known risk factors, such as hypertension, arrhythmias, and altered glucose metabolism [20]
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