Blood Pressure Profile and N-Terminal-proBNP Dynamics in Response to Intravenous Methylprednisolone Pulse Therapy of Severe Graves' Orbitopathy.

Piotr Miskiewicz,Tomasz Bednarczuk,Renata Glowczynska,Justyna Milczarek-Banach,Grzegorz Opolski

doi:10.3390/ijms19102918

Abstract

Hypercortisolemia is associated with increased risk of hypertension. Natural and synthetic glucocorticoids (GCs) have different effects on blood pressure (BP). The effect of synthetic GCs on BP depends on the dose, treatment duration, type of GCs, and route of administration. Intravenous methylprednisolone (IVMP) pulse therapy is the first line of treatment for severe Graves’ orbitopathy (GO). The aim of this study was to evaluate influence of IVMP pulses on BP and N-terminal pro-brain natriuretic peptide (NT-proBNP) dynamics. A total of 32 patients with GO were treated with one IVMP pulse every week for 12 weeks. We performed 48-h BP monitoring (24-h before and 24-h after IVMP) and measured NT-proBNP before, 24 h, and 48 h after the 1st, 6th, and 12th IVMP pulse. Mean BP did not change after any of the pulses. We did not observe an increase in maximal systolic BP or mean nocturnal BP, except after the last pulse. Additionally, the dipping phenomenon was less frequent after the last pulse. We found a significant increase in median NT-proBNP levels after all analyzed pulses. Our study suggests that IVMP may have an unfavorable cumulative effect on BP. Variation in NT-proBNP concentration indicates a compensatory effect of brain natriuretic peptide secretion.

Highlights

High dose intravenous (i.v.) glucocorticoid (GC) pulse therapy is an effective immunosuppressive treatment used in various inflammatory and autoimmune diseases [1]
Dipping phenomenon during sleeping was defined as a reduction of nocturnal systolic blood pressure (BP) (SBP) more than 10% in relation to the SBP during awake period
This study was a prospective, open, non-randomized, clinical study involving consecutive patients with active, moderate-to-severe Graves’ orbitopathy (GO) treated with intravenous methylprednisolone (IVMP) pulse therapy according to European Group On Graves’ Orbitopathy (EUGOGO) recommendations [2]

Summary

Introduction

High dose intravenous (i.v.) glucocorticoid (GC) pulse therapy is an effective immunosuppressive treatment used in various inflammatory and autoimmune diseases [1]. One of the indications for this treatment is Graves’ orbitopathy (GO). High-dose GCs, preferably via the i.v. route, are the first line of treatment for active, moderate-to-severe GO. According to the European Group On Graves’ Orbitopathy (EUGOGO) recommendations, this therapy was proven to be more effective compared to high-dose oral GC therapy and is associated with a lower recurrence rate [2]. EUGOGO recommends treatment with IVMP for patients with moderate-to-severe and very severe GO (dysthyroid optic neuropathy−DON). Moderate-to-severe GO, EUGOGO advices 12 pulses of IVMP with a treatment duration of 12 weeks with single weekly i.v. pulses.

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