SUN-083 Hypertension and Hemodynamic Parameters in Men with Hypogonadism Improve Under Long-Term Treatment with Testosterone Undecanoate Injections (TU) Compared to Untreated Hypogonadal Control Patients

Abstract

Background: The prevalence of hypogonadism in men with hypertension is high and may be related to overweight and obesity. In an ongoing registry study in a single urology practice, we monitored blood pressure and hemodynamic parameters for up to 12 years. Material and Methods: In a registry study of men with hypogonadism in a urological office, 676 of 805 patients (84%) had hypertension defined as systolic blood pressure (SBP) ≥130 and/ or diastolic blood pressure (DBP) ≥85 mmHg according to the harmonized definition of the metabolic syndrome. 376 received testosterone therapy (TTh) with TU 1000 mg/12 weeks following an initial 6-week interval (T-group). 304 had opted against TTh and served as controls (CTRL). 10-year data are reported. Changes over time between groups were compared by mixed effects model for repeated measures with random effect for intercept and fixed effects for time, group and their interaction, and adjusted for age, weight, waist circumference, fasting glucose, blood pressure and lipids to account for baseline differences between groups. Results: Mean (median) follow-up: T-group 7.7±2.6 (9), CTRL 8.1±2.1 (9) years. Total observation time: T-group 2900, CTRL 2463 years. Baseline age was 58.5±6.8 (T-group) and 63.8±4.8 years (CTRL). In the T-group, 189 men were and 187 were not aware of their hypertension at their first visit to the urologist, in CTRL, 139 and 161, respectively. Antihypertensives were used by 52.7% in T-group and 46.7% in CTRL. All patients were encouraged to improve their lifestyle at baseline. SBP decreased in the T-group by 23.6±0.7mmHg [95% CI: -24.9;-22.3] (p<0.0001) and increased in CTRL by 7.7±0.8mmHg [95% CI: 6.0;9.3] (p<0.0001), estimated adjusted difference between groups: -31.3mmHg [95% CI: -33.7;-28.9] (p<0.0001). DBP decreased in the T-group by 12.8±0.7 mmHg [95% CI: -14.1;-11.4] (p<0.0001) and increased in CTRL by 4.4±0.9 mmHg [95% CI: 2.6;6.1] (p<0.0001), difference between groups: -17.1 mmHg [95% CI: -19.5;-14.7] (p<0.0001). Heart rate decreased in the T-group by 1.6±0.3 bpm [95% CI: -2.3;-1.0] (p<0.0001) and increased in CTRL by 1.2±0 bpm [95% CI: 0.4;2.1] (p<0.005), difference between groups: -2.9 mmHg [95% CI: -4.0;-1.7] (p<0.0001). (p<0.0001). Pulse pressure, a surrogate marker of arterial stiffness, decreased in the T-group by 10.3±0.7 mmHg [95% CI: -11.7;-9.0] (p<0.0001) and increased in CTRL by 2.4±0.9 mmHg [95% CI: 0.7;4.0] (p<0.01), difference between groups: -12.7 mmHg [95% CI: -15.0;-10.4] (p<0.0001). Adverse events: T-group: 15 deaths (4%), no myocardial infarctions (MIs) or strokes. CTRL: 65 deaths (21.7%), 59 MIs (19.7%), 52 strokes (17.3%). Conclusion: Long-term testosterone therapy in hypogonadal men improved blood pressure, heart rate and arterial stiffness. In the untreated control group, all these parameters increased. Considerably less major adverse cardiovascular events occurred in the T-group.