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. 2020 Nov 30:11:577173.
doi: 10.3389/fendo.2020.577173. eCollection 2020.

Hypertension in Acromegaly in Relationship to Biochemical Control and Mortality: Global ACROSTUDY Outcomes

Greisa Vila  1 , Anton Luger  1 , Aart Jan van der Lely  2 , Sebastian J C M M Neggers  2 , Susan M Webb  3 , Beverly M K Biller  4 , Srinivas Valluri  5 , Judith Hey-Hadavi  6
Affiliations

Hypertension in Acromegaly in Relationship to Biochemical Control and Mortality: Global ACROSTUDY Outcomes

Greisa Vila et al. Front Endocrinol (Lausanne). .

Abstract

Context: Hypertension is a major cardiovascular risk factor related to increased mortality in acromegaly. Surgical cure of acromegaly is associated with improvement in blood pressure levels, however little is known about the effect of pegvisomant (PEGV) treatment in patients with hypertension. This analysis evaluates outcomes in patients with hypertension and acromegaly included in ACROSTUDY.

Methods: ACROSTUDY is a global non-interventional surveillance study of long-term treatment with PEGV, monitoring its safety and efficacy. The cohort was retrospectively divided in two subgroups: patients with and without hypertension. Stepwise logistic regression and Kaplan-Meyer analyses were performed for testing predictors of mortality.

Results: The total cohort included 2,090 patients with acromegaly treated with PEGV who were followed for a median of 6.8 years (range up to 12.1 years). In ACROSTUDY there were 1,344 patients with hypertension (52.3% males). This subgroup was older, had a higher BMI, and higher prevalence of diabetes, hyperlipidemia, and cardiovascular disease (CVD) when compared to patients without hypertension. During ACROSTUDY, 68 deaths were reported in the hypertension cohort, vs 10 in the cohort without hypertension. Both CVD (p<0.0001) and anterior pituitary deficiencies (p=0.0105) at study entry independently predicted mortality in patients with acromegaly and hypertension; Kaplan-Meier analysis confirmed that CVD significantly impairs survival.

Conclusions: Hypertension is common in patients with acromegaly and significantly increases mortality, especially when there is concomitant CVD. These data suggest that treatment goals should extend beyond IGF-I normalization, and include optimisation of substitution of pituitary deficiencies and scrutinous screening and treatment of CVD.

Keywords: acromegaly; cardiovascular disease; hypertension; hypopituitarism; mortality; pegvisomant; prognosis.

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Conflict of interest statement

GV has received research grants to her institution from Chiasma and Novartis, and consultancy- and/or speakers fees from Pfizer, Novartis and Ipsen. AL has received lecture and/or consulting honoraria from Ipsen, Novartis, and Pfizer; research grants to the Medical University of Vienna from Ipsen and Pfizer. AJL has received grants, consultancy- and speaker’s fees from Pfizer. SN has received research grants and speaker fees from Ipsen, Novartis, and Pfizer, and consulting fees from Ipsen. SW has received honoraria as a member of the Acrostudy Advisory Board, and lecture fees from Pfizer, Novartis and Ipsen. BB has served as PI of research grants from Novartis, Crinetics and Ionis to Massachusetts General Hospital and has received occasional consulting honoraria from Novartis, Crinetics and Pfizer. SV and JH-H are Pfizer employees.

Figures

Figure 1
Figure 1
ACROSTUDY flow chart.
Figure 2
Figure 2
Number and proportion of patients with normal IGF-I (bar charts) and respective PEGV (pegvisomant) dose (blue boxes) in the subcohorts of patients with (A) and without (B) hypertension.
Figure 3
Figure 3
Kaplan Meier plot survival curves in patients with acromegaly and hypertension in relation to the presence of (A) pituitary deficiencies and (B) cardiovascular disease at baseline visit (ACROSTUDY entry).
See this image and copyright information in PMC

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