Endocrinol Metab.  2021 Aug;36(4):778-789. 10.3803/EnM.2021.1101.

The Positive Association between Subclinical Hypothyroidism and Newly-Diagnosed Hypertension Is More Explicit in Female Individuals Younger than 65

• Wang X
• Wang H
• Yan L
• Yang L
• Xue Y
• Yang J
• Yao Y
• Tang X
• Tong N
• Wang G
• Zhang J
• Wang Y
• Ba J
• Chen B
• Du J
• He L
• Lai X
• Li Y
• Yan Z
• Liao E
• Liu C
• Liu L
• Qin G
• Qin Y
• Quan H
• Shi B
• Sun H
• Ye Z
• Zhang Q
• Zhang L
• Zhu J
• Zhu M
• Li Y
• Teng W
• Shan Z

• KMID: 2519666
• DOI: http://doi.org/10.3803/EnM.2021.1101

Abstract

Background
Subclinical hypothyroidism (SCH) is the most common thyroid dysfunction, and its relationship with blood pressure (BP) has been controversial. The aim of the study was to analyze the association between SCH and newly-diagnosed hypertension.
Methods
Based on data from the Thyroid disease, Iodine nutrition and Diabetes Epidemiology (TIDE) study, 49,433 euthyroid individuals and 7,719 SCH patients aged ≥18 years were enrolled. Patients with a history of hypertension or thyroid disease were excluded. SCH was determined by manufacturer reference range. Overall hypertension and stage 1 and 2 hypertension were diagnosed according to the guidelines issued by the American College of Cardiology/American Heart Association in 2017.
Results
The prevalence of overall hypertension (48.7%), including stage 1 (28.9%) and 2 (19.8%) hypertension, increased significantly in SCH patients compared with euthyroid subjects. With elevated serum thyroid stimulating hormone (TSH) level, the hypertension prevalence also increased significantly from the euthyroid to different SCH subgroups, which was more profound in females or subjects aged <65 years. The age- and sex-specific regression analysis further demonstrated the same trends in the general population and in the 1:1 propensity matched population. Similarly, several BP components (i.e., systolic, diastolic, and mean arterial BP) were positively associated with TSH elevation, and regression analysis also confirmed that all BP components were closely related with SCH in female subjects aged <65 years.
Conclusion
The prevalence of hypertension increases for patients with SCH. SCH tends to be associated with hypertension and BP components in females younger than 65 years.

Keyword

Hypothyroidism; Blood pressure; Hypertension

Figure

• 

  Fig. 1 Screening process of the participants. BP, blood pressure; OHypo, overt hypothyroidism; TSH, thyroid stimulating hormone.

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  Fig. 2 Hypertension (HTN) prevalence in euthyroid subjects and patients with different grades of subclinical hypothyroidism (SCH). Percentages in the left and right columns represent the prevalence of stage 1 hypertension (S1-HTN) and stage 2 hypertension (S2-HTN), respectively, and the percentages at the right side of the bar graph represent the overall prevalence of HTN. TSH, thyroid stimulating hormone. aP<0.05 compared with the euthyroid group; bP<0.01 compared with the euthyroid group.

• 

  Fig. 3 Hypertension (HTN) prevalence stratified by age and sex in euthyroid subjects and patients with different grades of subclinical hypothyroidism (SCH). S1-HTN, stage 1 hypertension; S2-HTN, stage 2 hypertension; TSH, thyroid stimulating hormone. aP for trend <0.05; bP for trend <0.01.

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