EC Pulmonology and Respiratory Medicine

Hypertension is a chronic medical condition characterized by persistently elevated blood pressure levels, significantly contributing to cardiovascular morbidity and mortality. It is a multifactorial disease influenced by genetic predisposition, neurohumoral activation, obesity, dietary factors, and endocrine disorders such as thyroid dysfunction. Both hyperthyroidism and hypothyroidism have been implicated in the pathogenesis of hypertension. Hyperthyroidism typically leads to systolic hypertension through increased cardiac output, while hypothyroidism is associated with diastolic hypertension due to increased systemic vascular resistance and arterial stiffness.

Early diagnosis and treatment are essential to mitigate target organ damage, including cardiovascular, renal, and cerebrovascular complications. Emerging evidence suggests a strong interplay between hypertension and pulmonary diseases, particularly pulmonary hypertension (PH) and chronic obstructive pulmonary disease (COPD), where systemic hypertension may exacerbate pulmonary vascular remodeling and contribute to right ventricular dysfunction.

The pathophysiological mechanisms of hypertension involve increased cardiac output, vascular resistance, and endothelial dysfunction, which collectively lead to arterial stiffness and atherosclerosis. Additionally, patients with obstructive sleep apnea (OSA), a condition frequently associated with pulmonary disease, exhibit a high prevalence of hypertension due to intermittent hypoxia and sympathetic overactivity, further highlighting the cardiopulmonary-endocrine interdependence. Thyroid dysfunction can aggravate these mechanisms by altering metabolic rate, cardiac contractility, and vascular reactivity.

Hypertension progresses through various stages, from early asymptomatic elevation of blood pressure to advanced end-organ damage, including left ventricular hypertrophy and heart failure. Pharmacological management includes thiazide diuretics, calcium channel blockers, ACE inhibitors, angiotensin receptor blockers, and beta-blockers, often in combination to achieve optimal blood pressure control. Notably, certain antihypertensive agents, such as calcium channel blockers, play a dual role in managing both systemic hypertension and pulmonary arterial hypertension (PAH) by promoting vasodilation in the pulmonary circulation. Beyond pharmacotherapy, lifestyle modifications such as weight reduction, sodium restriction, and physical activity remain integral to hypertension management.

Given the increasing recognition of the bidirectional relationship between systemic and pulmonary hypertension, and the impact of endocrine disorders such as thyroid disease on cardiovascular regulation, screening for both pulmonary and thyroid-related complications in hypertensive patients-especially those with respiratory symptoms or unexplained blood pressure fluctuations-should be emphasized. Understanding the overlap between these conditions can improve diagnostic accuracy and optimize therapeutic strategies, ultimately reducing the burden of cardiovascular, pulmonary, and endocrine-related diseases.

 Keywords: Arterial Hypertension; Thyroid Disorders; Pulmonary Hypertension (PH); Chronic Obstructive Pulmonary Disease (COPD); Obstructive Sleep Apnea (OSA); Pulmonary Arterial Hypertension (PAH)

1. Kociancic M. “Treatment of essential hypertension” (1981): 3-27.
2. Zafirovska K. “Handbook of arterial hypertension” (1987): 3-12.
3. Whelton PK., et al. “Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines”. Hypertension 71 (2018): 13-15.
4. Pinto E. “Blood pressure and ageing”. Postgraduate Medical Journal 976 (2007): 109-114.
5. Hall JE., et al. “Hypertension: physiology and pathophysiology”. Comprehensive Physiology 4 (2012): 2393-2442.
6. Klein I and Danzi S. “Thyroid disease and the heart”. Circulation 15 (2007): 1725-1735.
7. Biondi B., et al. “Effects of subclinical thyroid dysfunction on the heart”. Annals of Internal Medicine 11 (2002): 904-914.
8. Stabouli S., et al. “Hypothyroidism and hypertension”. Expert Review of Cardiovascular Therapy 11 (2010): 1559-1565.
9. Lee MM. “Reproductive hormones in infant girls--a harbinger of adult reproductive function?” Journal of Clinical Endocrinology and Metabolism 8 (2003): 3513-3514.
10. Biondi B and Cooper DS. “The clinical significance of subclinical thyroid dysfunction”. Endocrine Reviews 1 (2008): 76-131.
11. Pokharel Y., et al. “Hypertension-A silent killer without global bounds: what next?” Journal of the American College of Cardiology 8 (2022): 818-820.
12. Mancia G., et al. “Reappraisal of European guidelines on hypertension management: a European Society of Hypertension Task Force document”. Journal of Hypertension 11 (2009): 2121-2158.
13. McNiece KL., et al. “Prevalence of hypertension and pre-hypertension among adolescents”. Journal of Pediatrics 6 (2007): 640-644.
14. Kit J., et al. “New approaches in hypertension management: a review of current and developing technologies and their potential impact on hypertension care”. Current Hypertension Reports 6 (2019): 44.
15. Avramovski P., et al. “Bone strength and arterial stiffness impact on cardiovascular mortality in a general population”. Journal of Osteoporosis (2016): 7030272.
16. “ESH-ESC Guidelines for the management of arterial hypertension 2007”. European Heart Journal 28 (2007): 1462-1536.
17. Kanugula AK., et al. “Renin-angiotensin system: updated understanding and role in physiological and pathophysiological states”. Cureus6 (2023): e40725.
18. Whelton PK., et al. “Primary prevention of hypertension. Clinical and public health advisory from the National High Blood Pressure Education Program”. Journal of the American Medical Association 15 (2000): 1882-1888.
19. Casto C., et al. “Hashimoto's thyroiditis and graves' disease in genetic syndromes in pediatric age”. Genes (Basel)2 (2021): 222.
20. Shukla AN., et al. “Prevalence and predictors of undiagnosed hypertension in an apparently healthy Western Indian population”. Advances in Epidemiology (2015): 649184.
21. Alexander LF., et al. “Thyroid ultrasound: diffuse and nodular disease”. Radiologic Clinics of North America 6 (2020): 1041-1057.
22. Siddiq A., et al. “Association of pro-inflammatory cytokines with vitamin D in Hashimoto's thyroid autoimmune disease”. Medicina (Kaunas)5 (2023): 853.
23. Hashimoto T., et al. “Response by Hashimoto et al to letter regarding article "potential influences of gut microbiota on the formation of intracranial aneurysm". Hypertension1 (2019): e2-e3.
24. Wu G., et al. “Ultrasonography in the diagnosis of Hashimoto's thyroiditis”. Frontiers in Bioscience (Landmark Edition)5 (2016): 1006-1012.
25. Zhang Q., et al. “Deep learning to diagnose Hashimoto's thyroiditis from sonographic images”. Nature Communications 1 (2022): 3759.
26. Mounier-Vehier C and Madika AL. “Hypertension artérielle de la ménopause: dépister, traiter, accompagner, prévenir [Post-menopausal hypertension: Detecting, treating, accompany, prevent]”. La Presse Médicale 11.1 (2019): 1288-1294.
27. Dhir G., et al. “Thyroid disorders”. Primary Care3 (2024): 405-415.
28. Jonklaas J., et al. “Guidelines for the treatment of hypothyroidism: prepared by the American thyroid association task force on thyroid hormone replacement”. Thyroid12 (2014): 1670-1751.
29. Cappola AR., et al. “Thyroid and cardiovascular disease: research agenda for enhancing knowledge, prevention, and treatment”. Circulation25 (2019): 2892-2909.
30. Jonklaas J., et al. “Guidelines for the treatment of hypothyroidism: prepared by the American thyroid association task force on thyroid hormone replacement”. Thyroid12 (2014): 1670-1751.
31. Jabbar A., et al. “Thyroid and cardiovascular disease: a research agenda for improving understanding of risks and outcomes”. Thyroid 4 (2017): 507-516.
32. Gumz ML., et al. “Toward precision medicine: circadian rhythm of blood pressure and chronotherapy for hypertension - 2021 NHLBI workshop report”. Hypertension3 (2023): 503-522.
33. Whelton P., et al. “ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American college of cardiology/American heart association task force on clinical practice guidelines”. Journal of the American College of Cardiology 19 (2018): e127-e248.
34. Cavero-Redondo I., et al. “Antihypertensive drug recommendations for reducing arterial stiffness in patients with hypertension: machine learning-based multicohort (RIGIPREV) study”. Journal of Medical Internet Research 2526 (2024): e54357.
35. Carey RM., et al. “Resistant hypertension: detection, evaluation, and management: a scientific statement from the American heart association”. Hypertension5 (2018): e53-e90.