Nocturnal hypertension and impaired sympathovagal tone in Turner syndrome
Abstract
OBJECTIVE: Increased blood pressure (BP), night: day BP ratio, and heart rate is seen in Turner syndrome (TS), and an increased risk of ischaemic heart disease and type 2 diabetes, as well as aortic dilatation and dissection. We hypothesized that altered heart rate variability is present in TS in comparison with controls, and can be influenced by hormonal replacement therapy (HRT). MATERIAL AND METHODS: We examined the impact of HRT on sympathovagal control of heart rate variability. Patients (n = 8, aged 29.5 +/- 5.3 years; no treatment or HRT) and controls (n = 8, aged 28.5 +/- 4.2 years; no treatment) were examined by short-term spectral analysis (supine-standing), bedside neuropathy tests, and 24-h ambulatory BP. N-terminal pro-brain natriuretic peptide (BNP), renin, aldosterone and urinary albumin excretion was determined. The interaction between position and status (TS or control) was examined for data from spectral analysis. RESULTS: Low-frequency (LF) power, coefficient of component variation of LF (both measures of sympathetic and vagal activity), and the LF: high-frequency (HF) power ratio (a measure of sympathovagal balance) were diminished in TS compared with controls, especially during standing. Systolic and diastolic night ambulatory BP (both P = 0.03), and systolic and diastolic night: day ratio (P = 0.01; P = 0.004) was increased in TS. During HRT diastolic day (P = 0.05) and 24-h diastolic ambulatory BP (P = 0.08) decreased. N-terminal pro-BNP was elevated in TS. CONCLUSION: Decreased sympathovagal balance or tone and nocturnal hypertension is present in TS, and N-terminal pro-BNP is elevated. HRT did not modulate the sympathovagal tone, but decreased BP. These changes may be linked to the increased cardiovascular risk and possibly the increased risk of aortic dilatation in TS.
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The prevalence of hypertension is as high as 20%-40% in children and up to 60% in adults with TS.
“The prevalence of hypertension is as high as 20%-40% in children441,453 and up to 60% in adults with TS.357,452,454-456”
From Clinical practice guidelines for the care of girls and women with Turner syndrome. (2024) · cites this paper as [454]
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- Authors
- Gravholt, C. H., Hansen, K. W., Erlandsen, M., Ebbehøj, E., & Christiansen, J. S.
- Affiliations
- Aarhus University Hospital (DK)
- Regionshospitalet Silkeborg (DK)
- Aarhus University (DK)
- Corresponding author
- Gravholt, Claus Højbjerg
- ORCID
- Venue
- Journal of Hypertension
- Published
- 2006-02
- Volume
- 24
- Issue
- 2
- Pages
- 353-360
- ISSN
- 0263-6352 (ISSN-L)
- OpenAlex
- W2048818063
- Cited by
- 90
- References
- 50
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 5 · 2022: 4 · 2021: 2 · 2020: 3 · 2019: 3 · 2018: 7 · 2017: 3 · 2016: 3 · 2015: 7 · 2014: 7 · 2013: 7 · 2012: 4
- FWCI
- 6.13
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Hypertension (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Genetic and Clinical Aspects of Sex Determination and Chromosomal Abnormalities
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Keywords
- Turner syndrome, nocturnal hypertension, sympathovagal balance, heart rate variability, hormone replacement therapy, natriuretic peptides, ambulatory blood pressure, autonomic nervous system, aortic dilatation, cardiovascular risk
- MeSH terms
- Adult, Circadian Rhythm, Female, Heart Rate, Humans, Hypertension, Peptide Fragments, Posture, Sympathetic Nervous System, Turner Syndrome, Vagus Nerve, Cross-Over Studies, Blood Pressure Monitoring, Ambulatory, Natriuretic Peptide, Brain, Hormone Replacement Therapy
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