CARDIOVASCULAR RESPONSES IN HYPERTHYROIDISM BEFORE AND DURING 0-ADRENOCEPTOR BLOCKADE: EVIDENCE AGAINST ADRENERGIC HYPERSENSITIVITY

Abstract

The relationship between the sympathetic nervous system and cardiovascular responses was studied indirectly in 10 hyperthyroid patients and age matched euthyroid controls. Nyctohemeral variations in heart rate, and heart rate and blood pressure responses to exercise were measured before and during .beta.-blockade with slow-release propranolol. Both groups showed a parallel variation in heart rate over 24 h, with an increase in heart rate in the hyperthyroid group that was the same during the day (27.9 .+-. 0.95 beats/min) and during the night (26.7 .+-. 0.75 beats/min). Similarly, the increase in resting heart rate (32.7 .+-. 4.4 beats/min) in the hyperthyroid group was close to the increase inpeak exercise-induced heart rate (25.0 .+-. 4.7 beats/min). Adequate .beta.-blockade was achieved in all subjects as evidenced by a percentage reduction in peak exercise heart rate of 25-45%. Propranolol caused a greater reduction in daytime than night-time heart rate in both groups and blunted the response to exercise. Following .beta.-blockade, the mean percentage reduction in heart rate and systolic blood pressure during exercise, and heart rate responses over 24 h were similar in hyperthyroid and euthyroid groups. The closest correlation between thyroid hormone levels and heart rate was that of serum total triiodothyronine and nocturnal heart rate during .beta.-blockade (r = 0.92; P < 0.001). Excess circulating thyroid hormones apparently exert a direct effect on the cardiovascular system additive to the sympathetic nervous system; there is no evidence of adrenergic hypersensitivity in hyperthyroidism.