Arterial Hypertension and Thyroid Disorders: Unveiling the Silent Killers - Pathophysiological Links, Mechanisms, and Emerging Therapeutic Strategies

Tododrovska, Liljana and Avramovska, Maja and Nikleski, Zorica and Taleva, Biljana and Tuntevski, Nikola and Avramovski, Petar (2025) Arterial Hypertension and Thyroid Disorders: Unveiling the Silent Killers - Pathophysiological Links, Mechanisms, and Emerging Therapeutic Strategies. EC PULMONOLOGY AND RESPIRATORY MEDICINE Review Article. ISSN 14.7 (2025): 01-12.

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Abstract

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

Item Type:	Article
Subjects:	Scientific Fields (Frascati) > Medical and Health Sciences > Clinical medicine
Divisions:	Higher Medical School
Depositing User:	Prof. d-r. Nikola Tuntevski
Date Deposited:	16 Feb 2026 09:01
Last Modified:	16 Feb 2026 09:01
URI:	https://eprints.uklo.edu.mk/id/eprint/11318

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