Hypertension is one of the most common comorbidities in acromegaly, affecting approximately 35% of patients. The pathogenesis of hypertension in this context is multifactorial, involving increased plasma volume (due to sodium retention) and altered vascular resistance. Unlike essential hypertension, "acromegalic hypertension" is directly linked to the duration of GH excess. Effective management requires not only standard antihypertensive therapy but also the strict biochemical control of the underlying pituitary adenoma.

The relationship between acromegaly and coronary artery disease remains a subject of clinical debate, as it is often confounded by traditional risk factors like diabetes and dyslipidemia. However, the direct effect of IGF-1 on the myocardium promotes structural remodeling that can lead to arrhythmias, particularly atrial fibrillation. Technical insights into the use of echocardiography and cardiac MRI for monitoring these patients are detailed in the Acromegaly Market clinical guidelines. Physicians are encouraged to perform baseline cardiac evaluations and provide ongoing monitoring to prevent irreversible cardiac remodeling.