Blood pressure, left ventricular mass and intracellular calcium in primary hyperparathyroidism

Abstract

1. Blood pressure, left ventricular mass and platelet cytosolic free calcium concentrations were measured in 23 patients with untreated primary hyperparathyroidism, 30 normotensive control subjects and 23 control subjects matched for age, sex and blood pressure. In 12 patients measurements were repeated after parathyroidectomy. 2. Patients with primary hyperparathyroidism had significantly elevated blood pressures (139 +/- 6/86 +/- 3 mmHg, mean +/- SEM) compared with control subjects (125 +/- 2/78 +/- 1 mmHg), but high values persisted after hypercalcaemia was corrected. 3. Despite chronic extracellular hypercalcaemia, intracellular free calcium levels were lower in patients with hyperparathyroidism than in controls matched for age, sex and blood pressure (median concentrations 81.5 nmol/l vs 93 nmol/l, 95% confidence interval 0.1 to 20.1; P less than 0.05) and values tended to increase after parathyroidectomy. 4. Left ventricular mass index was increased in the primary hyperparathyroid group as compared with control subjects matched for age, sex and blood pressure (123 g/m2 vs 100 g/m2, 95% confidence interval -36.1 to -3.1; P = 0.03). Parathyroidectomy resulted in a small reduction of the left ventricular mass index (123.5 g/m2 vs 104 g/m2, 95% confidence interval 46.5 to 2.5; P = 0.1) but no change in blood pressure. 5. Hypertension and left ventricular hypertrophy in primary hyperparathyroidism are associated with relatively low levels of free calcium in platelets.

Ambulatory monitoring of blood pressure (AMBP) in patients with primary hyperparathyroidism

“…According to some authors, this prevalence may vary from 20 to 80%. [2][3][4][5] The results of our study confirm and extend these data reported in the 30,31 (c) renal function injury; 7,8 (d) activation of the renin-angiotension-aldosterone system; [32][33][34] (e) activation of the sympathetic nervous system; 26,29 (f) activation of the endothelin 35 and adrenomedullin 36 systems.…”

“…Further- Table 6 What is known on this topic K The prevalence of arterial hypertension has been shown to be higher in PHPT than in general population: the prevalence may vary from 20 to 80% [2][3][4][5] K Calcium was studied as a factor responsible for the pathogenesis of hypertension in PHPT 4 …”

“…An association between PHPT and hypertension has been accepted for 40 years, with a prevalence of the latter that varies between 20 and 80%. [3][4][5] In some studies, most patients with PHPT and hypertension have blood pressure (BP) values that significantly decrease after parathyroidectomy. 6 That allows these patients to reduce antihypertensive treatment or even to stop it definitively.…”

“…6 That allows these patients to reduce antihypertensive treatment or even to stop it definitively. 3,[7][8][9] Ambulatory monitoring of blood pressure (AMBP), using either invasive or noninvasive recorders, has shown that BP tends to be higher during the day and lower at night in normotensive subjects. [10][11][12][13][14] In particular, some hypertensive patients do not exhibit the normal nocturnal BP fall, and they have been called 'non-dippers', whereas those with normal circadian rhythm have been called 'dippers'.…”

Correlation between Left Ventricular Mass Index and Calcium Metabolism in Patients with Essential Hypertension

“…Parathormone (PTH) and vitamin D are the major calcitropic hormones, and the levels of these two hormones have been reported to vary in patients with essential hypertension (11). In several studies, a relationship between hyperparathyroidism with LVH and BP elevation has been demonstrated in hypertensive patients (1,(12)(13)(14). However, whether the increase in PTH level is the result of or the reason for the BP elevation has not been elucidated (15).…”