High serum parathyroid hormone and calcium are risk factors for hypertension in Japanese patients

Yagi, Shusuke; Aihara, Ken‐ichi; Kondo, Takeshi; Endo, Itsuro; Hotchi, Junko; Ise, Takayuki; Igarashi, Takashi; Akiyama, Masashi; Matsumoto, Toshio; Sata, Masataka

doi:10.1507/endocrj.ej14-0004

Cited by 20 publications

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References 21 publications

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“…A PubMed search using the key words ‘normocalcaemic hyperparathyroidism’ returned 453 articles, of which 54 were original clinical NCHP studies. BP was reported in five studies including 553 individuals (70 patients with NCHP and 662 controls). Systolic BP was 3·6% (95% CI: −0·4 to 7·6%), and diastolic BP was 2·9% (95% CI: −1·7 to 9·3%) higher in patients with NCHP compared to controls (Fig.…”

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‘Hyperaldosteronaemic or normocalcaemic’ hyperparathyroidism?

Lee

Greenfield

2015

Clinical Endocrinology

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Normocalcaemic hyperparathyroidism (NCHP) is increasingly diagnosed among patients presenting with fractures. However, the aetiology of this condition and its optimal treatment remain unclear. 1 NCHP is characterized biochemically by normal calcium and elevated parathyroid hormone (PTH) levels in the absence of demonstrable secondary causes of hyperparathyroidism. 1 While some view NCHP as an early manifestation of primary hyperparathyroidism, parathyroid adenoma is present in some, but not all, cases, 1 and parathyroidectomy does not always normalize NCHP, 1 suggesting the presence of yet unidentified aetiological factors.Recent evidence has emerged suggesting primary aldosteronism (PA) could be a hyperparathyroid state, stemming from bidirectional interaction between calcium-PTH and the reninangiotensin-aldosterone system (RAAS). 2 Circulating PTH levels are elevated in PA, leading to suggestion of PTH measurement incorporation into the PA diagnostic workup. 3 An unexplored question is whether the high PTH levels observed in patients with NCHP heralds early PA.To date, no studies have examined the RAAS in patients with NCHP. Since the earliest manifestation of PA is hypertension, this question could be probed by examining blood pressure (BP) in patients with/without NCHP.A PubMed search using the key words 'normocalcaemic hyperparathyroidism' returned 453 articles, of which 54 were original clinical NCHP studies. BP was reported in five studies 1,4-8 including 553 individuals (70 patients with NCHP and 662 controls). Systolic BP was 3Á6% (95% CI: À0Á4 to 7Á6%), and diastolic BP was 2Á9% (95% CI: À1Á7 to 9Á3%) higher in patients with NCHP compared to controls (Fig. 1). Calculated mean arterial BP was higher among patients with NCHP (97 AE 4 vs 93 AE 1 mmHg, P = 0Á06).When studies reporting PTH levels in patients with PA were reviewed, the results were striking: all hyperparathyroid patients with PA were normocalcaemic. 3 Interestingly, PA also independently increases the risk of fractures, a consequence shared with NCHP. 9 In other words, high PTH eucalcaemic state in PA appears to be a 'yin and yang' reminiscence of NCHP. Finally, adenoma resection or aldosterone antagonist therapy normalizes hyperparathyroidism in patients 3 with PA, demonstrating reversibility of PA-induced high PTH state.While these interpretations should be viewed as hypothesis generating, their implications are clinically relevant. First, BP was reported in less than 10% of NCHP studies, highlighting the underappreciation of possible RAAS involvement in the pathogenesis of NCHP, despite clues from parallel PA literature. Second, parathyroid localization studies are costly, averaging between US$6000 and 8000, 10 and could lead to unnecessary surgery with no guarantee of cure. In contrast, pharmacological aldosterone antagonism may not only be a simple 'diagnostic test', but also an inexpensive therapeutic option. Finally, the proposed hypothesis may stimulate research into the relation between NCHP and RAAS, thereby shedding new insight on ...

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“…Comparison of systolic ( SBP ) and diastolic blood pressure ( DBP ) in published studies between patients with normocalcaemic hyperparathyroidism and age‐ and gender‐matched controls.…”

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‘Hyperaldosteronaemic or normocalcaemic’ hyperparathyroidism?

Lee

Greenfield

2015

Clinical Endocrinology

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“…PTH regulates calcium, phosphorus and magnesium levels in the bones and blood through the kidneys , bones and intestines. An increase in serum PTH levels leaves patients prone to develop incident HT [ 3 – 5 ]. The association between PTH and BP in HT patients has been studied by many researchers, nevertheless the results of their studies are conflicting [ 8 – 10 , 29 ].…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have stated that lower levels of vitamin D are associated with incident HT [ 1 , 2 ]. Moreover, other studies have shown that elevated serum PTH levels are related with an increased risk of HT development [ 3 , 4 ] even in patients with normal serum PTH levels [ 5 ]. It is well known that primary hyperparathyroidism is associated with established HT and that parathyroidectomy significantly reduces blood pressure (BP) [ 6 , 7 ].…”

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confidence: 99%

Association of parathyroid hormone and vitamin D with untreated hypertension: Is it different in white-coat or sustained hypertension?

et al. 2017

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BackgroundPrevious reports about the relationship between a high parathyroid hormone (PTH) and low vitamin D levels with blood pressure in different hypertension groups are conflicting.ObjectiveWe studied serum PTH and vitamin D levels in white-coat (WCHT) and sustained hypertension (SHT) patients who had not been on antihypertensive treatment. We also investigated the association between serum PTH and vitamin D levels with respect to blood pressure in SHT and WCHT patients.MethodsWe included 52 SHT patients (54.06 ± 9.2 years, 32 newly diagnosed and 20 previously diagnosed with SHT who had not been treated with antihypertensive medication for 3 months or more), 48 WCHT patients (53.64 ± 9.5 years), and 50 normotensive (NT) healthy controls (53.44 ± 8.4 years) in our study. In addition to routine tests, PTH and vitamin D levels were measured.ResultsSerum PTH levels were significantly higher in SHT patients not taking antihypertensive medications than in WCHT patients and NT controls (p = 0.004). Although PTH levels were higher in WCHT than in NT groups, the difference was not statistically significant. In SHT patients, PTH levels showed a positive correlation with office systolic (r = 0.363, p = 0.008), office diastolic (r = 0.282, p = 0.038), home systolic (r = 0.390, p = 0.004), and home diastolic blood pressures (r = 0.397, p = 0.003). Serum vitamin D levels were similar in SHT, WCHT and NT groups. Vitamin D levels were not associated with blood pressures in the entire study group. Furthermore, no significant relation was found between vitamin D and PTH levels in SHT and WCHT groups.ConclusionPTH levels are significantly higher in untreated SHT patients than WCHT patients and NT subjects. However, vitamin D levels are similar in SHT, WCHT and NT groups. There is a significant association between PTH levels and blood pressures suggesting PTH has a role in increase of blood pressure in SHT.

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“…In another study from the United States with 191 obese participants (BMI 43 -9.2 kg/m2), there was no correlation between 25(OH)D levels and TC, TG, HDL-C, or LDL-C. 37 Recent studies have shown that hyperparathyroidism is correlated with arteriosclerosis and hypertension. [38][39][40] It has been shown that PTH levels within the upper normal range were related to cardiovascular disease in the elderly. 8 There appeared to be an activation of the renin-angiotensinaldosterone system in hyperparathyroidism.…”

Section: Discussionmentioning

confidence: 99%