Influence of Surgical Correction of Primary Hyperparathyroidism on Associated Hypertension

Madhavan, T.

doi:10.1001/archsurg.1970.01340200100022

Cited by 41 publications

(7 citation statements)

References 11 publications

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“…However, the patients in the present study had no impairment of kidney function compared with controls when evaluated by creatinine clear¬ ance; the creatinine clearance was unaltered after parathyroid surgery and was not significantly correlated to BP. This is in accordance with other recent investigations (Jones et al 1983;Madhaven et al 1970;Lueg 1982), and a primary renal hyper¬ tensive mechanism in PHP seems less likely. Serum magnesium may play a role in BP regula¬ tion in both essential hypertension (Resnick et al 1983) and PHP.…”

Section: Discussionsupporting

confidence: 93%

“…Several studies have reported an increased pre¬ valence of arterial hypertension in patients with PHP (Jones et al 1983;Chowdhury & Gray 1973;Madhaven et al 1970;Lafferty 1981;Lueg 1982). Disagreement, however, exists concerning both the mechanisms causing the increased BP and the reversibility of the hypertension after parathyroidectomy.…”

Section: Discussionmentioning

confidence: 99%

“…Arterial hypertension is common in patients with primary hyperparathyroidism (PHP) (Jones et al 1983;Chowdhury & Gray 1973;Madhaven et al 1970), but the mechanism is unknown. Elevated blood pressure (BP) may be caused by 1) a changed vascular reactivity to circulating pressor hor¬ mones; 2) an abnormal balance between BP-elevating hormones, i.e.…”

mentioning

confidence: 99%

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Elevated angiotensin II and vasopressin in primary hyperparathyroidism. Angiotensin II infusion studies before and after removal of the parathyroid adenoma

Jespersen

Charles

et al. 1989

Acta Endocrinologica

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In order to evaluate the role of calcium metabolism in blood pressure regulation, 15 patients with primary hyperparathyroidism and 9 healthy control subjects were studied before and during angiotensin II infusion. The patients were re-investigated 2\p=n-\5months after removal of the parathyroid adenoma. Blood pressure, plasma levels of angiotensin II, aldosterone, arginine vasopressin, and atrial natriuretic peptide, and creatinine clearance were determined. Blood pressure and the blood pressure response to angiotensin II infusion were both the same before and after the operation. Angiotensin II and arginine vasopressin during basal conditions were significantly higher before than after the operation (angiotensin II: 17 (median) to 10 pmol/l, P < 0.02; arginine vasopressin: 2.9 to 1.9 pmol/l, P < 0.01), whereas aldosterone, atrial natriuretic peptide, and creatinine clearance were unchanged. During angiotensin II infusion, aldosterone, arginine vasopressin, and atrial natriuretic peptide increased to approximately the same levels before and after the operation. Blood pressure was not correlated to any of the hormones measured. Thus, patients with primary hyperparathyroidism have elevated plasma levels of angiotensin II and arginine vasopressin which may be compensatory phenomena counteracting volume depletion owing to a decreased renal concentrating ability induced by hypercalcemia, and owing to PTH-induced inhibition of renal sodium reabsorption.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

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Elevated angiotensin II and vasopressin in primary hyperparathyroidism. Angiotensin II infusion studies before and after removal of the parathyroid adenoma

Jespersen

Charles

et al. 1989

Acta Endocrinologica

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“…It has been known for several decades that blood pressure is elevated in primary hyperparathyroidism (HPT) Hellström et al, 1958;Madhavan et al, 1970;Jones et al, 1993). The reason for this blood pressure elevation is, however, not clear.…”

Section: Introductionmentioning

confidence: 99%

“…The reason for this blood pressure elevation is, however, not clear. Impaired renal function, increased levels of calcium and parathyroid hormone (PTH), increased activity of the sympathetic system or renin-angiotensine system have all been suggested to be of pathogenetic importance (Brinton et al, 1975;Britton et al, 1971;Hellström et al, 1958;Madhavan et al, 1970;Jones et al, 1993, Vlachakis et al, 1982. The preoperative SBP was correlated to both the intraoperative and postoperative SBP (r = 0.59 and r = 0.61, both p < 0.00001).…”

Section: Introductionmentioning

confidence: 99%

Blood pressure reaction during the intraoperative and early postoperative periods in patients with primary hyperparathyroidism

Lind¹,

Ljunghall²

2009

Exp Clin Endocrinol Diabetes

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Hypertension is a well known finding in primary hyperparathyroidism (HPT). In the present study, systolic blood pressure (SBP) and heart rate were recorded before, during and after surgery for HPT in 101 patients (mean serum calcium 2.96 +/- 0.22 mmol/l) and compared to 91 scheduled general surgical patients matched for age, sex, duration of surgery and type of general anesthesia. The HPT patients displayed an increased mean SBP, given as mean +/- standard deviation, both before (147 +/- 28 vs 131 +/- 25 mm Hg in controls) and during surgery (142 +/- 24 vs 117 +/- 21 mm Hg in controls) as well as postoperatively (141 +/- 23 vs 118 +/- 17 mm Hg in controls, all p < 0.0001). The preoperative SBP was correlated to both the intraoperative and postoperative SBP (r = 0.59 and r = 0.61, both p < 0.00001). However, the blood pressure elevation during and after surgery was still significant (both p < 0.001) when corrected for the influence of the preoperative blood pressure level using multiple regression analysis. The heart rate was increased in the HPT subjects only in the postoperative period (88 +/- 12 vs 83 +/- 12 beats/min in controls, p < 0.007). In conclusion, the systolic blood pressure was found to be elevated both before, during and after surgery in HPT subjects when compared to a general surgical population. In the postoperative period, also the heart rate was increased in the HPT subjects. These findings suggest an increased cardiovascular response to surgical stress in HPT subjects.

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Primary hyperparathyroidism. Changing clinical spectrum, prevalence of hypertension, and discriminant analysis of laboratory tests

Lafferty

1981

Archives of Internal Medicine

128

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The clinical spectrum of 100 consecutive cases of surgically proved primary hyperparathyroidism treated from 1974 through 1978 was analyzed. Their laboratory test results were compared with 64 cases of other form of hypercalcemia using multivariate discriminant analysis. The clinical spectrum has dramatically shifted during the past three decades from renal calculi and bone disease to the asymptomatic patient discovered by routine serum chemical analysis. Hypertension was twice as common among hyperparathyroid patients as in the general population but failed to improve in 92% after parathyroidectomy. The most useful discriminant laboratory test in descending order of value were the serum chloride, serum calcium, hematocrit, serum phosphorus, and parathormone. Multivariate discriminant analysis of the serum calcium, phosphorus, chloride, and Hct provided a 98% degree of accuracy in separating hyperparathyroidism from other forms of hypercalcemia.

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Influence of Surgical Correction of Primary Hyperparathyroidism on Associated Hypertension

Cited by 41 publications

References 11 publications

Elevated angiotensin II and vasopressin in primary hyperparathyroidism. Angiotensin II infusion studies before and after removal of the parathyroid adenoma

Elevated angiotensin II and vasopressin in primary hyperparathyroidism. Angiotensin II infusion studies before and after removal of the parathyroid adenoma

Blood pressure reaction during the intraoperative and early postoperative periods in patients with primary hyperparathyroidism

Primary hyperparathyroidism. Changing clinical spectrum, prevalence of hypertension, and discriminant analysis of laboratory tests

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