Long-Term Effects of Parathyroidectomy on Hypertension Prevalence and Circadian Blood Pressure Profile in Primary Hyperparathyroidism

Abstract

Our aims were to evaluate the prevalence and outcome of hypertension in patients with primary hyperparathyroidism (PHPT), previously and after follow-up of parathyroidectomy. A group of 46 consecutive patients with sporadic PHPT due to adenoma undergoing surgery were followed an average of 3.5 years (range 36 to 53 months). In 16 nonselected, consecutive parathyroidectomized patients, with normalized biochemical measurements, circadian rhythm of blood pressure was evaluated with ambulatory blood pressure monitoring (ABPM). Prevalence of hypertension in PHPT was 54.35%, and there was no significant association of PTH, total and ionic calcium levels with SBP and DBP. During follow-up, none of the patients with presurgical hypertension became normotensive and five of the normotensive patients developed clinical hypertension. In ABPM, 6/11 hypertensive and 3/5 normotensive subjects showed nondipper behavior. Serum total calcium was significantly related to night-time systolic blood pressure (SBP) (r = 0.620, P < 0.02), and night-time diastolic blood pressure (DBP) (r = 0.758, P < 0.002). In dippers, creatinine clearance was significantly higher (91.3 +/- 18.5 vs. 64.3 +/- 11.5 ml/min, P < 0.01), while serum total calcium was lower (2.42 +/- 0.13 vs. 2.23 +/- 0.17 mmol/L, P < 0.04) than in nondippers. In conclusion, our results suggest that parathyroidectomy has little effect on hypertension prevalence. Renal impairment, a condition that did not improve after parathyroidectomy, may be a causal factor of hypertension in PHPT. Also, the high prevalence of nondipper behavior in hypertensive and normotensive subjects after parathyroidectomy, suggests that target organ risk persists. We hypothesized that slight elevations of serum total calcium even in the normal range could be involved in the alteration of the circadian rhythm of blood pressure.

Interdisciplinary Aspects of Primary Hyperparathyroidism: Symptomatology in a Series of 100 Cases

“…In the present study the incidence of HA was 55%. Other studies confirm this tendency, and in one report the HA incidence was even higher (81%) [35][36][37]. It has also been directly observed that PTH infusion results in HA in healthy subjects [38].…”

“…It has also been directly observed that PTH infusion results in HA in healthy subjects [38]. Still, data describing the impact of surgical PHPT treatment on HA and the circadian rhythm of blood pressure are not consistent [36,37].…”

Risk Factors for Intraoperative Hypertension during Surgery for Primary Hyperparathyroidism

“…Hypertension secondary to pHPT is still being debated [22] . The 54.1% incidence rate of hypertension in pHPT is within the range of 20-69% reported in various studies [5,23,24] . This large variation in reported incidence could be due to variations between different authors due to differences in blood pressure measurement criteria of hypertension and different patient characteristics.…”

Cardiovascular manifestations of primary hyperparathyroidism: a narrative review

“…Limited data exist on the effect of PTx on blood pressure in patients with mild PHPT; blood pressure was reduced one year after surgical intervention in one study (38) while it remained stable after 6 months in another investigation (39,40). It should be noted that the only randomized two-year duration study in mild PHPT patients showed neither benefit after PTx nor a deleterious effect on blood pressure with conservative management (41).…”