Relationship between calcitrophic hormones and blood pressure in elderly subjects

John, Andrew St; Dick, I.; Hoad, Kirsten; Retallack, R.W.; Welborn, T.; Prince, Richard

doi:10.1530/eje.0.1300446

Cited by 29 publications

(22 citation statements)

References 7 publications

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“…In a group of 583 elderly patients untreated for hypertension and who did not suffer from primary HPT, calcium and PTH levels significantly correlated with mean BP, and PTH correlated positively with age (16). Similar results were obtained in patients with essential hypertension, confirming the presence of alteration of calcium metabolism in those patients (20).…”

Section: Discussionsupporting

confidence: 69%

“…In fact, calciotropic hormones, such as PTH and calcitriol, have been shown to be increased in some forms of hypertension. St John et al (16), in a group of hypertensive elderly subjects, showed that PTH was an independent significant predictor of mean BP. Moreover, PTH levels, which are elevated both in patients with HPT and in those with essential hypertension, can probably influence intracellular calcium levels and subsequently smooth muscle contraction (17).…”

Section: Discussionmentioning

confidence: 96%

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Relationship between serum parathyroid hormone, serum calcium and arterial blood pressure in patients with primary hyperparathyroidism: results of a multivariate analysis

Lumachi

Ermani

Luisetto

et al. 2002

European Journal of Endocrinology

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Objective: To evaluate the possible relationship between serum calcium, serum parathyroid hormone (PTH) levels and arterial blood pressure (BP) in patients with primary hyperparathyroidism (HPT). Design: A retrospective population-based study. Methods: Charts of 194 patients with proven primary HPT were reviewed, and the main clinical and biochemical parameters were recorded. There were 48 men (24.7%) and 146 women (75.3%), with a median age of 59 years (range 23-82 years). Patients who used antihypertensive drugs or hormone replacement therapy had been previously excluded. All patients underwent successful parathyroidectomy, and were cured of their disease. Results: There were no differences ðP ¼ NSÞ between men and women in systolic ð143:3^19:1 vs 145:4^17:1 mmHgÞ and diastolic ð87:1^12:3 vs 88:4^9:9 mmHgÞ BP, and in the main biochemical parameters. A significant ðP , 0:01Þ correlation was found between (i) serum calcium and serum PTH levels ðr ¼ 0:39; F ¼ 88:36Þ; (ii) age and BP, both systolic ðr ¼ 0:61; F ¼ 118:16Þ and diastolic ðr ¼ 0:48; F ¼ 64:5Þ; and (iii) body mass index (BMI) and BP (r ¼ 0:45 and 0.36 respectively). There was no significant association of serum calcium levels with systolic ðr ¼ 0:0974; t ¼ 1:3422; P ¼ 0:18Þ or diastolic ðr ¼ 0:1117; t ¼ 1:5409; P ¼ 0:12Þ BP, and of serum PTH levels with systolic ðr ¼ 20:0349; t ¼ 20:4783; P ¼ 0:63Þ or diastolic ðr ¼ 20:0793; t ¼ 21:0913; P ¼ 0:28Þ BP. Multivariate analysis confirmed that none of the independent biochemical parameters significantly correlated with BP, both systolic and diastolic. Conclusions: In patients with primary HPT there is no relationship between PTH, calcium and BP. Thus, in hyperparathyroid patients, BP should be considered as an independent variable, mainly related to age and BMI.

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Section: Discussionsupporting

confidence: 69%

Section: Discussionmentioning

confidence: 96%

Relationship between serum parathyroid hormone, serum calcium and arterial blood pressure in patients with primary hyperparathyroidism: results of a multivariate analysis

Lumachi

Ermani

Luisetto

et al. 2002

European Journal of Endocrinology

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“…A modest J-or U-shaped association was found (P value for quadratic PTH ϭ 0.08). Results were not materially changed after including 25 Among the components, a significant inverse multivariate association of 25(OH)D with fasting hyperglycemia in men and a positive association with high triglycerides in women were present (P trend ϭ 0.01 for both) ( Table 3). The adjusted odds of high blood pressure, hyperglycemia, and low HDL were significantly elevated among men in the highest quintile of PTH compared with men in the lowest quintile.…”

Section: Discussionmentioning

confidence: 94%

“…Elevated PTH secondary to low vitamin D increases calcium resorption from the skeleton at the expense of an increased risk of fracture (20). Secondary hyperparathyroidism may also increase the risk of developing components of metabolic syndrome, including hypertension (21)(22)(23)(24)(25)(26), obesity (6,9,10,(27)(28)(29), and diabetes (30 -32). However, we are unaware of previous research investigating whether PTH levels are also associated with the metabolic syndrome.…”

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confidence: 99%

Vitamin D, Parathyroid Hormone Levels, and the Prevalence of Metabolic Syndrome in Community-Dwelling Older Adults

Mühlen²,

et al. 2007

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OBJECTIVE -Accumulating research suggests low-circulating vitamin D concentrations, i.e., 25-hydroxyvitamin-D [25(OH)D], may be associated with an increased prevalence of metabolic syndrome; however, previous studies have not accounted for parathyroid hormone (PTH) levels. We examined the association of 25(OH)D and PTH with the prevalence of metabolic syndrome in a community-based cohort of older adults. RESULTS -In men, there was a significant trend (P ϭ 0.03) of increasing adjusted odds for metabolic syndrome with increasing PTH concentrations, primarily due to an odds ratio of 2.02 (95% CI 0.96 -4.24) in men in the top quintile (Ն63 ng/l) of PTH concentration. This association remained unchanged after taking into account 25(OH)D levels and excluding men with diabetes or impaired renal function; it was attenuated after adjustment for the homeostasis model assessment of insulin resistance. Neither PTH in women nor 25(OH)D levels in either sex was related to the metabolic syndrome. RESEARCH DESIGN AND METHODSCONCLUSIONS -These findings suggest an increased risk of metabolic syndrome with elevated PTH levels in older men and no effect of 25(OH)D concentrations in either sex. The reason for the sex difference in the PTH-metabolic syndrome association is unknown. Prospective studies are necessary to better determine the roles of 25(OH)D and PTH in the etiology of metabolic syndrome. Diabetes Care 30:1549-1555, 2007D ecreased vitamin D and elevated parathyroid hormone (PTH) levels may play a role in the etiology of metabolic syndrome, either through an association with individual components of metabolic syndrome or via insulin resistance (1,2). Vitamin D levels have been shown to be inversely related both with fasting glucose concentrations (3-5) and adiposity (6 -10) and have been suspected to be involved in the regulation of blood pressure, based on blood pressure reduction with vitamin D 3 supplementation in patients with essential hypertension (11,12). Other evidence suggests a role for vitamin D in maintaining normal insulin synthesis and secretion (13,14). Vitamin D and PTH are both responsible for maintaining extracellular calcium homeostasis (19). Vitamin D increases the efficiency of intestinal calcium absorption, and PTH is secreted in response to low-circulating calcium concentrations. Elevated PTH secondary to low vitamin D increases calcium resorption from the skeleton at the expense of an increased risk of fracture (20). Secondary hyperparathyroidism may also increase the risk of developing components of metabolic syndrome, including hypertension (21-26), obesity (6,9,10,27-29), and diabetes (30 -32). However, we are unaware of previous research investigating whether PTH levels are also associated with the metabolic syndrome.Previous studies linking low 25(OH)D with an increased prevalence of metabolic syndrome (1,18) were limited by their inability to simultaneously account for PTH, since both vitamin D and PTH operate within a tightly controlled feedback system to maintain extracellular calcium conce...

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“…St. John et al (27) investigated the relationship between calcitropic hormones and blood pressure in 583 elderly subjects who were untreated for hypertension, but who were not vitamin D deficient. Univariate analysis demonstrated that serum PTH and 1,25-(OH) 2 D 3 were correlated significantly with mean blood pressure.…”

Section: Discussionmentioning

confidence: 99%

Effects of a Short-Term Vitamin D3 and Calcium Supplementation on Blood Pressure and Parathyroid Hormone Levels in Elderly Women

Pfeifer¹

2001

Journal of Clinical Endocrinology & Metabolism

375

350

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Calcium supplementation is effective in reducing blood pressure in various states of hypertension, including pregnancy-induced hypertension and preeclampsia. In addition, calcitropic hormones are associated with blood pressure. The hypothesis is that short-term therapy with calcium and vitamin D 3 may improve blood pressure as well as secondary hyperparathyroidism more effectively than calcium monotherapy.The effects of 8 weeks of supplementation with vitamin D 3 (cholecalciferol) and calcium on blood pressure and biochemical measures of bone metabolism were studied. The sample consisted of 148 women (mean Ϯ SD age, 74 Ϯ 1 yr) with a 25-hydroxycholecalciferol (25OHD 3 ) level below 50 nmol/L. They received either 1200 mg calcium plus 800 IU vitamin D 3 or 1200 mg calcium/day. We measured intact PTH, 25OHD 3 , 1,25-dihydroxyvitamin D 3 , blood pressure, and heart rate before and after treatment.Compared with calcium, supplementation with vitamin D 3 and calcium resulted in an increase in serum 25OHD 3 of 72% (P Ͻ 0.01), a decrease in serum PTH of 17% (P ϭ 0.04), a decrease in systolic blood pressure (SBP) of 9.3% (P ϭ 0.02), and a decrease in heart rate of 5.4% (P ϭ 0.02). Sixty subjects (81%) in the vitamin D 3 and calcium group compared with 35 (47%) subjects in the calcium group showed a decrease in SBP of 5 mm Hg or more (P ϭ 0.04). No statistically significant difference was observed in the diastolic blood pressures of the calcium-treated and calcium-plus vitamin D 3 -treated groups (P ϭ 0.10). Pearson coefficients of correlation between the change in PTH and the change in SBP were 0.49 (P Ͻ 0.01) for the vitamin D 3 plus calcium group and 0.23 (P Ͻ 0.01) for the calcium group. 1-3). In addition, other reports suggest that calcium intake may have effects in a variety of unrelated diseases such as arterial hypertension (4 -7), cancer of the colon (8, 9), and prevention of nephrolithiasis (10). Furthermore, an association of 1,25-dihydroxyvitamin D 3 [1,25-(OH) 2 D 3 ] and blood pressure has been shown in normotensive men (11), myocardial infarction was inversely associated with plasma 25-hydroxyvitamin D 3 (25OHD 3 ) levels in a community-based study (12), and higher blood pressure in elderly women correlated to increased bone loss in a recently published prospective study (13). On the other hand, dietary calcium intake fails to meet recommended levels in virtually all categories of Americans (14, 15), and hypovitaminosis D affects both Americans (16) and Europeans (17).We have previously shown that short-term supplementation with vitamin D 3 and calcium improves body sway and secondary hyperparathyroidism and therefore prevents falls and subsequent nonvertebral fractures in elderly women (18,19). We have now extended our studies to the effects of short-term supplementation with vitamin D 3 and calcium on blood pressure, as vascular smooth muscle is a target organ for vitamin D (20). The role of calcitropic hormones in the regulation of blood pressure is unclear (21-23). To our knowledge this is the ...

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Relationship between calcitrophic hormones and blood pressure in elderly subjects

Cited by 29 publications

References 7 publications

Relationship between serum parathyroid hormone, serum calcium and arterial blood pressure in patients with primary hyperparathyroidism: results of a multivariate analysis

Relationship between serum parathyroid hormone, serum calcium and arterial blood pressure in patients with primary hyperparathyroidism: results of a multivariate analysis

Vitamin D, Parathyroid Hormone Levels, and the Prevalence of Metabolic Syndrome in Community-Dwelling Older Adults

Effects of a Short-Term Vitamin D3 and Calcium Supplementation on Blood Pressure and Parathyroid Hormone Levels in Elderly Women

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