Abstract
Objective
The pathogenesis of hypertension in patients with primary hyperparathyroidism (PHPT)
is unclear, and the prevailing opinion is that parathyroidectomy does not affect the
blood pressure (BP). Most previous studies have been based on BP measurements at rest
in a clinical setting. The aim of this study was to get additional information by
24-hour ambulatory measurements.
Design and patients
Forty-nine consecutive patients with PHPT (age 63±12 years, 44 women) were examined before and 6 months after curative parathyroid surgery.
Measurements
Serum concentrations of calcium and PTH, and 24-hour ambulatory mean, minimum, and
maximum systolic (S) and diastolic BP, and mean arterial BP.
Results
On average, the patients showed no BP change after parathyroidectomy. However, those
with a history of hypertension (n=20) showed generally increased BP values after parathyroidectomy, with significantly
increased minimum and average SBP (P=0.02 and P=0.04, respectively), whereas patients without a history of hypertension (n=29) showed unchanged or slightly reduced BP values after parathyroidectomy, with significantly
decreased maximum SBP (P=0.04). Serum concentrations of PTH and calcium were not significantly related to any
of the BP variables measured.
Conclusions
The novel finding that patients with both PHPT and hypertension may show increased
BP after parathyroidectomy warrants intensified BP control postoperatively in these
patients, and motivates early treatment of PHPT in order to prevent the development
of complicating hypertension.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to International Journal of CardiologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Primary hyperparathyroidism and heart disease — a review.Eur Heart J. 2004; 25: 1776-1787
- Increased intima–media thickness of the carotid artery wall, normal BP profile and normal left ventricular mass in subjects with primary hyperparathyroidism.Eur J Endocrinol. 2002; 147: 453-459
- Vascular actions of the calcium regulating hormones.Semin Nephrol. 1995; 15: 536-549
- Functional parathyroid hormone receptors are present in an umbilical vein endothelial cell line.Am J Physiol Endocrinol Metab. 2000; 279: 654-662
- Studies on flow-mediated vasodilation and intima–media thickness of the brachial artery in patients with primary hyperparathyroidism.Am J Hypertens. 2000; 13: 759-764
- Case–control study on symptoms and signs of “asymptomatic” primary hyperparathyroidism.Surgery. 1998; 124: 980-985
- A case-comparison study of hypertension and hyperparathyroidism.J Clin Endocrinol Metab. 1982; 55: 303-306
- Relationships between calcium metabolic indices and BP in patients with essential hypertension as compared with a healthy population.J Hypertens. 1987; 5: 451-456
- Enhanced parathyroid function in essential hypertension: a homeostatic response to a urinary calcium leak.Hypertension. 1980; 2: 162-168
- Calciotrophic hormones in human and experimental hypertension.Am J Hypertens. 1990; 3: 171S-178S
- Abnormalities of calcium metabolism in essential hypertension.Clin Sci. 1983; 65: 137-141
- Parathyroid hormone/adenylate cyclase coupling in vascular smooth muscle cells.Hypertension. 1994; 23: 468-475
- Effect of parathyroid hormone and antagonist on aortic cAMP levels.Can J Physiol Pharm. 1987; 65: 2349-2353
- Cyclic AMP and the vascular action of parathyroid hormone.Can J Physiol Pharm. 1986; 64: 1543-1547
- The effects of parathyroid hormone on L-type voltage-dependent calcium channel currents in vascular smooth muscle cells and ventricular myocytes are mediated by a cyclic AMP dependent mechanism.FEBS Lett. 1991; 282: 331-334
- Endothelium-independent linkage of parathyroid hormone receptors of rat vascular tissue with increased adenosine 3−, 5−-monophosphate and relaxation of vascular smooth muscle.Endocrinology. 1986; 119: 349-356
- Parathyroid hormone acute vascular effect is mediated by decreased Ca2+ uptake and enhanced cAMP level.Mol Cell Endocrinol. 1989; 67: 63-71
- Parathyroid hormone and calcium entry blockade in a vascular tissue.Life Sci. 1988; 42: 1395-1400
- Relaxation of renal arterioles by parathyroid hormone and parathyroid hormone-related protein.Pharmacology. 1991; 42: 91-96
- Vasorelaxant effect of parathyroid hormone in isolated segments of porcine coronary artery.Artery. 1988; 15: 61-70
- Cardiovascular effects of human parathyroid hormone and parathyroid hormone-related peptide.J Cardiovasc Pharmacol. 1994; 23: 38-41
- Endothelial vasodilatory dysfunction in primary hyperparathyroidism is reversed after parathyroidectomy.Surgery. 1999; 129: 1049-1055
- Effect of chronic hypercalcemia on the heart. An analysis of 18 necropsy patients.Am J Med. 1981; 71: 371-384
- Wave reflection in the systemic circulation and its implications in ventricular function.J Hypertens. 1993; 11: 327-337
- Augmentation of central arterial pressure in mild primary hyperparathyroidism.J Clin Endocrinol Metab. 2000; 85: 3515-3519
- Arterial stiffness in mild primary hyperparathyroidism.J Clin Endocrinol Metab. 2005; 90: 3326-3330
- Premature death in patients operated on for primary hyperparathyroidism.World J Surg. 1990; 14: 829-836
- Increased risk of death from primary hyperparathyroidism — an update.Eur J Clin Investig. 1998; 28: 277-278
- Increased cardiovascular mortality and normalized serum calcium in patients with mild hypercalcemia followed up for 25 years.Surgery. 2001; 130: 978-985
- Cardiovascular events before and after surgery for primary hyperparathyroidism.World J Surg. 2003; 27: 216-222
- Survival after the diagnosis of hyperparathyroidism: a population based study.Am J Med. 1998; 2: 115-122
- Cardiovascular disease, hypertension and renal function in primary hyperparathyroidism.J Intern Med. 2002; 251: 476-483
- Summary statement from a workshop on asymptomatic primary hyperparathyroidism: a perspective for the 21st century.J Clin Endocrinol Metab. 2002; 87: 5353-5361
- Calcium regulating hormones in essential hypertension. Importance of gender.Am J Hypertens. 1990; 3 (suppl): 161S-166S
- Serum parathyroid hormone as a predictor of increase in systolic blood pressure in men.J Hypertens. 2005; 23: 1639-1644
- Population based study on serum ionised calcium, serum parathyroid hormone, and blood pressure. The Tromsø study.Eur J Endocrinol. 1999; 141: 350-357
- Parathyroid hormone, platelet calcium, and blood pressure in normotensive subjects.Hypertension. 1991; 18: 176-182
- Relationship between serum parathyroid hormone levels in the elderly and 24-h ambulatory blood pressure.J Hypertens. 1997; 15: 1271-1276
- Atorvastatin in patients with type 2 diabetes mellitus undergoing hemodialysis.N Engl J Med. 2005; 353: 238-248
- Erratum.N Engl J Med. 2005; 353: 1640
- Arterial calcifications and bone histomorphometry in end-stage renal disease.J Am Soc Nephrol. 2004; 15: 1943-1951
- Cinacalcet for secondary hyperparathyroidism in patients receiving hemodialysis.N Engl J Med. 2004; 350: 1516-1525
- Impaired flow-mediated vasodilation of the brachial artery in patients with primary hyperparathyroidism improves after parathyroidectomy.Cardiovasc Res. 2000; 47: 813-818
- Serum parathyroid hormone levels predict coronary heart disease: the Tromsø study.Eur J Cardiovasc Prev Rehabil. 2004; 11: 69-74
- J Vasc Med Biol. 1993; 4: 265
- Chronic continuous PTH infusion results in hypertension in normal subjects.J Clin Hypertens. 1986; 2: 360-370
- Different arterial pressure responses to norcalcin, a parathyroid calcium receptor agonist, between the spontaneously hypertensive and the Wistar–Kyoto normotensive rats.Circulation. 1996; 94: 628
- Parathyroid hypertensive factor.J Hypertens. 1990; 8: S155-S159
- A vasopressor factor partially purified from human parathyroid glands.Biochem Biophys Res Commun. 1992; 188: 323-329
- Expression of parathyroid hypertensive factor in hypertensive primary hyperparathyroid patients.Blood Pressure. 1993; 2: 22-27
- Parathyroid hypertensive factor predicts efficacy in the treatment of essential hypertension with verapamil.Blood Pressure. 1996; 5: 98-104
- Quantitative determination of parathyroid hypertensive factor by enzyme-linked immunosorbent assay.Am J Hypetens. 2000; 13: 1173-1179
- Ethical authorship and publishing.Int J Cardiol. 2009; 131: 149-150
Article info
Publication history
Published online: December 31, 2008
Accepted:
December 6,
2008
Received:
August 12,
2008
Identification
Copyright
© 2008 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
