Background
Primary hyperparathyroidism (PHPT) is associated with an increased risk of cardiovascular
disease, including hypertension. The purpose of this study was to determine the effect
of parathyroidectomy on systolic and diastolic blood pressures (BP) in hypertensive
patients with PHPT.
Methods
A retrospective review of medical records was performed in 368 patients undergoing
parathyroidectomy and 96 patients undergoing thyroidectomy by a single surgeon. We
evaluated changes in serum calcium, parathyroid hormone (PTH), and BP before and 6
months after surgery.
Results
In patients undergoing parathyroidectomy with hypertension (n = 147), a significant decrease in both systolic and diastolic BP was observed; systolic
BP decreased from 152.5 ± 10.5 to 140.3 ± 16.2 mmHg (P < .001) and diastolic BP decreased from 94.5 ± 6.8 to 81.7 ± 10.3 mmHg (P < .001). In these patients, PTH decreased from 136 ± 186 to 58.7 ± 44.3 pg/mL (P < .001) and serum calcium decreased from 11.1 ± 0.6 to 9.5 ± 0.7 mg/dL (P < .001). In patients undergoing parathyroidectomy without hypertension (n = 145) and thyroidectomy alone (n = 96), no significant change in systolic or diastolic BP was observed.
Conclusion
Parathyroidectomy in hypertensive patients seems to reduce both systolic and diastolic
BP . The mechanisms responsible for this effect are unknown and deserve further study.
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References
- Diagnosis and management of asymptomatic primary hyperparathyroidism: consensus development conference statement.Ann Intern Med. 1991; 114: 593-597
- Asymptomatic primary hyperparathyroidism. 10-year prospective study.Mayo Clin Proc. 1981; 56: 473-478
- A case-comparison study of hypertension and hyperparathyroidism.J Clin Endocrinol Metab. 1982; 55: 303-306
- Enhanced parathyroid function in essential hypertension: a homeostatic response to a urinary calcium leak.Hypertension. 1980; 2: 162-168
- Blood pressure in patients with primary hyperparathyroidism before and after parathyroidectomy.Exp Clin Endocrinol. 1985; 86: 346-352
- The effect of surgical treatment on secondary hyperaldosteronism and relative hyperinsulinemia in primary hyperparathyroidism.Eur J Endocrinol. 1998; 138: 543-547
- Maintained normalization of cardiovascular dysfunction 5 years after parathyroidectomy in primary hyperparathyroidism.Surgery. 2005; 137: 632-638
- Left ventricular hypertrophy in primary hyperparathyroidism. Effects of successful parathyroidectomy.Clin Endocrinol (Oxf). 1999; 50: 321-328
- Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies.Lancet. 2002; 360: 1903-1913
- Parathyroid hypertension. A reversible disorder.Arch Intern Med. 1986; 146: 1709-1712
- Parathyroid hormone and the risk of incident hypertension.J Hypertens. 2008; 26: 1390-1394
- Cardiac abnormalities in patients with primary hyperparathyroidism: implications for follow-up.J Clin Endocrinol Metab. 1997; 82: 106-112
- Medical observation, compared with parathyroidectomy, for asymptomatic primary hyperparathyroidism: a prospective, randomized trial.J Clin Endocrinol Metab. 2007; 92: 1687-1692
- Chronic continuous PTH infusion results in hypertension in normal patients.J Clin Hypertens. 1986; 2: 360-370
- Blood pressure effects of acute hypercalcemia in normal patients and thyroparathyroidectomized patients.Miner Electrolyte Metab. 1985; 11: 369-373
- Effects of acute hypercalcaemia on blood pressure in patients with and without parathyroid hormone secretion.Acta Physiol Scand. 2005; 184: 113-119
- Effects of PTH(1-34) on blood pressure, renal function, and hormones in essential hypertension: the altered pattern of reactivity may counteract raised blood pressure.Am J Hypertens. 1997; 10: 1356-1367
- The effect of surgical treatment on secondary hyperaldosteronism and relative hyperinsulinemia in primary hyperparathyroidism.Eur J Endocrinol. 1998; 138: 543-547
- Hypertension and primary hyperparathyroidism: the role of adrenergic and renin-angiotensin-aldosterone systems.Miner Electrolyte Metab. 1995; 21: 77-81
- PTH and PTH-related peptide enhance steroid secretion from human adrenocortical cells.Am J Physiol Endocrinol Metab. 2001; 280: E209-E213
- Endothelial vasodilatory function and blood pressure response to local and systemic hypercalcemia.Surgery. 2001; 130: 986-990
- Sympathetic system function and vascular reactivity in hypercalcemic patients.Hypertension. 1982; 4: 452-458
- Parathyroid hormone has a prosclerotic effect on vascular smooth muscle cells.Kidney Blood Press Res. 2003; 26: 27-33
- Augmentation of central arterial pressure in mild primary hyperparathyroidism.J Clin Endocrinol Metab. 2000; 85: 3515-3519
- Impaired flow-mediated vasodilation of the brachial artery in patients with primary hyperparathyroidism improves after parathyroidectomy.Cardiovasc Res. 2000; 47: 813-818
- Optimal vitamin D status attenuates the age-associated increase in systolic blood pressure in white Americans: results from the third National Health and Nutrition Examination Survey.Am J Clin Nutr. 2008; 87: 136-141
Article info
Publication history
Accepted:
September 24,
2009
Footnotes
Supported by the National Institutes of Health Grant #NIIH K23AR054334.
Identification
Copyright
© 2009 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
