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

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 (P=NS) between men and women in systolic (143.3+/-19.1 vs 145.4+/-17.1 mmHg) and diastolic (87.1+/-12.3 vs 88.4+/-9.9 mmHg) BP, and in the main biochemical parameters. A significant (P<0.01) correlation was found between (i) serum calcium and serum PTH levels (r=0.39, F=88.36), (ii) age and BP, both systolic (r=0.61, F=118.16) and diastolic (r=0.48, F=64.5), and (iii) body mass index (BMI) and BP (r=0.45 and 0.36 respectively). There was no significant association of serum calcium levels with systolic (r=0.0974, t=1.3422, P=0.18) or diastolic (r=0.1117, t=1.5409, P=0.12) BP, and of serum PTH levels with systolic (r=-0.0349, t=-0.4783, P=0.63) or diastolic (r=-0.0793, t=-1.0913, P=0.28) 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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Is Normocalcemic Primary Hyperparathyroidism Harmful or Harmless?

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2014-4432 ◽

2015 ◽

Vol 100 (6) ◽

pp. 2420-2424 ◽

Cited By ~ 30

Author(s):

Gang Chen ◽

Ying Xue ◽

Qiongyao Zhang ◽

Ting Xue ◽

Jin Yao ◽

...

Keyword(s):

Blood Pressure ◽

Primary Hyperparathyroidism ◽

Serum Calcium ◽

Low Density Lipoprotein ◽

Density Lipoprotein ◽

Serum Parathyroid Hormone ◽

Hydroxyvitamin D ◽

Outcomes Measures ◽

25 Hydroxyvitamin D ◽

Serum Pth

Context: Primary hyperparathyroidism (PHPT) is reported to be associated with an increased frequency of hypertension, however, information in this regard is sparse in relation to normocalcemic primary hyperparathyroidism (NPHPT). Objective: The aim of this study was to determine the association between NPHPT and blood pressure. Design, Setting, and Patients: We retrospectively enrolled 940 patients who visited the Fujian Provincial Hospital between September 2010 and December 2013 with a measured serum parathyroid hormone (PTH) and calcium level. Among them, 11 patients were diagnosed with NPHPT, while 296 cases with normal PTH and albumin-adjusted serum calcium. Main Outcomes Measures: Systolic blood pressure (SBP), diastolic blood pressure (DBP), intact serum PTH, and serum calcium were recorded. Results: There were no significant differences between subjects identified with NPHPT and those with normal PTH in terms of age, sex, body mass index, serum calcium, 25-Hydroxyvitamin D, serum creatinine, fasting plasma glucose, triglycerides, total cholesterol, high density lipoprotein, and low density lipoprotein. The subjects with a diagnosis of NPHPT had higher levels of SBP (141.9 ± 20.2 vs 131.2 ± 16.5, P = .041) and DBP (85.2 ± 12.4 vs 76.8 ± 10.3, P = .026) than the subjects in the cohort with normal PTH. After adjustment for all potential confounders, risks (odds ratios and 95% confidence interval) of SBP and DBP in NPHPT patients were 1.035 (1.000, 1.071) and 1.063 (1.004, 1.125), respectively (P < .05). Conclusions: The NPHPT had higher risk of high blood pressure than subjects with normal PTH. It is worth considering the necessity of more aggressive therapeutic intervention aimed to normalize PTH even if patients with NPHPT continue to be normocalcemic.

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The relation between serum parathyroid hormone (PTH) and blood pressure. The Tromsø study

Norsk Epidemiologi ◽

10.5324/nje.v16i2.192 ◽

2009 ◽

Vol 16 (2) ◽

Author(s):

Rolf Jorde

Keyword(s):

Blood Pressure ◽

Parathyroid Hormone ◽

Serum Creatinine ◽

Diastolic Blood Pressure ◽

Serum Calcium ◽

Randomized Clinical Trials ◽

Smoking Status ◽

Calcium Excretion ◽

Serum Parathyroid Hormone ◽

Serum Pth

The objective of the present cross-sectional epidemiological study from Tromsø, North Norway was to evaluate the relation between blood pressure and serum parathyroid hormone (PTH). 10419 subjects were invited to participate in the fifth Tromsø study and 8128 attended. 7954 subjects had serum PTH measured, and among these, information on blood pressure medication was available in 5841 subjects (2554 males) with serum calcium within the reference range 2.20-2.60 mmol/L. In a multiple linear<br />regression model with age, BMI, serum calcium, serum creatinine, and smoking status as covariables, serum PTH was a significant and positive predictor of systolic and diastolic blood pressure in both genders. When dividing the cohort in PTH quartiles, and adjusting for age, BMI, serum calcium, and serum creatinine, the differences between the lowest and highest PTH quartile in systolic and diastolic blood pressure were 5.0 and 3.5 mmHg for males and 4.1 and 2.5 mmHg for females, respectively. In previous studies we have found serum PTH to be a positive predictor for future increase in blood pressure, and also that the association between serum PTH and blood pressure cannot alone be ascribed to a blood pressure induced increase in urinary calcium excretion. To further elucidate the relation between serum PTH and blood pressure, randomized clinical trials with calcium and/or vitamin D supplementation to subjects with increased serum PTH levels are needed

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Rapid effects of parathyroid hormone(1–34) and prostaglandin E2 on bone blood flow and strontium clearance in the rat in vivo

Journal of Endocrinology ◽

10.1677/joe.0.1310359 ◽

1991 ◽

Vol 131 (3) ◽

pp. 359-365 ◽

Cited By ~ 7

Author(s):

E. Cochrane ◽

I. D. McCarthy

Keyword(s):

Blood Pressure ◽

Blood Flow ◽

Parathyroid Hormone ◽

Arterial Blood Pressure ◽

Vascular Resistance ◽

Prostaglandin E ◽

Bone Blood Flow ◽

Vascular Effects ◽

Arterial Blood ◽

Mineral Ions

ABSTRACT The vascular effects of noradrenaline, ATP, parathyroid hormone (PTH) and prostaglandin E2 (PGE2) were investigated in the rat. Additionally, the exchange of mineral ions between bone and blood was assessed by measuring strontium clearance, with the aim of investigating whether the vascular effects of these agents altered uptake of mineral ions or if this exchange could be changed independently of blood flow. Radioactive microspheres and 85Sr were used to establish bone blood flow and mineral clearance. Measurements of bone blood flow and arterial pressure were made in each animal and used to calculate vascular resistance. A measurement of 85Sr clearance was also obtained. Arterial blood pressure was significantly affected by noradrenaline (P ≤ 0·003) and ATP (P ≤ 0·015). Additionally, noradrenaline significantly (P ≤ 0·03) reduced bone blood flow. This decrease was related to a significant increase in vascular resistance. Arterial blood pressure and bone blood flow were significantly reduced by both bovine PTH(1–34) (P ≤ 0·001, P ≤ 0·02) and PGE2 (P ≤ 0·005, P ≤ 0·001). Vascular resistance to bone was increased by both agents but this was only statistically significant in the case of PGE2 (P ≤ 0·01). A significant (P ≤ 0·001) reduction in strontium was also produced by PGE2. In each group the relationship between bone blood flow and strontium clearance was then analysed. Only the PGE2-treated group had a slope of the regression which was statistically different from both the control animals and the other drug-treated groups. Treatment with PGE2 therefore resulted in a dose-related decrease in 85Sr clearance which was not related to the reduction in bone blood flow. Journal of Endocrinology (1991) 131, 359–365

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High phosphate diet increases arterial blood pressure via a parathyroid hormone mediated increase of renin

Journal of Hypertension ◽

10.1097/hjh.0000000000000261 ◽

2014 ◽

Vol 32 (9) ◽

pp. 1822-1832 ◽

Cited By ~ 20

Author(s):

Milica Bozic ◽

Sara Panizo ◽

Maria A. Sevilla ◽

Marta Riera ◽

Maria J. Soler ◽

...

Keyword(s):

Blood Pressure ◽

Parathyroid Hormone ◽

Arterial Blood Pressure ◽

Arterial Blood ◽

High Phosphate

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Serum parathyroid hormone level is associated with body mass index. The 5th Tromso study

Acta Endocrinologica ◽

10.1530/eje.0.1510167 ◽

2004 ◽

pp. 167-172 ◽

Cited By ~ 113

Author(s):

E Kamycheva ◽

J Sundsfjord ◽

R Jorde

Keyword(s):

Physical Activity ◽

Body Mass Index ◽

Vitamin D ◽

Parathyroid Hormone ◽

Relative Risk ◽

Body Mass ◽

Serum Calcium ◽

Population Based ◽

Serum Parathyroid Hormone ◽

Serum Pth

OBJECTIVE: To study whether serum parathyroid hormone (PTH) and serum calcium are associated with body mass index (BMI), and their predicting role in obesity. DESIGN: Population based, cross-sectional study. METHODS: In 2001 a population-based health survey was held in Tromso, North Norway. Questionnaires on medical history and life-style factors were completed and anthropometric data were collected. Calcium and vitamin D intakes and a physical activity score were calculated. Serum calcium and PTH were measured in a subset of 3447 men and 4507 women. Pearson correlation and linear regression were used to evaluate associations between BMI, PTH and serum calcium, and logistic regression was used to test PTH and serum calcium as predictors of obesity and to calculate odds ratio. Relative risk was calculated using frequency tables. RESULTS: For serum calcium and PTH there was a significant positive relation to BMI in both genders (P<0.001), which to our knowledge has not previously been reported on the basis of a large epidemiological study. Age, low calcium and vitamin D intakes were explanatory variables for serum PTH. The highest quartile of serum PTH (>4.20 pmol/l) was a significant predictor for obesity (P<0.001) in both genders, adjusted for age, physical activity and serum calcium. Obesity rates were higher in those with PTH levels in the highest quartile compared with those in the lower quartiles, which resulted in a relative risk of 1.40 (95% confidence interval (C.I.) 1.20-1.60) for men and 1.48 (95% C.I. 1.31-1.67) for women. CONCLUSIONS: Serum PTH, adjusted for age, physical activity and serum calcium, is positively associated with BMI in both sexes, and serum PTH is an independent predictor of obesity in our statistical model.

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Effects of hypercalcemia and parathyroid hormone on blood pressure in normal and renal-failure rats

AJP Renal Physiology ◽

10.1152/ajprenal.1986.250.5.f924 ◽

1986 ◽

Vol 250 (5) ◽

pp. F924-F929 ◽

Cited By ~ 1

Author(s):

K. Iseki ◽

S. G. Massry ◽

V. M. Campese

Keyword(s):

Blood Pressure ◽

Renal Failure ◽

Parathyroid Hormone ◽

Chronic Renal Failure ◽

Mean Arterial Pressure ◽

Primary Hyperparathyroidism ◽

Serum Calcium ◽

Induced Hypertension ◽

Calcium Infusion ◽

Permissive Role

Hypertension is common in primary hyperparathyroidism, but the mechanisms are not clear. Significant hypercalcemia induces elevation in blood pressure (BP), whereas excessive parathyroid hormone (PTH) lowers BP. However, in chronic renal failure (CRF) and secondary hyperparathyroidism, the hypercalcemia-induced hypertension is more severe. We examined the interaction between PTH and calcium on BP in normal rats and in those with CRF. Calcium caused a dose-related rise in serum calcium and a rise in mean arterial pressure (MAP). For a comparable rise in serum calcium, the increment in MAP in parathyroidectomized (PTX) rats (7 +/- 3 mmHg) was significantly lower (P less than 0.05) than in sham PTX rats (19 +/- 7.3 mmHg). In PTX rats receiving PTH, the MAP response to calcium infusion (17 +/- 2.4 mmHg) was similar to that in the sham PTX rats. The infusion of similar amounts of calcium in CRF rats caused a greater rise in serum calcium. In CRF-PTX rats, the changes in MAP during calcium infusion were significantly lower (P less than 0.05) than in CRF-sham PTX animals, despite similar rise in serum calcium. For a comparable rise in serum calcium, the rise in MAP in CRF rats was greater than in normal rats. These data suggest that the presence of PTH plays an important permissive role for the hypertensive action of the hypercalcemia.

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Population based study on serum ionised calcium, serum parathyroid hormone, and blood pressure. The Tromso study

Acta Endocrinologica ◽

10.1530/eje.0.1410350 ◽

1999 ◽

pp. 350-357 ◽

Cited By ~ 33

Author(s):

R Jorde ◽

KH Bonaa ◽

J Sundsfjord

Keyword(s):

Blood Pressure ◽

Parathyroid Hormone ◽

Diastolic Blood Pressure ◽

Positive Association ◽

Population Based ◽

Serum Parathyroid Hormone ◽

Significant Positive Association ◽

Female Population ◽

Ionised Calcium ◽

Serum Pth

OBJECTIVE: To study associations between serum ionised calcium, serum parathyroid hormone (PTH) and blood pressure. DESIGN: A population based, cross-sectional study was used.Methods: Blood pressure, body mass index, serum ionised calcium and serum PTH were measured in 460 males and 486 females in the Tromso study in 1994/1995. None were on medication for hypertension. The data were analysed with a multiple linear regression model. RESULTS: When looking at subjects with serum ionised calcium<1.39mmol/l, there was a significant negative association (P<0.01) between serum ionised calcium and PTH. There was no association between blood pressure and serum ionised calcium. In both sexes there was a significant positive association between age and serum PTH (P<0.01). For women, but not for men, there was a significant positive association between serum PTH and systolic and diastolic blood pressure (P<0.01). Within each age group there was a difference in both systolic and diastolic blood pressure of 3-10mmHg between the upper and lower serum PTH halves of the female population. Females with hypertension had significantly higher serum PTH levels than the normotensive females (P<0.01). CONCLUSION: Serum PTH is strongly and positively associated with blood pressure in women.

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Ultrasound combined with biochemical parameters can be used to differentiate parathyroid carcinoma from benign tumors in patients with primary hyperparathyroidism

Clinical Hemorheology and Microcirculation ◽

10.3233/ch-200846 ◽

2020 ◽

Vol 76 (3) ◽

pp. 351-359

Author(s):

Hui Huang ◽

Manying Li ◽

Jiamin Pan ◽

Wenjuan Tong ◽

Meiqing Cheng ◽

...

Keyword(s):

Blood Flow ◽

Parathyroid Hormone ◽

Primary Hyperparathyroidism ◽

Serum Calcium ◽

Biochemical Parameters ◽

Parathyroid Carcinoma ◽

Benign Tumors ◽

Gender Distribution ◽

Parathyroid Tumors ◽

Significant Difference

BACKGROUND: Primary hyperparathyroidism (PHPT) results from excessive secretion of parathyroid hormone from parathyroid tumors. Differentiating parathyroid tumors can be challenging before operation. OBJECTIVES: To differentiate parathyroid carcinoma from benign tumors in patients with PHPT by the application of ultrasound and biochemical parameters. METHODS: This study is a retrospective study. The study enrolled 17 patients with parathyroid carcinoma (PC) and 57 patients with parathyroid adenoma (PA), confirmed by postoperative pathology, between September 2010 and July 2017. This study retrospectively compared the ultrasonic features of the tumors included echotexture, maximum lesion diameter, shape, margin, blood flow inside the mass, intralesional calcifications, cysts in the mass, and biochemical parameters included serum calcium, phosphorus, parathyroid hormone (PTH), alkaline phosphatase (ALP) levels, gender distribution and age of patients between patients with PC and those with PA. RESULTS: In the US images, the two groups showed significant differences in heterogeneity, the appearance of a taller-than-wide shape, irregular or lobulated margins, and intralesional calcifications (p < #x003C;< #x200A;0.05). However, no significant difference was found in echogenicity, maximum lesion diameter, blood flow, and cystic components of the mass (p > #x003E;> #x200A;0.05). The mean PTH levels were significantly different between the two groups (p < #x003C;< #x200A;0.05). The PC and PA patients did not differ significantly in terms of mean serum calcium, mean serum phosphorus, and mean ALP levels (p > #x003E;> #x200A;0.05). There were significant differences to distinguish PC from PA in calcifications in mass or/and taller-than-wide shape combine with PTH > #x003E;> #x200A;1000 pg/mL (p < #x003C;< #x200A;0.05). Significant difference existed in the age between the two groups (p < #x003C;< #x200A;0.001). No significant difference existed in the gender distribution between the two groups (p > #x003E;> #x200A;0.05). CONCLUSION: Ultrasound features especially intralesional calcifications and taller-than-wide shape combine with an extremely high serum PTH (>1000 pg/mL) are helpful in differentiating between benign and parathyroid tumors in patients with PHPT.

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