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Jensen NS, Wehland M, Wise PM, Grimm D. Latest Knowledge on the Role of Vitamin D in Hypertension. Int J Mol Sci 2023; 24:ijms24054679. [PMID: 36902110 PMCID: PMC10003079 DOI: 10.3390/ijms24054679] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 02/24/2023] [Accepted: 02/26/2023] [Indexed: 03/06/2023] Open
Abstract
Hypertension is the third leading cause of the global disease burden, and while populations live longer, adopt more sedentary lifestyles, and become less economically concerned, the prevalence of hypertension is expected to increase. Pathologically elevated blood pressure (BP) is the strongest risk factor for cardiovascular disease (CVD) and related disability, thus making it imperative to treat this disease. Effective standard pharmacological treatments, i.e., diuretics, angiotensin converting enzyme (ACE) inhibitors, angiotensin receptor blocker (ARBs), beta-adrenergic receptor blockers (BARBs), and calcium channel blockers (CCBs), are available. Vitamin D (vitD) is known best for its role in bone and mineral homeostasis. Studies with vitamin D receptor (VDR) knockout mice show an increased renin-angiotensin-aldosterone system (RAAS) activity and increased hypertension, suggesting a key role for vitD as a potential antihypertensive agent. Similar studies in humans displayed ambiguous and mixed results. No direct antihypertensive effect was shown, nor a significant impact on the human RAAS. Interestingly, human studies supplementing vitD with other antihypertensive agents reported more promising results. VitD is considered a safe supplement, proposing its great potential as antihypertensive supplement. The aim of this review is to examine the current knowledge about vitD and its role in the treatment of hypertension.
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Affiliation(s)
- Niklas S. Jensen
- Department of Biomedicine, Aarhus University, Ole Worms Allé 4, 8000 Aarhus, Denmark
| | - Markus Wehland
- Department of Microgravity and Translational Regenerative Medicine, University Clinic for Plastic, Aesthetic and Hand Surgery, Otto von Guericke University, Universitätsplatz 2, 39106 Magdeburg, Germany
- Research Group “Magdeburger Arbeitsgemeinschaft für Forschung unter Raumfahrt- und Schwerelosigkeitsbedingungen” (MARS), Otto von Guericke University, 39106 Magdeburg, Germany
| | - Petra M. Wise
- The Saban Research Institute, Children’s Hospital Los Angeles, University of Southern California, 4650 Sunset Blvd, Los Angeles, CA 90027, USA
| | - Daniela Grimm
- Department of Biomedicine, Aarhus University, Ole Worms Allé 4, 8000 Aarhus, Denmark
- Department of Microgravity and Translational Regenerative Medicine, University Clinic for Plastic, Aesthetic and Hand Surgery, Otto von Guericke University, Universitätsplatz 2, 39106 Magdeburg, Germany
- Research Group “Magdeburger Arbeitsgemeinschaft für Forschung unter Raumfahrt- und Schwerelosigkeitsbedingungen” (MARS), Otto von Guericke University, 39106 Magdeburg, Germany
- Correspondence: ; Tel.: +45-21379702
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Villa-Etchegoyen C, Lombarte M, Matamoros N, Belizán JM, Cormick G. Mechanisms Involved in the Relationship between Low Calcium Intake and High Blood Pressure. Nutrients 2019; 11:E1112. [PMID: 31109099 PMCID: PMC6566648 DOI: 10.3390/nu11051112] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 05/01/2019] [Accepted: 05/16/2019] [Indexed: 01/21/2023] Open
Abstract
There is increasing epidemiologic and animal evidence that a low calcium diet increases blood pressure. The aim of this review is to compile the information on the link between low calcium intake and blood pressure. Calcium intake may regulate blood pressure by modifying intracellular calcium in vascular smooth muscle cells and by varying vascular volume through the renin-angiotensin-aldosterone system. Low calcium intake produces a rise of parathyroid gland activity. The parathyroid hormone increases intracellular calcium in vascular smooth muscles resulting in vasoconstriction. Parathyroidectomized animals did not show an increase in blood pressure when fed a low calcium diet as did sham-operated animals. Low calcium intake also increases the synthesis of calcitriol in a direct manner or mediated by parathyroid hormone (PTH). Calcitriol increases intracellular calcium in vascular smooth muscle cells. Both low calcium intake and PTH may stimulate renin release and consequently angiotensin II and aldosterone synthesis. We are willing with this review to promote discussions and contributions to achieve a better understanding of these mechanisms, and if required, the design of future studies.
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Affiliation(s)
- Cecilia Villa-Etchegoyen
- Laboratory of Cardiovascular Surveillance of Drugs, Department of Toxicology and Pharmacology, School of Medicine, Universidad de Buenos Aires, Ciudad Autonoma de Buenos Aires, Buenos Aires 1121, Argentina.
| | - Mercedes Lombarte
- Bone Biology Laboratory, School of Medicine, Rosario National University, Rosario, Santa Fe 3100, Argentina.
| | - Natalia Matamoros
- Instituto de Desarrollo e Investigaciones Pediátricas "Prof. Dr. Fernando E. Viteri" Hospital de Niños "Sor María Ludovica de La Plata (IDIP), Ministerio de Salud/Comisión de Investigacines Científicas de la Provincia de Buenos Aires, La Plata, Buenos Aires 1900, Argentina.
| | - José M Belizán
- Department of Mother and Child Health Research, Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Ciudad Autonoma de Buenos Aires, Buenos Aires 1414, Argentina.
| | - Gabriela Cormick
- Department of Mother and Child Health Research, Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Ciudad Autonoma de Buenos Aires, Buenos Aires 1414, Argentina.
- Departamento de Salud, Universidad Nacional de La Matanza, Florencio Varela, San Justo 1903, Argentina.
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Underbjerg L, Sikjaer T, Rejnmark L. Cardiovascular findings in patients with nonsurgical hypoparathyroidism and pseudohypoparathyroidism: A cohort study. Clin Endocrinol (Oxf) 2019; 90:592-600. [PMID: 30589959 DOI: 10.1111/cen.13927] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 12/20/2018] [Accepted: 12/23/2018] [Indexed: 01/27/2023]
Abstract
OBJECTIVE As only sparse data are available on indices of cardiovascular health among patients with nonsurgical hypoparathyroidism (Ns-HypoPT) and pseudohypoparathyroidism (PHP), we aimed to compare the cardiovascular profile between these groups of patients. METHODS A total of 56 patients with Ns-HypoPT and 30 with PHP were included and underwent a clinical examination including blood sampling and measurements of arterial stiffness, pulse wave velocity (PWV) and blood pressure (BP). Arterial stiffness and PWV were measured using AtCor SphygmoCor-XCEL (Atcor Medical Pty Ltd, Sydney, NSW, Australia). RESULTS Patients with Ns-HypoPT had an average age of 47 ± 17 years (68% females) and PHP patients 36 ± 13 years (80% females). Over 70% in both groups were genetically screened. Groups did not differ in terms of a history of cardiovascular disease, smoking status, use of calcium and vitamin D supplements or treatment with cholesterol-lowering or antihypertensive drugs. Compared with Ns-HypoPT, PHP patients had significantly lower levels of high-density lipoproteins (HDL) cholesterol and average glucose from HbA1c (Pboth = 0.01). PWV was significantly higher among patients with Ns-HypoPT (Pcrude = 0.02), even after adjustment for mean arterial pressure, body mass index, age and gender (Padjusted < 0.01). Heart rate was significantly higher in Ns-HypoPT compared with PHP (P = 0.03). Office BP and 24-hour ambulatory BP did not differ between groups (P > 0.05). CONCLUSION Patients with Ns-HypoPT have compared with PHP a higher arterial stiffness and heart rate. This has been associated with an increased risk of cardiovascular disease. Our data suggest that resistance to PTH is present in the cardiovascular system in PHP.
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Affiliation(s)
- Line Underbjerg
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Tanja Sikjaer
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Lars Rejnmark
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark
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DeCarlo KE, Agrawal N. Double hit! A unique case of resistant hypertension. BMJ Case Rep 2017; 2017:bcr-2017-221530. [PMID: 29275380 DOI: 10.1136/bcr-2017-221530] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A middle-aged woman with obesity, hyperlipidaemia and diet-controlled diabetes was referred for resistant hypertension. Her blood pressure (BP) was uncontrolled on five medications, including a diuretic. Physical exam revealed a systolic ejection murmur, and ECHO demonstrated moderate hypertrophy. Laboratory examination revealed elevated aldosterone level (20.7 ng/dL) and elevated aldosterone:renin ratio (41.4 (ng/dL)/(ng/mL/h)), meeting criteria for primary aldosteronism (PA), and confirmed by saline infusion testing. CT scan of the adrenals was non-localising. Adrenal venous sampling confirmed bilateral idiopathic adrenal hyperplasia. Concurrent primary hyperparathyroidism was demonstrated by elevated calcium and parathyroid hormone levels and localised by sestamibi scan. Idiopathic adrenal hyperplasia was treated medically with spironolactone. Her BP remained elevated until postparathyroidectomy. Evidence shows that a hyperfunctioning parathyroid gland may contribute to maintaining hyperaldosteronism in PA making this bidirectional link unique. The significance of this case is in the potential for further understanding of the pathophysiology of common causes of secondary hypertension.
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Affiliation(s)
- Kristen Elizabeth DeCarlo
- Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Nidhi Agrawal
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, NYU School of Medicine, New York City, New York, USA
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Wetzel J, Pilz S, Grübler MR, Fahrleitner-Pammer A, Dimai HP, von Lewinski D, Kolesnik E, Perl S, Trummer C, Schwetz V, Meinitzer A, Belyavskiy E, Völkl J, Catena C, Brandenburg V, März W, Pieske B, Brussee H, Tomaschitz A, Verheyen ND. Plasma parathyroid hormone and cardiovascular disease in treatment-naive patients with primary hyperparathyroidism: The EPATH trial. J Clin Hypertens (Greenwich) 2017; 19:1173-1180. [DOI: 10.1111/jch.13064] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 06/01/2017] [Accepted: 06/04/2017] [Indexed: 12/19/2022]
Affiliation(s)
- Julia Wetzel
- Department of Anesthesiology; University Hospital of the RWTH Aachen; Aachen Germany
| | - Stefan Pilz
- Department of Internal Medicine; Division of Endocrinology and Diabetology; Medical University of Graz; Graz Austria
- Department of Epidemiology and Biostatistics; EMGO Institute for Health and Care Research; VU University Medical Centre; Amsterdam The Netherlands
| | - Martin R. Grübler
- Swiss Cardiovascular Center Bern; Department of Cardiology; Bern University Hospital; Bern Switzerland
| | - Astrid Fahrleitner-Pammer
- Department of Internal Medicine; Division of Endocrinology and Diabetology; Medical University of Graz; Graz Austria
| | - Hans P. Dimai
- Department of Internal Medicine; Division of Endocrinology and Diabetology; Medical University of Graz; Graz Austria
| | | | - Ewald Kolesnik
- Department of Cardiology; Medical University Graz; Graz Austria
| | - Sabine Perl
- Department of Cardiology; Medical University Graz; Graz Austria
| | - Christian Trummer
- Department of Internal Medicine; Division of Endocrinology and Diabetology; Medical University of Graz; Graz Austria
| | - Verena Schwetz
- Department of Internal Medicine; Division of Endocrinology and Diabetology; Medical University of Graz; Graz Austria
| | - Andreas Meinitzer
- Clinical Institute of Medical and Chemical Laboratory Diagnostics; Medical University of Graz; Graz Austria
| | - Evgeny Belyavskiy
- Department of Cardiology; Campus Virchow; Charité University; Berlin Germany
| | - Jakob Völkl
- Department of Cardiology; Campus Virchow; Charité University; Berlin Germany
| | - Cristiana Catena
- Hypertension Unit; Internal Medicine; Department of Experimental and Clinical Medical Sciences; University of Udine; Udine Italy
| | - Vincent Brandenburg
- Department of Cardiology; University Hospital of the RWTH Aachen; Aachen Germany
| | - Winfried März
- Clinical Institute of Medical and Chemical Laboratory Diagnostics; Medical University of Graz; Graz Austria
- Synlab Academy; Synlab Services GmbH; Mannheim Germany
- Medical Clinic V (Nephrology, Hypertensiology, Endocrinology, Diabetolgy, and Rheumatology); Mannheim Medical Faculty; University of Heidelberg; Mannheim Germany
| | - Burkert Pieske
- Department of Cardiology; Medical University Graz; Graz Austria
- Department of Cardiology; Campus Virchow; Charité University; Berlin Germany
| | - Helmut Brussee
- Department of Cardiology; Medical University Graz; Graz Austria
| | - Andreas Tomaschitz
- Medical Clinic V (Nephrology, Hypertensiology, Endocrinology, Diabetolgy, and Rheumatology); Mannheim Medical Faculty; University of Heidelberg; Mannheim Germany
- Bad Gleichenberg Clinic; Bad Gleichenberg Austria
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Zaheer S, Brown JM, Connors M, Williams JS, Adler GK, Vaidya A. Angiotensin-Converting Enzyme Inhibition and Parathyroid Hormone Secretion. Int J Endocrinol 2017; 2017:4138783. [PMID: 28808443 PMCID: PMC5541811 DOI: 10.1155/2017/4138783] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 05/31/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Prior studies suggest that renin-angiotensin-aldosterone system (RAAS) inhibitors decrease parathyroid hormone (PTH) secretion. OBJECTIVE To evaluate the effect of angiotensin-converting enzyme inhibitors (ACEi) on serum PTH in participants with and without primary hyperparathyroidism (P-HPT). METHODS An open-label, single-arm, pilot study whereby participants with and without P-HPT had PTH were evaluated before and after 1 week of maximally tolerated lisinopril therapy. RESULTS A total of 12 participants with, and 15 participants without, P-HPT successfully completed the protocol. Following 1 week of lisinopril, participants with P-HPT had a decrease in systolic blood pressure (SBP) (-6.4 mmHg, P < 0.01), an increase in plasma renin activity (PRA) (+1.50 ng/mL/h, P = 0.06), and a decrease in PTH (79.5 (21.6) to 70.9 (19.6) pg/mL, ∆ = -8.6 pg/mL, P = 0.049); however, serum and urine calcium did not change. In contrast, although 1 week of lisinopril significantly decreased SBP and increased PRA among participants without P-HPT, there were no changes in PTH or calcium. CONCLUSION In this short pilot investigation, 1 week of maximally titrated ACEi did not impact PTH in participants without P-HPT, but resulted in a modest and marginally significant reduction of PTH but not calcium, among participants with P-HPT. This trial is registered with ClinicalTrials.gov NCT01691781.
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Affiliation(s)
- Sarah Zaheer
- Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- *Sarah Zaheer: and
| | - Jenifer M. Brown
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Molly Connors
- Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jonathan S. Williams
- Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Gail K. Adler
- Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Anand Vaidya
- Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- *Anand Vaidya:
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7
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Effect of eplerenone on parathyroid hormone levels in patients with primary hyperparathyroidism. J Hypertens 2016; 34:1347-56. [DOI: 10.1097/hjh.0000000000000927] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Abstract
Primary aldosteronism (PA) is the most frequent cause of secondary arterial hypertension. Beyond its effects on intravascular volume and blood pressure, PA causes metabolic alterations and a higher cardiovascular morbidity, which is reduced by PA-directed therapy. Experimental studies demonstrated that mineralocorticoid excess may also influence mineral homeostasis. A role in cardiovascular disease has also been attributed to parathyroid hormone (PTH). Increasing evidence supports a bidirectional interaction between aldosterone and PTH.Primary hyperparathyroidism is associated with arterial hypertension and an increased cardiovascular morbidity and mortality, which might be associated to higher aldosterone values; parathyreoidectomy results in lowered aldosterone and blood pressure levels. PA leads to secondary hyperparathyroidism, which is reversible by PA-directed therapy. A lower bone mineral density and a higher fracture rate were also shown to be reversible by PA-directed therapy. There is a suspicion of a bidirectional interaction between aldosterone and PTH, which might lead to a higher cardiovascular risk. There are more and more reports about coincident PA and primary hyperparathyroidism. From a pathophysiologic point of view this constellation is best characterized as tertiary hyperparathyroidism. Future aspects should further clarify the extent of these endocrine interactions and analyze the influence of this interplay on cardiovascular morbidity and mortality and bone health.
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Affiliation(s)
- E Asbach
- Medizinische Klinik und Poliklinik IV, Klinikum der Ludwig-Maximilians-Universität München, München, Germany
| | - M Bekeran
- Medizinische Klinik und Poliklinik IV, Klinikum der Ludwig-Maximilians-Universität München, München, Germany
| | - M Reincke
- Medizinische Klinik und Poliklinik IV, Klinikum der Ludwig-Maximilians-Universität München, München, Germany
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Verheyen ND, Kienreich K, Gaksch M, van Ballegooijen AJ, Grübler MR, Hartaigh BÓ, Schmid J, Fahrleitner-Pammer A, Kraigher-Krainer E, Colantonio C, Belyavskiy E, Treiber G, Catena C, Brussee H, Pieske B, März W, Tomaschitz A, Pilz S. Plasma Parathyroid Hormone Is Independently Related to Nocturnal Blood Pressure in Hypertensive Patients: The Styrian Hypertension Study. J Clin Hypertens (Greenwich) 2015; 18:543-50. [DOI: 10.1111/jch.12710] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Revised: 08/12/2015] [Accepted: 08/16/2015] [Indexed: 12/21/2022]
Affiliation(s)
| | - Katharina Kienreich
- Department of Internal Medicine; Division of Endocrinology and Metabolism; Medical University of Graz; Graz Austria
| | - Martin Gaksch
- Department of Internal Medicine; Division of Endocrinology and Metabolism; Medical University of Graz; Graz Austria
| | | | - Martin R. Grübler
- Department of Internal Medicine; Division of Endocrinology and Metabolism; Medical University of Graz; Graz Austria
| | - Briain Ó. Hartaigh
- Department of Radiology; Dalio Institute of Cardiovascular Imaging; NewYork-Presbyterian Hospital and the Weill Cornell Medical College; New York NY
- Department of Internal Medicine; Section of Geriatrics; Yale School of Medicine; Adler Geriatric Center; New Haven CT
| | - Johannes Schmid
- Department of Cardiology; Medical University of Graz; Graz Austria
| | - Astrid Fahrleitner-Pammer
- Department of Internal Medicine; Division of Endocrinology and Metabolism; Medical University of Graz; Graz Austria
| | - Elisabeth Kraigher-Krainer
- Medizinische Klinik mit Schwerpunkt Kardiologie; Campus Virchow-Klinikum; Charité-Universitaetsmedizin Berlin; Berlin Germany
| | | | - Evgeny Belyavskiy
- Medizinische Klinik mit Schwerpunkt Kardiologie; Campus Virchow-Klinikum; Charité-Universitaetsmedizin Berlin; Berlin Germany
| | - Gerlies Treiber
- Department of Internal Medicine; Division of Endocrinology and Metabolism; Medical University of Graz; Graz Austria
| | - Cristiana Catena
- Clinical Institute of Medical and Chemical Laboratory Diagnostics; Medical University of Graz; Graz Austria
| | - Helmut Brussee
- Department of Cardiology; Medical University of Graz; Graz Austria
| | - Burkert Pieske
- Department of Cardiology; Medical University of Graz; Graz Austria
- Medizinische Klinik mit Schwerpunkt Kardiologie; Campus Virchow-Klinikum; Charité-Universitaetsmedizin Berlin; Berlin Germany
| | - Winfried März
- Hypertension Unit; Internal Medicine; Department of Experimental and Clinical Medical Sciences; University of Udine; Udine Italy
- Synlab Academy; Synlab Services LLC; Mannheim Germany
- Medical Clinic V (Nephrology, Hypertensiology, Endocrinology); Medical Faculty Mannheim; Ruperto Carola University Heidelberg; Mannheim Germany
| | - Andreas Tomaschitz
- Department of Cardiology; Medical University of Graz; Graz Austria
- Medizinische Klinik mit Schwerpunkt Kardiologie; Campus Virchow-Klinikum; Charité-Universitaetsmedizin Berlin; Berlin Germany
- Specialist Clinic for Rehabilitation; PV Bad Aussee; Bad Aussee Austria
| | - Stefan Pilz
- Department of Internal Medicine; Division of Endocrinology and Metabolism; Medical University of Graz; Graz Austria
- Department of Epidemiology and Biostatistics; EMGO Institute for Health and Care Research; VU University Medical Centre; Amsterdam the Netherlands
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Vaidya A, Curhan GC, Paik JM, Kronenberg H, Taylor EN. Hypertension, Antihypertensive Medications, and Risk of Incident Primary Hyperparathyroidism. J Clin Endocrinol Metab 2015; 100:2396-404. [PMID: 25885946 PMCID: PMC4454810 DOI: 10.1210/jc.2015-1619] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
CONTEXT Hypertension is associated with higher PTH levels, and specific antihypertensive medications may modulate PTH. Whether hypertension or the use of specific antihypertensive medications influences the risk of developing incident primary hyperparathyroidism (P-HPTH) is not known. OBJECTIVE The purpose of this study was to investigate whether a history of hypertension and the use of specific antihypertensive medications determine the risk for developing P-HPTH in a large prospective study. DESIGN/PARTICIPANTS A longitudinal prospective cohort of female nurses in the Nurses' Health Study I (n = 75 600), who did not have P-HPTH at baseline and completed a questionnaire assessment of lifetime history of P-HPTH were followed from 1986 to 2008. Most participants were white and postmenopausal. SETTING The study was a nationwide cohort study. MAIN OUTCOME MEASURE Incident P-HPTH was assessed initially via questionnaire and then was confirmed by medical record review. Cox proportional hazards models were used to adjust for potential confounders. RESULTS We documented 347 incident cases of P-HPTH during 1 719 416 person-years of follow-up. The age-adjusted relative risk (RR) for incident P-HPTH associated with hypertension was 1.80 (95% confidence interval [CI], 1.43-2.26), and the multivariate-adjusted RR was 1.45 (95% CI, 1.10-1.91). Among participants with a history of hypertension, the use of furosemide, when compared with the use of other antihypertensive medications, was associated with increased risk for developing P-HPTH; age-adjusted RR for incident P-HPTH was 1.79 (95% CI, 1.15-2.79) and multivariate-adjusted RR was 1.71 (95% CI, 1.08-2.71). CONCLUSIONS In a large longitudinal prospective cohort study of mostly older white women, a history of hypertension and use of furosemide were associated with a significantly higher risk of developing P-HPTH.
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Affiliation(s)
- Anand Vaidya
- Division of Endocrinology, Diabetes, and Hypertension (A.V.), Division of Renal Medicine (G.C.C., J.M.P.), Channing Division of Network Medicine (G.C.C., J.M.P., E.N.T.), Brigham and Women's Hospital (A.V., G.C.C., J.M.P., E.N.T.), and Endocrine Unit (H.K.), Massachusetts General Hospital, Harvard Medical School (A.V., G.C.C., J.M.P., H.K.), Boston, Massachusetts 02115; and Division of Nephrology and Transplantation (E.N.T.), Maine Medical Center, Portland, Maine 04102
| | - Gary C Curhan
- Division of Endocrinology, Diabetes, and Hypertension (A.V.), Division of Renal Medicine (G.C.C., J.M.P.), Channing Division of Network Medicine (G.C.C., J.M.P., E.N.T.), Brigham and Women's Hospital (A.V., G.C.C., J.M.P., E.N.T.), and Endocrine Unit (H.K.), Massachusetts General Hospital, Harvard Medical School (A.V., G.C.C., J.M.P., H.K.), Boston, Massachusetts 02115; and Division of Nephrology and Transplantation (E.N.T.), Maine Medical Center, Portland, Maine 04102
| | - Julie M Paik
- Division of Endocrinology, Diabetes, and Hypertension (A.V.), Division of Renal Medicine (G.C.C., J.M.P.), Channing Division of Network Medicine (G.C.C., J.M.P., E.N.T.), Brigham and Women's Hospital (A.V., G.C.C., J.M.P., E.N.T.), and Endocrine Unit (H.K.), Massachusetts General Hospital, Harvard Medical School (A.V., G.C.C., J.M.P., H.K.), Boston, Massachusetts 02115; and Division of Nephrology and Transplantation (E.N.T.), Maine Medical Center, Portland, Maine 04102
| | - Henry Kronenberg
- Division of Endocrinology, Diabetes, and Hypertension (A.V.), Division of Renal Medicine (G.C.C., J.M.P.), Channing Division of Network Medicine (G.C.C., J.M.P., E.N.T.), Brigham and Women's Hospital (A.V., G.C.C., J.M.P., E.N.T.), and Endocrine Unit (H.K.), Massachusetts General Hospital, Harvard Medical School (A.V., G.C.C., J.M.P., H.K.), Boston, Massachusetts 02115; and Division of Nephrology and Transplantation (E.N.T.), Maine Medical Center, Portland, Maine 04102
| | - Eric N Taylor
- Division of Endocrinology, Diabetes, and Hypertension (A.V.), Division of Renal Medicine (G.C.C., J.M.P.), Channing Division of Network Medicine (G.C.C., J.M.P., E.N.T.), Brigham and Women's Hospital (A.V., G.C.C., J.M.P., E.N.T.), and Endocrine Unit (H.K.), Massachusetts General Hospital, Harvard Medical School (A.V., G.C.C., J.M.P., H.K.), Boston, Massachusetts 02115; and Division of Nephrology and Transplantation (E.N.T.), Maine Medical Center, Portland, Maine 04102
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12
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Mateus-Hamdan L, Beauchet O, Rolland Y, Schott AM, Annweiler C. Association of calcium concentration with pulse pressure in older women: data from a large population-based multicentric study. J Nutr Health Aging 2014; 18:323-9. [PMID: 24626762 DOI: 10.1007/s12603-013-0412-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE High arterial pulse pressure is a predictor of cardiovascular morbimortality. Mineral metabolism has been associated with blood pressure regulation. Our objective was to determine which variable among serum calcium, parathyroid hormone and 25-hydroxyvitamin D concentrations, was associated with pulse pressure among older adults. DESIGN Cross-sectional study corresponding to the baseline assessment of the EPIDOS study. SETTING Five French cities including Amiens, Lyon, Montpellier, Paris and Toulouse. PARTICIPANTS Randomized sample of 610 community-dwelling older women (mean age 80.2±3.5years) using no antihypertensive drugs. MEASUREMENTS Serum calcium, parathyroid hormone and 25-hydroxyvitamin D concentrations; supine pulse pressure after 15 minutes of rest (hypertension defined as pulse pressure >50mmHg). Age, body mass index, the number of morbidities and of drugs daily taken, diabetes mellitus, dysthyroidy, the use of estrogenic drugs, smoking, alcohol consumption, practice of a regular physical activity, creatinine clearance, and the effects of season and study centers were used as potential confounders. RESULTS Hypertensive participants (n=539) had higher calcium concentrations than normotensive ones (94.33±4.12mg/L versus 93.28±3.36mg/L respectively, P=0.040). There were no between-group differences for serum parathyroid hormone and 25-hydroxyvitamin D concentrations. The multiple logistic regressions examining the serum calcium, parathyroid hormone and 25-hydroxyvitamin D concentrations as predictors of hypertension found an association only with calcium (adjusted odds ratio=1.19, P=0.015), but not with parathyroid hormone (adjusted OR=1.01, P=0.349) or 25-hydroxyvitamin D concentration (adjusted OR=0.99, P=0.971). CONCLUSION Increased serum calcium concentration was independently and positively associated with high pulse pressure in our study, possibly due to increased arterial stiffness. Interventions aimed at normalizing calcaemia may be attractive to prevent hypertension and cardiovascular risk in older adults.
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Affiliation(s)
- L Mateus-Hamdan
- C. Annweiler, MD, PhD, Department of Neuroscience, Division of Geriatric Medicine, Angers University Hospital, 49933 Angers Cedex 9, France; E-mail: ; Phone: ++33 2 41 35 54 86; Fax: ++33 2 41 35 48 94
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van Ballegooijen AJ, Kestenbaum B, Sachs MC, de Boer IH, Siscovick DS, Hoofnagle AN, Ix JH, Visser M, Brouwer IA. Association of 25-hydroxyvitamin D and parathyroid hormone with incident hypertension: MESA (Multi-Ethnic Study of Atherosclerosis). J Am Coll Cardiol 2014; 63:1214-1222. [PMID: 24480627 DOI: 10.1016/j.jacc.2014.01.012] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Revised: 12/28/2013] [Accepted: 01/06/2014] [Indexed: 01/19/2023]
Abstract
OBJECTIVES This study investigated whether lower 25-hydroxyvitamin D and higher parathyroid hormone concentrations are associated with incident hypertension. BACKGROUND Disturbances in vitamin D metabolism are plausibly related to hypertension. METHODS MESA (Multi-Ethnic Study of Atherosclerosis) is a community-based, prospective cohort with baseline measurements obtained between 2000 and 2002. We studied 3,002 men and women free of prevalent cardiovascular disease and hypertension, age 45 to 84 years at baseline. Serum 25-hydroxyvitamin D and intact parathyroid hormone were measured from previously frozen baseline samples using liquid chromatography-mass spectroscopy and a 2-site immunoassay, respectively. We used a complementary log-log model with interval censoring to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for 25-hydroxyvitamin D and parathyroid hormone concentrations with incident hypertension through 2010. RESULTS During a median follow-up of 9.0 years, 41% of the cohort (n = 1,229) developed hypertension. Mean serum 25-hydroxyvitamin D was 26.3 ± 11.2 ng/ml and mean parathyroid hormone was 41.2 ± 17.3 pg/ml. Compared with 25-hydroxyvitamin D ≥30 ng/ml, 25-hydroxyvitamin D <20 ng/ml was associated with a greater hypertension risk (HR: 1.28 [95% CI: 1.09 to 1.50]), although the association was attenuated and not statistically significant after adjusting for potential confounders (HR: 1.13 [95% CI: 0.96 to 1.33]). Compared with parathyroid hormone <33 pg/ml, parathyroid hormone ≥65 pg/ml was associated with a significantly greater risk of hypertension (HR: 1.27 [95% CI: 1.01 to 1.59]) after adjusting for potential confounders. CONCLUSIONS Lower 25-hydroxyvitamin D concentrations were not associated with a greater risk of incident hypertension. Higher serum parathyroid hormone concentrations showed a significant, but statistically marginal, relationship to the development of hypertension. These findings will require further confirmation. (Multi-Ethnic Study of Atherosclerosis; NCT00005487).
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Affiliation(s)
- Adriana J van Ballegooijen
- Department of Health Sciences and the EMGO Institute, VU University Amsterdam, Amsterdam, the Netherlands.
| | - Bryan Kestenbaum
- Kidney Research Institute, Division of Nephrology, University of Washington, Seattle, Washington
| | - Michael C Sachs
- Kidney Research Institute, Division of Nephrology, University of Washington, Seattle, Washington
| | - Ian H de Boer
- Kidney Research Institute, Division of Nephrology, University of Washington, Seattle, Washington
| | - David S Siscovick
- Departments of Medicine and Epidemiology, Cardiovascular Health Research Unit, University of Washington, Seattle, Washington
| | - Andrew N Hoofnagle
- Department of Laboratory Medicine and Medicine, University of Washington, Seattle, Washington
| | - Joachim H Ix
- Department of Medicine, University of California San Diego, and the Nephrology Section, Veterans Affairs San Diego Healthcare System, San Diego, California
| | - Marjolein Visser
- Department of Health Sciences and the EMGO Institute, VU University Amsterdam, Amsterdam, the Netherlands
| | - Ingeborg A Brouwer
- Department of Health Sciences and the EMGO Institute, VU University Amsterdam, Amsterdam, the Netherlands
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Tomaschitz A, Ritz E, Pieske B, Rus-Machan J, Kienreich K, Verheyen N, Gaksch M, Grübler M, Fahrleitner-Pammer A, Mrak P, Toplak H, Kraigher-Krainer E, März W, Pilz S. Aldosterone and parathyroid hormone interactions as mediators of metabolic and cardiovascular disease. Metabolism 2014; 63:20-31. [PMID: 24095631 DOI: 10.1016/j.metabol.2013.08.016] [Citation(s) in RCA: 116] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2013] [Revised: 08/26/2013] [Accepted: 08/28/2013] [Indexed: 01/09/2023]
Abstract
Inappropriate aldosterone and parathyroid hormone (PTH) secretion is strongly linked with development and progression of cardiovascular (CV) disease. Accumulating evidence suggests a bidirectional interplay between parathyroid hormone and aldosterone. This interaction may lead to a disproportionally increased risk of CV damage, metabolic and bone diseases. This review focuses on mechanisms underlying the mutual interplay between aldosterone and PTH as well as their potential impact on CV, metabolic and bone health. PTH stimulates aldosterone secretion by increasing the calcium concentration in the cells of the adrenal zona glomerulosa as a result of binding to the PTH/PTH-rP receptor and indirectly by potentiating angiotensin 2 induced effects. This may explain why after parathyroidectomy lower aldosterone levels are seen in parallel with improved cardiovascular outcomes. Aldosterone mediated effects are inappropriately pronounced in conditions such as chronic heart failure, excess dietary salt intake (relative aldosterone excess) and primary aldosteronism. PTH is increased as a result of (1) the MR (mineralocorticoid receptor) mediated calciuretic and magnesiuretic effects with a trend of hypocalcemia and hypomagnesemia; the resulting secondary hyperparathyroidism causes myocardial fibrosis and disturbed bone metabolism; and (2) direct effects of aldosterone on parathyroid cells via binding to the MR. This adverse sequence is interrupted by mineralocorticoid receptor blockade and adrenalectomy. Hyperaldosteronism due to klotho deficiency results in vascular calcification, which can be mitigated by spironolactone treatment. In view of the documented reciprocal interaction between aldosterone and PTH as well as the potentially ensuing target organ damage, studies are needed to evaluate diagnostic and therapeutic strategies to address this increasingly recognized pathophysiological phenomenon.
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Affiliation(s)
- Andreas Tomaschitz
- Department of Cardiology, Medical University of Graz, Graz, Austria; Specialist Clinic for Rehabilitation PV Bad Aussee, Bad Aussee, Austria.
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15
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Kim H, Chung YE, Jung SC, Im H, Yang SY, Kim DY, Jeong E, Kim B, Park SK. Independent associations of circulating 25-hydroxyvitamin D and parathyroid hormone concentrations with blood pressure among Koreans: The Korea National Health and Nutrition Examination Survey (KNHANES), 2009-2010. Calcif Tissue Int 2013; 93:549-55. [PMID: 24114552 DOI: 10.1007/s00223-013-9789-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Accepted: 08/19/2013] [Indexed: 10/26/2022]
Abstract
Although lower vitamin D and higher parathyroid hormone (PTH) concentrations have been associated with hypertension, their independent contribution to blood pressure (BP) is unclear. The independent associations of serum 25-hydroxyvitamin D (25[OH]D) and PTH levels with BP were therefore investigated. This is a population-based cross-sectional study from the Korea National Health and Nutrition Examination Surveys, which includes a total of 4,513 participants (2,019 men and 2,494 women) aged ≥ 50 years. 25(OH)D and PTH were measured by radioimmunoassays, and BP was determined with a sphygmomanometer. Hypertensive subjects had significantly lower 25(OH)D (p = 0.023) and significantly higher PTH (p < 0.001) concentrations than normotensives. In subjects not taking antihypertensive medications, 25(OH)D showed reverse correlations with systolic and diastolic BP, both in men (p = 0.038-0.061 and p = 0.011-0.038, respectively) and in women (p = 0.006-0.018 and p = 0.001-0.011, respectively), while serum PTH concentrations showed positive correlations with systolic and diastolic BP in men (p = 0.001-0.014 and p < 0.001, respectively) and women (p < 0.001-0.008 and p = 0.001-0.040, respectively). When 25(OH)D and PTH were included in the same model, both remained independently associated with BP in men and women. In conclusion, both lower 25(OH)D and higher PTH may be independent factors for the development of hypertension.
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Affiliation(s)
- Hyeonmok Kim
- Department of Internal Medicine, Veterans Health Service Medical Center, 53 Jinhwangdo-ro 61-Gil, Gangdong-gu, Seoul, Korea
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16
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Helvacı A, Copur B, Adaş M. Correlation between Left Ventricular Mass Index and Calcium Metabolism in Patients with Essential Hypertension. Balkan Med J 2013; 30:85-9. [PMID: 25207075 DOI: 10.5152/balkanmedj.2012.097] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Accepted: 10/01/2012] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE To determine the correlation between left ventricular mass index and calcium metabolism in patients with essential hypertension. STUDY DESIGN Cross sectional case-control study. MATERIAL AND METHODS Twenty-seven patients with essential hypertension and 20 healthy individuals were compared with respect to calciotropic hormones, left ventricular mass index (LVMI), and urinary and serum biochemical parameters. The correlations between parathormone, vitamin D, and calcitonin levels and LVMI and blood pressure elevation were determined. RESULTS The parathormone level was significantly higher (p=0.006) and vitamin D level was significantly lower (p=0.01) in the patient group compared with the control group. However, the two groups were similar in terms of albumin-corrected calcium levels, which were within the normal range (p=0.988). The serum sodium (p=0.014) and urinary calcium (p=0.003) levels and LVMI (p<0.01) were also significantly higher in the patient group. No significant correlations were determined between ambulatory blood pressure and parathormone and vitamin D levels, but a significant correlation was found between LVMI and parathormone level (p=0.06) in hypertensive patients. CONCLUSION Essential hypertension alters calcium metabolism, causing calciuresis by hypernatremia. Parathormone release increases to compensate for this, and leads to protein synthesis, which in turn provokes the development of myocardial hypertrophy.
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Affiliation(s)
- Ayşen Helvacı
- Clinic of 2 Internal Medicine, Okmeydanı Training and Research Hospital, İstanbul, Turkey
| | - Besime Copur
- Clinic of 2 Internal Medicine, Okmeydanı Training and Research Hospital, İstanbul, Turkey
| | - Mine Adaş
- Clinic of 2 Internal Medicine, Okmeydanı Training and Research Hospital, İstanbul, Turkey
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Fisher A, Srikusalanukul W, Davis M, Smith P. Cardiovascular diseases in older patients with osteoporotic hip fracture: prevalence, disturbances in mineral and bone metabolism, and bidirectional links. Clin Interv Aging 2013; 8:239-56. [PMID: 23460043 PMCID: PMC3585505 DOI: 10.2147/cia.s38856] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Considerable controversy exists regarding the contribution of mineral/bone metabolism abnormalities to the association between cardiovascular diseases (CVDs) and osteoporotic fractures. AIMS AND METHODS To determine the relationships between mineral/bone metabolism biomarkers and CVD in 746 older patients with hip fracture, clinical data were recorded and serum concentrations of parathyroid hormone (PTH), 25-hydroxyvitamin D, calcium, phosphate, magnesium, troponin I, parameters of bone turnover, and renal, liver, and thyroid functions were measured. RESULTS CVDs were diagnosed in 472 (63.3%) patients. Vitamin D deficiency was similarly prevalent in patients with (78.0%) and without (82.1%) CVD. The CVD group had significantly higher mean PTH concentrations (7.6 vs 6.0 pmol/L, P < 0.001), a higher prevalence of secondary hyperparathyroidism (SPTH) (PTH > 6.8 pmol/L, 43.0% vs 23.3%, P < 0.001), and excess bone resorption (urinary deoxypyridinoline corrected by creatinine [DPD/Cr] > 7.5 nmol/μmol, 87.9% vs 74.8%, P < 0.001). In multivariate regression analysis, SHPT (odds ratio [OR] 2.6, P = 0.007) and high DPD/Cr (OR 2.8, P = 0.016) were independent indictors of CVD. Compared to those with both PTH and DPD/Cr in the normal range, multivariate-adjusted ORs for the presence of CVD were 17.3 (P = 0.004) in subjects with SHPT and 9.7 (P < 0.001) in patients with high DPD/Cr. CVD was an independent predicator of SHPT (OR 2.8, P = 0.007) and excess DPD/Cr (OR 2.5, P = 0.031). CVD was predictive of postoperative myocardial injury, while SHPT was also an independent predictor of prolonged hospital stay and in-hospital death. CONCLUSION SHPT and excess bone resorption are independent pathophysiological mediators underlying the bidirectional associations between CVD and hip fracture, and therefore are important diagnostic and therapeutic targets.
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Affiliation(s)
- A Fisher
- Department of Geriatric Medicine, The Canberra Hospital, Canberra, ACT, Australia.
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Chartsrisak K, Vipattawat K, Assanatham M, Nongnuch A, Ingsathit A, Domrongkitchaiporn S, Sumethkul V, Distha-Banchong S. Mineral metabolism and outcomes in chronic kidney disease stage 2-4 patients. BMC Nephrol 2013; 14:14. [PMID: 23324569 PMCID: PMC3551685 DOI: 10.1186/1471-2369-14-14] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Accepted: 01/08/2013] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Marked hyperphosphatemia, hyperparathyroidism and 25-hydroxyvitamin D deficiency are associated with mortality in dialysis patients. Such data in chronic kidney disease stage 2-4 population are limited. It has been suggested that high-normal serum phosphate predicts worse renal and patient outcomes. The data regarding parathyroid hormone and outcomes in this population is limited. The present study examined mineral metabolism and its association with the development of end-stage renal disease and mortality in stage 2-4 chronic kidney disease patients. METHODS This is a prospective cohort study that included 466 non-dialysis chronic kidney disease stage 2-4 patients. Mineral parameters were obtained at the time of enrollment and the patients were followed prospectively for 25 (1-44) months or until they reached the endpoints of end-stage renal disease or mortality. RESULTS Hyperparathyroidism and 25-hydroxyvitamin D deficiency began to occur in the early stages of chronic kidney disease, whereas significant hyperphosphatemia only developed in the later stages. High-normal and mildly elevated serum phosphate (>4.2 mg/dL) predicted the composite outcome of end-stage renal disease or mortality after adjustments for cardiovascular risk factors, chronic kidney disease stage and other mineral parameters. Parathyroid hormone levels above the upper limit of normal (>65 pg/mL) predicted the future development of end-stage renal disease and the composite outcome of end-stage renal disease or mortality after adjustments. 25-hydroxyvitamin D deficiency (<15 ng/mL) was also associated with worse outcomes. CONCLUSIONS In chronic kidney disease, hyperparathyroidism developed prior to significant hyperphosphatemia confirming the presence phosphate retention early in the course of chronic kidney disease. High-normal serum phosphate and mildly elevated parathyroid hormone levels predicted worse renal and patient outcomes. This data emphasizes the need for early intervention in the care of chronic kidney disease stage 2-4 patients.
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Affiliation(s)
- Kamonwan Chartsrisak
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand
| | - Kotcharat Vipattawat
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand
| | - Montira Assanatham
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand
| | - Arkom Nongnuch
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand
| | - Atiporn Ingsathit
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand
| | - Somnuek Domrongkitchaiporn
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand
| | - Vasant Sumethkul
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand
| | - Sinee Distha-Banchong
- Division of Nephrology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand
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Finch NC, Syme HM, Elliott J. Parathyroid hormone concentration in geriatric cats with various degrees of renal function. J Am Vet Med Assoc 2012; 241:1326-35. [DOI: 10.2460/javma.241.10.1326] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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20
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Tomaschitz A, Fahrleitner-Pammer A, Pieske B, Verheyen N, Amrein K, Ritz E, Kienreich K, Horina JH, Schmidt A, Kraigher-Krainer E, Colantonio C, Meinitzer A, Pilz S. Effect of eplerenone on parathyroid hormone levels in patients with primary hyperparathyroidism: a randomized, double-blind, placebo-controlled trial. BMC Endocr Disord 2012; 12:19. [PMID: 22974443 PMCID: PMC3515510 DOI: 10.1186/1472-6823-12-19] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2012] [Accepted: 08/31/2012] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Increasing evidence suggests the bidirectional interplay between parathyroid hormone and aldosterone as an important mechanism behind the increased risk of cardiovascular damage and bone disease observed in primary hyperparathyroidism. Our primary object is to assess the efficacy of the mineralocorticoid receptor-blocker eplerenone to reduce parathyroid hormone secretion in patients with parathyroid hormone excess. METHODS/DESIGN Overall, 110 adult male and female patients with primary hyperparathyroidism will be randomly assigned to eplerenone (25 mg once daily for 4 weeks and 4 weeks with 50 mg once daily after dose titration] or placebo, over eight weeks. Each participant will undergo detailed clinical assessment, including anthropometric evaluation, 24-h ambulatory arterial blood pressure monitoring, echocardiography, kidney function and detailed laboratory determination of biomarkers of bone metabolism and cardiovascular disease.The study comprises the following exploratory endpoints: mean change from baseline to week eight in (1) parathyroid hormone(1-84) as the primary endpoint and (2) 24-h systolic and diastolic ambulatory blood pressure levels, NT-pro-BNP, biomarkers of bone metabolism, 24-h urinary protein/albumin excretion and echocardiographic parameters reflecting systolic and diastolic function as well as cardiac dimensions, as secondary endpoints. DISCUSSION In view of the reciprocal interaction between aldosterone and parathyroid hormone and the potentially ensuing target organ damage, the EPATH trial is designed to determine whether eplerenone, compared to placebo, will effectively impact on parathyroid hormone secretion and improve cardiovascular, renal and bone health in patients with primary hyperparathyroidism. TRIAL REGISTRATION ISRCTN33941607.
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Affiliation(s)
- Andreas Tomaschitz
- Department of Cardiology, Medical University of Graz, Auenbruggerplatz 15, Graz, 8036, Austria
| | - Astrid Fahrleitner-Pammer
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Medical University of Graz, Auenbruggerplatz 15, Graz, 8036, Austria
| | - Burkert Pieske
- Department of Cardiology, Medical University of Graz, Auenbruggerplatz 15, Graz, 8036, Austria
| | - Nicolas Verheyen
- Department of Cardiology, Medical University of Graz, Auenbruggerplatz 15, Graz, 8036, Austria
| | - Karin Amrein
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Medical University of Graz, Auenbruggerplatz 15, Graz, 8036, Austria
| | - Eberhard Ritz
- Department of Medicine, Division of Nephrology, University Hospital Heidelberg, Heidelberg, Germany
| | - Katharina Kienreich
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Medical University of Graz, Auenbruggerplatz 15, Graz, 8036, Austria
| | - Jörg H Horina
- Department of Internal Medicine, Division of Nephrology, Medical University of Graz, Graz, Austria
| | - Albrecht Schmidt
- Department of Cardiology, Medical University of Graz, Auenbruggerplatz 15, Graz, 8036, Austria
| | | | - Caterina Colantonio
- Department of Cardiology, Medical University of Graz, Auenbruggerplatz 15, Graz, 8036, Austria
| | - Andreas Meinitzer
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - Stefan Pilz
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Medical University of Graz, Auenbruggerplatz 15, Graz, 8036, Austria
- Department of Epidemiology and Biostatistics and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
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Vaidya A, Williams JS. The relationship between vitamin D and the renin-angiotensin system in the pathophysiology of hypertension, kidney disease, and diabetes. Metabolism 2012; 61:450-8. [PMID: 22075270 PMCID: PMC3290690 DOI: 10.1016/j.metabol.2011.09.007] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2011] [Revised: 09/14/2011] [Accepted: 09/21/2011] [Indexed: 12/01/2022]
Abstract
Vitamin D has been implicated in the pathophysiology of extraskeletal conditions such as hypertension, kidney disease, and diabetes via its ability to negatively regulate the renin-angiotensin system (RAS). This article reviews the evidence supporting a link between vitamin D and the RAS in these conditions, with specific emphasis on translational observations and their limitations. A literature review of animal and human studies evaluating the role of vitamin D in hypertension, kidney disease, and diabetes was performed. Excess activity of the RAS has been implicated in the pathogenesis of hypertension, chronic kidney disease, decreased insulin secretion, and insulin resistance. Animal studies provide strong support for 1,25-dihydroxyvitamin D(3)-mediated downregulation of renin expression and RAS activity via its interaction with the vitamin D receptor. Furthermore, the activity of vitamin D metabolites in animals is associated with reductions in blood pressure, proteinuria and renal injury, and with improved β-cell function. Many observational, and a few interventional, studies in humans have supported these findings; however, there is a lack of well-designed prospective human interventional studies to definitively assess clinical outcomes. There is a need for more well-designed prospective interventional studies to validate this hypothesis in human clinical outcomes.
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Affiliation(s)
- Anand Vaidya
- Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
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Jungert A, Roth HJ, Neuhäuser-Berthold M. Serum 25-hydroxyvitamin D3, parathyroid hormone and blood pressure in an elderly cohort from Germany: a cross-sectional study. Nutr Metab (Lond) 2012; 9:20. [PMID: 22433818 PMCID: PMC3362780 DOI: 10.1186/1743-7075-9-20] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Accepted: 03/21/2012] [Indexed: 11/18/2022] Open
Abstract
Background Although several studies indicate a link between vitamin D status and blood pressure (BP), the results are inconsistent. The purpose of this study is to investigate whether in predominantly non-obese elderly people without vitamin D deficiency or very high intact parathyroid hormone (iPTH) levels serum 25-hydroxyvitamin D3 [25(OH)D3] and iPTH are independently associated with BP. Methods Cross-sectional data of 132 non-institutionalised subjects (90 women and 42 men, aged 66- 96 years) from Giessen, Germany, were analysed. Serum 25(OH)D3 and iPTH were measured by an electrochemiluminescence immunoassay and BP was determined with a sphygmomanometer. We performed univariate and multiple regression analyses to examine the influence of 25(OH)D3 and iPTH on BP with adjustments for age, body composition and lifestyle factors. Results While iPTH had no impact on BP, 25(OH)D3 was negatively associated with systolic BP in men, but not in women. After splitting the cohort into antihypertensive medication users and non-users, 25(OH)D3 was a significant predictor for systolic and diastolic BP only in men not receiving antihypertensive medicine, even after multiple adjustment. Adjustment for 25(OH)D3 resulted in an inverse association of iPTH with diastolic BP also only in men without intake of antihypertensive medicine. Conclusions In elderly men without vitamin D deficiency and not taking antihypertensive medicine, 25(OH)D3 may be a negative determinant of BP, independent of iPTH, body composition and lifestyle factors. Furthermore, iPTH may be an independent negative determinant of diastolic BP in men not taking antihypertensive medicine.
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Affiliation(s)
- Alexandra Jungert
- Institute of Nutritional Science, Justus-Liebig-University, Goethestrasse 55, 35390 Giessen, Germany.
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Tomaschitz A, Ritz E, Pieske B, Fahrleitner-Pammer A, Kienreich K, Horina JH, Drechsler C, März W, Ofner M, Pieber TR, Pilz S. Aldosterone and parathyroid hormone: a precarious couple for cardiovascular disease. Cardiovasc Res 2012; 94:10-9. [PMID: 22334595 DOI: 10.1093/cvr/cvs092] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Animal and human studies support a clinically relevant interaction between aldosterone and parathyroid hormone (PTH) levels and suggest an impact of the interaction on cardiovascular (CV) health. This review focuses on mechanisms behind the bidirectional interactions between aldosterone and PTH and their potential impact on the CV system. There is evidence that PTH increases the secretion of aldosterone from the adrenals directly as well as indirectly by activating the renin-angiotensin system. Upregulation of aldosterone synthesis might contribute to the higher risk of arterial hypertension and of CV damage in patients with primary hyperparathyroidism. Furthermore, parathyroidectomy is followed by decreased blood pressure levels and reduced CV morbidity as well as lower renin and aldosterone levels. In chronic heart failure, the aldosterone activity is inappropriately elevated, causing salt retention; it has been argued that the resulting calcium wasting causes secondary hyperparathyroidism. The ensuing intracellular calcium overload and oxidative stress, caused by PTH and amplified by the relative aldosterone excess, may increase the risk of CV events. In the setting of primary aldosteronism, renal and faecal calcium loss triggers increased PTH secretion which in turn aggravates aldosterone secretion and CV damage. This sequence explains why adrenalectomy and blockade of the mineralocorticoid receptor tend to decrease PTH levels in patients with primary aldosteronism. In view of the reciprocal interaction between aldosterone and PTH and the potentially ensuing CV damage, studies are urgently needed to evaluate diagnostic and therapeutic strategies addressing the interaction between the two hormones.
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Affiliation(s)
- Andreas Tomaschitz
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria.
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Agarwal R. Interdialytic hypertension-an update. Adv Chronic Kidney Dis 2011; 18:11-6. [PMID: 21224025 DOI: 10.1053/j.ackd.2010.10.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2010] [Revised: 09/14/2010] [Accepted: 10/06/2010] [Indexed: 11/11/2022]
Abstract
The reference standard for diagnosing hypertension among hemodialysis patients is 44-hour interdialytic ambulatory blood pressure (BP) recording. However, a more practical way to diagnose and manage hypertension is to measure home BP over the interdialytic interval. In contrast to pre- and postdialysis BP recordings, measurements of BP performed outside the dialysis unit correlate with the presence of left ventricular hypertrophy and directly and strongly with all-cause mortality. Hypervolemia that is not clinically obvious is the most common treatable cause of hypertension among patients with end-stage renal disease; thus, volume control should be the initial therapy to treat hypertension in most hemodialysis patients. To diagnose hypervolemia, continuous blood volume monitoring is emerging as an effective and simple technique. Reducing dietary and dialysate sodium is an often overlooked strategy to improve BP control. Although definitive randomized trials that show cardiovascular benefits of BP lowering among hypertensive hemodialysis have not been performed, emerging evidence suggests that lowering BP might reduce cardiovascular events. The treatment should be guided by BP obtained outside the dialysis unit because predialysis and postdialysis BP are quite variable and agree poorly with measurements obtained outside the dialysis unit. Although the appropriate level to which BP should be lowered remains elusive, current data suggest that interdialytic ambulatory systolic BP should be lowered to <130 mm Hg and averaged home systolic BP to <140 mm Hg. Antihypertensive drugs will be required by most patients receiving thrice weekly dialysis for 4 hours. Beta blockers, dihydropyridine calcium blockers, and agents that block the renin-angiotensin system appear to be effective in lowering BP in these patients.
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Affiliation(s)
- Anand Vaidya
- Division of Endocrinology, Diabetes, and Hypertension, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass, USA
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Poor vitamin D status may contribute to high risk for insulin resistance, obesity, and cardiovascular disease in Asian Indians. Med Hypotheses 2009; 72:647-51. [DOI: 10.1016/j.mehy.2008.12.031] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2008] [Accepted: 12/10/2008] [Indexed: 11/24/2022]
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McCarty MF, Barroso-Aranda J, Contreras F. Can moderate elevations of parathyroid hormone acutely increase risk for ischemic cardiac arrhythmias? Med Hypotheses 2009; 72:581-3. [PMID: 19188028 DOI: 10.1016/j.mehy.2008.12.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2008] [Accepted: 12/15/2008] [Indexed: 11/30/2022]
Abstract
There is suggestive evidence that chronic elevations of parathyroid hormone (PTH), associated with poor vitamin D status or low calcium intake, can increase risk for insulin resistance, weight gain, hypertension, and left ventricular hypertrophy, while stimulating production of acute phase reactants. New evidence that elevated PTH is prognostic for increased vascular mortality in very elderly subjects, prompts an examination of the possible impact of PTH on risk for arrhythmias. The cardiac effects of PTH are mediated by G protein-coupled receptors that activate phospholipase C (PLC). Catecholamines, angiotensin II, and endothelin have been shown to be arrhythmogenic for ischemic myocardium in animal studies; the receptors mediating this effect are all likewise linked to activation of PLC. Thus, it is reasonable to presume that a sufficient concentration of PTH can be arrhythmogenic in the ischemic heart. The extent to which this effect can be evoked by the high-normal PTH levels prevalent in many elderly subjects, can be assessed in epidemiological studies.
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Effect of successful parathyroidectomy on 24-hour ambulatory blood pressure in patients with primary hyperparathyroidism. Int J Cardiol 2008; 142:15-21. [PMID: 19117619 DOI: 10.1016/j.ijcard.2008.12.027] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2008] [Accepted: 12/06/2008] [Indexed: 11/20/2022]
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.
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Moranne O, Froissart M, Rossert J, Gauci C, Boffa JJ, Haymann JP, M'rad MB, Jacquot C, Houillier P, Stengel B, Fouqueray B. Timing of onset of CKD-related metabolic complications. J Am Soc Nephrol 2008; 20:164-71. [PMID: 19005010 DOI: 10.1681/asn.2008020159] [Citation(s) in RCA: 310] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Chronic kidney disease (CKD) guidelines recommend evaluating patients with GFR <60 ml/min per 1.73 m(2) for complications, but little evidence supports the use of a single GFR threshold for all metabolic disorders. We used data from the NephroTest cohort, including 1038 adult patients who had stages 2 through 5 CKD and were not on dialysis, to study the occurrence of metabolic complications. GFR was measured using renal clearance of (51)Cr-EDTA (mGFR) and estimated using two equations derived from the Modification of Diet in Renal Disease study. As mGFR decreased from 60 to 90 to <20 ml/min per 1.73 m(2), the prevalence of hyperparathyroidism increased from 17 to 85%, anemia from 8 to 41%, hyperphosphatemia from 1 to 30%, metabolic acidosis from 2 to 39%, and hyperkalemia from 2 to 42%. Factors most strongly associated with metabolic complications, independent of mGFR, were younger age for acidosis and hyperphosphatemia, presence of diabetes for acidosis, diabetic kidney disease for anemia, and both male gender and the use of inhibitors of the renin-angiotensin system for hyperkalemia. mGFR thresholds for detecting complications with 90% sensitivity were 50, 44, 40, 39, and 37 ml/min per 1.73 m(2) for hyperparathyroidism, anemia, acidosis, hyperkalemia, and hyperphosphatemia, respectively. Analysis using estimated GFR produced similar results. In summary, this study describes the onset of CKD-related complications at different levels of GFR; anemia and hyperparathyroidism occur earlier than acidosis, hyperkalemia, and hyperphosphatemia.
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Affiliation(s)
- Olivier Moranne
- INSERM Unit 780, 16, avenue Paul Vaillant-Couturier, 94807 Villejuif Cedex, France.
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Abstract
OBJECTIVE The presence of parathyroid hormone receptor mRNA in a wide variety of tissues, including the endothelium, suggests that parathyroid hormone has potentially important effects in addition to the maintenance of calcium and phosphate homeostasis. We conducted a prospective study to examine the association between plasma intact parathyroid hormone levels and the subsequent risk of developing hypertension. METHODS We measured intact parathyroid hormone in 481 men without hypertension from the Health Professionals Follow-up Study. During 10 years of follow-up, we observed 142 cases of incident hypertension. Cox proportional hazards regression was used to adjust for age, race, body mass index, alcohol use, smoking, physical activity, predicted plasma 25-hydroxyvitamin D level, and other factors. RESULTS Median baseline levels of intact parathyroid hormone were 40.1 pg/ml in individuals who developed hypertension and 36.3 pg/ml in those who did not (P = 0.01). After multivariate adjustment, the relative risk for incident hypertension in men in the highest quartile of parathyroid hormone (median 56.0 pg/ml) compared with the lowest quartile of parathyroid hormone (median 26.3 pg/ml) was 1.83 (95% confidence interval 1.10-3.03; P for trend = 0.01). Analyses restricted to men in the lowest 90th percentage of the parathyroid hormone distribution (< or =58 pg/ml) yielded similar results. Further adjustment for the intake of calcium and sodium, as well as for season and fasting status at time of blood draw, did not materially change the results. CONCLUSION Plasma levels of intact parathyroid hormone, even within ranges considered normal, are positively and independently associated with a higher risk of incident hypertension.
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Abstract
The classical actions of parathyroid hormone (PTH) are well recognized, but its effects on other target tissues, such as the cardiovascular system, are less appreciated. Several studies have evaluated the effects of PTH in patients with primary hyperparathyroidism in order to understand potential cardiovascular effects in terms of hypertension, cardiovascular mortality, left ventricular function, and endothelial function. We review these studies and evaluate the cellular mechanisms that may affect these outcomes.
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Affiliation(s)
- Lorraine A Fitzpatrick
- Research and Development, Musculoskeletal Diseases, GlaxoSmithKline, 2301 Renaissance Boulevard, RN0420, King of Prussia, PA 19406, USA.
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Reis JP, von Mühlen D, Kritz-Silverstein D, Wingard DL, Barrett-Connor E. Vitamin D, parathyroid hormone levels, and the prevalence of metabolic syndrome in community-dwelling older adults. Diabetes Care 2007; 30:1549-55. [PMID: 17351276 DOI: 10.2337/dc06-2438] [Citation(s) in RCA: 209] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
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. RESEARCH DESIGN AND METHODS Participants included 410 men and 660 women, 44-96 years old, who completed a follow-up clinic visit in 1997-1999 as part of the Rancho Bernardo Study. Sex-specific logistic regression models were fit to estimate the odds of ATP III (Adult Treatment Panel III)-defined metabolic syndrome across quintiles of 25(OH)D and PTH, adjusting for age, season, and major lifestyle factors. RESULTS In men, there was a significant trend (P = 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 (> or =63 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. CONCLUSIONS 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.
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Affiliation(s)
- Jared P Reis
- Department of Family and Preventive Medicine, University of California, San Diego, La Jolla, California 92093-0607, USA
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Snijder MB, Lips P, Seidell JC, Visser M, Deeg DJH, Dekker JM, van Dam RM. Vitamin D status and parathyroid hormone levels in relation to blood pressure: a population-based study in older men and women. J Intern Med 2007; 261:558-65. [PMID: 17547711 DOI: 10.1111/j.1365-2796.2007.01778.x] [Citation(s) in RCA: 159] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Evidence is accumulating that the vitamin D endocrine system has physiological functions beyond bone health including a role in the regulation of blood pressure. Effects of poor vitamin D status on blood pressure may be mediated by elevated parathyroid hormone (PTH) levels. AIM To evaluate whether serum 25-hydroxyvitamin D [25(OH)D] and PTH levels are independently associated with blood pressure in a population-based study of older men and women. METHODS Subjects were participants of the Longitudinal Aging Study Amsterdam, aged 65 years and older. In 1205 participants, serum 25(OH)D and PTH levels were determined and diastolic and systolic blood pressure were measured. Linear and logistic regression analyses were performed with adjustments for age, sex, region, season, lifestyle factors (physical activity, smoking, alcohol intake), and waist circumference. RESULTS Serum 25(OH)D was not significantly associated with diastolic (beta 0.00, P = 0.98) or systolic (beta 0.06, P = 0.11) blood pressure. In contrast, higher ln-PTH levels were significantly associated with higher diastolic (beta 1.93, P = 0.03) and systolic (beta 4.67, P = 0.01) blood pressure. Higher PTH levels were associated with a substantially higher prevalence of hypertension (OR 2.00, 95% CI 1.31-3.06 for the highest versus the lowest quartile), whereas 25(OH)D showed no significant association (OR 0.89, 95% CI 0.47-1.69 for the lowest versus the highest 25(OH)D category). CONCLUSION These results indicate that PTH is a potentially modifiable determinant of blood pressure in the general elderly population. Serum 25(OH)D, however, was not associated with blood pressure, possibly due to the relatively high levels in our population.
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Affiliation(s)
- M B Snijder
- Institute of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
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Jorde R, Svartberg J, Sundsfjord J. Serum parathyroid hormone as a predictor of increase in systolic blood pressure in men. J Hypertens 2005; 23:1639-44. [PMID: 16093907 DOI: 10.1097/01.hjh.0000179764.40701.36] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND In cross-sectional studies there appears to be a link between calcium metabolism and blood pressure, and most studies have found a positive association between serum parathyroid hormone (PTH) and hypertension. OBJECTIVE To determine the prognostic value of serum PTH regarding a future increase in blood pressure. DESIGN A prospective cohort study. SUBJECTS A total of 1784 individuals who had measurements of PTH in serum samples from both the fourth (1994) and fifth (2001) Tromsø studies, who did not use blood pressure medication during the observation period, and had serum calcium less than 2.61 mmol/l, were included. MAIN OUTCOME MEASURE Delta blood pressure (blood pressure from 2001 minus blood pressure from 1994). RESULTS The mean delta systolic blood pressure in the men and women during these 7 years was 5.8 and 8.1 mmHg, respectively. In a sex-specific linear regression model correcting for age, body mass index (BMI), and smoking status, serum PTH from 1994 was a significant predictor of delta systolic blood pressure in men (P < 0.01), but not in women. The difference in delta systolic blood pressure between those in the highest and those in the lowest PTH quartile was 3.5 mmHg. Similarly, delta serum PTH (serum PTH from 2001 minus serum PTH from 1994) was a significant predictor of delta systolic blood pressure in men (P < 0.05). CONCLUSIONS Although these findings do not prove a causal relationship between PTH and blood pressure, it adds to the growing number of indications that PTH is involved in the development of hypertension.
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Affiliation(s)
- Rolf Jorde
- Institute of Clinical Medicine, University of Tromsø, University Hospital of North Norway, 9038 Tromsø, Norway.
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Abstract
The kidneys are vital in the pathogenesis of hypertension and are also pathologically affected by the presence of hypertension. The prevalence of hypertension in chronic kidney disease (CKD) depends on age, the severity of renal failure, and proteinuria. The intricate and inextricable relationship between CKD and hypertension seems to cause cardiovascular disease that has assumed epidemic proportions. This article discusses the etiology and treatment of hypertension in CKD so that it can be better controlled.
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Affiliation(s)
- Martin J Andersen
- Division of Nephrology, Department of Medicine, Indiana University School of Medicine and Richard L. Roudebush Veterans Affairs Medical Center, 1481 West 10th Street, 111N, Indianapolis, IN 46202, USA
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Hatton DC, Yue Q, Dierickx J, Roullet C, Otsuka K, Watanabe M, Coste S, Roullet JB, Phanouvang T, Orwoll E, Orwoll S, McCarron DA. Calcium metabolism and cardiovascular function after spaceflight. J Appl Physiol (1985) 2002; 92:3-12. [PMID: 11744636 DOI: 10.1152/jappl.2002.92.1.3] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
To determine the influence of dietary calcium on spaceflight-induced alterations in calcium metabolism and blood pressure (BP), 9-wk-old spontaneously hypertensive rats, fed either high- (2%) or low-calcium (0.02%) diets, were flown on an 18-day shuttle flight. On landing, flight animals had increased ionized calcium (P < 0.001), elevated parathyroid hormone levels (P < 0.001), reduced calcitonin levels (P < 0.05), unchanged 1,25(OH)(2)D(3) levels, and elevated skull (P < 0.01) and reduced femur bone mineral density. Basal and thrombin-stimulated platelet free calcium (intracellular calcium concentration) were also reduced (P < 0.05). There was a tendency for indirect systolic BP to be reduced in conscious flight animals (P = 0.057). However, mean arterial pressure was elevated (P < 0.001) after anesthesia. Dietary calcium altered all aspects of calcium metabolism (P < 0.001), as well as BP (P < 0.001), but the only interaction with flight was a relatively greater increase in ionized calcium in flight animals fed low- compared with high-calcium diets (P < 0.05). The results indicate that 1) flight-induced disruptions of calcium metabolism are relatively impervious to dietary calcium in the short term, 2) increased ionized calcium did not normalize low-calcium-induced elevations of BP, and 3) parathyroid hormone was paradoxically increased in the high-calcium-fed flight animals after landing.
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Affiliation(s)
- Daniel C Hatton
- Division of Nephrology, Hypertension, and Clinical Pharmacology, Department of Medicine, Oregon Health Sciences University, Portland, Oregon 97201, USA.
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Jorde R, Sundsfjord J, Haug E, Bonaa KH. Relation between low calcium intake, parathyroid hormone, and blood pressure. Hypertension 2000; 35:1154-9. [PMID: 10818080 DOI: 10.1161/01.hyp.35.5.1154] [Citation(s) in RCA: 83] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In a population health survey in 1995, serum parathyroid hormone (PTH) was measured in 1113 subjects, aged 30 to 79 years, and was found to be elevated (>6.9 pmol/L) in 118 subjects. In 1998, this group and 131 subjects with normal PTH levels were invited for reexamination, and 82 and 90 subjects from each respective group attended the follow-up. At the follow-up, 72 subjects had elevated and 100 had normal serum PTH levels. Those with elevated serum PTH levels (8 subjects with hyperparathyroidism were excluded) had significantly lower serum calcium levels and intake of calcium than those with normal PTH (2.24+/-0.09 and 2.29+/-0.10 mmol/L [mean+/-SD] and 400.3+/-227.3 and 592.1+/-459.6 mg/d, respectively; P<0.01). Serum levels or intake of vitamin D did not differ between the 2 groups. Subjects with elevated PTH in both 1995 and 1998 had significantly lower bone mineral content and bone mineral density in the lumbar spine than did those with persistently normal PTH levels (P<0.05). In the females, but not in the males, the systolic and diastolic blood pressures were significantly higher in those with elevated serum PTH (158.0+/-27.5 versus 141.5+/-19.2 mm Hg and 90. 5+/-13.6 versus 82.6+/-8.6 mm Hg, respectively; P<0.01). This difference was even more pronounced when those with persistently elevated PTH were considered separately. In conclusion, reduced intake of calcium is frequently associated with high levels of serum PTH. This is associated with moderately reduced bone mineral content and bone mineral density in the lumbar spine. In women, high levels of serum PTH are also associated with markedly increased blood pressure.
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Affiliation(s)
- R Jorde
- Department of Medicine, University Hospital of Tromsø, Tromsø, Norway.
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