Plasma ionized calcium, platelet cytosolic calcium (using the fura-2 method in gel-filtered platelets), parathyroid hormone (both the intact hormone and a midmolecule portion), calcitriol, and calcidiol were measured in 19 untreated male patients with essential hypertension and 19 age-matched normotensive male research subjects. Mean levels of platelet cytosolic calcium, parathyroid hormone, calcitriol, and calcidiol were all significantly higher, whereas plasma ionized calcium was significantly lower, in the hypertensive group compared with the normotensive group. Both platelet cytosolic calcium and intact parathryoid hormone were positively correlated with mean arterial pressure (r=0.58, /?<0.001; r=0.S4, p<0.001, respectively), whereas plasma ionized calcium was inversely correlated with mean arterial pressure (r=-0.60, p<0.001) in the combined group of all study subjects. All three of these correlations were significant in the hypertensive group alone but not in the normotensive group alone. When analyzed with plasma ionized calcium, body mass index, serum calcitriol, and calcidiol in a multivariable regression model, the significance of the partial regressions of platelet cytosolic calcium and parathyroid hormone with mean arterial pressure persisted. Intact parathryoid hormone was positively correlated to platelet cytosolic calcium (r=0.43, p<0.01) and plasma ionized calcium was inversely correlated to platelet cytosolic calcium (r= -0.44,p<0.01). These results confirm previous reports of disturbances of calcium metabolism in essential hypertension and suggest that the elevated platelet cytosolic calcium observed in essential hypertension may be linked to one or more of these alterations of calcium metabolism. {Hypertension 1990;16:515-522) S everal studies have described disturbances of calcium metabolism in subjects with essential hypertension. McCarron 1 reported decreased plasma ionized calcium in patients with essential hypertension and also suggested that subjects with essential hypertension include less calcium in their diet.2 Further, McCarron and Morris 3 also found that supplementing the dietary calcium intake of subjects with essential hypertension could decrease the blood pressure of some subjects. The blood pressure-lowering effect of dietary calcium has also been observed in rat models of hypertension.