Relationship between serum parathyroid hormone levels in the elderly and 24 h ambulatory blood pressures

Morfis, Litsa; Smerdely, Peter; Howes, L. G.

doi:10.1097/00004872-199715110-00011

Cited by 46 publications

(35 citation statements)

References 10 publications

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“…38 We also found that BP Ͼ130/80 mmHg was independently related to higher PTH levels. Such a cross-sectional association is also reported in patients without CKD, 39 but establishing the existence of causality would require a prospective investigation. For hyperphosphatemia, the GFR threshold at diagnosis was 37 ml/min per 1.73 m 2 , consistent with results from the SEEK study, which used a slightly higher cutoff (1.48 mmol/L).…”

Section: Discussionmentioning

confidence: 82%

Timing of Onset of CKD-Related Metabolic Complications

Moranne

Froissart²,

Rossert³

et al. 2009

Journal of the American Society of Nephrology

419

283

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Chronic kidney disease (CKD) guidelines recommend evaluating patients with GFR Ͻ60 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 Ͻ20 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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Section: Discussionmentioning

confidence: 82%

Timing of Onset of CKD-Related Metabolic Complications

Moranne

Froissart²,

Rossert³

et al. 2009

Journal of the American Society of Nephrology

419

283

View full text Add to dashboard Cite

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“…Gennari et al (25) also found simultaneous increases in PTH and urinary calcium excretion and suggested that high levels of serum sodium in patients with essential hypertension may have been due to excessive dietary salt intake or a defect in the excretion of sodium, which leads to excessive calcium excretion (8,15,19,25,26). In agreement with the significant effect of renal dysfunction on PTH elevation reported in these previous studies, in the present study, sodium levels and urinary calcium levels were determined to be positively and significantly correlated with PTH, ASBP, and ADBP (p=0.001, for each) in our patient population.…”

Section: Discussionmentioning

confidence: 99%

“…In several studies, a relationship between hyperparathyroidism with LVH and BP elevation has been demonstrated in hypertensive patients (1,(12)(13)(14). However, whether the increase in PTH level is the result of or the reason for the BP elevation has not been elucidated (15). In addition, it has been reported that PTH increases cytosolic free calcium, and this might cause myocardial hypertrophy through biochemical mechanisms (16).…”

Section: Introductionmentioning

confidence: 99%

Correlation between Left Ventricular Mass Index and Calcium Metabolism in Patients with Essential Hypertension

2013

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IntroductionLeft ventricular hypertrophy (LVH) is an independent risk factor for cardiovascular morbidity and mortality in hypertensive patients (1-3). Even though some results regarding the relationship between hypertrophy and the severity of hypertension are contradictory, a number of studies have reported that the prevalence of hypertrophy increases with the severity of hypertension (4, 5).Essential hypertension is a multifactorial condition affecting a large percentage of the adult Turkish population (33.7%) (6). It induces LVH and dilatation, which can lead to heart failure (7, 8). The reasons for the development of LVH in patients with essential hypertension have not been established, and whether or not LVH results from long-term blood pressure (BP) elevation or non-hemodynamic factors affecting the myocardium is still a matter of debate (4, 9, 10).Disturbances in calcium metabolism due to an increase in urinary calcium excretion have been observed in patients with essential hypertension. Thus, it has been suggested that there might be a relationship between calcium metabolism and myocardial hypertrophy (9). Parathormone (PTH) and vitamin D are the major calcitropic hormones, and the levels of these two hormones have been reported to vary in patients with essential hypertension (11). In several studies, a relationship between hyperparathyroidism with LVH and BP elevation has been demonstrated in hypertensive patients (1,(12)(13)(14). However, whether the increase in PTH level is the result of or the reason for the BP elevation has not been elucidated (15). In addition, it has been reported that PTH increases cytosolic free calcium, and this might cause myocardial hypertrophy through biochemical mechanisms (16). Vitamin D increases the calcium level in myocytes as well, and subsequently cardiac contractility increases and affects the PTH level through receptor binding mechanisms (11).The purpose of the present study was to determine the relationship between calcium metabolism and hypertension by comparing healthy individuals and patients newly diagnosed with mild and moderate essential hypertension, and to elucidate the role of non-hemodynamic factors in the development of LVH in the hypertensive group. Study Design: Cross sectional case-control study. Material and Methods Study populationMaterial 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 L...

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“…Elevated PTH secondary to low vitamin D increases calcium resorption from the skeleton at the expense of an increased risk of fracture (20). Secondary hyperparathyroidism may also increase the risk of developing components of metabolic syndrome, including hypertension (21)(22)(23)(24)(25)(26), obesity (6,9,10,(27)(28)(29), and diabetes (30 -32). However, we are unaware of previous research investigating whether PTH levels are also associated with the metabolic syndrome.…”

mentioning

confidence: 99%

Vitamin D, Parathyroid Hormone Levels, and the Prevalence of Metabolic Syndrome in Community-Dwelling Older Adults

Mühlen²,

et al. 2007

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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. RESULTS -In men, there was a significant trend (P ϭ 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 (Ն63 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. RESEARCH DESIGN AND METHODSCONCLUSIONS -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. Diabetes Care 30:1549-1555, 2007D ecreased vitamin D and elevated parathyroid hormone (PTH) levels may play a role in the etiology of metabolic syndrome, either through an association with individual components of metabolic syndrome or via insulin resistance (1,2). Vitamin D levels have been shown to be inversely related both with fasting glucose concentrations (3-5) and adiposity (6 -10) and have been suspected to be involved in the regulation of blood pressure, based on blood pressure reduction with vitamin D 3 supplementation in patients with essential hypertension (11,12). Other evidence suggests a role for vitamin D in maintaining normal insulin synthesis and secretion (13,14). Vitamin D and PTH are both responsible for maintaining extracellular calcium homeostasis (19). Vitamin D increases the efficiency of intestinal calcium absorption, and PTH is secreted in response to low-circulating calcium concentrations. Elevated PTH secondary to low vitamin D increases calcium resorption from the skeleton at the expense of an increased risk of fracture (20). Secondary hyperparathyroidism may also increase the risk of developing components of metabolic syndrome, including hypertension (21-26), obesity (6,9,10,27-29), and diabetes (30 -32). However, we are unaware of previous research investigating whether PTH levels are also associated with the metabolic syndrome.Previous studies linking low 25(OH)D with an increased prevalence of metabolic syndrome (1,18) were limited by their inability to simultaneously account for PTH, since both vitamin D and PTH operate within a tightly controlled feedback system to maintain extracellular calcium conce...

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Relationship between serum parathyroid hormone levels in the elderly and 24 h ambulatory blood pressures

Abstract: Serum PTH levels are related strongly to the blood pressure, particularly the nocturnal blood pressure in the elderly. It is not known whether PTH levels are a consequence or a cause of the elevation in blood pressure.

Cited by 46 publications

References 10 publications

Timing of Onset of CKD-Related Metabolic Complications

Timing of Onset of CKD-Related Metabolic Complications

Correlation between Left Ventricular Mass Index and Calcium Metabolism in Patients with Essential Hypertension

Vitamin D, Parathyroid Hormone Levels, and the Prevalence of Metabolic Syndrome in Community-Dwelling Older Adults

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