Augmentation of Central Arterial Pressure in Mild Primary Hyperparathyroidism

• Published in: The journal of clinical endocrinology and metabolism 2000-10, Vol.85 (10), p.3515-3519
• Main Authors: Smith, J. C., Page, M. D., John, R., Wheeler, M. H., Cockcroft, J. R., Scanlon, M. F., Davies, J. S.
• Format: Article
• Language: English
• ISSN: 0021-972X; 1945-7197
• DOI: 10.1210/jcem.85.10.6880

Primary hyperparathyroidism (PHPT) is associated with increased cardiovascular risk, although the mechanisms involved remain unclear. Recent evidence has shown increased pulse pressure to be a powerful predictor of cardiovascular events. As increases in pulse pressure are due largely to arterial stiffening, we measured arterial stiffness in 21 subjects with PHPT (18 women and 3 men; 46–71 yr old) and 21 age- and sex-matched healthy controls using pulse wave analysis, a technique that measures peripheral arterial pressure waveforms and generates corresponding central aortic waveforms. This allows determination of the augmentation of central pressure resulting from wave reflection and augmentation index, a measure of vessel stiffness. Metabolic parameters were also measured. The serum calcium level among PHPT subjects was (mean ± sd) 2.74 ± 0.14 mmol/L. pulse wave analysis showed that both augmentation and the augmentation index were significantly higher in the PHPT group vs. controls [16 ± 5 vs. 10 ± 4 mm Hg (P < 0.001) and 36 ± 9% vs. 25 ± 6% (P < 0.001)] despite comparable brachial systolic pressures between groups (136 ± 13 vs. 134 ± 18 mm Hg). Patients with PHPT had higher fasting serum insulin levels[ median (range), 15.8 (7.4–39.4) vs. 11.6 (5.1–23) mU/L; P < 0.05] and triglyceride (1.6 ± 0.6 vs. 1.2 ± 0.4 mmol/L; P < 0.05), but lower high density lipoprotein cholesterol (1.4 ± 0.4 vs. 1.6 ± 0.3 mmol/L; P < 0.05). These data indicate that subjects with mild PHPT (calcium,