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
• Subjects: Aged; Aging - physiology; Arteries - pathology; Biological and medical sciences; Blood Glucose - metabolism; Blood Pressure - physiology; Calcium - blood; Endocrinopathies; Female; Humans; Hyperparathyroidism - pathology; Hyperparathyroidism - physiopathology; Lipids - blood; Male; Medical sciences; Middle Aged; Non tumoral diseases. Target tissue resistance. Benign neoplasms; Parathyroid Hormone - blood; Parathyroids. Parafollicular cells. Cholecalciferol. Phosphocalcic homeostasis (diseases); Risk Factors
• ISSN: 0021-972X; 1945-7197
• DOI: 10.1210/jc.85.10.3515

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,