Department of Internal Medicine and Medical Specialties, University of Rome "La Sapienza", Rome, Italy.
Department of Medicine and Surgery, University of Milano Bicocca, Milan, Italy.
Endocrine. 2018 Apr;60(1):129-137. doi: 10.1007/s12020-017-1362-x. Epub 2017 Jul 12.
Primary hyperparathyroidism is associated with a cluster of cardiovascular manifestations, including hypertension, leading to increased cardiovascular risk.
The aim of our study was to investigate the ambulatory blood pressure monitoring-derived short-term blood pressure variability in patients with primary hyperparathyroidism, in comparison with patients with essential hypertension and normotensive controls.
Twenty-five patients with primary hyperparathyroidism (7 normotensive,18 hypertensive) underwent ambulatory blood pressure monitoring at diagnosis, and fifteen out of them were re-evaluated after parathyroidectomy. Short-term-blood pressure variability was derived from ambulatory blood pressure monitoring and calculated as the following: 1) Standard Deviation of 24-h, day-time and night-time-BP; 2) the average of day-time and night-time-Standard Deviation, weighted for the duration of the day and night periods (24-h "weighted" Standard Deviation of BP); 3) average real variability, i.e., the average of the absolute differences between all consecutive BP measurements.
Baseline data of normotensive and essential hypertension patients were matched for age, sex, BMI and 24-h ambulatory blood pressure monitoring values with normotensive and hypertensive-primary hyperparathyroidism patients, respectively. Normotensive-primary hyperparathyroidism patients showed a 24-h weighted Standard Deviation (P < 0.01) and average real variability (P < 0.05) of systolic blood pressure higher than that of 12 normotensive controls. 24-h average real variability of systolic BP, as well as serum calcium and parathyroid hormone levels, were reduced in operated patients (P < 0.001). A positive correlation of serum calcium and parathyroid hormone with 24-h-average real variability of systolic BP was observed in the entire primary hyperparathyroidism patients group (P = 0.04, P = 0.02; respectively).
Systolic blood pressure variability is increased in normotensive patients with primary hyperparathyroidism and is reduced by parathyroidectomy, and may potentially represent an additional cardiovascular risk factor in this disease.
原发性甲状旁腺功能亢进与一系列心血管表现相关，包括高血压，从而增加心血管风险。
我们的研究旨在探讨原发性甲状旁腺功能亢进患者的动态血压监测衍生的短期血压变异性，与原发性高血压患者和血压正常的对照组进行比较。
25 名原发性甲状旁腺功能亢进患者（7 名血压正常，18 名高血压）在诊断时接受了动态血压监测，其中 15 名在甲状旁腺切除术后进行了重新评估。短期血压变异性通过动态血压监测得出，并计算为以下指标：1）24 小时、日间和夜间血压的标准差；2）日间和夜间标准差的平均值，根据白天和夜间时间段的持续时间加权（24 小时“加权”血压标准差）；3）平均真实变异性，即所有连续血压测量值之间的绝对差异的平均值。
血压正常的原发性甲状旁腺功能亢进患者的基线数据在年龄、性别、BMI 和 24 小时动态血压监测值方面与血压正常的对照组相匹配，高血压原发性甲状旁腺功能亢进患者的基线数据在年龄、性别、BMI 和 24 小时动态血压监测值方面与高血压原发性高血压患者相匹配。血压正常的原发性甲状旁腺功能亢进患者的 24 小时加权标准差（P<0.01）和收缩压平均真实变异性（P<0.05）高于 12 名血压正常的对照组。手术后患者的 24 小时收缩压平均真实变异性、血清钙和甲状旁腺激素水平均降低（P<0.001）。在整个原发性甲状旁腺功能亢进患者组中，血清钙和甲状旁腺激素水平与 24 小时收缩压平均真实变异性呈正相关（P=0.04，P=0.02）。
原发性甲状旁腺功能亢进的血压正常患者的收缩压变异性增加，甲状旁腺切除术后降低，可能是该疾病的另一个心血管危险因素。
