Departments of Endocrinology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Departments of Endocrinology, Postgraduate Institute of Medical Education and Research, Chandigarh, India -
Minerva Endocrinol. 2020 Sep;45(3):181-188. doi: 10.23736/S0391-1977.19.03104-3. Epub 2019 Nov 28.
The prevalence of hypertension in primary hyperparathyroidism (PHPT) varies from 20-80% with data being based on office-based blood pressure measurements. Little is known about ambulatory monitoring of blood pressure (AMBP) in PHPT and changes in blood pressure (BP) variables post-curative parathyroidectomy. Hence, we conducted a prospective study wherein we performed AMBP in apparently normotensive patients with PHPT and reevaluated them 3 months post-curative parathyroidectomy.
Consecutive patients with symptomatic PHPT aged 20 years and above underwent 24 hours AMBP at enrollment and at 3 months after successful parathyroidectomy. Pre- and postoperative BP variables were compared and correlated with serum calcium, creatinine and intact parathyroid hormone (iPTH) levels.
After exclusion, 17 symptomatic PHPT patients were enrolled in the study. AMBP detected hypertension in 4 (23.5%) patients. There was a significant reduction in the average nighttime systolic (P=0.007) and diastolic BP (P=0.034) after parathyroidectomy. However, the average 24 hours systolic/diastolic BP, daytime systolic/diastolic BP and average 24 hours mean arterial pressure did not differ before and after surgery. Non-dipping blood pressure pattern was seen in 53% of patients at presentation and persisted in 50% of cases after successful surgery. None of the biochemical parameters significantly correlated with any BP variable.
AMBP can help detect hypertension in patients with PHPT that remains unrecognized with routine office-based blood pressure measurement. In addition, AMBP detects loss of normal dipping pattern in BP that persists in almost half of the patients even after successful parathyroidectomy, perhaps because of permanent vascular damage induced by PHPT.
原发性甲状旁腺功能亢进症（PHPT）患者的高血压患病率为 20-80%，这些数据基于诊所血压测量。关于 PHPT 患者的动态血压监测（ABPM）和甲状旁腺切除术后血压（BP）变量变化知之甚少。因此，我们进行了一项前瞻性研究，对貌似血压正常的 PHPT 患者进行 ABPM，并在甲状旁腺切除术后 3 个月对其进行重新评估。
连续纳入年龄 20 岁及以上、有症状的 PHPT 患者，在入组时和成功甲状旁腺切除术后 3 个月进行 24 小时 ABPM。比较术前和术后的 BP 变量，并与血清钙、肌酐和全段甲状旁腺激素（iPTH）水平相关。
排除后，共有 17 例有症状的 PHPT 患者纳入研究。ABPM 检测到 4 例（23.5%）患者患有高血压。甲状旁腺切除术后，平均夜间收缩压（P=0.007）和舒张压（P=0.034）显著降低。然而，术后 24 小时收缩压/舒张压、白天收缩压/舒张压和平均 24 小时平均动脉压与术前无差异。就诊时 53%的患者存在非杓型血压模式，术后 50%的患者仍存在该模式。无任何生化参数与任何 BP 变量显著相关。
ABPM 有助于发现常规诊所血压测量未能识别的 PHPT 患者中的高血压。此外，ABPM 检测到 PHPT 患者的 BP 正常杓型模式消失，即使在甲状旁腺切除术后成功，这种模式仍在近一半的患者中持续存在，这可能是由于 PHPT 引起的永久性血管损伤。
