In the case of arterial hypertension associated with primary hyperparathyroidism, the average arterial pressure is reduced after an intervention which consists in removing the adenoma — a benign tumor which develops on a gland — of the parathyroid. The use of anti-hypertensive treatments is also reduced.
In a study of patients with hypertension and hyperparathyroidism (PTH > 65 pg/ml) from a large Californian cohort of patients, the Kaiser Permanente, a decrease in mean arterial pressure of 0.8 mm Hg was observed at 2 years after parathyroidectomy in patients operated for symptomatic primary hyperparathyroidism (n=501), including arterial hypertension. Above all, after surgery, there is a very significant reduction in the use of anti-hypertensive treatments and a lower number of initiations of anti-hypertensive treatments. This study is published in JAMA Surgery.
A systemic disease
Primary hyperparathyroidism is now most often responsible for chronic complications, mainly renal and skeletal. Cardiovascular complications (hypertension, coronary disease, stroke, etc.) are widely suspected but not clearly defined in current recommendations.
Indications for surgery during hyperparathyroidism according to current recommendations are only: young age, kidney damage, skeletal damage (lowered bone densitometry and increased blood calcium levels (hypercalcaemia).
A clear link to the cardiovascular system
Parathormone apparently stimulates the renin-angiotensin system and vascular smooth muscle, which can lead to hypertension. However, until now, the link between parathyroidectomy and cardiovascular complications has been contradictory according to studies.
In this beautiful study, this significant result on a significant number of patients is modest on average, but other studies had shown on small series, that surgery made it possible to lower systolic and diastolic blood pressure by 10 mm Hg in patients hypertensives related to hyperparathyroidism.
This study suggests that, in hypertensive patients with hyperparathyroidism, parathyroidectomy can reduce blood pressure and the need for antihypertensive treatments, with a view to reducing cardiovascular complications.
.
