Cardiovascular disease, hypertension and renal function in primary hyperparathyroidism

Objectives. Patients with primary hyperparathyroidism run an increased risk of death in cardiovascular disease. Long ago, hypertension was found to frequently occur in these patients. The aim of this study was to compare the death risk after surgery for hyperparathyroidism of hypertensive patients with that of normotensive ones, and to investigate relations between variables of cardiovascular disease and variables of hyperparathyroidism and renal function. Methods. A series of 845 patients with primary hyperparathyroidism and serum creatinine less than or equal to160 mumol L-1 was followed-up mean 10.2 (SD 5.7) years after surgery. Survival and correlation tests were performed. Death risk was estimated using a hazard function according to Poisson. Results. The death risk of hypertensive hyperparathyroid patients was 50% higher compared with that of the normotensive patients, but the yearly death risk decrease after surgery for the hypertensive patients was almost doubled as compared with the decrease of the normotensive patients. Cardiovascular disease was directly related to serum calcium level, adenoma weight, osteitis fibrosa, and serum creatinine, and inversely related to glomerular filtration rate and urine osmolality, but unrelated to the symptom variables. A negative relation was found between cardiovascular disease and renal stone disease. Conclusions. It can be concluded that cardiovascular disease is more a part of primary hyperparathyroidism than just associated with it, being related to both serum calcium and adenoma weight. There was also a relationship between cardiovascular disease and decreased renal function. Death risk decrease after surgery was rather more pronounced for the hypertensive patients compared with the normotensive ones.