Remodeling of the cardiovascular system in patients with essential arterial hypertension associated with primary subclinical hyperparathyroidism

Background. One of the pathogenetic mechanisms of essential arterial hypertension (AH) is a genetically determined violation of the transmembrane transport of calcium ions in smooth muscle cells of resistance vessels. It is known that the parathyroid glands are among the main regulators of calcium metabolism in the body. Objective. Assessment of the structural and functional remodeling of the heart and blood vessels in the presence of primary subclinical hyperparathyroidism in patients with essential AH. Methods. A cross-sectional clinical study included 88 patients (51 men and 37 women) with uncomplicated/asymptomatic AH I-II degree. In the examined subjects, the blood parathyroid hormone (PTH) levels were in the reference range for age and ranged from 5 to 78 pg/mL. The patients were divided into 3 groups: in group 1 (28 patients) PTH levels ranged from 0 to 20 pg/mL, in group 2 (37 patients) - from 21 to 55 pg/mL, and in group 3 (23 patients) - from 56 pg/mL to the upper reference value. All patients underwent echocardiography and 24-hour blood pressure monitoring, and also determination of the flow-mediated vasodilation of the brachial artery and the daily calciuresis. Results. The detection rate of left ventricular (LV) hypertrophy in group 3 compared to group 1 was significantly higher: 65.2 versus 39.3% (p=0.036). In addition, the value of daily calciuresis, total and free blood calcium in the group 3 was significantly higher than in the group 1. The parameters of the LV myocardial mass index, the interventricular septum thickness and the LV posterior wall thickness in the group 3 significantly (p<0.05) exceeded those in the group 1. In the group 2 and 3, the most pronounced LV diastolic dysfunction was revealed. It was shown that the PTH level directly correlates with the thickness of the intima-media complex of the carotid artery (R=0.57; p<0.001) and the LV myocardial mass index (R=0.29; p=0.006), inversely - with the value of the endothelium-dependent vasodilation (R= -0.33; p=0.002). Conclusion. It was revealed that the blood PTH level, which is the 90th percentile of the reference range, correlates with signs of cardiac and vascular remodeling in patients with uncomplicated/asymptomatic essential AH.

arterial hypertension, hyperparathyroidism, calcuresis, parathyroid hormone, cardiac remodeling, endothelial dysfunction