Augmentation of Central Arterial Pressure in Mild Primary Hyperparathyroidism

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Abstract
Primary hyperparathyroidism (PHPT) is associated with increased cardiovascular risk, although the mechanisms involved remain un- clear. Recent evidence has shown increased pulse pressure to be a powerful predictor of cardiovascular events. As increases in pulse pressure are due largely to arterial stiffening, we measured arterial stiffness in 21 subjects with PHPT (18 women and 3 men; 46 -71 yr old) and 21 age- and sex-matched healthy controls using pulse wave analysis, a technique that measures peripheral arterial pressure waveforms and generates corresponding central aortic waveforms. This allows determination of the augmentation of central pressure resulting from wave reflection and augmentation index, a measure of vessel stiffness. Metabolic parameters were also measured. The serum calcium level among PHPT subjects was (mean 6 SD) 2.74 6 0.14 mmol/L. pulse wave analysis showed that both augmen- tation and the augmentation index were significantly higher in the PHPT group vs. controls (16 6 5 vs. 10 6 4m m Hg (P , 0.001) and 36 6 9% vs. 25 6 6% (P , 0.001)) despite comparable brachial systolic pressures between groups (136 6 13 vs. 134 6 18 mm Hg). Patients with PHPT had higher fasting serum insulin levels (median (range), 15.8 (7.4 -39.4) vs. 11.6 (5.1-23) mU/L; P , 0.05) and triglyceride (1.6 6 0.6 vs. 1.2 6 0.4 mmol/L; P , 0.05), but lower high density lipoprotein cholesterol (1.4 6 0.4 vs. 1.6 6 0.3 mmol/L; P , 0.05). These data indicate that subjects with mild PHPT (calcium, ,3.0 mmol/L) have increased arterial stiffness, as evidenced by higher augmentation of central aortic pressures. Enhanced vessel stiffness may arise from a combination of structural and functional vascular changes due to hypercalcemia and/or metabolic abnormalities. In- creased vascular stiffness in subjects with PHPT may account in part for the increased cardiovascular risk in this group. (J Clin Endocrinol Metab 85: 3515-3519, 2000)

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