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Query: UMLS:C0020538 (hypertension)
 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Two hundred and eighty-nine patients operated on for primary hyperparathyroidism (PHPT) in the years 1956-79 have been followed up for a mean period of 5 years. The aim of the study was to investigate the symptomatology of PHPT and the disappearance of the symptoms after operative treatment. Of the presenting symptoms hypercalcaemic crisis and cystic bone changes were cured, and none of the patients with pancreatitis as presenting symptom had a recurrence. In the renal stone group, 10% of the patients had recurring stones during the follow-up period. The presenting symptom disappeared in 84% of the patients. Thirty-five% of the patients had no presenting symptom and were classified as "asymptomatic", though, on questioning, most of them had various symptoms which disappeared postoperatively. Malaise, fatigue and muscular weakness disappeared in 79% of the patients, upper abdominal pains in 66%, constipation in 63%, pains in the extremities in 51% depression in 65%. Hypertension increased by 28% during the follow-up period; only three of the 90 patients with hypertension has discontinued antihypertensive treatment postoperatively. During the follow-up study, 6% of the patients were hypercalcaemic, though the serum calcium was only slightly elevated in almost all of these patients (mean +/- SD 2.75 +/- 0.09 mmol/l) and most of them had the multiglandular form of PHPT. The renal function did not deteriorate as much as was expected on the basis of earlier reports; only two patients had a serum creatinine over 500 mumol/l.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Long-term effect of surgical treatment on the symptoms of primary hyperparathyroidism. 407 2

Studies were performed in 86 patients with proven primary hyperparathyroidism pre-operatively and 6-7 months after parathyroidectomy. The 29% incidence of hypertension between patients with primary hyperparathyroidism is higher as compared with the incidence of hypertension in the general population. Systolic and diastolic blood pressures were significantly higher in patients with primary hyperparathyroidism before operation than after parathyroidectomy (p less than 0.001). In patients hypertensive before operation both the systolic and diastolic blood pressure significantly fell after parathyroidectomy (p less than 0.001). The blood pressure was found to have normalized in 13 of the 25 patients with hypertension. Renal damage and changes in renin levels are not the mechanisms in the production of hypertension in hyperparathyroid patients.
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PMID:Blood pressure in patients with primary hyperparathyroidism before and after parathyroidectomy. 409 45

Of 40 patients with primary hyperparathyroidism 13 were hypertensive. Nine presented with hypertension and, of these, seven were discovered to have hyperparathyroidism by the routine determination of serum calcium in 900 patients referred for investigation of hypertension. The association of hypertension and hyperparathyroidism is well recognized but the cause is in doubt. The incidence of primary hyperparathyroidism in patients with hypertension is about 1 in 130, which is considerably higher than in the general population (1 in 1,000-2,000). All patients with hypertension should have a routine serum calcium estimation. Parathyroidectomy in these otherwise asymptomatic cases may prevent renal damage.
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PMID:Hypertension and hyperparathyroidism. 463 52

A case of 49-year-old Japanese house wife with a functioning parathyroid carcinoma was reported. Because of lack of bone and renal involvements, she was classified as chemical type of primary hyperparathyroidism. Abnormally high levels of serum calcium and a small palpable tumor on the right anterior neck had suspected a functioning parathyroid carcinoma, which was proved histologically after operation. Preoperatively, she had a labile hypertension (116-190/68-126 mmHg) with high plasma renin activity (PRA; 2.3-8.4 ng/ml/h). The marked responses of PRA to furosemide and captopril were accompanied by inappropriate low response of aldosterone. After removal of the tumor, her blood pressure returned to normal with lowered PRA and normal serum calcium. These observations strongly suggested that her elevated PRA might be a main role to yield hypertension.
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PMID:A case of functioning parathyroid carcinoma with hypereninemic hypertension. 634 70

Two patients with both primary hyperparathyroidism and primary hyperaldosteronism are described. Each presented with high blood pressure and a history of renal calculi. Mild hypercalcaemia was associated with raised plasma parathyroid hormone concentrations and a parathyroid adenoma was excised from each. Both patients also had hypokalaemia, hyperaldosteronism and low plasma renin concentrations. Quadric analysis, adrenal vein plasma aldosterone concentrations, adrenal venography and CT scanning all suggested an adrenal adenoma in each patient. This suspicion was confirmed at operation in one patient; the other patient is unfit for adrenal surgery but her blood pressure and plasma potassium concentration have remained within the normal range during prolonged treatment with either spironolactone or amiloride. Because of this unusual association a search was made for parathyroid hormone excess in patients with primary hyperaldosteronism and for aldosterone excess in primary hyperparathyroidism. None was found.
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PMID:Primary hyperparathyroidism associated with primary hyperaldosteronism. 634 7

In an effort to identify new trends in the presentation and treatment of primary hyperparathyroidism, 66 patients treated since 1975 were compared with 100 patients diagnosed and treated from 1948 to 1970. Despite widespread use of multichannel analyzers, the late patients had an insignificant increase in diagnosis while asymptomatic (18 percent versus 9 percent in the early group). Hypertension was the most common presenting complaint in patients seen since 1975, compared with renal disease in patients seen before 1970. Findings of diffuse hyperplasia were more common in the late patients (17 percent versus 3 percent in the early patients). There were no differences in rates of operative complications or persistent postoperative hypercalcemia. In the late series of patients persistent hypercalcemia after surgery for hyperplasia was due to inadequate resection of parathyroid tissue. In the adenoma patients, failure to locate the abnormal parathyroid gland was the cause of operative failure.
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PMID:Primary hyperparathyroidism in the seventies. A decade of change? 661 28

Changes in blood pressure and renal function were investigated in 62 patients with primary hyperparathyroidism treated surgically, in an attempt to assess whether or not hypertension and renal impairment should be regarded as important indications for parathyroidectomy. 29% were hypertensive pre-operatively and the blood pressure remained elevated after parathyroidectomy in all of these patients. Hypertension developed for the first time after parathyroidectomy in 45% of those patients who were normotensive before surgery. Renal function was normal initially in 73% and mild renal impairment developed after surgery in 9% of these patients. At the end of the follow-up period, the prevalence of hypertension was higher in patients with renal impairment pre-operatively (88%) than in those with normal renal function (51%). We conclude that hypertension alone should not be regarded as an indication for parathyroidectomy in asymptomatic hyperparathyroidism. No firm conclusions can be reached about the importance of mild renal failure as an indication for surgery and the question is unlikely to be resolved without conducting a prospective controlled trial.
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PMID:Changes in blood pressure and renal function after parathyroidectomy in primary hyperparathyroidism. 663 39

A causal relationship between hyperparathyroidism and hypertension has been presumed to exist. In order to determine the nature of any such relationship, 50 patients with primary hyperparathyroidism and diastolic hypertension undergoing surgical correction of hypercalcemia (study group) were compared to 50 matched eucalcemic patients with diastolic hypertension of similar magnitude undergoing equivalent elective surgery (control group). There were no significant differences in average preoperative diastolic pressures, average postoperative diastolic pressures, or the magnitude of early postoperative reduction in diastolic pressure between the study and control groups (P greater than 0.05). Bed rest may play a significant role in the early postoperative reduction in blood pressure frequently observed in patients undergoing correction of hyperparathyroidism.
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PMID:Primary hyperparathyroidism and hypertension. 663 92

In 75 operatively proved cases of primary hyperparathyroidism (PH) mean systolic and diastolic blood pressure (BP) values were significantly higher pre- than postoperatively. There were 27 patients (36%) who showed hypertension before operation (systolic BP greater than or equal to 150 mm Hg, mean 169 +/- 20 mm Hg). In 20 of these the hypertension was reversible after successful treatment of PH, in seven cases elevated values persisted. The mean age of patients with persisting hypertension was significantly higher than the group with normalization of BP after operation (P less than 0.01). As far as clinical presentation of PH was concerned it were those cases with hypercalcaemic syndrome and with accidentally discovered hypercalcaemia who most often showed hypertension. In cases with recurrent urolithiasis and with osteitis fibrosa as leading symptoms there was no significant increase of hypertension as compared to the whole group. Because of the relatively high incidence of hypertension in PH this possibility should be taken into consideration in each diagnostic clarification of hypertensive patients.
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PMID:Reversible hypertension in primary hyperparathyroidism--pre- and posteroperative blood pressure in 75 cases. 674 60

PTH causes dose dependent transient vasodilatation in various vascular beds, specifically renal, coeliac, coronary, but not osseous. It has an acute dose-dependent hypotensive effect in the intact animal which is not mediated by alpha- or beta-adrenergic, cholinergic or histaminergic mechanisms. Aortic medial smooth muscle cells respond to PTH with an increase of cAMP, cGMP and, presumably via protein kinase, with activation of phosphorylase B kinase. The acute vasodilatory effect of PTH is antagonised by indomethacin and diclofenac as well as by ouabain, suggesting that the membrane Na-K pump and prostaglandins are involved in PTH-induced vasodilatation. Parathyroidectomy and a high calcium diet attenuate the rise of arterial pressure in experimental hypertension, pointing to some permissive effect of PTH for development hypertension. This is most likely due to long term effects of PTH on vessel wall calcium content and exchange. This chronic effect of PTH may explain the high prevalence of hypertension in patients with primary hyperparathyroidism.
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PMID:Vascular effects of parathyroid hormone (PTH). 675 27


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