Scanferla F, Morachiello P, Bazzato G
Hemodynamics effects of correction of hyperparathyroidism by
vitamin D in hemodialysis patients
12th Annual ASH Meeting
Am J Hypertens
(Apr) 10:192A 1997
Parathyroid hormone displays protean effects on nearly all physiologic
processes, including the hypertension of ESRD. Surprisingly few
studies have looked at changes in BP control after successful medical
treatment of hyperparathyroidism.
This is a prospective, non-placebo-controlled study of 11 ESRD
patients with secondary hyperparathyroidism. After washout from
cardiovascular drugs, 24 hour ambulatory BP monitoring and
transthoracic impedance measurements of cardiac output were performed.
Patients were treated with p.o. calcitriol (2.5 mcg twice a week) for
2 months. 9/11 responded with iPTH fall to < 2x normal limit. The
responders were restudied and found to have statistically significant
falls in SBP and DBP, but no change in cardiac output.
Comment: Raine reported in 1993
(Kidney Int 43:700-705, 1993) that CRF (non-ESRD)
patients showed BP improvement after treatment with alfacalcidiol.
Harnett et al reported (J Am Soc Nephrol 4:1486, Jan
94) on the development of LVH in dialysis patients and found no
increased prevalence of hyperparathyroidism in those who did develop
LVH. The present study is small, and doesn't report the BP of the two
patients who didn't respond to calcitriol. It is a good start,
however, and points to the need for larger studies of this issue.
(James A. Sondheimer MD, Wayne State University, Detroit, MI)
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12th Annual ASH Meeting
H: Special problems :
Endocrine hypertension
CRF by organ system :
Cardiovascular/Hypertension