Parathyroid hormone, aldosterone-to-renin ratio and fibroblast growth factor-23 as determinants of nocturnal blood pressure in primary hyperparathyroidism: the eplerenone in primary hyperparathyroidism trial

N. Verheyen, A. Fahrleitner-Pammer, B. Pieske, A. Meinitzer, E. Belyavskiy, J. Wetzel, M. Gaksch, M.R. Grubler, C. Catena, L. A. Sechi, Adriana J. van Ballegooijen, Vincent M. Brandenburg, H. Scharnagl, S. Perl, H. Brussee, W. Marz, S. Pilz, A. Tomaschitz

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

OBJECTIVES: The high prevalence of arterial hypertension in primary hyperparathyroidism (pHPT) is largely unexplained. Apart from parathyroid hormone (PTH), the mineral hormones fibroblast growth factor (FGF)-23 and aldosterone-to-renin ratio (ARR) are upregulated in pHPT. We aimed to determine whether nocturnal blood pressure (BP) is related with PTH, FGF-23 or ARR in a relatively large sample of pHPT patients.

METHODS: Cross-sectional data of the single-center "Eplerenone in Primary Hyperparathyroidism" trial were used. All patients with a biochemical diagnosis of pHPT who had both available 24-h ambulatory BP monitoring and valid laboratory data were included.

RESULTS: Full data were available in 136 patients (mean age 67 ± 10 years, 78% women). Median PTH was 99 (interquartile range: 82-124) pg/ml and mean calcium was 2.63 ± 0.15 mmol/l. ARR, but not PTH or FGF-23, was significantly and directly related with nocturnal SBP (Pearson's r = 0.241, P < 0.01) and DBP (r = 0.328, P < 0.01). In multivariate regression analyses, with adjustment for age, sex, PTH, FGF-23, traditional cardiovascular risk factors, antihypertensive medication and parameters of calcium metabolism ARR remained significantly and directly related with nocturnal BP (SBP: adjusted β-coefficient = 0.289, P < 0.01; DBP: β = 0.399, P < 0.01). The relationship between ARR and nocturnal SBP was exclusively present in patients with PTH levels above the median of 99 pg/ml.

CONCLUSION: ARR, but not FGF-23 or PTH, was independently and directly related with nocturnal BP parameters in patients with pHPT, and this relationship was dependent on pHPT disease severity. Inappropriately, elevated aldosterone may partially explain the high prevalence of arterial hypertension in pHPT.

Original languageEnglish
Pages (from-to)1778-1786
Number of pages9
JournalJournal of Hypertension
Volume34
Issue number9
DOIs
Publication statusPublished - Sep 2016

Cite this

Verheyen, N. ; Fahrleitner-Pammer, A. ; Pieske, B. ; Meinitzer, A. ; Belyavskiy, E. ; Wetzel, J. ; Gaksch, M. ; Grubler, M.R. ; Catena, C. ; Sechi, L. A. ; van Ballegooijen, Adriana J. ; Brandenburg, Vincent M. ; Scharnagl, H. ; Perl, S. ; Brussee, H. ; Marz, W. ; Pilz, S. ; Tomaschitz, A. / Parathyroid hormone, aldosterone-to-renin ratio and fibroblast growth factor-23 as determinants of nocturnal blood pressure in primary hyperparathyroidism : the eplerenone in primary hyperparathyroidism trial. In: Journal of Hypertension. 2016 ; Vol. 34, No. 9. pp. 1778-1786.
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title = "Parathyroid hormone, aldosterone-to-renin ratio and fibroblast growth factor-23 as determinants of nocturnal blood pressure in primary hyperparathyroidism: the eplerenone in primary hyperparathyroidism trial",
abstract = "OBJECTIVES: The high prevalence of arterial hypertension in primary hyperparathyroidism (pHPT) is largely unexplained. Apart from parathyroid hormone (PTH), the mineral hormones fibroblast growth factor (FGF)-23 and aldosterone-to-renin ratio (ARR) are upregulated in pHPT. We aimed to determine whether nocturnal blood pressure (BP) is related with PTH, FGF-23 or ARR in a relatively large sample of pHPT patients.METHODS: Cross-sectional data of the single-center {"}Eplerenone in Primary Hyperparathyroidism{"} trial were used. All patients with a biochemical diagnosis of pHPT who had both available 24-h ambulatory BP monitoring and valid laboratory data were included.RESULTS: Full data were available in 136 patients (mean age 67 ± 10 years, 78{\%} women). Median PTH was 99 (interquartile range: 82-124) pg/ml and mean calcium was 2.63 ± 0.15 mmol/l. ARR, but not PTH or FGF-23, was significantly and directly related with nocturnal SBP (Pearson's r = 0.241, P < 0.01) and DBP (r = 0.328, P < 0.01). In multivariate regression analyses, with adjustment for age, sex, PTH, FGF-23, traditional cardiovascular risk factors, antihypertensive medication and parameters of calcium metabolism ARR remained significantly and directly related with nocturnal BP (SBP: adjusted β-coefficient = 0.289, P < 0.01; DBP: β = 0.399, P < 0.01). The relationship between ARR and nocturnal SBP was exclusively present in patients with PTH levels above the median of 99 pg/ml.CONCLUSION: ARR, but not FGF-23 or PTH, was independently and directly related with nocturnal BP parameters in patients with pHPT, and this relationship was dependent on pHPT disease severity. Inappropriately, elevated aldosterone may partially explain the high prevalence of arterial hypertension in pHPT.",
keywords = "Aged, Aldosterone/blood, Antihypertensive Agents/therapeutic use, Blood Pressure, Blood Pressure Monitoring, Ambulatory, Calcium/blood, Circadian Rhythm, Cross-Sectional Studies, Diastole, Female, Fibroblast Growth Factors/blood, Humans, Hyperparathyroidism, Primary/blood, Hypertension/blood, Male, Middle Aged, Mineralocorticoid Receptor Antagonists/therapeutic use, Parathyroid Hormone/blood, Randomized Controlled Trials as Topic, Renin/blood, Risk Factors, Sex Factors, Spironolactone/analogs & derivatives, Systole",
author = "N. Verheyen and A. Fahrleitner-Pammer and B. Pieske and A. Meinitzer and E. Belyavskiy and J. Wetzel and M. Gaksch and M.R. Grubler and C. Catena and Sechi, {L. A.} and {van Ballegooijen}, {Adriana J.} and Brandenburg, {Vincent M.} and H. Scharnagl and S. Perl and H. Brussee and W. Marz and S. Pilz and A. Tomaschitz",
note = "M1 - 9 ISI Document Delivery No.: DS6CX Times Cited: 0 Cited Reference Count: 44 Verheyen, Nicolas Fahrleitner-Pammer, Astrid Pieske, Burkert Meinitzer, Andreas Belyavskiy, Evgeny Wetzel, Julia Gaksch, Martin Gruebler, Martin R. Catena, Cristiana Sechi, Leonardo A. Van Ballegooijen, Adriana J. Brandenburg, Vincent M. Scharnagl, Hubert Perl, Sabine Brussee, Helmut Maerz, Winfried Pilz, Stefan Tomaschitz, Andreas Catena, Cristiana/0000-0001-5039-435X; Grubler, Martin R./0000-0002-1761-2914 Austrian National Bank (Jubilaeumsfond) [14621, 13878 AU5, 13905]; Austrian Society of Bone and Mineral Research (OEGKM) N.V. was supported by funding of the Austrian National Bank (Jubilaeumsfond: project number 14621) and by the Austrian Society of Bone and Mineral Research (OEGKM, Felix-Bronner Grant 2014). M.G. was supported by funding of the Austrian National Bank (Jubilaeumsfond: project numbers 13878 AU5 and 13905). 0 1 LIPPINCOTT WILLIAMS & WILKINS PHILADELPHIA J HYPERTENS",
year = "2016",
month = "9",
doi = "10.1097/hjh.0000000000001004",
language = "English",
volume = "34",
pages = "1778--1786",
journal = "Journal of Hypertension",
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Verheyen, N, Fahrleitner-Pammer, A, Pieske, B, Meinitzer, A, Belyavskiy, E, Wetzel, J, Gaksch, M, Grubler, MR, Catena, C, Sechi, LA, van Ballegooijen, AJ, Brandenburg, VM, Scharnagl, H, Perl, S, Brussee, H, Marz, W, Pilz, S & Tomaschitz, A 2016, 'Parathyroid hormone, aldosterone-to-renin ratio and fibroblast growth factor-23 as determinants of nocturnal blood pressure in primary hyperparathyroidism: the eplerenone in primary hyperparathyroidism trial' Journal of Hypertension, vol. 34, no. 9, pp. 1778-1786. https://doi.org/10.1097/hjh.0000000000001004, https://doi.org/10.1097/HJH.0000000000001004

Parathyroid hormone, aldosterone-to-renin ratio and fibroblast growth factor-23 as determinants of nocturnal blood pressure in primary hyperparathyroidism : the eplerenone in primary hyperparathyroidism trial. / Verheyen, N.; Fahrleitner-Pammer, A.; Pieske, B.; Meinitzer, A.; Belyavskiy, E.; Wetzel, J.; Gaksch, M.; Grubler, M.R.; Catena, C.; Sechi, L. A.; van Ballegooijen, Adriana J.; Brandenburg, Vincent M.; Scharnagl, H.; Perl, S.; Brussee, H.; Marz, W.; Pilz, S.; Tomaschitz, A.

In: Journal of Hypertension, Vol. 34, No. 9, 09.2016, p. 1778-1786.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Parathyroid hormone, aldosterone-to-renin ratio and fibroblast growth factor-23 as determinants of nocturnal blood pressure in primary hyperparathyroidism

T2 - the eplerenone in primary hyperparathyroidism trial

AU - Verheyen, N.

AU - Fahrleitner-Pammer, A.

AU - Pieske, B.

AU - Meinitzer, A.

AU - Belyavskiy, E.

AU - Wetzel, J.

AU - Gaksch, M.

AU - Grubler, M.R.

AU - Catena, C.

AU - Sechi, L. A.

AU - van Ballegooijen, Adriana J.

AU - Brandenburg, Vincent M.

AU - Scharnagl, H.

AU - Perl, S.

AU - Brussee, H.

AU - Marz, W.

AU - Pilz, S.

AU - Tomaschitz, A.

N1 - M1 - 9 ISI Document Delivery No.: DS6CX Times Cited: 0 Cited Reference Count: 44 Verheyen, Nicolas Fahrleitner-Pammer, Astrid Pieske, Burkert Meinitzer, Andreas Belyavskiy, Evgeny Wetzel, Julia Gaksch, Martin Gruebler, Martin R. Catena, Cristiana Sechi, Leonardo A. Van Ballegooijen, Adriana J. Brandenburg, Vincent M. Scharnagl, Hubert Perl, Sabine Brussee, Helmut Maerz, Winfried Pilz, Stefan Tomaschitz, Andreas Catena, Cristiana/0000-0001-5039-435X; Grubler, Martin R./0000-0002-1761-2914 Austrian National Bank (Jubilaeumsfond) [14621, 13878 AU5, 13905]; Austrian Society of Bone and Mineral Research (OEGKM) N.V. was supported by funding of the Austrian National Bank (Jubilaeumsfond: project number 14621) and by the Austrian Society of Bone and Mineral Research (OEGKM, Felix-Bronner Grant 2014). M.G. was supported by funding of the Austrian National Bank (Jubilaeumsfond: project numbers 13878 AU5 and 13905). 0 1 LIPPINCOTT WILLIAMS & WILKINS PHILADELPHIA J HYPERTENS

PY - 2016/9

Y1 - 2016/9

N2 - OBJECTIVES: The high prevalence of arterial hypertension in primary hyperparathyroidism (pHPT) is largely unexplained. Apart from parathyroid hormone (PTH), the mineral hormones fibroblast growth factor (FGF)-23 and aldosterone-to-renin ratio (ARR) are upregulated in pHPT. We aimed to determine whether nocturnal blood pressure (BP) is related with PTH, FGF-23 or ARR in a relatively large sample of pHPT patients.METHODS: Cross-sectional data of the single-center "Eplerenone in Primary Hyperparathyroidism" trial were used. All patients with a biochemical diagnosis of pHPT who had both available 24-h ambulatory BP monitoring and valid laboratory data were included.RESULTS: Full data were available in 136 patients (mean age 67 ± 10 years, 78% women). Median PTH was 99 (interquartile range: 82-124) pg/ml and mean calcium was 2.63 ± 0.15 mmol/l. ARR, but not PTH or FGF-23, was significantly and directly related with nocturnal SBP (Pearson's r = 0.241, P < 0.01) and DBP (r = 0.328, P < 0.01). In multivariate regression analyses, with adjustment for age, sex, PTH, FGF-23, traditional cardiovascular risk factors, antihypertensive medication and parameters of calcium metabolism ARR remained significantly and directly related with nocturnal BP (SBP: adjusted β-coefficient = 0.289, P < 0.01; DBP: β = 0.399, P < 0.01). The relationship between ARR and nocturnal SBP was exclusively present in patients with PTH levels above the median of 99 pg/ml.CONCLUSION: ARR, but not FGF-23 or PTH, was independently and directly related with nocturnal BP parameters in patients with pHPT, and this relationship was dependent on pHPT disease severity. Inappropriately, elevated aldosterone may partially explain the high prevalence of arterial hypertension in pHPT.

AB - OBJECTIVES: The high prevalence of arterial hypertension in primary hyperparathyroidism (pHPT) is largely unexplained. Apart from parathyroid hormone (PTH), the mineral hormones fibroblast growth factor (FGF)-23 and aldosterone-to-renin ratio (ARR) are upregulated in pHPT. We aimed to determine whether nocturnal blood pressure (BP) is related with PTH, FGF-23 or ARR in a relatively large sample of pHPT patients.METHODS: Cross-sectional data of the single-center "Eplerenone in Primary Hyperparathyroidism" trial were used. All patients with a biochemical diagnosis of pHPT who had both available 24-h ambulatory BP monitoring and valid laboratory data were included.RESULTS: Full data were available in 136 patients (mean age 67 ± 10 years, 78% women). Median PTH was 99 (interquartile range: 82-124) pg/ml and mean calcium was 2.63 ± 0.15 mmol/l. ARR, but not PTH or FGF-23, was significantly and directly related with nocturnal SBP (Pearson's r = 0.241, P < 0.01) and DBP (r = 0.328, P < 0.01). In multivariate regression analyses, with adjustment for age, sex, PTH, FGF-23, traditional cardiovascular risk factors, antihypertensive medication and parameters of calcium metabolism ARR remained significantly and directly related with nocturnal BP (SBP: adjusted β-coefficient = 0.289, P < 0.01; DBP: β = 0.399, P < 0.01). The relationship between ARR and nocturnal SBP was exclusively present in patients with PTH levels above the median of 99 pg/ml.CONCLUSION: ARR, but not FGF-23 or PTH, was independently and directly related with nocturnal BP parameters in patients with pHPT, and this relationship was dependent on pHPT disease severity. Inappropriately, elevated aldosterone may partially explain the high prevalence of arterial hypertension in pHPT.

KW - Aged

KW - Aldosterone/blood

KW - Antihypertensive Agents/therapeutic use

KW - Blood Pressure

KW - Blood Pressure Monitoring, Ambulatory

KW - Calcium/blood

KW - Circadian Rhythm

KW - Cross-Sectional Studies

KW - Diastole

KW - Female

KW - Fibroblast Growth Factors/blood

KW - Humans

KW - Hyperparathyroidism, Primary/blood

KW - Hypertension/blood

KW - Male

KW - Middle Aged

KW - Mineralocorticoid Receptor Antagonists/therapeutic use

KW - Parathyroid Hormone/blood

KW - Randomized Controlled Trials as Topic

KW - Renin/blood

KW - Risk Factors

KW - Sex Factors

KW - Spironolactone/analogs & derivatives

KW - Systole

U2 - 10.1097/hjh.0000000000001004

DO - 10.1097/hjh.0000000000001004

M3 - Article

VL - 34

SP - 1778

EP - 1786

JO - Journal of Hypertension

JF - Journal of Hypertension

SN - 0263-6352

IS - 9

ER -