Correlation between Left Ventricular Mass Index and Calcium Metabolism in Patients with Essential Hypertension

Objective: To determine the correlation between left ventricular mass index and calcium metabolism in patients with essential hypertension. Study Design: Cross sectional case-control study. Material and Methods: Twenty-seven patients with essential hypertension and 20 healthy individuals were compared with respect to calciotropic hormones, left ventricular mass index (LVMI), and urinary and serum biochemical parameters. The correlations between parathormone, vitamin D, and calcitonin levels and LVMI and blood pressure elevation were determined. Results: The parathormone level was significantly higher (p=0.006) and vitamin D level was significantly lower (p=0.01) in the patient group compared with the control group. However, the two groups were similar in terms of albumin-corrected calcium levels, which were within the normal range (p=0.988). The serum sodium (p=0.014) and urinary calcium (p=0.003) levels and LVMI (p&lt;0.01) were also significantly higher in the patient group. No significant correlations were determined between ambulatory blood pressure and parathormone and vitamin D levels, but a significant correlation was found between LVMI and parathormone level (p=0.06) in hypertensive patients. Conclusion: Essential hypertension alters calcium metabolism, causing calciuresis by hypernatremia. Parathormone release increases to compensate for this, and leads to protein synthesis, which in turn provokes the development of myocardial hypertrophy. Turkish Başlık: Esansiyel Hipertansiyonlu Hastalarda Sol Ventrikül Kitle İndeksi ile Calsiyum Metabolizması Arasındaki Korelasyon Anahtar Kelimeler: Esansiyel hipertansiyon, sol ventrikül hipertrofisi, kalsiyum metabolizması, parathormon Amaç: Esansiyel hipertansiyonlu hastalarda sol ventrikül kitle indeksi ile kalsiyum metabolizması arasındaki korelasyonu araştırmak Gereç ve Yöntemler: Yirmiyedi esansiyel hipertansiyonlu ve 20 sağlıklı şahısın sırasıyla kalsitropik hormonlar, sol ventrikül kitle indeksi (LVMI) ve idrar, serum biyokimyasal parametreleri karşılaştırıldı. Parathormon, vitamin D, ve calcitonin düzeyleri, LVMI ve kan basıncı arasındaki korelasyonlar incelendi. Bulgular: Hasta grubunda; kontrol grubu ile karşılaştırıldığında parathormon düzeyi önemli ölçüde yüksek ( p=0.006) ve vitamin D seviyesi önemli ölçüde düşüktü (p=0.01). Bununla beraber, iki grup albümine göre düzeltilmiş kalsiyum düzeyleri bakımından benzerdi ve bu düzey normal sınırlar içindeydi (p=0.988). Hasta grubunda serum sodyum ( p=0.014) ve üriner kalsiyum (p=0.003) düzeyleri ve LVMI (p&lt;0.001) de önemli ölçüde yüksekti. Hipertansif hastalarda ambulatuvar kan basıncı, parathormon ve vitamin D düzeyleri arasında önemli bir korelasyon saptanmadı fakat LVMI ve parathormon düzeyi (p=0.06) arasında önemli korelasyon bulundu. Sonuç: Esansiyel hipertansiyon hipernatremi nedeniyle kalsiüresise sebep olarak kalsiyum metabolizmasını değiştirir. Parathormon salınımı bunu kompanse etmek için artar ve miyokardiyal hipertrofi gelişmesine yol açan protein sentezine neden olur.

Keywords:

Essential hypertension left ventricular hypertrophy, calcium metabolism, parathormone,

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Ghali JK, Liao Y, Simmons B, Castaner A, Cao G, Cooper RS. The prognostic role of left ventricular hypertrophy in patients with or without coronary artery disease. Ann Intern Med 1992;117:831-6.
Levy D, Garrison RJ, Savage DD, Kannel WB, Castelli WP. Prognostic implications of echocardiographically determined left ventricular mass in the Framingham Heart Study. N Engl J Med 1990;322:1561-6. [CrossRef]
Pearson AC, Pasierski T, Labovitz AJ. Left ventricular hypertrophy:diagnosis, prognosis, and management. Am Heart J 1991;121:148-57. [CrossRef]
Duprez D, Bauwens F, De Buyzere M, De Backer T, Kaufman JM, Van Hoecke J, et al. Relationship between parathyroid hormone and left ventricular mass in moderate essential hypertension. J Hypertens Suppl 1991;9:116-7. [CrossRef]
Levy D. Left ventricular hypertrophy. Epidemiological insights from the Framingham Heart Study. Drugs 1988;35:1-5. [CrossRef]
Onat A, Sansoy V, Yıldırım B, Keleş İ, Çetinkaya A, Aksu H, et al. Investigations blood pressure levels in turkish adults: 8-year trends, rate of treatment, relationship to other risk factors and to coronary disease Türk Kardiyol Dern Arş 1999;27:136-43.
Messerli FH. Clinical determinants and consequences of left ventricular hypertrophy. Am J Med 1983;75:51-6. [CrossRef]
Kaplan NM, Lieberman E. Clinical hypertension. 7th ed. Williams & Wilkins, Baltimore;1998:281-99.
Bauwens FR, Duprez DA, De Buyzere ML, De Backer TL, Kaufman JM, Van Hoecke, J, et al. Influence of the arterial blood pressure and nonhemodynamic factors on left ventricular hypertrophy in moderate essential hypertension. Am J Cardiol 1991;68:925-9. [CrossRef]
Frohlich ED. Left ventricular hypertrophy, cardiac diseases and hypertension:recent experiences. J Am Coll Cardiol 1989;14:1587-94. [CrossRef]
Brickman AS, Nyby MD, von Hungen K, Eggena P, Tuck ML. Calcitropic hormones, platelet calcium, and blood pressure in essential hypertension. Hypertension 1990;16:515-22. [CrossRef]
Piovesan A, Molineri N, Casasso F, Emmolo I, Ugliengo G, Cesario F, et al. Left ventricular hypertrophy in primary hyperparathyroidism. Effects of successful parathyroidectomy. Clin Endocrinol (Oxf) 1999;50:321-8. [CrossRef]
Dominiczak AF, Lyall F, Morton JJ, Dargie HJ, Boyle IT, Tune TT, et al. Blood pressure, left ventricular mass and intracellular calcium in primary hyperparathyroidism. Clin Sci (Lond) 1990;78:127-32.
Stefenelli T, Abela C, Frank H, Koller-Strametz J, Globits S, Bergler-Klein J, et al. Cardiac abnormalities in patients with primary hyperparathyroidism:implications for follow-up. J Clin Endocrinol Metab 1997;82:106-12. [CrossRef]
Morfis L, Smerdely P, Howes LG. Relationship between serum parathyroid hormone levels in the elderly and 24 h ambulatory blood pressures. J Hypertens 1997;15:1271-6. [CrossRef]
Marban E, Koretsune Y. Cell calcium, oncogenes, and hypertrophy. Hypertension 1990;15:652-8. [CrossRef]
The sixth report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure. Arch Intern Med 1997;157:2413-46. [CrossRef]
Foppa M, Duncan BB, Rohde LL. Echocardiography-based left ventricular mass estimation. How should we define hypertrophy? Cardiovasc Ultrasound 2005;17:3-17.
Mosteller RD. Simplified calculation of body-surface area. N Engl J Med 1987;317:1098. [CrossRef]
McCarron DA, Pingree PA, Rubin RJ, Gaucher SM, Molitch M, Krutzik S. Enhanced parathyroid function in essential hypertension:a homeostatic response to a urinary calcium leak. Hypertension 1980;2:162-8. [CrossRef]
Grobbee DE, Burger H, Hofman A, Pols HA. Blood pressure and bone density are inversely related in the elderly. J Hypertens 1996;14:35.
Resnick LM, Müller FB, Laragh JH. Calcium-regulating hormones in essential hypertension. Relation to plasma renin activity and sodium metabolism. Ann Intern Med 1986;105:649-54.
Young EW, Morris CD, McCarron DA. Urinary calcium excretion in essential hypertension. J Lab Clin Med 1992;120:624-32.
Kristal-Boneh E, Froom P, Harari G, Ribak J. Association of calcitriol and blood pressure in normotensive men. Hypertension 1997;30:1289-94. [CrossRef]
Gennari C, Nami R, Bianchini C, Pavese G, Lucani B, Perrone AF. Renal excretion of calcium in human hypertension. Am J Nephrol 1986;6:124-7. [CrossRef]
Sowers JR, Zemel MB, Standley PR, Zemel PC. Calcium and hypertension. J Lab Clin Med 1989;114:338-48.
Steingrimsdottir L, Gunnarsson O, Indridason OS, Franzson L, Sigurdsson G. Relationship between serum parathyroid hormone levels, vitamin D sufficiency, and calcium intake. JAMA 2005;294:2336-41. [CrossRef]
Lips P, Chapuy MC, Dawson-Hughes B, Pols HA, Holick MF. An international comparison of serum 25- hydroxyvitamin D measurements. Osteoporos Int 1999;9:394-7. [CrossRef]
Savage DD, Drayer JI, Henry WL, Mathews EC Jr, Ware JH, Gardin JM, et al. Echocardiographic assessment of cardiac anatomy and function in hypertensive subjects. Circulation 1979:59:623-32. [CrossRef]
Stefenelli T, Abela C, Frank H, Koller-Strametz J, Niederle B. Time course of regression of left ventricular hypertrophy after successful parathyroidectomy. Surgery 1997;121:157-61. [CrossRef]
Schlüter KD, Piper HM. Left ventricular hypertrophy and parathyroid hormone:a causal connection? Cardiovascular Res 1998;37:34-41. [CrossRef]
Halapas A, Diamanti-Kondarakis E, Kremastinos D, Koutsilleris M. The PTHrP/PTH.1-R bioregulation system in cardiac hypertrophy:possible therapeutic implications. In vivo 2006;20:837-44.
Stefenelli T, Mayr H, Bergler-Klein J, Globits S, Woloszczuk W, Niederle B. Primary hyperparathyroidism:incidence of cardiac abnormalities and partial reversibility after successful parathyroidectomy. Am J Med 1993;95:197-202. [CrossRef]