Parathyroidectomy Does Not Correct Hypertension in Patients on Maintenance Hemodialysis

Both hypertension and secondary hyperparathyroidism (2° HPT) are common features of the uremic syndrome. It has been suggested that 2° HPT causes hypertension in end-stage renal disease (ESRD). We compared predialysis blood pressure (BP), weight and dose of antihypertensive medications (AHM) prescribed in 19 hemodialysis patients 1 month before total parathyroidectomy (PTx), during the first month after PTx, and long-term (mean 16 months) in 12 of 19 patients.At the time of PTx, study patients had a mean age of 47 ± 9 years, mean duration of ESRD was 112 ± 57 months, and mean intact parathyroid hormone (PTH) level of 1,181 ± 552 pg/ml. Mean BP and predialysis weight were equivalent during the month before and the month after PTx.Of 12 patients followed long term, 8 (67%) were receiving AHM before PTx; after PTx; 3 (36%) of 8 discontinued AHM within 1 year, 2 (25%) of 8 required more AHM, while 2 (25%) of 8 continued on their original AHM, and 1 patient who was not on AHM prior to PTx required initiation of AHM after PTx.There was a clinically significant increase in predialysis weight at 1 year after PTx (median 13 lb) and over time (r = 0.7; slope = 0.5; p = 0.07). However, there was neither a clinically nor statistically significant change in either systolic (r = –0.18; slope = –0.01; p = 0.61) or diastolic (r = –0.6; slope = –0.24; p = 0.12) BP over time. We conclude that PTx fails to correct hypertension in hemodialysis patients with 2° HPT.