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Original Investigation
Pacific Coast Surgical Association
October 9, 2019

Parathyroidectomy for Patients With Primary Hyperparathyroidism and Associations With Hypertension

Author Affiliations
  • 1John Wayne Cancer Institute, Santa Monica, California
  • 2Department of Surgery, Kaiser Permanente San Jose Medical Center, San Jose, California
  • 3Department of Surgery, Kaiser Permanente Woodland Hills Medical Center, Woodland Hills, California
  • 4Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena
  • 5The Angeles Clinic and Research Institute, Los Angeles, California
JAMA Surg. Published online October 9, 2019. doi:10.1001/jamasurg.2019.3950
Key Points

Question  Do patients with hypertension and parathyroidectomy for primary hyperparathyroidism have a significant reduction in their mean arterial pressure or antihypertensive medication use compared with those without surgery?

Findings  In this cohort study of 2380 patients, 501 with primary hyperparathyroidism and hypertension underwent parathyroidectomy. Patients with parathyroidectomy had significantly lower median mean arterial pressure after surgery than those without surgery, and on multivariable analysis, patients with parathyroidectomy were significantly less likely to increase antihypertensive medications at 6 months, 1 year, and 2 years after surgery.

Meaning  This study’s findings suggest that parathyroidectomy may provide cardiovascular benefits to those with primary hyperparathyroidism and hypertension.

Abstract

Importance  Hyperparathyroidism is associated with cardiovascular disease. However, evidence for a beneficial consequence of parathyroidectomy on hypertension is limited.

Objective  To investigate if parathyroidectomy improves hypertension in patients with primary hyperparathyroidism (PHPT).

Design, Setting, and Participants  In this cohort study and retrospective database review, patients with PHPT and hypertension between January 1, 2008, and December 31, 2016, were identified. The mean arterial pressure (MAP) and number of antihypertensive medications were compared between those who did and did not undergo parathyroidectomy. The setting was a large health care system. Primary hyperparathyroidism was defined using biochemical data, and hypertension was identified by International Classification of Diseases, Ninth Revision codes.

Exposure  Parathyroidectomy was identified in the database by Current Procedural Terminology codes.

Main Outcomes and Measures  The MAP and use of antihypertensive medications were compared for patients who underwent parathyroidectomy and those who did not at 6 months, 1 year, and 2 years. Multivariable logistic regression was used to assess the adjusted odds ratios for both increased and decreased use of antihypertensive medications.

Results  In this cohort study of 2380 participants (79.0% female), patients undergoing parathyroidectomy (n = 501) were younger (mean [SD] age, 65.3 [9.7] vs 71.9 [10.4] years; P < .001) and took fewer antihypertensive medications at baseline (mean [SD] number of medications, 1.2 [1.1] vs 1.5 [1.3], P < .001) than nonsurgical patients (n = 1879). Patients with parathyroidectomy showed greater improvement in their MAP at all follow-up time points (the median [SD] MAP change from baseline to 1 year was 0.1 [8.7] mm Hg without parathyroidectomy vs −1.2 [7.7] mm Hg after parathyroidectomy, P = .002). Nonsurgical patients were more likely vs those with parathyroidectomy to require more antihypertensive medications at 6 months (15.9% [n = 298] vs 9.8% [n = 49], P = .001), 1 year (18.1% [n = 340] vs 10.8% [n = 54], P < .001), and 2 years (17.6% [n = 330] vs 12.2% [n = 61], P = .004). By multivariable analysis, parathyroidectomy was independently associated with freedom from an increased number of antihypertensive medications at all periods (eg, adjusted odds ratio, 0.49; 95% CI, 0.34-0.70; P < .001 at 1 year). Among patients who were initially not taking antihypertensive medications, patients with parathyroidectomy were less likely vs no surgery to start antihypertensive medication treatment at all periods (eg, 10.2% [13 of 127] vs 30.4% [136 of 447], P < .001 at 1 year).

Conclusions and Relevance  This study’s findings suggest that, among hypertensive patients with PHPT, parathyroidectomy may be associated not only with greater decreases in their MAP but also with reduced requirements for antihypertensive medications. Parathyroidectomy decreased the number of patients who began taking antihypertensive medications. Additional study will be required to find whether there are downstream cardiovascular benefits of parathyroidectomy. Preexisting hypertension, particularly in those not already taking antihypertensive medications, should be considered when weighing surgical treatment.

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