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Parathyroid hormone, aldosterone and hypertension: An underrated threat?

Abstract:

Primary hyperparathyroidism (PHPT) is a common endocrine disorder characterized by autonomic parathyroid hormone secretion (PTH). Although its asymptomatic variant is the most frequently found in clinical practice (which is incidentally diagnosed), bone and kidney complications significantly affect the patient's quality of life. However, the spectrum of manifestations of this disorder is not limited to mineral metabolism, since elevated concentrations of PTH are associated with an increased risk of metabolic syndrome, type 2 diabetes mellitus and cardiovascular disease. In this area, hypertension (AHT), related to approximately 9.4 million deaths per year, has been considered a non-classical manifestation of PHPT. The interaction PTH-Aldosterone has emerged as an important link to try to explain this relationship, posing various theoretical mechanisms that position PTH as a direct stimulator of aldosterone synthesis in the glomerular zone cells. However, these theoretical mechanisms have been surrounded by controversy in their epidemiological and clinical aspects, and there are still very few population studies exploring this link and its relation with cardiovascular morbimortality, which is why more research is needed in the area in order to know. The true impact of these mechanisms on the health of individuals. This review summarizes aspects of calcium metabolism, as well as the main mechanisms underlying the HPTP-HTA link, and available epidemiological data on the topic, in order to provide a better understanding of this novel approach.