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Değişik Seviyelerde Böbrek Fonksiyonu Olan Yeni Tanı Almış Hipertansif Hastalarda Paratiroid Hormon, İnsülin Direnci ve Kan Basıncı Arasındaki İlişki

The Relationship Between Parathyroid Hormone, Insulin Resistance and Blood Pressure in Newly Diagnosed Hypertensive Patients with Various Levels of Kidney Function

Journal Name:

Publication Year:

DOI: 
10.5262/tndt.2013.1002.08
Abstract (2. Language): 
AMAÇ: Literatürde insülin direnci, paratiroid hormonu (PTH) ve kan basıncı arasındaki ilişkiyi araştıran az sayıda yayın vardır. Bu çalışmada yeni tanı almış ve ilaç kullanmayan esansiyel hipertansif hastalarda kan basıncı, insülin direnci ve PTH arasındaki ilişkinin araştırması amaçlandı. GEREÇ ve YÖNTEMLER: Bütün hastaların tıbbı öyküleri alındı, fi zik muayeneleri yapıldı, kan basınçları ölçüldü, elektrokardiyografi leri çekildi, rutin idrar incelemeleri, biyokimyasal analizleri yapıldı.24 saatlik idrar toplatılarak protein atılımı ve kreatinin klirensi hesaplandı. İnsülin direnci homeostasis model assessment (HOMA) indeksi ile hesaplandı. BULGULAR: Toplamda 92 hasta çalışmaya alındı. Sperman korelasyon analizinde sistolik kan basıncı diyastolik kan basıncı ile (rho: 0.337, p: 0.001), yaş ile (rho: 0.214, p: 0.041), vücut kitle indeksi ile BMI (rho: 0,325, p: 0,004), kan üre nitrojeni ile (rho: 0,262, p: 0,012), HOMA indeksi ile (rho: 0,273, p: 0,009) ve insülin seviyeleri ile ilişkili bulundu (rho: 0,262, p: 0,012). Sistolik kan basıncı ile PTH arasında herhangi bir korelasyon bulunamadı. Sperman korelasyon analizinde diyastolik kan basıncı açlık kan şekeri (rho: 0.220, p: 0.035) ve PTH seviyeleri (rho: 0,235, p: 0,024) ile ilişkili bulundu. SONUÇ: Her ne kadar PTH ve HOMA-indeksi kan basıncı ile ilişkili olsa da bu ilişki, sistolik ve diyastolik kan basıncı açısından farklılık göstermektedir.
Abstract (Original Language): 
OBJECTIVE: There are scarce data regarding the relationship between insulin resistance, parathyroid hormone (PTH) and blood pressure (BP) in the literature. This study is aimed to investigate the interrelationships between BPs, insulin resistance and PTH levels in never treated newly diagnosed essential hypertensive patients. MATERIAL and METHODS: All patients underwent history taking, physical examination, BP measurement, 12 lead electocardiographic evaluations, routine urine analysis, biochemical analysis and 24-hour urine collection to measure protein excretion and creatinine clearance. Insulin resistance was calculated by homeostasis model assessment (HOMA) index. RESULTS: In total 92 patients were included. Spearman correlation analysis revealed that systolic BP was correlated with diastolic BP (rho: 0.337, p: 0.001), with age (rho: 0.214, p: 0.041) with body mass index (rho: 0.325, p: 0.004), with blood urea nitrogen (rho: 0.262, p: 0.012), with HOMA-INDEX (rho: 0.273, p: 0.009) and with insulin levels (rho: 0.262, p: 0.012). There was no correlation between PTH and systolic BP. Spearman correlation analysis revealed that diastolic BP was correlated with fasting blood glucose (rho: 0.220, p: 0.035), and PTH levels (rho: 0.235, p: 0.024). CONCLUSION: In conclusion, we suggest that although PTH and HOMA-INDEX are related with BPs, discrepancy exists regarding systolic and diastolic BPs.
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REFERENCES

References: 

1. Lima NK, Abbasi F, Lamendola C, Reaven GM: Prevalence of
insulin resistance and related risk factors for cardiovascular disease
in patients with essential hypertension. Am J Hypertens 2009; 22:
106-111
2. Raji A, Williams GH, Jeunemaitre X, Hopkins PN, Hunt SC,
Hollenberg NK, Seely EW: Insulin resistance in hypertensives:
Effect of salt sensitivity, renin status and sodium intake. J Hypertens
2001; 19: 99-105
3. Fliser D, Franek E, Fode P, Stefanski A, Schmitt CP, Lyons M, Ritz
E: Subacute infusion of physiological doses of parathyroid hormone
raises blood pressure in humans. Nephrol Dial Transplant 1997; 12:
933-938
4. Massry SG, Iseki K, Campese VM: Serum calcium, parathyroid
hormone, and blood pressure. Am J Nephrol 1986; 6: 19-28
5. Mann JFE, Wiecek A, Bommer J, Ganten U, Ritz E: Effects of
parathyroidectomy on blood pressure in spontaneously hypertensive
rats. Nephron 1987; 45: 46-52
6. Kumar S, Olukoga AO, Gordon C, Mawer EB, France M Hosker
JP, Davies M, Boulton AJ: Impaired glucose tolerance and insulin
sensitivity in primary hyperparathyroidism. Clin Endocrinol 1994;
40: 47-53
7. Ayturk S, Gursoy A, Bascil Tutuncu N, Ertugrul DT, Guvener
Demirag N: Changes in insulin Sensitivity and glucose and bone
metabolism over time in patients with asymptomatic primary
hyperparathyroidism. J Clin Endocrinol Metab 91: 4260-4263
8. Junge W, Wilke B, Halabi A, Klein G: Determination of reference
intervals for serum creatinine, creatinine excretion and creatinine
clearance with an enzymatic and a modifi ed Jaffe method. Clin
Chim Acta 2004; 344: 137-148
9. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA,
Izzo JL Jr, Jones DW, Materson BJ, Oparil S, Wright JT Jr, Roccella
EJ; Joint National Committee on Prevention, Detection, Evaluation,
and Treatment of High Blood Pressure. National Heart, Lung, and
Blood Institute; National High Blood Pressure Education Program
Coordinating Committee: Seventh Report of the Joint National
Committee on prevention, detection, evaluation, and treatment of
high blood pressure. Hypertension 2003; 42: 1206-1252
10. Reaven GM, Lithell H, Landsberg L: Hypertension and associated
metabolic abnormalities: The role of insulin resistance and the
sympathoadrenal system. N Engl J Med 1996; 334: 374-380
11. Hall JE, Brands MW, Dixon WN, Smith MJ Jr: Obesity-induced
hypertension. Renal function and systemic hemodynamics.
Hypertension 1993; 22: 292-299
12. Julius S: Corcoran Lecture. Sympathetic hyperactivity and coronary
risk in hypertension. Hypertension 1993; 21: 886-893
13. Steinberg HO, Chaker H, Leaming R, Johnson A, Brechtel G,
Baron AD: Obesity/insulin resistance is associated with endothelial
dysfunction. Implications for the syndrome of insulin resistance. J
Clin Invest 1996; 97: 2601-2610
14. Gennari C, Nami R, Gonnelli S: Hypertension and primary
hyperparathyroidism: The role of adrenergic and renin-angiotensinaldosterone
systems. Miner Electrolyte Metab 1995; 21: 77-8115. Schleiffer R: Parathyroid hormone and genetic hypertension. Int J
Cardiol 1992; 35: 303-310
16. Jorde R, Svartberg J, Sundsfjord J: Serum parathyroid hormone as a
predictor of increase in systolic blood pressure in men. J Hypertens
2005; 23: 1639-1644
17. Broulik PD, Horký K, Pacovský V: The effect of parathyroid
hormone on plasma renin activity in humans. Horm Metab Res
1986; 18: 490-492
18. Vlachakis ND, Frederics R, Valasquez M, Alexander N, Singer F,
Maronde RF: Sympathetic system function and vascular reactivity
in hypercalcemic patients. Hypertension 1982; 4: 452-458
19. Nilsson IL, Åberg J, Rastad J, Lind L: Endothelial vasodilatory
dysfunction in primary hyperparathyroidism is reversed after
parathyroidectomy. Surgery 1999; 126: 1049-1055
20. Hedbäck GM, Odén AS: Cardiovascular disease, hypertension and
renal function in primary hyperparathyroidism. J Intern Med 2002;
251: 476-483
21. Hulter HN, Melby JC, Peterson JC, Cooke CR: Chronic continuous
PTH infusion results in hypertension in normal subjects. J Clin
Hypertens 1986; 2: 360-370
22. Chiu KC, Chuang LM, Lee NP, Ryu JM, McGullam JL, Tsai GP,
Saad MP: Insulin sensitivity is inversely correlated with plasma
intact parathyroid hormone level. Metabolism 2000; 49: 1501-1505
23. Hjelmesaeth J, Hofsø D, Aasheim ET, Jenssen T, Moan J, Hager H,
Røislien J, Bollerslev J: Parathyroid hormone, but not vitamin D, is
associated with the metabolic syndrome in morbidly obese women
and men: A cross-sectional study. Cardiovasc Diabetol 2009; 8: 7
24. Ljunghall S, Palmér M, Akerström G, Wide L: Diabetes mellitus,
glucose tolerance and insulin response to glucose in patients with
primary hyperparathyroidism before and after parathyroidectomy.
Eur J Clin Invest 1983; 13: 373-377
25. Kautzky-Willer A, Pacini G, Niederle B, Schernthaner G, Prager R:
Insulin secretion, insulin sensitivity and hepatic insulin extraction
in primary hyperparathyroidism before and after surgery. Clin
Endocrinol (Oxf) 1992; 37: 147-55
26. Adler AI, Stratton IM, Neil HA, Yudkin JS, Matthews DR, Cull CA,
Wright AD, Turner RC, Holman RR: Association of systolic blood
pressure with macrovascular and microvascular complications of
type 2 diabetes (UKPDS 36): Prospective observational study. BMJ
2000; 321: 412-419
27. Zanchetti A, Bond MG, Hennig M, Neiss A, Mancia G, Dal Palu
C, Hansson L, Magnani B, Rahn KH, Reid J, Rodicio J, Safar M,
Eckes L, Ravinetto R: Risk factors associated with alterations in
carotid intima-media thickness in hypertension: Baseline data from
the European Lacidipine Study on Atherosclerosis. J Hypertens
1998; 16: 949-961
28. Bergman RN, Prager R, Volund A, Olefsky JM: Equivalence of
the insulin sensitivity index in man derived by the minimal model
method and the euglycemic glucose clamp. J Clin Invest 1987; 79:
790-800

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