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Indexed/Abstracted in: EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 1,118
Online ISSN 1827-1634
Yiyun ZHANG, Bo FENG
Department of Endocrinology, East hospital affiliated to Tongji university, Shanghai
BACKGROUND: Primary aldosteronism (PA) is a major cause of secondary hypertension, and is strongly associated with high morbidity and mortality of cardiovascular diseases. Aldosterone excess may influence mineral homeostasis through higher urinary calcium (Ca) excretion, reduce calcium plasma levels, and lead to secondary increase of parathyriod hormone (PTH). The purpose of the present study is to clarify the association of serum PTH and Ca levels with PA in a meta-analysis.
METHODS: We identified relevant studies by searching Pubmed, OVID and Sciencedirect (up to September 2014). Studies that met our predefined criteria were included.
RESULTS: Six articles from 8 case-control studies were included, involving 748 subjects. Overall, the pooled analyses indicated that subjects with PA had significantly higher serum PTH concentrations and lower Ca levels than controls with essential hypertension (EH) (PTH: SMD=1.146, 95% CI=[0.774,1.518]; Ca: SMD=-0.698, 95% CI=[-1.102,-0.294]). Subgroup analysis stratified by type of Ca measurement found a similar pattern by spectrophotometry (SMD=-1.078, 95% CI=[-1.532,-0.623]), but not by ion selective electrode (SMD=-0.248, 95%CI=[-0.810,0.315]). Sensitivity analysis showed that the results were not materially changed in the leave-one-out analyses by omitting one study in turn. No evidence of publication bias was observed.
CONCLUSIONS:This meta-analysis supports a significant association of PTH and Ca concentration with PA. Metabolic and cardiovascular implications of such an association should be noted in the clinical practice. More mechanistic studies are needed to further explain the association between PTH and Ca concentration and RA.