Influence of correction of secondary hyperparathyroidism on the pulse wave indicators and mineral density of bone tissue in middle‑aged women with uncomplicated arterial hypertension

Abstract

The aim — to assess the effect of correction of secondary hyperparathyroidism on the background of deficiency and insufficiency of 25 (OH) vitamin D on the parameters of central blood pressure (BP) and pulse wave, bone mineral density (BMD) in elderly patients with controlled uncomplicated arterial hypertension (AH).Materials and methods. The study included 44 women of middle age (69.04 ± 0.72 years) with AH of stage II, 2nd degree (main group) and 30 practically healthy patients (control group) of middle age (69.0 ± 1.21 years). The duration of the postmenopausal period in the main group averaged 18.40 ± 0.85 years, in the control group — 19.40 ± 1.18 years (p > 0.05). At the time of randomization AH was controlled, patients received antihypertensive therapy (AHT) based on a fixed combination of dihydropyridine calcium channel blocker (CCB) and thiazide diuretic (Aryfam, Servier, France) at the dose of 5 mg/1.5 mg or 10 mg/1.5 mg (BP levels < 140/90 mm Hg). To correct the deficiency/insufficiency of 25 (OH) vitamin D3 all patients of the main group were additionally prescribed vitamin D (in a daily dose of 3000 — 4000 IU per day) and the ossein hydroxyapatite compound in a dose 830 mg (291 mg of ossein which consists of non‑collagen peptides and proteins (75 mg) and collagen (216 mg), hydroxyapatite (444 mg) including calcium (178 mg) and phosphorus (82 mg) (Osteogenone, Pierre Fabre Medicare Productions, France) for 2 tablets 2 times a day for 6 months. After 6 months, the patients of the main group were divided into two subgroups. In I subgroup 18 women continuously received the therapy, in II subgroup (n = 21) the patients did not follow the recommendations for the correction of vitamin D metabolism. All patients had a general clinical and laboratory examination, arterial pressure monitoring and echocardiography. Parameters of central hemodynamics and arterial stiffness were measured using SphygmoCor (AtCor Medical, Australia) with the definition of central blood pressure (cBP), augmentation pressure (AP), augmentation index (AIx), including normalized one for a pulse rate of 75 beats/min (AIx75), amplification pressure (PPampl), carotid radial (PWVrad) and carotid‑femoral pulse wave velocity (PWVfem). Mineral density of bone tissue was investigated using Hologic Discovery apparatus. To evaluate the Trabecular Bone Score (TBS), the TBS iNsight method developed by Med‑Imaps (France) was used.Results and discussion. The patients of the main group had statistically significant increase in AP, AIx, AIx75 — by 37.7 %, 57.5 % and 58.2 %, respectively (p < 0.001), PWVrad — by 31 %, PWVfem — by 32 % (all p < 0.001) and decrease in PPampl — by 20.8 % (p < 0.001) in comparison with the control group at the time of inclusion in the study. When comparing indicators of applanation tonometry in patients of I subgroup, in the absence of significant changes in brachial and central blood pressure, AR, AIx75 and PPampl significantly decreased — by 18.0 %, 11.5 % and 5.0 %, respectively, (all p < 0.05) compared with the indicators of II subgroup. The marker for bone remodeling — propeptide prokologen type I was unchanged in both subgroups; the level of 25 (OH) of vitamin D was normalized in I subgroup, which was also accompanied by the normalization of parathyroid hormone levels and b‑CTx resorption marker. Bone mineral density increased at the level of the femoral neck in patients of I subgroup (p < 0.05).Conclusions. 6 months comprehensive hypotensive, hypolipidemic therapy and correction of secondary hyperparathyroidism, 25 (OH) vitamin D deficiency/insufficiency showed greater effectiveness in improving of the index of arterial stiffness and structural and functional state of bone tissue compared to therapy without vitamin D and ossein‑hydroxyapatite compounds in patients with uncomplicated hypertension.