Clinical Investigation

Kidney International (1981) 20, 92–96; doi:10.1038/ki.1981.109

Acute hypercalcemic hypertension in man: Role of hemodynamics, catecholamines, and renin

Claudio Marone1, Carlo Beretta-Piccoli1 and Peter Weidmann1

1Medizinische Poliklinik, University of Berne, Switzerland

Correspondence: Dr P Weidmann, Medizinische Universitäts-Poliklinik, Freiburgstrasse 3, 3010 Bern, Switzerland.

Received 6 May 1980; Revised 1 October 1980.

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Abstract

Acute hypercalcemic hypertension in man: Role of hemodynamics, catecholamines, and renin. The effect of acute hypercalcemia on blood pressure, blood volume, hemodynamic parameters, plasma norepinephrine, epinephrine, dopamine, renin, and aldosterone concentrations was investigated. After 1 hour of equilibration, 10 patients received an infusion of calcium gluconate in 5% dextrose (calcium 15 mg/kg of body wt in 3 hours). The calcium infusion increased the mean serum calcium from 8.7 to 13.0 mg/dl, the systolic blood pressure from 144 plusminus 10 to 184 plusminus (SEM) 12 mm Hg (P < 0.001), the diastolic pressure from 78 plusminus 4 to 93 plusminus 5 mm Hg (P < 0.01). The plasma volume was decreased by 9% (P < 0.001), whereas the hematocrit was increased (P < 0.05). Heart rate and cardiac output remained unchanged. Total peripheral resistance was increased from 1643 plusminus 223 to 2256 plusminus 387 dynedotsec/cm5 (P < 0.05). The plasma epinephrine concentration rose from 4.5 plusminus 0.7 to 6.9 plusminus 1.2 ng/dl (P < 0.01). The plasma norepinephrine concentration was unchanged after 2 hours and increased only slightly after 3 hours of calcium infusion. Plasma renin, aldosterone, and dopamine concentrations were not significantly changed. These findings demonstrate that acute hypercalcemic hypertension is mediated by an increase in peripheral vascular resistance. Hypercalcemic hypertension may be induced by a direct effect of calcium on blood vessels; calcium-mediated increase in adrenal epinephrine release may play a mild contributory role, and plasma volume contraction, an inhibitory role.

Hypertension hypercalcémique aiguë chez l'homme: Rôle des facteurs hémodynamiques, des catécholamines, et de la rénine plasmatiques. L'effet de l'hypercalcémie aiguë sur la pression artérielle, le volume sanguin, les paramètres hémodynamiques, la norépinéphrine, l'épinéphrine, la dopamine, la rénine, et l'aldostérone plasmatiques a été étudié. Après une heure d'équilibration, 10 sujets ont reçu une perfusion de gluconate de calcium dans du dextrose 5% (calcium, 15 mg/kg de poids en 3 heures). La perfusion de calcium a augmenté la concentration sérique moyenne de calcium de 8,7 à 13,0 mg/dl, la pression artérielle systolique de 144 plusminus à 184 plusminus (SEM) 12 mm Hg (P < 0,001), la pression diastolique de 78 plusminus à 93 plusminus 5 mm Hg (P < 0,01). Le volume plasmatique a diminué de 9% (P < 0,001) alors que l'hématocrite a augmenté (P < 0,05). La fréquence cardiaque et le débit cardiaque sont restés inchangés. Les résistances totales périphériques ont augmenté de 1643 plusminus 223 à 2256 plusminus 387 dynedotsec/cm5 (P < 0,05). La concentration plasmatique de norépinéphrine n'était pas modifiée après 2 heures et n'a que peu augmenté après trois heures de perfusion de calcium. Les concentrations plasmatiques de rénine, d'aldostérone et de dopamine n'ont pas été significativement modifiées. Ces constatations montrent que l'hypertension aiguë hypercalcémique a pour médiateur une augmentation des résistances vasculaires périphériques. L'hypertension hypercalcémique peut être déterminée par un effet direct de calcium sur les vaisseaux; l'augmentation de la libération d'épinéphrine par les surrénales, qui a le calcium pour médiateur, peut jouer un rôle adjuvant faible et la contraction du volume plasmatique un rôle inhibiteur.

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