Calcium metabolism in elderly hypertensive patients: possible participation of exaggerated sodium, calcium and phosphate excretion.

1. Renal handling of electrolytes, including calcium (Ca), in response to physiological saline infusion (20 mL/kg, i.v., for 2 h) as well as basal circulating levels of Ca-regulating hormones were compared in 27 hypertensive elderly females (mean age 80 +/- 9 years), in 44 normotensive elderly females (79 +/- 9 years) and in 19 young normotensive females (23 +/- 4 years). 2. The hypertensive elderly females showed excessive increase in urine volume and urinary excretions of sodium (Na), Ca and inorganic phosphate (P) in response to saline infusion, associated with slight but significant decrease in circulating levels of Na and ionized Ca compared with those in the other groups. These hypertensive elderly patients also showed characteristic features both in circulating blood pressure and Ca regulating factors; they showed significantly low levels of plasma renin activity and aldosterone concentration, significantly high plasma levels of atrial natriuretic peptide and noradrenalin, compared with those in young controls and normotensive elderly females. 3. Moreover they showed significant increase in basal serum levels of parathyroid hormone and 1,25-dihydroxyvitamin D, and significant decrease in basal serum levels of calcitonin, 25-hydroxyvitamin D and 24,25-dihydroxyvitamin D, compared with those in the other groups. 4. These results suggest that the exaggerated natriuresis associated with excessive loss of Ca and P in urine may participate in the abnormality of Ca metabolism in low-renin hypertensive elderly patients.