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Primary hyperparathyroidism (pHPT) has been associated with premature death in cardiovascular diseases. Short-term prospects for normalization of cardiovascular derangements have been described after parathyroidectomy. This study explores long-term effects of parathyroidectomy on cardiovascular functions in pHPT.Thirty consecutive patients with pHPT were reexamined 1 and 5 years after parathyroidectomy, together with 30 matched controls, with echocardiography and a bicycle exercise test.Serum calcium was normal in all patients and control subjects at follow-up. The maximal blood pressure during the exercise was higher before parathyroidectomy (median 223 [range, 200–268] mm Hg vs 202 [165–277] mm Hg, P < .05) but not 5 years after (230 [155–270] mm Hg vs 219 [165–252] mm Hg. The ST-segment depression diminished from −1.4 (−8.3–0) to −0.8 (−3.3–0) mm 1 year after parathyroidectomy and further to −0.1 (−3.3–0.0) mm after 5 years but was unchanged in the control group. The number of ventricular extrasystolic beats at exercise testing in the pHPT group before parathyroidectomy was higher than in the control group (1 [0–340] vs 0 [0–3]). The isovolemic relaxation time at rest was prolonged before parathyroidectomy (mean 100 ± 17 ms [SD] vs 89 ± 14 ms, P < .05).Parathyroidectomy can induce long-lasting improvement in regulation of blood pressure, left ventricular diastolic function, cardiac irritability (ventricular extrasystolic beats), and other signs of myocardial ischemia, with potential implications for the postoperative life expectancy of patients with pHPT who have undergone parathyroidectomy.