Heart failure (HF) is a clinical syndrome featuring cardiac pump failure along with signs and symptoms arising
from salt and water retention mediated by activated renin-angiotensin-aldosterone system (RAAS). In addition to this
cardiorenal perspective, HF is accompanied by a systemic illness, especially in advanced stages characterized by oxidative
stress in various tissues, causing damage to soft tissue and bone. Secondary hyperparathyroidism (SHPT) which is also
considered to contribute this systemic illness is therefore prominent in advanced HF. SHPT in HF occurs as a result of
RAAS activation, prominent hyperaldosteronism, loop diuretic usage and decreased calcitriol level, all of which results in
calcium excretion. We review the evidence that high parathyroid hormone (PTH) is associated with advanced HF, as well
as evidence that it’s associated with HF with preserved ejection fraction (HFPEF).