Objective To investigate the clinical features of hypotensive maintenance dialysis patients after total parathyroidectomy with autotransplantation (TPTX + AT).Methods The consecutive patients who received TPTX + AT were enrolled between January 1,2010 and May 1,2015 in the nephrology department at the central hospital of Jiangmen.According to level of the blood pressure after TPTX + AT,the patients can be divided into hypotensive-group and non-hypotensive-group.The clinical and laboratory examinations of them were compared.Results The probability of calcification of aortic valve (4.76％ vs 30％,P =0.045),bicuspid valve (9.52％ vs 40％,P =0.032) and pulmonary hypertension (14.29％ vs 45％,P =0.043) was lower in the hypotensive-group with statistical significance.Serum parathyroid hormone [(9.31 ± 5.41) pg/ml vs (60.12 ± 96.95) pg/ml,P =0.021] and angiotensinⅡ (Ang Ⅱ) [(34.26 ± 15.73) pg/ml vs (63.78 ±23.55) pg/ml,P =0.000] were lower in the hypotensive-group with statistical significance.Serum intact parathyroid hormone (iPTH) (P =0.036) and AngⅡ (P =0.002) were the affecting factors of hypotension after TPTX + AT.Conclusions Hypotension after TPTX + AT is associated with the lower level of serum iPTH and Ang Ⅱ.The probability of calcification of cardiac valve and pulmonary hypertension is lower in the patients with hypotension,indicate that they may have better cardiac prognosis.