Vitamin D Supplementation and Blood Pressure | Journal Scan

Study Questions:

Does supplementation with vitamin D or its analogues reduce blood pressure (BP)?

Methods:

The D-PRESSURE Study Group did a comprehensive systematic review and meta-analysis without language restrictions for the period January 1, 1966, through March 31, 2014. They included randomized placebo-controlled clinical trials that used vitamin D supplementation (vit D) for a minimum of 4 weeks for any indication, and reported BP data. Studies were included if they used active or inactive forms of vit D or vit D analogues. Co-interventions were permitted if identical in all treatment arms. Data were extracted on baseline demographics, 25-hydroxyvitamin D levels, systolic and diastolic BP (SBP and DBP), and change in BP from baseline to the final follow-up. Individual patient data on age, sex, medication use, diabetes mellitus, baseline and follow-up BP, and 25-hydroxyvitamin D levels were requested from the authors of the included studies. For trial-level data, between-group differences in BP change were combined in a random-effects model. For individual patient data, between-group differences in BP at the final follow-up, adjusted for baseline BP, were calculated before combining in a random-effects model.

Results:

A total of 46 trials with 4,541 participants were included in the trial-level meta-analysis. Individual patient data were obtained for 27 trials with 3,092 participants. At the trial level, no effect of vit D was seen on SBP (effect size, 0.0; 95% confidence interval [CI], −0.8 to 0.8 mm Hg; p = 0.97) or DBP (effect size, −0.1; 95% CI, −0.6 to 0.5 mm Hg; p = 0.84). Similar results were found analyzing individual patient data for SBP (effect size, −0.5; 95% CI, −1.3 to 0.4 mm Hg; p = 0.27) and DBP (effect size, 0.2; 95% CI, −0.3 to 0.7 mm Hg; p = 0.38). Subgroup analysis did not reveal any baseline factor predictive of a better response to therapy.

Conclusions:

The authors concluded that vitamin D supplementation is ineffective as an agent for lowering BP, and thus, should not be used as an antihypertensive agent.

Perspective:

Lower 25-hydroxyvitamin D levels are associated with higher BP levels and increase in the incident hypertension, diabetes, and the metabolic syndrome in cross-sectional studies. But there is no evidence of a treatment effect possibly related to interfering risk factors. Comprehensive analysis of the literature supports the conclusion that vitamin D supplements in persons with low levels reduce fractures, and possibly respiratory infection and all-cause mortality.

Clinical Topics: Diabetes and Cardiometabolic Disease, Dyslipidemia, Prevention, Lipid Metabolism

Keywords: 25-Hydroxyvitamin D 2, Antihypertensive Agents, Blood Pressure, Calcifediol, Diabetes Mellitus, Follow-Up Studies, Metabolic Syndrome X, Primary Prevention, Risk Factors, Vitamin D


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