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Cholecalciferol Treatment to Reduce Blood Pressure in Older Patients With Isolated Systolic Hypertension: The VitDISH Randomized Controlled Trial
Study Questions:
What is the effect of high-dose, intermittent cholecalciferol supplementation on blood pressure in older patients with isolated systolic hypertension?
Methods:
This was a parallel group, double-blind, placebo-controlled randomized trial conducted in primary care clinics and hospital clinics. Patients 70 years and older with isolated systolic hypertension (supine systolic blood pressure >140 mm Hg and supine diastolic blood pressure <90 mm Hg) and baseline 25-hydroxyvitamin D levels <30 ng/ml were randomized into the trial from June 1, 2009, through May 31, 2011. A total of 100,000 U of oral cholecalciferol or matching placebo every 3 months for 1 year was administered. Difference in office blood pressure, 24-hour blood pressure, arterial stiffness, endothelial function, cholesterol level, insulin resistance, and B-type natriuretic peptide level during 12 months were the main outcome measures.
Results:
A total of 159 participants were randomized (mean age, 77 years). Mean baseline office systolic blood pressure was 163/78 mm Hg. Mean baseline 25-hydroxyvitamin D level was 18 ng/ml. 25-Hydroxyvitamin D levels increased in the treatment group compared with the placebo group (+8 ng/ml at 1 year, p < 0.001). No significant treatment effect was seen for mean (95% confidence interval) office blood pressure (−1 [−6 to 4]/−2 [−4 to 1] mm Hg at 3 months and 1 [−2 to 4]/0 [−2 to 2] mm Hg overall treatment effect). No significant treatment effect was evident for any of the secondary outcomes (24-hour blood pressure, arterial stiffness, endothelial function, cholesterol level, glucose level, and walking distance). There was no excess of adverse events in the treatment group, and the total number of falls was nonsignificantly lower in the group receiving vitamin D (36 vs. 46, p = 0.24).
Conclusions:
The authors concluded that vitamin D supplementation did not improve blood pressure in older patients with isolated systolic hypertension.
Perspective:
This study reported that vitamin D supplementation did not improve blood pressure or markers of vascular health in older patients with isolated systolic hypertension. Since this was a small study, a small beneficial effect on blood pressure cannot be excluded, but the clinical relevance of such small improvements, at least at an individual patient level, is questionable. Whether vitamin D supplementation may have beneficial effects on cardiovascular health via non–blood pressure effects will be answered by ongoing large randomized trials in the next few years. Overall, these results do not support the use of high-dose, intermittent cholecalciferol to treat isolated systolic hypertension in older white patients.
Keywords: Natriuretic Peptides, Dietary Supplements, Insulin Resistance, Hypertension, Cholecalciferol
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