Ageing and Health, Ninewells Hospital, University of Dundee, Dundee DD1 9SY, United Kingdom.
Hypertension. 2014 Apr;63(4):706-12. doi: 10.1161/HYPERTENSIONAHA.113.02177. Epub 2014 Jan 13.
Low 25-hydroxyvitamin D levels are associated with higher prevalent blood pressure. We tested whether high-dose intermittent oral vitamin D therapy could reduce blood pressure and left ventricular mass in patients with hypertension resistant to conventional treatment. We conducted a parallel-group, double-blind, randomized placebo-controlled trial. Patients with supine office blood pressure >140/90 mm Hg on ≥3 antihypertensive agents received 100 000 U oral vitamin D3 or matching placebo every 2 months. Office and 24-hour ambulatory blood pressure, glucose, and cholesterol were measured at baseline, 2, 4, and 6 months; left ventricular mass index was measured by cardiac MRI on a subgroup at baseline and 6 months. The primary outcome was mean 24-hour ambulatory blood pressure at 6 months. A total of 68 participants were randomized, 34 in each group. Mean age was 63 (SD 11) years, mean baseline office blood pressure was 154/84 (13/10) mm Hg, and mean baseline 25-hydroxyvitamin D level was 42 (16) nmol/L. Treatment with vitamin D did not reduce 24-hour ambulatory blood pressure (adjusted treatment effects: systolic, +3 mm Hg; 95% confidence interval, -4 to +11; P=0.33; diastolic, -2 mm Hg; 95% confidence interval, -6 to +2; P=0.29); similar results were seen for office blood pressure. Left ventricular mass index was measured in a subgroup (n=25); no reduction was seen with vitamin D treatment (adjusted treatment effect, +4 g/m(2); 95% confidence interval, 0 to +7; P=0.04). There was no significant change in cholesterol or glucose levels. Thus, 6 months of intermittent, high-dose oral vitamin D3 did not reduce blood pressure or left ventricular mass in patients with resistant hypertension.
低 25-羟维生素 D 水平与更高的普遍血压相关。我们测试了高剂量间歇性口服维生素 D 治疗是否可以降低对常规治疗有抵抗的高血压患者的血压和左心室质量。我们进行了一项平行组、双盲、随机安慰剂对照试验。仰卧位诊室血压 >140/90 mmHg 的患者接受 100000U 口服维生素 D3 或匹配的安慰剂，每 2 个月一次。在基线、2、4 和 6 个月时测量诊室和 24 小时动态血压、血糖和胆固醇；在基线和 6 个月时通过心脏 MRI 测量左心室质量指数。主要结局是 6 个月时的平均 24 小时动态血压。共有 68 名患者被随机分配，每组 34 名。平均年龄为 63（11）岁，平均基线诊室血压为 154/84（13/10）mmHg，平均基线 25-羟维生素 D 水平为 42（16）nmol/L。维生素 D 治疗并未降低 24 小时动态血压（调整治疗效果：收缩压，+3mmHg；95%置信区间，-4 至 +11；P=0.33；舒张压，-2mmHg；95%置信区间，-6 至 +2；P=0.29）；诊室血压也有类似的结果。在亚组（n=25）中测量了左心室质量指数；维生素 D 治疗没有减少（调整治疗效果，+4g/m2；95%置信区间，0 至 +7；P=0.04）。胆固醇或血糖水平没有显著变化。因此，6 个月的间歇性、高剂量口服维生素 D3 并不能降低耐药性高血压患者的血压或左心室质量。
