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Meta-Analysis
. 2006 Apr 19;2006(2):CD004639.
doi: 10.1002/14651858.CD004639.pub2.

Calcium supplementation for the management of primary hypertension in adults

H O Dickinson  1 , D J Nicolson, J V Cook, F Campbell, F R Beyer, G A Ford, J Mason
Affiliations
Meta-Analysis

Calcium supplementation for the management of primary hypertension in adults

H O Dickinson et al. Cochrane Database Syst Rev. .

Abstract

Background: Metabolic studies suggest calcium may have a role in the regulation of blood pressure. Some epidemiological studies have reported that people with a higher intake of calcium tend to have lower blood pressure. Previous systematic reviews and meta-analyses have reached conflicting conclusions about whether oral calcium supplementation can reduce blood pressure.

Objectives: To evaluate the effects of oral calcium supplementation as a treatment for primary hypertension in adults.

Search strategy: We searched the Cochrane Library, MEDLINE, EMBASE, Science Citation Index, ISI Proceedings, ClinicalTrials.gov, Current Controlled Trials, CAB abstracts, and reference lists of systematic reviews, meta-analyses and randomised controlled trials (RCTs) included in the review.

Selection criteria: Inclusion criteria were: 1) RCTs comparing oral calcium supplementation with placebo, no treatment, or usual care; 2) treatment and follow-up >/=8 weeks; 3) participants over 18 years old, with raised systolic blood pressure (SBP) >/=140 mmHg or diastolic blood pressure (DBP) >/=85 mmHg; 4) SBP and DBP reported at end of follow-up. We excluded trials where: participants were pregnant; received antihypertensive medication which changed during the study; or calcium supplementation was combined with other interventions.

Data collection and analysis: Two reviewers independently abstracted data and assessed trial quality. Disagreements were resolved by discussion or a third reviewer. Random effects meta-analyses and sensitivity analyses were conducted.

Main results: We included 13 RCTs (n=485), with between eight and 15 weeks follow-up. The results of the individual trials were heterogeneous. Combining all trials, participants receiving calcium supplementation as compared to control had a statistically significant reduction in SBP (mean difference: -2.5 mmHg, 95% CI: -4.5 to -0.6, I(2 )= 42%), but not DBP (mean difference: -0.8 mmHg, 95% CI: -2.1 to 0.4, I(2) = 48%). Sub-group analyses indicated that heterogeneity between trials could not be explained by dose of calcium or baseline blood pressure. Heterogeneity was reduced when poor quality trials were excluded. The one trial reporting adequate concealment of allocation and the one trial reporting adequate blinding yielded results consistent with the primary meta-analysis.

Authors' conclusions: In view of the poor quality of included trials and the heterogeneity between trials, the evidence in favour of causal association between calcium supplementation and blood pressure reduction is weak and is probably due to bias. This is because poor quality studies generally tend to over-estimate the effects of treatment. Larger, longer duration and better quality double-blind placebo controlled trials are needed to assess the effect of calcium supplementation on blood pressure and cardiovascular outcomes.

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Conflict of interest statement

None. The funding source was not in a position to benefit financially from the results of the review.

Figures

1
1
Fig 1. Flow chart.
2
2
Fig 2. SBP funnel. SBP funnel plot: standard error of estimated treatment effect vs. estimated treatment effect
3
3
Fig 3. DBP funnel. DBP funnel plot: standard error of estimated treatment effect vs. estimated treatment effect
1.1
1.1. Analysis
Comparison 1 Calcium vrs control (parallel trials only), Outcome 1 Systolic BP.
1.2
1.2. Analysis
Comparison 1 Calcium vrs control (parallel trials only), Outcome 2 Diastolic BP.
2.1
2.1. Analysis
Comparison 2 Calcium vrs control (crossover trials only), Outcome 1 Systolic BP.
2.2
2.2. Analysis
Comparison 2 Calcium vrs control (crossover trials only), Outcome 2 Diastolic BP.
3.1
3.1. Analysis
Comparison 3 Calcium vrs control (calcium dose subgroups), Outcome 1 Systolic blood pressure.
3.2
3.2. Analysis
Comparison 3 Calcium vrs control (calcium dose subgroups), Outcome 2 Diastolic blood pressure.
4.1
4.1. Analysis
Comparison 4 Calcium vrs control (baseline BP subgroups), Outcome 1 Systolic blood pressure.
4.2
4.2. Analysis
Comparison 4 Calcium vrs control (baseline BP subgroups), Outcome 2 Diastolic blood pressure.
5.1
5.1. Analysis
Comparison 5 Calcium vrs control: excluding trials not confirming double blinding, Outcome 1 Systolic BP.
5.2
5.2. Analysis
Comparison 5 Calcium vrs control: excluding trials not confirming double blinding, Outcome 2 Diastolic BP.
6.1
6.1. Analysis
Comparison 6 Calcium vrs control: excluding trials not reporting SD, Outcome 1 Systolic BP.
6.2
6.2. Analysis
Comparison 6 Calcium vrs control: excluding trials not reporting SD, Outcome 2 Diastolic BP.
7.1
7.1. Analysis
Comparison 7 Calcium vrs control: (parallel trials), Outcome 1 Withdrawal from treatment (all causes).
8.1
8.1. Analysis
Comparison 8 Calcium vrs control: (parallel trials), Outcome 1 Diarrhoea.
9.1
9.1. Analysis
Comparison 9 Calcium vrs control: (crossover trials), Outcome 1 Gastro‐intestinal effects (including diarrhoea).
10.1
10.1. Analysis
Comparison 10 Calcium vrs control, Outcome 1 Serum calcium.
See this image and copyright information in PMC

Update of

  • doi: 10.1002/14651858.CD004639

References

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