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Randomized Controlled Trial
. 2023 Jan 1;36(1):50-62.
doi: 10.1093/ajh/hpac096.

Does Vitamin D Provide Added Benefit to Antihypertensive Therapy in Reducing Left Ventricular Hypertrophy Determined by Cardiac Magnetic Resonance?

Phillip D Levy  1   2 , Michael J Twiner  1   2 , Aaron M Brody  1   2 , Rachelle Dawood  1   2 , Brian Reed  1   2 , LynnMarie Mango  1   2 , Laura Gowland  1 , Greg Grandits  3 , Kenneth Svendsen  3 , Ewart Mark Haacke  4 , Tao Li  5 , Liying Zhang  2   6 , Candace D McNaughton  7 , John M Flack  8
Affiliations
Randomized Controlled Trial

Does Vitamin D Provide Added Benefit to Antihypertensive Therapy in Reducing Left Ventricular Hypertrophy Determined by Cardiac Magnetic Resonance?

Phillip D Levy et al. Am J Hypertens. .

Abstract

Background: Left ventricular hypertrophy (LVH) and vitamin D deficiency have been linked to hypertension (HTN) and cardiovascular disease, particularly in African Americans (AAs). Our objective was to determine if the addition of vitamin D to antihypertensive therapy would lead to greater regression of LV mass index (LVMI) as determined by cardiac magnetic resonance (CMR) after 1 year in vitamin D deficient AA patients with uncontrolled HTN and LVH.

Methods: This study was a randomized, double-blind, placebo-controlled, single-center study. AA patients with HTN (systolic blood pressure [BP] >160 mm Hg), increased LVMI, and vitamin D deficiency (<20 ng/ml) were randomized. All patients received antihypertensive therapy combined with biweekly 50,000 IU vitamin D3 (vitamin D group, n = 55) or placebo (placebo group, n = 58).

Results: At 1 year, there were no statistical differences between the vitamin D and placebo groups in LVMI (-14.1 ± 14.6 vs. -16.9 ± 13.1 g/m2; P = 0.34) or systolic BP (-25.6 ± 32.1 vs. -25.7 ± 25.6 mm Hg; P = 0.99) reduction, respectively. Serum vitamin D levels increased significantly in the vitamin D group compared with placebo (12.7 ± 2.0 vs. 1.8 ± 8.2 ng/ml; P < 0.001).

Conclusions: In this high-risk cohort of AAs we did not find an association between vitamin D supplementation and differential regression of LVMI or reduction in systolic BP. However, our study suffered from a small sample size with low statistical power precluding a definitive conclusion on the therapeutic benefit of vitamin D in such patients.

Clinical trials registration: Trial Number NCT01360476. Full trial protocol is available from corresponding author.

Keywords: African Americans; blood pressure; cardiac magnetic resonance imaging; hypertension; left ventricular hypertrophy; subclinical hypertensive heart disease; vitamin D deficiency.

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Figures

Graphical Abstract
Graphical Abstract
Figure 1.
Figure 1.
Study flow diagram and retention. Abbreviations: CMR, cardiac magnetic resonance; ED, emergency department; eGFR, estimated glomerular filtration rate; LVH, left ventricular hypertrophy.
Figure 2.
Figure 2.
Effect of vitamin D supplementation and standardized, evidence-based antihypertensive therapy with goal systolic blood pressure <130 mm Hg on (a) systolic and diastolic BPs over 1 year and (b) antihypertensive therapeutic intensity (a metric of antihypertensive treatment that is derived from the number of antihypertensive medications and percentage of maximal efficacious dose). Data are shown as mean ± SD. Note: Circle symbols represent placebo and square symbols represent vitamin D treatment groups. Asterisk (*) represents cardiac magnetic resonance (CMR) date. Abbreviations: BP, blood pressure; ED, emergency department.
See this image and copyright information in PMC

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