Can You Take Nugenix With High Blood Pressure Medication? Best 177 Answer

Pronunciation: tes TOS ter one Brand: Jatenzo

What is the most important information I should know about testosterone? You should not be treated with testosterone if you have prostate cancer, male breast cancer, or age-related low testosterone levels. Testosterone can raise your blood pressure, which can increase your risk of heart attack, stroke, or death. You may need to stop using testosterone or start taking blood pressure medication. Testosterone should not be used to enhance athletic performance.

What is testosterone? Testosterone is a naturally occurring sex hormone produced in a man’s testicles. Small amounts of testosterone are also produced in a woman’s ovaries and adrenal system. Testosterone is used as hormone replacement therapy in adult men with certain medical conditions that cause low or no testosterone levels. Testosterone will not improve athletic performance and should not be used for this purpose. Testosterone may also be used for purposes not listed in this medication guide.

What should I discuss with my doctor before taking testosterone? You should not use testosterone if you are allergic to it or if you have: male breast cancer;

prostate cancer; or

Low testosterone levels due to aging. Although this medicine is only for men, testosterone can harm an unborn baby and should not be used by a pregnant woman. Tell your doctor if you have ever had: heart problems;

high blood pressure;

sleep apnea (pauses in breathing during sleep);

an enlarged prostate and problems urinating;

liver or kidney disease;

depression, anxiety, a mood disorder, suicidal thoughts or actions; or

Elevated hematocrit or hemoglobin level in a blood test. Testosterone use can increase your risk of developing prostate cancer. Ask your doctor about this risk. Testosterone can decrease your sperm count, which can affect fertility (your ability to have children).

How should I take testosterone? Your doctor will do a blood test to make sure testosterone is the right treatment for your condition. Follow all directions on your prescription label and read any medication guides or directions for use. Your doctor may occasionally change your dose. Use the medicine exactly as directed. Testosterone is usually taken 1 time in the morning and 1 time in the evening. Follow your doctor’s dosage instructions very carefully. Always take this medicine with a meal. You will need frequent blood tests and your blood pressure will need to be checked frequently. Your next dose may be delayed based on the results. Testosterone abuse can have dangerous or irreversible effects, such as enlarged breasts, small testicles, infertility, high blood pressure, heart attack, stroke, liver disease, bone growth problems, addiction, and psychological effects such as aggression and violence. It is against the law to steal, sell or give away this medicine. Store at room temperature away from moisture and heat. Keep track of your medication. You should be aware if someone is using it improperly or without a prescription.

What happens if I miss a dose? Take the medicine as soon as possible, but skip the missed dose if it is almost time for your next dose. Do not take two doses at the same time.

What happens if I overdose? See an ambulance or call the poison control center at 1-800-222-1222.

What should I avoid while taking testosterone? Follow your doctor’s advice about any food, drink, or activity restrictions.

What side effects can testosterone have? Get medical help if you have signs of an allergic reaction: hives; difficult breathing; swelling of the face, lips, tongue or throat. Testosterone can raise your blood pressure, which can increase your risk of heart attack, stroke, or death. You may need to stop using testosterone or start taking blood pressure medication. Call your doctor at once if you have: swelling in your feet, ankles, or legs;

pain or swelling in your breasts;

breathing problems during sleep (breathing may stop);

unusual mood or behavior changes, new or worsening depression, thoughts of harming yourself;

liver problems – nausea, vomiting, abdominal pain (upper right side), dark urine, jaundice (yellowing of the skin or eyes);

– nausea, vomiting, abdominal pain (upper right side), dark urine, jaundice (yellowing of the skin or eyes); signs of a blood clot in the lungs – chest pain, sudden cough, wheezing, rapid breathing, coughing up blood;

– chest pain, sudden cough, wheezing, rapid breathing, coughing up blood; signs of a blood clot deep in the body – pain, swelling, warmth or redness in your leg; or

– pain, swelling, warmth or redness in your leg; or worsening symptoms of an enlarged prostate – increased urination, a poor stream of urine, an urgent need to urinate, or loss of bladder control. Common side effects may include: increased red blood cell count;

an enlarged prostate;

erections that occur more often or last longer than usual;

increased blood pressure;

nausea, heartburn, belching;

Diarrhea;

Headache; or

Swelling in the lower legs. This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You can report side effects to the FDA at 1-800-FDA-1088.

What other drugs affect testosterone? Tell your doctor about all your other medicines, especially: insulin;

blood pressure medication;

medicines to treat pain, cough or cold symptoms;

a blood thinner – Warfarin, Coumadin, Jantoven; or

– Warfarin, Coumadin, Jantoven; or steroid medicine – prednisone, dexamethasone and others. This list is incomplete. Other drugs can affect testosterone, including prescription and over-the-counter drugs, vitamins, and herbal products. Not all possible drug interactions are listed here.

Where can I get more information? Your pharmacist can give you more information about testosterone.

Remember to keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medicine only for the indication prescribed. Every effort has been made to ensure that the information provided by Cerner Multum, Inc. (“Multum”) is accurate, current and complete, but no guarantee is made. The drug information contained herein may be time sensitive. Multum information was compiled for use by healthcare professionals and consumers in the United States, and as such, Multum does not warrant that use outside of the United States is appropriate unless expressly stated otherwise. Multum drug information does not endorse any drug, diagnose patients, or recommend therapy. Multum’s drug information is an informational resource intended to assist licensed healthcare professionals in the care of their patients and/or consumers who consider this service to be a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare professionals. The absence of a warning for a particular drug or drug combination should in no way be construed to mean that the drug or drug combination is safe, effective, or appropriate for any particular patient. Multum assumes no responsibility for any aspect of healthcare performed using the information provided by Multum. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have any questions about the medicines you are taking, ask your doctor, nurse or pharmacist. Copyright 1996-2022 Cerner Multum, Inc. Version: 1.01. Revision date: 02/21/2020.

1. Magnesium Magnesium is a mineral that is critical to many bodily functions, including blood pressure regulation (3). Studies show that magnesium supplements may help lower blood pressure by increasing the production of nitric oxide — a signaling molecule that helps blood vessels relax (4). A review of 11 randomized trials found that magnesium intake at 365–450 mg per day for an average of 3.6 months significantly reduced blood pressure in people with chronic conditions (5). Another review of 10 studies involving over 200,000 people suggested that a greater dietary intake of magnesium may protect against high blood pressure in the first place. Every 100 mg daily increase in dietary magnesium was associated with a 5% reduction in the risk of hypertension (6).

2. Vitamin D Research shows that people with high blood pressure tend to have lower levels of vitamin D than people without the condition (7, 8). Studies also show that higher levels of vitamin D in the blood can help protect against high blood pressure. A review of data from over 300,000 people found that those with the highest levels of vitamin D had up to a 30% reduced risk of high blood pressure compared to those with the lowest levels (9, 10). Therefore, people with high blood pressure should have their vitamin D levels checked and supplemented accordingly. Dietary Supplement 101: Vitamin D

3. B vitamins Several B vitamins can help lower blood pressure. For example, vitamin B2 (riboflavin) supplements have been shown to help lower blood pressure in adults with mutations in the methylenetetrahydrofolate reductase (MTHFR) gene that make high blood pressure more likely (11, 12, 13). Folic acid and folate supplements — vitamin B9 — may also lower blood pressure in people with heart disease. In addition, higher folic acid intake in young adulthood may protect against this condition later in life (14, 15). While animal studies suggest that vitamin B6 supplements also lower high blood pressure, human research is lacking (16).

4. Potassium Potassium is probably the best-known dietary supplement for blood pressure regulation. Studies suggest that increasing intake through food or supplements helps reduce high blood pressure (17, 18, 19, 20). Potassium works by promoting sodium excretion through the urine and helping the blood vessels relax. In a review of 23 studies, potassium supplements caused a modest but significant drop in blood pressure compared to placebo ( 18Trusted Source ). Other reviews note that these supplements are safe and effective, although they appear to be most effective in people with high blood pressure who are on a high-sodium diet (19, 21).

5. CoQ10 Coenzyme Q10 — commonly called CoQ10 — is a vitamin-like molecule made by your body and found in certain foods (22). When taken as a dietary supplement, it can help lower blood pressure. A review of 17 studies found that CoQ10 supplements significantly lowered systolic blood pressure, which is the highest number on any reading ( 23Trusted Source ). However, results from other studies are mixed. Therefore, more research is needed (24).

6. L-Arginine L-arginine is an amino acid that may lower blood pressure when taken as a dietary supplement. A comprehensive review of 7 meta-analyses in 4,676 people showed that L-arginine supplements significantly reduced total blood pressure in people with high levels, as well as diastolic blood pressure in pregnant women with high levels (25). In addition, the review found that L-arginine supplements significantly improved blood vessel function and blood flow ( 25Trusted Source ).

7. Vitamin C Vitamin C is a water-soluble nutrient that your body needs for many important processes. Although study results have been mixed, recent research suggests that vitamin C supplements may help lower blood pressure. In a review of 8 studies in people with hypertension, taking 300–1,000 mg of vitamin C per day significantly reduced their levels (26). Research also suggests that people with low blood levels of this vitamin are at higher risk of high blood pressure than those with optimal vitamin C levels (27).

8. Beetroot Share on Pinterest Leslie Grow/Offset Images Athletes often take beetroot supplements to increase exercise performance, as this root vegetable improves blood flow and oxygenation to your muscles (28). Interestingly, beetroot supplements have been shown to lower blood pressure in people with and without hypertension (28, 29). For example, a review of 11 studies found that beetroot juice lowered blood pressure in people with and without the condition ( 30Trusted Source ).

9. Garlic Garlic is linked to a variety of benefits, including reduced blood pressure and the risk of heart disease (31). Adding a garlic supplement to your routine can help lower your blood pressure naturally. In fact, in a review of 12 studies, garlic supplements reduced systolic and diastolic blood pressure by an average of 8.3 mmHg and 5.5 mmHg, respectively (32). Researchers estimated that this reduction may help reduce your risk of stroke, heart attack, and coronary artery disease by up to 40% (32).

10. Fish Oil Fish oil may improve heart health by lowering blood lipid levels, inflammation and high blood pressure. Studies show that people with high blood pressure may benefit from high-dose fish oil supplements (33). In one review, taking the omega-3 fats EPA and DHA, including fish oil supplements, resulted in significant reductions in systolic and diastolic blood pressure of 4.51 and 3.05 mmHg, respectively, in people with high blood pressure who were not taking medication (34 ). Additionally, research finds that higher levels of omega-3 in the blood may protect against high blood pressure (35).

11. Probiotics Probiotics are beneficial bacteria that occur naturally in your gut. Dietary supplements containing these bacteria have been linked to numerous health benefits, including lower blood pressure. In a review of nine studies, probiotic supplements significantly lowered blood pressure compared to control groups ( 36Trusted Source ). However, researchers found that treatment was more effective when multiple strains of probiotics were taken, the supplements were taken for 8 weeks or more, and the daily dose was greater than 10 billion colony-forming units (CFU) (36). Notably, another review found that probiotic supplements significantly lowered blood pressure in people with high levels compared to control groups ( 37Trusted Source ).

12. Melatonin Melatonin is an endogenous hormone that you can also take as a dietary supplement. Although these supplements are popularly used to promote sleep, they are also associated with other health benefits. For example, studies show that melatonin supplements can lower blood pressure in people with high levels. A review of 5 studies linked melatonin supplements to a significant reduction in blood pressure compared to control groups (38). Another study suggested that low melatonin production may be a risk factor for high blood pressure in women (39).

13. Green Tea Green tea has been linked to a variety of impressive health benefits, including healthy blood pressure levels (40). A review of 24 studies showed that taking green tea supplements or drinking green tea for 3–16 weeks significantly reduced blood pressure in people with and without high levels (41). Although these results are promising, larger long-term studies are needed.

14. Ginger Share on Pinterest Joanna Wojewoda/Offset Images Research suggests that high-dose ginger supplements may help lower high blood pressure. A review of 6 studies found that ginger supplements, when taken in doses of 3 grams or more per day for 8 weeks or less, significantly reduced blood pressure in people aged 50 and younger (42). In a 12-week study of 37 people with metabolic syndrome — a group of conditions that increase the risk of heart disease — taking 2 grams per day of ginger powder significantly reduced blood pressure, triglycerides, and fasting blood sugar compared to a placebo (43rd ).

Precautions Although several supplements can lower blood pressure, this does not mean that every supplement is safe. It’s important to realize that many supplements can interact with common medications, including blood pressure medications (44, 45). In addition, taking too little of a supplement may be ineffective for lowering blood pressure, but taking too much can lead to serious side effects. Therefore, you should always consult your doctor before adding any supplements to your routine. Your healthcare provider can help you determine a safe and effective dose based on your needs. It is also important to choose a quality brand. Whenever possible, purchase dietary supplements that have been tested for purity by organizations such as the United States Pharmacopeia (USP) or NSF International. Useful Supplement Buying Guides Check out these two articles to make supplement shopping a breeze: How to Choose Quality Vitamins and Supplements

How to Read Supplement Labels Like a Pro If you have questions about choosing a quality supplement, consult a qualified healthcare provider, such as a Registered Dietitian, for advice. Summary Before taking any dietary supplement, talk to your doctor to make sure it is safe and effective for its intended use.

Beta blockers are drugs used to treat high blood pressure and heart disease.

Coffee and other caffeinated beverages or foods such as soda, high-energy drinks, tea, and dark chocolate decrease the effectiveness of beta-blockers by counteracting their anti-adrenergic effects.

Beta blockers lower blood pressure by reducing the effects of the excitatory neurotransmitter adrenaline on the heart, lowering blood pressure. However, caffeine raises blood pressure by increasing the effects of adrenaline on the heart.

Coffee increases the rate at which beta blockers are metabolized in the body. This can cause the drug to remain active in the body for a shorter period of time.

Although coffee initially increases blood pressure, regular coffee consumption may not have this effect.

Therefore, it is recommended to avoid excessive caffeine while taking beta-blockers.

Coffee increases blood pressure in the following ways:

For example, nutritious foods and prescription drugs seem like a couple made in wholesome heaven, right? Not necessarily. According to board-certified primary care physician and Vireo Health’s chief medical officer, Stephen Dahmer, M.D., food and drink can affect how much of a drug is absorbed and how quickly the body metabolizes it. These food-drug interactions can render a prescription ineffective or increase its absorption and risk of dangerous side effects. Dahmer explains some common food-drug interactions that seniors and caregivers should be aware of below.

5 foods that can trigger food-drug interactions

Grapefruit and Grapefruit Products Vitamin C, fiber and potassium are just a few of the health benefits of eating grapefruit. However, even small amounts of grapefruit juice can disrupt important gut enzymes and alter the way some medications are metabolized by the body. Grapefruit products are contraindicated for patients taking certain prescription medications such as statins (Lipitor, Mevacor, Zocor), immunosuppressants (cyclosporine), calcium channel blockers (Adalat, Afeditab, Procardia, Plendil), psychotropic drugs (BuSpar, Zoloft), and benzodiazepines (Valium, Triazolam, Halcion). Dahmer says that eating grapefruit with any of these drugs can increase your risk of side effects and adverse events.

Kelly O’Connor, RD, LDN, CDE, a nutritionist in outpatient oncology at the University of Maryland Upper Chesapeake Health System’s Kaufman Cancer Center, warns that certain sodas like Squirt and Fresca may also contain grapefruit juice, so it’s important to read the drink labels to check carefully. to. It offers a simple solution to enjoy the health benefits and flavor profile of grapefruit without risk: swap it out for other citrus fruits like oranges, lemons, limes, or a combination of these. Bananas A potassium powerhouse, bananas are typically a good choice for those looking to reduce their risk of cancer, stroke, and heart disease. However, eating too many potassium-rich foods such as bananas, oranges, and green leafy vegetables can be problematic if a person is taking ACE inhibitors or angiotensin receptor blockers (ARBs). Designed to lower blood pressure, these drugs also reduce potassium excretion through urination. According to the FDA, people taking ACE inhibitors (Lotensin, Capoten, Zestril) or ARBs (Cozaar) can develop hyperkalemia (elevated potassium levels) and dangerous heart palpitations if they overindulge in foods high in potassium. This risk is increased in older people with impaired kidney function.

Bananas also contain tyramine, an amino acid found in red wine, soy, and certain cheeses that can negatively interact with monoamine oxidase inhibitors (MAOIs). MAOIs (Nardil, Parnate) are a class of drugs that are commonly prescribed to treat depression. O’Connor says a low-tyramine diet is usually recommended for people taking these drugs. Cranberry Juice Urinary Tract Infections (UTIs) are a common and potentially serious problem for seniors. Many caregivers use home remedies like cranberry juice or cranberry extract to prevent and treat recurring UTIs, but this juice contains chemicals that can interact with warfarin (Coumadin) and some statin drugs. Leafy greens Spinach, kale, cabbage, and broccoli are highly acclaimed in health circles for their vitamin K content, minerals, fiber, and low calorie content. But for people taking blood thinners like warfarin, eating too much greens can be bad.

Dahmer warns that vitamin K promotes blood clotting, which can counteract the blood-thinning effects of anticoagulant drugs. However, taking blood thinners doesn’t mean seniors have to forego a healthy diet. According to O’Connor, it’s okay for people taking these medications to consistently consume a moderate amount of leafy greens like spinach (eg, 1/2 cup two to three times a week). The key is to discuss usual diet with the prescribing doctor and they will optimize anticoagulant therapy to suit lifestyle factors and prevent blood clots. High-fiber foods and high-fiber supplements Fiber, found in whole grains, vegetables, and fruits, is an important part of a nutritious diet. In fact, fiber has been shown to play a role in reducing the risk of heart disease and diabetes. It can also help relieve constipation and promote healthy weight control. However, because fiber slows the rate at which the stomach empties, Dahmer warns that it can also slow the rate at which medications are absorbed, leading to lower blood levels of certain prescription drugs like antibiotics. This effect is enhanced with fiber supplements such as Metamucil and Citrucel.

It’s important to understand that the average American is not getting the recommended daily amount of fiber from the food they eat. Talk to your doctor about your fiber intake and whether you’re taking a fiber supplement. You’re unlikely to need to avoid high-fiber foods, but you may need to adjust when taking your supplement and medication.

Administer medicines responsibly

Any time a doctor adds a medication to your treatment, tell them about all prescription drugs, over-the-counter (OTC) drugs, and dietary supplements you’re already taking to make sure everything is working for its intended purpose and to minimize the possibility of side effects.

You don’t always have to avoid a certain food just because it may interact with your medication. To find out how specific medications interact with common foods, other drugs, alcohol, and even herbal supplements, use the Drug Interaction Checker on Drugs.com.

Don’t hesitate to talk to your doctor about any questions or concerns you may have about how your diet or lifestyle might be affecting your prescription drug treatment. He or she may be able to recommend alternative medications that don’t require dietary restrictions.

Be sure to read the labels and package inserts that accompany all medications to learn what foods and beverages to avoid (if any) and whether they should be taken with food or on an empty stomach. If you need to review a medication insert, visit the U.S. Food & Drug Administration (FDA) to search their extensive database of drug guides.

Finally, Dahmer shares a tip for caregivers and seniors: Take medication with plenty of water to aid absorption and reduce upset stomach.

overview

Vitamin D is a nutrient your body needs to build and maintain healthy bones. That’s because your body can’t absorb calcium, the main component of bones, unless vitamin D is present. Vitamin D also regulates many other cellular functions in your body. Its anti-inflammatory, antioxidant and neuroprotective properties support immune system health, muscle function and brain cell activity.

Vitamin D doesn’t occur naturally in many foods, but you can get it from fortified milk, fortified cereals, and oily fish like salmon, mackerel, and sardines. Your body also makes vitamin D when direct sunlight converts a chemical in your skin into an active form of the vitamin (calciferol).

The amount of vitamin D your skin makes depends on many factors, including time of day, season, latitude, and your skin pigmentation. Depending on where you live and your lifestyle, vitamin D production can decrease or be absent in the winter months. While sunscreen is important for preventing skin cancer, it can also decrease vitamin D production.

Many older adults don’t get regular sun exposure and have trouble absorbing vitamin D. If your doctor suspects you’re not getting enough vitamin D, a simple blood test can check the levels of this vitamin in your blood.

Taking a multivitamin supplement with vitamin D can help improve bone health. The recommended daily amount of vitamin D is 400 International Units (IU) for children up to 12 months of age, 600 IU for people aged 1 to 70 years and 800 IU for people over 70 years of age.

proof

Research into the use of vitamin D for certain medical conditions shows:

Cancer. Evidence on the benefits of vitamin D for cancer prevention is mixed. More studies are needed to determine whether vitamin D supplementation can reduce the risk of certain types of cancer.

Evidence on the benefits of vitamin D for cancer prevention is mixed. More studies are needed to determine whether vitamin D supplementation can reduce the risk of certain types of cancer. cognitive health. Research shows that low levels of vitamin D in the blood are linked to cognitive decline. However, more studies are needed to determine the benefits of vitamin D supplementation for cognitive health.

Research shows that low levels of vitamin D in the blood are linked to cognitive decline. However, more studies are needed to determine the benefits of vitamin D supplementation for cognitive health. Hereditary bone diseases. Vitamin D supplements can be used to treat hereditary disorders that result from an inability to absorb or process vitamin D, such as: B. Familial hypophosphatemia.

Vitamin D supplements can be used to treat hereditary disorders that result from an inability to absorb or process vitamin D, such as: B. Familial hypophosphatemia. Multiple sclerosis. Research suggests that long-term vitamin D supplementation reduces the risk of multiple sclerosis.

Research suggests that long-term vitamin D supplementation reduces the risk of multiple sclerosis. osteomalacia. Vitamin D supplements are used to treat adults with severe vitamin D deficiency leading to loss of bone mineral content, bone pain, muscle weakness, and soft bones (osteomalacia).

Vitamin D supplements are used to treat adults with severe vitamin D deficiency leading to loss of bone mineral content, bone pain, muscle weakness, and soft bones (osteomalacia). Osteoporosis. Studies suggest that people who get enough vitamin D and calcium in their diets can slow bone mineral loss, prevent osteoporosis, and reduce bone fractures. Ask your doctor if you need a calcium and vitamin D supplement to prevent or treat osteoporosis.

Studies suggest that people who get enough vitamin D and calcium in their diets can slow bone mineral loss, prevent osteoporosis, and reduce bone fractures. Ask your doctor if you need a calcium and vitamin D supplement to prevent or treat osteoporosis. Psoriasis. Applying vitamin D or a topical preparation containing a vitamin D compound called calcipotriene to the skin can treat plaque psoriasis in some people.

Applying vitamin D or a topical preparation containing a vitamin D compound called calcipotriene to the skin can treat plaque psoriasis in some people. Rickets. This rare condition occurs in children with vitamin D deficiency. Vitamin D supplementation can prevent and treat the problem.

Our opinion

Generally safe

Without vitamin D, your bones can become soft, thin, and brittle. A lack of vitamin D is also associated with osteoporosis. If you’re not getting enough vitamin D from sunlight or dietary sources, you may need vitamin D supplements.

safety and side effects

Taken in appropriate doses, vitamin D is generally considered harmless.

However, taking too much vitamin D in supplement form can be harmful. Children 9 years and older, adults, and pregnant and breastfeeding women who take more than 4,000 IU of vitamin D daily may experience:

nausea and vomiting

loss of appetite and weight loss

constipation

Weakness

confusion and disorientation

cardiac arrhythmias

kidney stones and kidney damage

interactions

Possible interactions are:

Aluminum. Taking vitamin D and aluminum-containing phosphate binders, which can be used to treat high serum phosphate levels in people with chronic kidney disease, can lead to harmful aluminum levels long-term in people with kidney failure.

Taking vitamin D and aluminum-containing phosphate binders, which can be used to treat high serum phosphate levels in people with chronic kidney disease, can lead to harmful aluminum levels long-term in people with kidney failure. anticonvulsants. The anticonvulsants phenobarbital and phenytoin (Dilantin, Phenytek) increase the breakdown of vitamin D and decrease calcium absorption.

The anticonvulsants phenobarbital and phenytoin (Dilantin, Phenytek) increase the breakdown of vitamin D and decrease calcium absorption. Atorvastatin (Lipitor). Taking vitamin D can affect the way your body processes this cholesterol drug.

Taking vitamin D can affect the way your body processes this cholesterol drug. Calcipotria (Dovonex, Sorilux). Do not take vitamin D with this psoriasis medication. The combination could increase the risk of too much calcium in the blood (hypercalcaemia).

Do not take vitamin D with this psoriasis medication. The combination could increase the risk of too much calcium in the blood (hypercalcaemia). Cholestyramine (Prevalit). Taking vitamin D along with this cholesterol-lowering drug may decrease your vitamin D absorption.

Taking vitamin D along with this cholesterol-lowering drug may reduce your vitamin D absorption. Cytochrome P-450 3A4 (CYP3A4) substrates. Use vitamin D cautiously if you are taking medications that are processed by these enzymes.

Use vitamin D cautiously if you are taking medications that are processed by these enzymes. Digoxin (Lanoxin). Avoid taking high doses of vitamin D with this heart medication. High doses of vitamin D can cause hypercalcemia, which increases the risk of fatal heart problems with digoxin.

Avoid taking high doses of vitamin D with this heart medication. High doses of vitamin D can cause hypercalcemia, which increases the risk of fatal heart problems with digoxin. Diltiazem (Cardizem, Tiazac, others). Avoid taking high doses of vitamin D with this blood pressure medication. High doses of vitamin D can cause hypercalcemia, which can reduce the drug’s effectiveness.

Avoid taking high doses of vitamin D with this blood pressure medication. High doses of vitamin D can cause hypercalcemia, which can reduce the drug’s effectiveness. Orlistat (Xenical, Alli). Taking this drug for weight loss may decrease your vitamin D absorption.

Taking this drug for weight loss may decrease your vitamin D absorption. thiazide diuretics. Taking these blood pressure medications with vitamin D increases the risk of hypercalcemia.

Taking these blood pressure medications with vitamin D increases the risk of hypercalcemia. steroids. Taking steroid mediations such as prednisone can decrease calcium absorption and interfere with your body’s processing of vitamin D.

Taking steroid medications such as prednisone can decrease calcium absorption and interfere with your body’s processing of vitamin D. Stimulant laxatives. Long-term use of high doses of stimulant laxatives can decrease absorption of vitamin D and calcium.

Long-term use of high doses of stimulant laxatives can decrease absorption of vitamin D and calcium. Verapamil (Verelan, Calan SR). Taking high doses of vitamin D along with this blood pressure drug can cause hypercalcemia and may also decrease the effectiveness of verapamil.

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Diet can have a significant impact on blood pressure. The DASH meal plan significantly lowers blood pressure in people with normal or high blood pressure. Increasing potassium intake while reducing sodium intake has also been shown to lower blood pressure. Supplemental vitamin C lowers blood pressure in individuals with normal and high blood pressure, while supplemental riboflavin may lower blood pressure in hypertensive individuals with a specific genetic predisposition. Although the scientific evidence on garlic is less consistent, there is some evidence that garlic supplements may lower blood pressure in hypertensive individuals.

disease overview

Blood pressure refers to the force of blood exerted on the walls of arteries when the heart pumps blood.

A blood pressure measurement consists of two measurements: the systolic and the diastolic blood pressure

Systolic blood pressure (SBP) is the pressure exerted on arterial walls as the heart contracts during a heartbeat.

Diastolic blood pressure (DBP) is the pressure exerted on the walls of the arteries between heartbeats when the heart is relaxed.

When blood pressure is elevated, there is a constant, increased force that stretches the arteries beyond a healthy limit. This leads to a long list of negative effects such as: B.: tearing and scarring, weak spots that tear easily, blood clots, increased plaque formation and increased workload on the heart.

High blood pressure (HBP) is considered both a risk factor and a disease:

HBP is a major risk factor for cardiovascular disease, increasing the likelihood of heart attack, stroke, heart failure, and atrial fibrillation. It’s also considered a modifiable risk factor, meaning there are things you can do to change your blood pressure.

HBP is sometimes called “the silent killer” because it damages the cardiovascular system with no obvious symptoms.

Below is specific information on nutrients and dietary factors relevant to high blood pressure.

DEFINITIONS

Artery (adj: arterial) – A muscular blood vessel that carries blood away from the heart

Plaque – A deposit of fat, cholesterol, immune cells, fibrin (a clotting protein) and other substances that forms inside the walls of arteries

Commonly used treatments and medications

The Dietary Approaches to Stop Hypertension (DASH) meal plan.

In addition to the nutrients listed below, eating habits play a key role in blood pressure regulation. For example, adhering to the DASH meal plan — a diet high in fruits, vegetables, and low-fat dairy while low in saturated and total fats — has been associated with significant reductions in both systolic and diastolic blood pressure.

For more information on the DASH meal plan, visit the National Institutes of Health.

antihypertensive drugs

There are many medications that are prescribed to lower blood pressure. The five major classes of antihypertensive drugs and potential dietary interactions are listed in Table 1.

Table 1. Major classes of antihypertensive drugs Class How drugs lower blood pressure Possible interactions Angiotensin converting enzyme (ACE) inhibitors help the body produce less angiotensin II, a chemical that causes blood vessels to narrow (narrow) and become elevated Potassium levels in the blood Angiotensin II receptor blockers block the action of angiotensin II, a chemical that causes narrowing (narrowing) of blood vessels and can lead to increased levels of potassium in the blood;

Grapefruit juice may decrease drug availability. Calcium channel blockers prevent calcium from entering the smooth muscle cells of the heart and arteries, leading to widening (dilation) of blood vessels and a decreased heart rate. Grapefruit juice may increase drug availability. Diuretics help the body eliminate excess sodium and water in the urine, which can lead to decreased levels of sodium and potassium in the blood

potassium-sparing diuretics may increase blood potassium levels

may lead to increased levels of calcium in the blood when taken with calcium supplements

Prolonged use can increase the loss of zinc, magnesium, and thiamine. β-blockers decrease the heart rate and the force of the heart’s contractions, which can lead to increased levels of potassium in the blood

nutrition research

DEFINITIONS

Test tube experiment (in vitro) – a research experiment performed in a test tube, culture dish or other artificial environment outside of a living organism; in vitro is a Latin phrase meaning in glass

Animal experiment – a research experiment conducted on a laboratory animal; Many different species of animals are studied in the laboratory, including terrestrial (land), aquatic (aquatic) and microscopic animals

Observational study – a human research study that does not use any experimental intervention or treatment and simply observes the participants over an extended period of time

Randomized Controlled Trial – A human research study in which participants are randomly assigned to receive either an experimental agent (the treatment group) or a placebo (the control group).

Placebo – a chemically inactive substance

calcium

what it does

General

Calcium is an essential mineral that is a structural component of bones and teeth, is required for proper nerve transmission and muscle contraction, and affects blood pressure.

blood pressure specific

Calcium can affect the narrowing and widening (narrowing and widening) of blood vessels through its effects on the smooth muscle cells that make up the walls of arteries.

what we know

Several large observational studies indicate that higher dietary calcium intake is associated with lower systolic and diastolic blood pressure.

In randomized controlled trials, supplemental calcium had no significant effect on blood pressure in normotensive individuals; a slight reduction in systolic blood pressure (-2.5 mmHg) has been observed in subjects with hypertension.

Research shows that calcium intake at the recommended level of 1,000-1,200 milligrams/day can help prevent and treat moderate hypertension.

For references and more information see the Hypertension section of the Calcium article.

magnesium

what it does

General

Magnesium is an essential mineral that serves as a structural component of the skeleton; helps in hundreds of enzymatic reactions involved in the synthesis of energy, DNA and proteins; and is required for proper nerve conduction and muscle contraction.

blood pressure specific

The way magnesium affects blood pressure is not clear. Magnesium can induce relaxation of vascular smooth muscle cells, alter levels of inflammatory mediators, and reduce angiotensin-induced aldosterone synthesis, all of which can lower blood pressure.

what we know

Several large observational studies indicate that higher dietary magnesium intake is associated with lower blood pressure and a reduced risk of developing hypertension.

However, it is difficult to attribute an independent effect of magnesium on blood pressure because foods high in magnesium (fruits, vegetables, and whole grains) are also high in other nutrients (potassium, fiber) that can affect blood pressure. lowering effect.

A pooled analysis of randomized controlled trials showed a beneficial effect of magnesium supplementation in the treatment of hypertension. An average dose of 410 milligrams (mg) of magnesium per day for 11.3 months lowered blood pressure in people with hypertension. However, the dose of supplemental magnesium required to lower blood pressure appears to depend on whether the person is taking antihypertensive medications such as diuretics – the dose required is higher in untreated people.

DEFINITIONS

Diuretic – an agent that increases the production of urine by the kidneys, resulting in water loss in people using the diuretic

SAFETY HIGHLIGHT

The Tolerable Upper Intake Level (UL) for magnesium is 350 milligrams (mg) of additional magnesium per day. Because of the potential risks of high-dose magnesium supplementation, especially in the case of impaired renal function, magnesium supplementation should be carried out under medical supervision.

For references and more information see the Hypertension section of the Magnesium article.

potassium

what it does

General

Potassium is an essential mineral that helps maintain fluid and electrolyte balance, affects blood pressure, and is required for proper nerve conduction and muscle contraction.

blood pressure specific

Increased potassium intake leads to increased excretion of sodium in the urine. This loss of sodium in the urine helps reduce water retention, blood volume, and blood pressure.

what we know

Numerous observational studies show that higher dietary potassium intake is associated with lower blood pressure.

Even more important than potassium intake alone is the ratio of potassium to sodium in the diet. Most experts recommend increasing your potassium intake while decreasing your sodium chloride (salt) intake.

Randomized controlled trials show that increased potassium intake, usually in the form of potassium chloride supplementation, has a modest antihypertensive effect in people with normal or high blood pressure.

Some people, e.g. B. Individuals with kidney disease or those taking certain medications (Table 1) should follow their doctor’s advice regarding potassium intake.

Interactions with other drugs

Many drugs are known to increase the risk of hyperkalemia (high serum potassium) and hypokalemia (low serum potassium) (Table 2).

Table 2. Drugs that increase the risk of abnormal blood potassium levels Hyperkalemia (high blood potassium levels) Hypokalemia (low blood potassium levels) α-blockers Aminoglycosides Angiotensin converting enzyme (ACE) inhibitors Certain antibiotics Angiotensin receptor blockers Antifungals Anti-infectives Drugs β-adrenergic agonists β-blockers Cisplatin Digitalis Diuretics Heparin Methylxanthines Nonsteroidal anti-inflammatory drugs (NSAIDs) Mineralocorticoids Potassium-sparing diuretics See the Safety section of the Potassium article for more information.

For references and more information, see the high blood pressure section of the potassium article.

riboflavin

what it does

General

Riboflavin is a B vitamin that helps convert food into usable energy and supports several metabolic and antioxidant enzymes.

blood pressure specific

As a helper to the enzyme MTHFR, riboflavin helps convert folic acid into a form necessary for the conversion of homocysteine ​​to methionine.

Riboflavin deficiency can reduce the conversion of homocysteine ​​to methionine, and too much homocysteine ​​in the blood is linked to an increased risk of high blood pressure.

what we know

Individuals with a specific genetic variation (polymorphism) in MTHFR may be at increased risk of developing high blood pressure.

In hypertensive individuals with the MTHFR c.677C>T polymorphism (homozygotes), riboflavin supplementation lowers both homocysteine ​​levels and blood pressure.

TO MARK

MTHFR polymorphism is measured by genetic testing. A genetic test uses a small amount of blood, saliva, or tissue to isolate and determine a person’s genetic information. Genetic testing is voluntary; Doctors and genetic counselors can advise you on choosing this type of test. MTHFR polymorphism is measured by genetic testing. A genetic test uses a small amount of blood, saliva, or tissue to isolate and determine a person’s genetic information. Genetic testing is voluntary; Doctors and genetic counselors can advise you on choosing this type of test. Source: National Institute for Human Genome Research

For references and more information, see the hypertension section of the Riboflavin article.

sodium chloride

what it does

General

Sodium is an essential mineral that helps maintain fluid and electrolyte balance, affects blood pressure, and is required for proper nerve conduction and muscle contraction.

The most common dietary source of sodium is salt, also known as sodium chloride. A teaspoon of salt contains 2.3 grams of sodium.

blood pressure specific

Sodium (coupled with chloride) is the primary determinant of extracellular (outside cells) fluid volume, including blood volume.

The kidneys regulate blood volume by regulating the amount of sodium and water lost in the urine; Sodium retention leads to water retention and sodium excretion leads to water excretion.

Most people consume more sodium chloride than recommended, which can lead to water retention, increased blood volume, edema (a buildup of excess fluid in the body), and increased blood pressure.

what we know

Observational studies consistently show that higher sodium intake is associated with higher blood pressure.

Many randomized controlled trials have examined the effect of dietary salt restriction on blood pressure. Even a small reduction in salt (less than a teaspoon per day) lowers systolic and diastolic blood pressure in people with and without hypertension.

Even more important than sodium reduction alone may be the ratio of sodium to potassium ingested in the diet. Therefore, most experts recommend reducing sodium chloride (salt) intake while increasing potassium intake.

HIGHLIGHT: SALT SENSITIVITY A measure of how your blood pressure responds to salt intake.

Animal experiments suggest that “salt sensitivity” may be related to an impaired ability of the kidneys to eliminate excess sodium.

While certain subgroups of the population tend to have greater changes in blood pressure in response to changes in sodium intake, the genetic basis for salt sensitivity is still being studied.

Even without knowing if you are “salt sensitive,” certain subgroups of the population respond better to reduced sodium intake: people with high blood pressure, the elderly, African Americans

For references and more information, see the hypertension section of the sodium article.

vitamin C

what it does

General

Vitamin C (ascorbic acid) neutralizes a variety of reactive oxygen species and recycles key cellular antioxidants.

and recycles important cellular . Vitamin C is also a cofactor in numerous enzymatic reactions involved in the production of collagen, L-carnitine and several neurotransmitters, as well as in the regulation of gene expression.

blood pressure specific

Vitamin C’s antioxidant activities may protect the lining of blood vessels from damage caused by oxidative stress and increase the availability of nitric oxide, a gaseous signaling molecule that helps arterial walls relax.

what we know

Several large observational studies found no association between vitamin C intake and high blood pressure.

On the other hand, plasma vitamin C concentration has been inversely associated with blood pressure in both men and women. In other words, the higher the body’s vitamin C status, the lower the blood pressure.

with blood pressure in both men and women. In other words, the higher the body’s vitamin C status, the lower the blood pressure. A pooled analysis of short-term randomized controlled trials showed that vitamin C supplementation (median dose of 500 milligrams [mg]/day for a median duration of eight weeks) reduced blood pressure in both normotensive and hypertensive adults (Table 3).

Table 3. Mean reduction in blood pressure after short-term vitamin C supplementation Systolic blood pressure (mm Hg) Diastolic blood pressure (mm Hg) Normotonic -3.84 -1.48 Hypertensive -4.85 -1.67

DEFINITIONS

Reactive Oxygen Species (ROS) – very unstable oxygen-containing compounds that readily react with nearby cellular structures, potentially causing damage

Antioxidants – Compounds that prevent or repair the damage caused by reactive oxygen species

Oxidative stress – a situation in which the production of reactive oxygen species exceeds an organism’s ability to eliminate or neutralize them

Inverse association – a relationship between two variables in which they move in opposite directions

For references and more information, see the high blood pressure sections of the Vitamin C article.

Vitamin D

what it does

General

Vitamin D is a fat-soluble vitamin that helps maintain calcium and phosphorus balance, promotes bone health and immune function, and affects cell growth and development.

blood pressure specific

Vitamin D affects the production of renin, an enzyme that regulates blood pressure. A lack of vitamin D could contribute to an increased activity of the renin-angiotensin system and an increased risk of high blood pressure.

what we know

Higher vitamin D status has been linked to lower blood pressure.

A pooled analysis of randomized controlled trials found no overall effect of vitamin D supplementation on blood pressure. However, there is evidence that vitamin D supplementation may improve blood pressure in individuals with serum 25(OH)-vitamin D levels less than 30 nanograms (ng)/mL.

For references and more information, see the sections on high blood pressure in the article Vitamin D: Prevention of Cardiovascular Disease and Treatment of Cardiovascular Disease.

Coenzyme Q10

what it does

General

Coenzyme Q10 is a compound that is made in the body and can be obtained from foods and supplements.

is a compound that can be made in the body and obtained from foods and supplements. Coenzyme Q10 helps the body convert food into usable energy and acts as an antioxidant in cell membranes.

blood pressure specific

Increased oxidative stress can impair the production and availability of nitric oxide, a potent vasodilator. Decreased nitric oxide levels contribute to vasoconstriction (narrowing of blood vessels) and increased blood pressure.

can affect the production and availability of , a potent . Decreased nitric oxide levels contribute to vasoconstriction (narrowing of blood vessels) and increased blood pressure. The antioxidant properties of coenzyme Q10 can help reduce oxidative stress and thereby increase the availability of nitric oxide.

what we know

Results from clinical trials examining whether coenzyme Q10 supplementation might help treat high blood pressure have been mixed.

Dietary supplements could help treat high blood pressure. The effect of coenzyme Q10 on blood pressure should be investigated in large, well-designed clinical trials.

DEFINITIONS

Antioxidant – a compound that prevents or repairs the damage caused by reactive oxygen species

Reactive Oxygen Species (ROS) – very unstable oxygen-containing compounds that readily react with nearby cellular structures, potentially causing damage

Oxidative stress – a situation in which the production of reactive oxygen species exceeds an organism’s ability to eliminate or neutralize them

Nitric Oxide – a gaseous signaling molecule; Nitric oxide promotes relaxation of arterial walls, leading to vasodilation

Vasodilator – something that widens blood vessels

For references and more information, see the hypertension section of the Coenzyme Q10 article.

Additional reference:

Ho MJ, Li EC, Wright JM. Blood pressure lowering efficacy of coenzyme Q 10 in primary hypertension. Cochrane Database Syst Rev. 2016;3:Cd007435

garlic

what it does

General

Garlic is a rich source of organosulfur compounds, a category of phytochemicals that give garlic its pungent smell and taste.

These organosulfur compounds and their breakdown products may be responsible for some of garlic’s beneficial health effects.

blood pressure specific

Test tube and animal studies show that garlic can affect blood pressure in a variety of ways.

Garlic’s bioactive compounds have been shown to: Induce antioxidant enzyme activity Increase production of hydrogen sulfide and nitric oxide, gaseous signaling molecules that relax blood vessels Inhibit enzymes involved in vasoconstriction (narrowing of blood vessels).

what we know

Garlic supplements appear to have an antihypertensive effect in hypertensive patients. On average, garlic supplements reduced systolic blood pressure by 9.1 mm Hg and diastolic blood pressure by 3.8 mm Hg when taken for at least two months.

No serious side effects have been reported. The most common side effect is garlic smell, taste and breath.

Garlic should not be used in place of antihypertensive medication.

HIGHLIGHT Although the results are promising, it is cautioned that the scientific evidence for garlic’s effect on high blood pressure is not strong. The majority of randomized controlled trials only recruited small numbers of participants, were of relatively short duration (most lasted only 12 weeks), and used different forms and dosages of garlic supplements.

DRUG INTERACTIONS Garlic may potentiate the anticoagulant effects of warfarin

Garlic may decrease the bioavailability of HIV protease inhibitors

See the high blood pressure section of the Garlic article for references and more information.

Dongdong Zhang, MD1; ChengCheng, MD2; Yan Wang, MD1; Hualei Sun, MD1; Songcheng Yu, MD1; Yuan Xue, MD1; Yiming Liu, MD1; Wenjie Li, MD, PhD1; Xing Li, MD1 (show author affiliations)

Suggested citation for this article: Zhang D, Cheng C, Wang Y, Sun H, Yu S, Xue Y, et al. Effect of vitamin D on blood pressure and hypertension in the general population: An updated meta-analysis of cohort studies and randomized controlled trials. Previous Chronic Dis 2020;17:190307. DOI: http://dx.doi.org/10.5888/pcd17.190307external symbol.

PEER REVIEW

Summary What is already known about this topic? The effects of vitamin D on the risk of hypertension and blood pressure have been extensively studied in cohort studies and randomized controlled trials (RCTs), but whether the association is causal is still unknown. What does this report add? We performed an updated meta-analysis of cohort studies and RCTs in a generally healthy population and found that the dose-response relationship between circulating 25-hydroxyvitamin D levels and risk of hypertension was approximately L-shaped. However, pooled results from RCTs showed that there was still no significant reduction in systolic and diastolic blood pressure. What are the implications for public health practice? Vitamin D supplementation is ineffective to prevent high blood pressure.

abstract

background

The effect of vitamin D supplementation on blood pressure has been examined in previous meta-analyses, but whether the association is causal in the general population is still unknown. We evaluated the club comprehensively and quantitatively.

methods

We searched PubMed and Embase for relevant cohort studies and randomized controlled trials (RCTs). We used a 2-stage generalized least squares method to assess the dose-response association of circulating 25-hydroxyvitamin D (25[OH]D) and hypertension and a fixed effects model to estimate the weighted mean differences (WMDs) and corresponding pooled 95% confidence intervals (95% CI) of blood pressure across RCTs.

Results

We identified 11 cohort studies and 27 RCTs with 43,320 and 3,810 participants, respectively. The dose-response relationship between circulating 25(OH)D levels and risk of hypertension was approximately L-shaped (P-nonlinearity = 0.04), suggesting that risk of hypertension increased substantially below 75 nmol/L , when 25(OH)D decreased. but it remained significant over the range of 75-130 nmol/L. However, pooled results from RCTs showed that there was no significant reduction in systolic blood pressure (WMD, -0.00 mm Hg; 95% CI, -0.71 to 0.71) or diastolic blood pressure (WMD, 0.19 mm Hg ; 95% CI, -) gave 0.29 to 0.67) after vitamin D intervention.

Conclusions

The results of this meta-analysis indicate that vitamin D supplementation does not lower blood pressure in the general population. RCTs with long-term interventions and a sufficient number of participants with low vitamin D levels are needed to validate these results.

above

introduction

Recent evidence suggests that vitamin D deficiency is a widespread global problem (1). According to the Institute of Medicine (IOM), vitamin D deficiency is defined as a circulating 25-hydroxyvitamin D (25[OH]D) level of <50 nmol/L, based on the optimal concentration for skeletal health (2). There has been growing interest in the potential health consequences of vitamin D deficiency, such as an increased risk of cardiovascular disease, cancer, and Alzheimer's (3–5). Although observational data have shown that poor vitamin D status is associated with an increased risk of hypertension (6–9), randomized controlled trials (RCTs) have provided little support for the beneficial effects of vitamin D supplementation on blood pressure (10-13). Given the potential confusion that remains, it is difficult to infer causality or reversibility in this relationship and to reach consensus from these results. Several meta-analyses of observational studies and RCTs have been published, but the results are conflicting (14–17). Golzarand et al. evaluated 30 RCTs with 4,744 participants and concluded that vitamin D has a beneficial effect in subgroups with daily doses > 800 IU/day, duration less than 6 months, or in older subjects (14). Kunutsor et al. suggested that vitamin D supplementation significantly reduced diastolic blood pressure (DBP) by 1.31 mm Hg in participants with pre-existing cardiometabolic diseases (16). However, another meta-analysis that included individual data supported that vitamin D supplementation is ineffective in lowering blood pressure (15).

Taken together, it can be hypothesized that the increased blood pressure or risk for hypertension is partially explained by the individual’s baseline vitamin D status, sample size, intervention dose, and length of follow-up. Given that pre-existing medical conditions such as diabetes, cardiovascular disease, and kidney disease can affect the physiological mechanism of vitamin D on blood pressure, there can be significant differences between individual patients and the general population. Therefore, limiting participants to the general population can help explore the true association hidden by the confounders. Analyzing the population as a whole, rather than restricting analyzes to specific population subgroups, can help us explore the true association that confounders hide. In addition, since the last meta-analysis in 2015, results from at least 10 other studies involving 1,716 participants on this topic have been published (10–12,18–24).

Our aim was to provide a comprehensive and quantitative meta-analysis from the published cohort studies and RCTs on the effect of vitamin D on hypertensive risk and blood pressure levels in the general population.

above

methods

We used the PRISMA checklist (Preferred Reporting Items for Systematic Review and Meta-analyses) to conduct the meta-analysis and to report the results (25).

Data Source and Searches

We searched PubMed and Embase databases up to 12 June 2019 for cohort studies reporting an association between blood 25(OH)D levels and the risk of developing hypertension and for RCTs evaluating the effect of vitamin D -Supplementation (alone or in combination with other nutrients) on blood pressure. The search terms “vitamin D” and “blood pressure” were used in combination to retrieve relevant datasets. Records were limited to human studies, and additional studies were retrieved by manually searching the references of identified articles and relevant systematic reviews.

study selection

Two investigators (D.Z. and C.C.) independently reviewed the titles and abstracts to identify articles for potentially relevant sources. Full text versions were requested to assess eligibility. To be included, the study had to meet the following criteria: 1) followed an RCT or cohort study design; 2) studied the relationship between vitamin D and the risk of hypertension or the effect of blood pressure; 3) included a general population (≥ 18 years) rather than patients with specific medical conditions (eg, diabetes, hypertension, stroke, heart failure); and 4) provided estimates of risk of hypertension in at least 3 categories of 25(OH)D blood levels or reported continuous risk estimates for dose-response analysis or reported blood pressure for meta-analysis of RCTs. We excluded articles if they 1) measured other metabolites of vitamin D (eg, 1,25-dihydroxyvitamin D); 2) focused on pregnant women or groups with specific diseases; or 3) did not report baseline/end blood pressure or post-invention changes from baseline. Inconsistencies were resolved through group discussions or decided by a third reviewer.

data extraction

Using predefined protocols, D.Z. extracted data from each study and C.C. checked for correctness. For cohort studies, the following information was abstracted: first author, publication year, country, follow-up period, sample size, age, number of cases/participants, categories of 25(OH)D values, reported risk estimates, 95% confidence intervals (CIs), and covariates that adjusted in the analyses. When several fitted models were examined, we extracted the risk measures from the model with the largest number of covariates. When the lowest 25(OH)D value was not the reference, we modified the risk estimates using the method of Hamling et al. (26) recalculated. When the mean or mean 25(OH)D level per category was not reported, we assigned the value as the midpoint of the lower and upper bounds in each category (27). If the category was open, we assumed the width of the interval to be the same as in the adjacent category (27). When studies reported 25(OH)D levels in ng/mL, we converted the values ​​to nmol/L by multiplying by 2.5.

For RCTs, we collected the following data: study design (sample size of each group, blinding methods, type and amount of intervention/placebo, duration of intervention, type of vitamin D, and frequency of intervention); Participant characteristics (age, gender, baseline circulating 25[OH]D levels); and baseline/terminal blood pressure in both the intervention and placebo groups and/or blood pressure changes from baseline. When studies used different doses of vitamin D, we extracted only the highest dose in the analysis. If blood pressure values ​​were measured repeatedly at different intervals in studies during the intervention, we only recorded the blood pressure values ​​at the longest follow-up time point. Attempts have been made to contact the appropriate authors for unavailable information.

Risk of bias assessment

We used the 9-star Newcastle-Ottawa scale to assess the quality of individual cohort studies; The scale is based on 8 aspects covering choice, comparability and ranges of outcomes (28). Meanwhile, we assessed the risk of bias for each study using 7 fields from The Cochrane Collaboration’s tool: random sequence generation, assignment obfuscation, blinding of participants and staff, blinding of outcome assessment, incomplete outcome data, selective reporting, and others Distortions (29). Summary ratings for studies were rated as high, low, or unclear according to the risk bias in each outcome. Differences of opinion were resolved in group discussions. Publication bias was assessed using the Egger test (30).

Data synthesis and analysis

To provide dose-response evidence from all cohort studies, we used the two-stage generalized least squares method (31). Study-specific slope coefficients were examined by constrained cubic splines with three nodes at 25%, 50%, and 75% of the distribution of circulating 25(OH)D concentrations. For the dose-response analyzes of 25(OH)D, the reference category was rescaled to 75 nmol/L, which corresponds to the cut-off between insufficient and sufficient vitamin D status. P-values ​​for nonlinearity were calculated using the Wald χ2 test, assuming that the coefficient of the second spline was zero. We used the DerSimonian and Laird random effects model to estimate study-specific dose-response risk, and we calculated the pooled risk of hypertension for each 25 nmol/L increase in 25(OH)D levels using a random Effects model (32). .

We assessed the effect of vitamin D supplementation using mean blood pressure changes (including systolic blood pressure [SBP] and DBP) in the intervention group minus blood pressure changes in the placebo group. Standard deviations (SDs) were obtained as indicated or calculated from 95% CIs, P-values ​​for t-statistics, or individual standard errors (SE) from intervention and placebo groups. When the studies reported no changes in blood pressure from baseline, we calculated mean values ​​using post-intervention blood pressure minus baseline blood pressure, and the standard deviation of changes was obtained according to the following formula, which is described in the Cochrane manual for systematic reviews of interventions (29):

above

S D c h a n g e = S D b a s e l i n e 2 + S D f i n a l 2 – ( 2 × C o r r × S D b a s e l i n e × S D f i n a l )

We estimated the correlation by calculations from 2 studies that provided complete data for SD baseline, SD final value, SD change in both the intervention and placebo groups (33,34). Heterogeneity between studies was assessed using I2 and Q statistics. We used fixed effects models and forest plots to pool the weighted mean differences (WMDs) and corresponding 95% CIs of blood pressure across studies.

Predefined subgroup analyzes were performed to examine possible effect modifications and sources of heterogeneity. We also performed sensitivity analyses, removing one study at a time, to ensure that the pooled result was not simply dependent on one large or individual case. All statistics were analyzed using Stata, version 12.1 (StataCorp, LLC). Significance was set at P<0.05. above Results Descriptive study characteristics The systematic search in PubMed and Embase yielded 8,956 publications, 3 more were identified by manual search. After checking for duplicates and first viewing the titles and abstracts, 156 potentially relevant articles were obtained in full text for further evaluation. Finally, 119 articles were excluded and 37 publications (including 11 cohort studies in 10 publications [6–9,35–40] and 27 studies [10–13,18–24,33,34,41–54]) were eligible for inclusion. Eleven cohort studies with 8,397 new cases of hypertension and 43,320 participants were identified from 10 publications. With the exception of one study conducted in Asia, most were conducted in Europe (n=4) and the United States (n=6). Follow-up ranged from 1.3 to 15.3 years (median 5.0 years). Analyzes of the quality of the studies resulted in an average NOS score of 7.5, nine of which were of high quality (score ≥7). 27 studies were RCTs with 3,810 participants. Of these, 2 studies included only men, 10 only women and 15 included both studies. Five of the included studies were conducted in Asia, 12 were conducted in Europe, 4 were conducted in Oceania, and the remaining 6 were conducted in the United States. Mean or median baseline 25(OH)D concentrations varied from 25.6 nmol/L to 78.0 nmol/L, and 11 studies evaluated the effects in individuals with vitamin D insufficiency, vitamin D deficiency, or both. Nine studies did not provide final 25(OH)D concentrations in the intervention arms, while the remaining studies showed a significant increase in circulating 25(OH)D levels compared to baseline. All studies had a low risk of bias in random assignment and selective reporting. There was insufficient information about attribution concealment in 5 studies and a high risk of bias in 1 study. One open-label study had a high risk of bias for blinding of participants and staff and an unclear risk of bias for blinding of outcome assessment (43). Results of meta-analyses Circulating 25(OH)D levels and risk of hypertension Quantitative results from meta-analysis of cohort studies showed that the risk of new onset hypertension increased by 7% (risk ratio [RR] = 0.93; 95% CI, 0.89-0.98) per 25 nmol/L increment at 25 (OH)D levels decreased, with significant heterogeneity (I2 = 61.6%, P heterogeneity = 0.004). Ten studies reporting RR for 25(OH)D exposures in at least 3 levels were eligible for linear trend estimation. The results of constrained cubic spline analysis showed an approximate L-shaped correlation between circulating 25(OH)D levels and risk of hypertension (P-nonlinearity = 0.04, Figure 1). The risk of hypertension increased significantly below 75 nmol/L when 25(OH)D decreased, but remained significant over the range of 75-130 nmol/L. Illustration 1. Nonlinear dose-response association between circulating 25(OH)D levels and risk of hypertension, updated meta-analysis of cohort studies on the effect of 25(OH)D levels on hypertension in the general population. The dashed line indicates the pooled constrained cubic spline model and the solid lines indicate the 95% CIs of the pooled curve. Abbreviations: 25(OH)D, 25-hydroxyvitamin D; CI, confidence interval. [A tabular description of this figure is available.] Subgroup analyzes showed gender (male, female, or mixed), length of follow-up (≤ 5 years or > 5 years), region (Americas, Europe, or Asia), number of cases (< 1,000 or ≥ 1,000), and study quality (high, intermediate, or low ) as potential sources of heterogeneity (Table 1). However, the association of 25(OH)D levels per 25 nmol/L increment showed no significance in subgroups of males (RR = 0.93; 95% CI, 0.85-1.00), females (RR = 0 .88, 95% CI, 0.76-1.01), European Region (RR = 0.97, 95% CI, 0.94-1.01), small sample size (RR = 0.95, 95% CI , 0.89-1.02) and moderate or low study quality (RR = 0.91; 95% CI, 0.80-1.03). Furthermore, the pooled estimates could not be changed significantly by removing one study at a time, and we found no evidence of publication bias from Egger's test (P = 0.38). Vitamin D supplementation and blood pressure levels Figures 2 and 3 show the Wald plots for the effect of vitamin D supplementation on SBP and DPB in the 27 studies included. Overall, vitamin D supplementation had no significant effect on SBP reduction (WMD, -0.00 mm Hg; 95% CI, -0.71 to 0.71), with evidence of little heterogeneity (I2 = 41 .7%, P heterogeneity = 0.01). There was also no significant reduction in DBP after the intervention, and the WMD (95% CI) was 0.19 mm Hg (−0.29 to 0.67), with no evidence of significant heterogeneity (I2 = 3.3%, P heterogeneity = 0.42). figure 2 Meta-analysis of the effect of vitamin D supplementation on systolic blood pressure, updated meta-analysis of randomized controlled trials on the effect of vitamin D on blood pressure in the general population. Abbreviations: CI, confidence interval; WMD, weighted mean difference. [A text description of this figure is available.] figure 3 Meta-analysis of the effect of vitamin D supplementation on diastolic blood pressure, updated meta-analysis of randomized controlled trials on the effect of vitamin D on blood pressure in the general population. Abbreviation: WMD, weighted mean difference. [A text description of this figure is available.] Table 2 shows the subgroup analyzes of summary weapons of mass destruction in SBP and DBP. We found that heterogeneity decreased in studies involving males, studies involving overweight or obese subjects, studies with large sample sizes (≥200), and studies with intervention durations of 6 months or longer. The effects of vitamin D supplementation on SBP and DBP were still insignificant in all subgroups. In sensitivity analyses, the summary results remained similar when one study was removed at a time. According to Egger's test, we found no evidence of publication bias in studies on SBP (P = 0.60) and DBP (P = 0.07). above discussion This meta-analysis of cohort studies suggested an inverse association between 25(OH)D levels and the onset of hypertension, with the risk of hypertension being reduced by 7% for every 25 nmol/L increment in 25(OH)D levels. Meanwhile, pooled data from RCTs showed no evidence of blood pressure reduction with vitamin D supplementation, a finding consistent with subgroup analyzes based on overweight/obesity status at baseline, baseline 25(OH)D, length of follow-up, and based on the intervention dose. The results of numerous observational studies have shown that an adequate vitamin D status is a protective factor for high blood pressure. Analysis of Mendelian randomization also provided causal evidence for the effect of increased circulating 25(OH)D levels on reduced blood pressure and risk of hypertension (55). However, our subgroup analyzes of the cohort studies yielded conflicting results, suggesting that the quantitative data could not provide convincing evidence for the protective effect of vitamin D in hypertension. Meanwhile, most intervention studies have not provided consistent evidence of blood pressure benefits from vitamin D supplementation (11–13, 21, 49, 50, 53). Given these results, we suspect that the beneficial effect seen in cohort studies may be partially explained by the tendency for adequate vitamin D levels to be closely associated with healthy lifestyles or young study participants. This may also be partly due to the hypothesis that low 25(OH)D levels may be the result of poor health rather than a precursor to disease. In addition, there are differences between the different methods used (i.e. liquid chromatography-mass spectrometry; high performance liquid chromatography; and enzymoimmunoassay, radioimmunoassay and chemiluminescent immunoassay) and in the laboratories that measured the 25(OH)D levels, which would also have an impact the accuracy of the study results (56). Similar to our findings, previous meta-analyses also failed to show an overall lowering effect of vitamin D supplementation on blood pressure (14–16,57). However, they suggested that vitamin D might show a beneficial effect on blood pressure in certain subgroups, such as: or individuals with pre-existing cardiometabolic disease (14,16). A possible reason for this discrepancy is that the recruited populations of the included studies were highly heterogeneous. Therefore, we limited this meta-analysis to analyzes of apparently healthy individuals. We excluded studies targeting patients with hypertension, diabetes, cardiovascular disease, or other diseases because the known or unknown interaction between vitamin D and antihypertensive or cardiovascular drugs may mask or mitigate the small effects of blood pressure reduction. Complicated factors such as baseline vitamin D status, intervention design, or obesity may modify or mitigate the beneficial effect of improving vitamin D levels on blood pressure. A growing body of evidence supports the existence of thresholds in vitamin D status (58). Similarly, the roughly L-shaped relationship between 25(OH)D levels and hypertensive risk in our meta-analysis showed that hypertensive risk increased significantly below 75 nmol/L but remained marginally significant above 75 nmol/L, which suggesting that individuals with vitamin D insufficiency or deficiency show a higher response to supplementation. Furthermore, a therapeutic effect of cholecalciferol was shown only in vitamin D-deficient participants, reducing their 24-hour blood pressure by 3–4 mmHg (59). Therefore, we speculated that the protective effect would only occur in subjects with low vitamin D levels. In fact, we classified the studies by their baseline vitamin D status, but the results showed that vitamin D supplementation had no apparent effect on blood pressure, regardless of its baseline status. This finding is consistent with a recent meta-analysis using individual patient data (15). Given that the number of people with low vitamin D levels in our study may not be sufficient, more studies are needed to confirm this result. Individuals taking vitamin D supplements should do so for at least 6 months to achieve peak 25(OH)D levels (60). It can be assumed that the effect of vitamin D is time-dependent. However, our results from subgroup analyzes of RCTs suggested that blood pressure response to vitamin D is independent of intervention duration (< 6 months and ≥ 6 months). Similar findings have been reported (16,61). However, given these results, we cannot rule out that the duration of vitamin D intervention may not be sufficient to detect a mild but significant reduction in blood pressure, particularly in apparently healthy subjects who are less likely to further improve from normal. It is worth noting that as of June 2019, only one RCT up to 2 years in duration was included in our study; therefore, a protective effect of a longer intervention could not be sufficiently investigated. Future RCTs with longer follow-up durations are needed to provide more insight into the long-term benefits of vitamin D supplementation. The optimal dose for vitamin D supplementation would affect the effect on blood pressure. A 4-arm study performed in African-American men reported a dose-dependent reduction in SBP after 3 months of cholecalciferol supplementation at 1,000 IU, 2,000 IU, and 4,000 IU per day (0.66 mm Hg, 3.4 mm Hg, and 4.0mmHg). (34). In addition, a meta-analysis synthesizing the results of 30 RCTs suggested that vitamin D supplementation at a dose >800 IU/day significantly reduced blood pressure (14). Contrary to these results, we found no dose-response relationship for vitamin D on blood pressure. We should consider the possibility that the additional doses in most of the included studies may be larger or smaller to observe a beneficial effect. Further studies are needed to explore the potential quantitative model.

This meta-analysis of RCTs included 3,810 individuals from the general population, providing significant statistical power to demonstrate the potential impact and thereby improving the generalizability of our results. However, our study also contains several potential limitations. First, we are unable to answer the question of whether these factors would modify the effect of the intervention because most studies failed to capture changes in diet, sun exposure or latitude, genetic factors, and educational status. Second, there are several studies that did not have sufficient power (below 80%) to detect a weak difference between intervention and placebo groups due to small sample size and high noncompliance rate (13,20,53). Although we stratified the length of follow-up (maximum 2.0 years) and found no significant difference between subgroups, it remains unclear whether there are long-term (>2 years) effects of vitamin D to improve blood pressure levels. However, we can conclude that vitamin D supplementation does not affect blood pressure in the short term.

The results of this meta-analysis indicate that vitamin D supplementation does not lower blood pressure in the general population. Based on this finding, we do not recommend using vitamin D supplementation to prevent high blood pressure. However, future RCTs with long-term interventions and sufficient sample sizes of people with low vitamin D levels are needed to replicate this finding.

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thanks

DZ and W.L. contributed to the creation of the original idea. C.C., D.Z., Y.W. and H.S. searched for studies and agreed on inclusion and exclusion. D.Z., C.C. and S.Y. Data extracted and data analysis performed. D.Z., Y.X. and Y.L. wrote the manuscript. All authors have read and approved the manuscript.

This work was supported by the National Nature Science Foundation of China (Grant Nos. 81872626, 81573151, U1204823, and 81573243); and the Science and Technology Foundation for Innovation Talent of Henan Province (Grant No. 154200510010). All funders played no role in the design, analysis or writing of this article.

The authors have no relevant interests to declare. Die Ergebnisse und Schlussfolgerungen in diesem Bericht sind die der Autoren und geben nicht unbedingt die offizielle Position der Centers for Disease Control and Prevention wieder. Für diesen Artikel wurden keine geliehenen Materialien, urheberrechtlich geschützten Umfragen, Instrumente oder Tools verwendet.

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Informationen zum Autor

Korrespondierende Autoren: Wenjie Li, MD, PhD, Department of Nutrition and Food Hygiene, College of Public Health, Zhengzhou University, 100 Kexue Ave, Zhengzhou, 450001 Henan, China. Telefon: 86-371-6778-1305. E-Mail: [email protected].

Autorenzugehörigkeiten: 1Abteilung für Ernährung und Lebensmittelhygiene, Hochschule für öffentliche Gesundheit, Universität Zhengzhou, Henan, China. 2Abteilung für Epidemiologie und Gesundheitsstatistik, Hochschule für öffentliche Gesundheit, Universität Zhengzhou, Henan, China.

Informationen zum Autor

.Xing Li, MD, Abteilung für Ernährung und Lebensmittelhygiene, Hochschule für öffentliche Gesundheit, Zhengzhou University, 100 Kexue Ave, Zhengzhou, 450001, Henan, China. Telefon: 86-371-6778-1305. E-Mail: [email protected].

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references

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tables

Tabelle 1. Untergruppenanalysen für die Dosis-Wirkungs-Assoziation zwischen dem Zuwachs an zirkulierendem 25-Hydroxyvitamin D pro 25 nmol/l und dem Hypertonierisiko, aktualisierte Metaanalyse der Kohortenstudien, 2019 Untergruppe Anzahl der Studien Anzahl der Teilnehmer RR (95 % KI) P-Wert I2, % Geschlecht Männlich 3 3.230 0,93 (0,85–1,00) 0,06 28,7 Weiblich 2 3.351 0,88 (0,76–1,01) 0,07 0 Gemischt 6 36.739 0,95 (0,89–1,00) 0,06 76,4 Region Vereinigte Staaten 6 30.002 0,90,90 (0,83–0,97) 0,006 65,1 Europa 4 10.862 0,97 (0,94–1,01) 0,11 0 Asien 1 2.456 0,97 (0,90–1,05) 0,44 — Fallzahl <1.000 6 5.696 0,95 (0,89–1,02) 0,16 ≥ 39,6 1.000 5 37.624 0,94 (0,91–0,96) 0,02 77,1 Dauer, Jahre ≤5 6 31.171 0,92 (0,84–1,00) 0,06 73,9 >5 5 12.149 0,96 (0,93–0,99) 0,01 0 Studienqualität Hoch 7 18,48 (8 0,94) 0,99) 0,006 9,5 Mittel oder niedrig 2 24.832 0,91 (0,80–1,03) 0,13 87,0

Tabelle 2. Subgruppenanalysen der Vitamin-D-Supplementierung und der Blutdruckwerte in der Allgemeinbevölkerung, aktualisierte Metaanalyse randomisierter kontrollierter Studien, 2019 Subgruppe Anzahl der Studien Anzahl der Teilnehmer SBP DBP WMD (95 % KI) P I2, % WMD (95 % KI) P I2, % Geschlecht Männlich 2 211 2,49 (−0,33 bis 5,31) 0,08 0 0,80 (−1,33 bis 2,93) 0,46 0 Weiblich 10 1.215 −0,68 (−2,59 bis 1,23) 0,48 55,5 0,18 (− 0,60 bis 0,97) 0,65 13,2 Gemischt 15 2.384 0,11 (−0,81 bis 1,02) 0,82 28,6 0,14 (−0,49 bis 0,76) 0,66 11,7 Alter, J. <50 15 1.751 0,04 (−0,88 bis 0,96) 0,7 0,29 0,43 bis 0,88) 0,50 9,1 ≥50 12 2.059 −0,27 (−2,01 bis 1,48) 0,76 55,5 0,15 (−0,55 bis 0,84) 0,68 4,0 Region USA 6 569 −0,01 (−2,17 bis 2,14) 0,99 50,3 −0,09 (−1,11 bis 0,92) 0,86 0 Europa 12 1.698 −0,61 (−2,20 bis 0,97) 0,45 52,9 0,42 (−0,27 bis 1,11) 0,23 19,1 Asien 5 469 1,24 (−0,87 bis 3,35) 0,25 0 −0,06 (− 1,57 bis 1,44) 0,94 33,4 Ozeanien 4 1.074 −0,06 (−1,67 bis 1,56) 0,94 48,4 0,06 (−1,01 bis 1,14) 0,91 0 Adipositasstatus zu Studienbeginn Übergewichtig/fettleibig 9 895 1,01 (−0,32 bis 2,34) 0,14 26,9 0,40 (−0,53 bis 1,33) 0,40 3,4 nicht freia 18 2.915 −0,41 (−1,25 bis 0,43) 0,34 44,4 0,11 (−0,44 bis 0,67) 0,69 7,3 Vitamin-D-Ausgangsstatus unzureichend/Mangel 11 924 –0,44 (–2,33 bis 1,44) 0,64 51,9 200 22 2.240 −0,01 (−0,82 bis 0,84) 0,98 47,5 0,04 (−0,55 bis 0,63) 0,88 7,8 ≥200 5 1.570 −0,03 (−1,41 bis 1,35) 0,96 13,5 0,46 (−0,35 bis 0,27 0) Typ von Vitamin D Cholecalciferol 25 3.620 −0,01 (−0,76 bis 0,73) 0,98 46,2 0,25 (−0,24 bis 0,74) 0,32 7,3 Ergocalciferol 2 190 0,12 (−2,27 bis 2,50) 0,92 0 −0,73 (−2,63 bis 1,17) 0,45 0 Häufigkeit Täglich 18 2.053 −0,36 (−1,74 bis 1,02) 0,61 52,3 0,27 (−0,34 bis 0,88) 0,39 26,3 Wöchentlich 3 416 0,91 (−0,99 bis 2,81) 0,35 0 ​​−0,02 (−1,42 bis 1,37) 0,97 0 Fortnightly 1 71 3.69 (−0.49 to 7.87) .08 — 1.54 (−1.81 to 4.89) .37 — Monthly 3 1,031 −1.02 (−2.71 to 0.67) .24 0 −0.11 (−1.21 to 1.00) .85 0 Single dose 2 239 1.30 (−1.84 to 4.43) .42 0 0.25 (−1.72 to 2.21) .80 0 Durationb <6 months 15 1,330 −0.23 (−1.71 to 1.26) .76 55.8 0.11 (−0.58 to 0.80) .75 28.7 ≥6 months 10 2,241 −0.02 (−1.15 to 1.12) .98 20.9 0.26 (−0.44 to 0.97) .47 0.0 Intervention typec Vitamin D alone 18 2,774 0.16 (−0.69 to 1.00) .72 0 0.25 (−0.30 to 0.80) .38 6.0 Vitamin D + calcium 7 867 −0.65 (−3.66 to 2.37) .68 70.4 −0.02 (−1.14 to 1.10) .97 0 Intervention amountd ≤800 IU/d 6 619 −1.91 (−4.24 to 0.42) .15 57.9 −0.66 (−1.75 to 0.43) .51 0 >800 IU/d 12 1,434 0.87 (−0.30 to 2.05) .15 30.1 0.69 (−0.05 to 1.42) .07 33.1 Risk of bias Low 12 1,564 −0.39 (−1.50 to 0.72) .49 41.4 0.23 (−0.55 to 1.00) .56 0 High 7 1,166 0.03 (−2.34 to 2.41) .98 63.1 −0.38 (−1.34 to 0.58) .44 18.2 Unclear 8 1,080 0.74 (−0.49 to 1.97) .24 7.0 0.53 (−0.26 to 1.32) .19 8.2

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Blood pressure has a daily pattern.

Normally, blood pressure begins to rise a few hours before you wake up. It continues to increase during the day and reaches its peak at noon. Blood pressure typically falls in the late afternoon and evening. Blood pressure is usually lower at night while you sleep. Nocturnal blood pressure measurement is called nocturnal blood pressure.

Examples of an irregular blood pressure pattern include:

High blood pressure at night

high blood pressure early in the morning

Less than 10% fall in blood pressure overnight (non-falling blood pressure)

A rise in blood pressure overnight to early morning has been linked to an increased risk of heart disease.

An irregular blood pressure pattern could also mean you have:

Poorly controlled high blood pressure

Obstructive sleep apnea

kidney disease

diabetes

thyroid disease

A disorder of the nervous system

Poor diet, lack of exercise, and certain lifestyle factors can affect blood pressure patterns, including:

night shift work

Smoking

overweight or obese

stress and anxiety

Improper use of medication for blood pressure or sleep apnea, or ineffective treatment

Your doctor can tell you if an irregular daily blood pressure pattern needs treatment. Sometimes a person’s blood pressure just goes up when they see a doctor. This is called white coat hypertension.

A 24-hour blood pressure monitoring test can be done to measure blood pressure at regular intervals over 24 hours. The test is called an ambulatory blood pressure measurement. It provides a detailed overview of blood pressure changes over an average day and night.

With Francisco Lopez-Jimenez, M.D.

There is a problem with the information submitted for this request. Check/update the information highlighted below and resubmit the form. From the Mayo Clinic to your inbox Subscribe for free and stay up to date with research advances, health tips and hot topics in health such as COVID-19, as well as health management expertise. Email ErrorEmail field is required. ErrorPlease provide a valid email address. Learn more about how Mayo Clinic uses data. In order to provide you with the most relevant and helpful information and to understand what information is useful, we may combine your email and website usage information with other information we have about you. If you are a Mayo Clinic patient, this may include proprietary health information. If we combine this information with your Protected Health Information, we will treat all such information as Protected Health Information and will only use or disclose such information as described in our Privacy Practices Statement. You can unsubscribe from email communications at any time by clicking the unsubscribe link in the email. Subscribe to! Thank you for subscribing to our Housecall e-newsletter to keep you up to date with the latest health information. Sorry, there was an error with your subscription. Please try again in a few minutes. Try it again

If you’re overweight, losing as little as 5 pounds (2.3 kilograms) can lower your blood pressure. The more weight is lost, the more blood pressure can drop. As you lose weight, it may be possible to reduce your dose of blood pressure medication — or stop taking blood pressure medication entirely. However, never make any changes to your blood pressure medication on your own. Talk to your doctor first.

Remember, high blood pressure is not a problem you treat and then ignore. Even though you can safely stop taking blood pressure medication, it’s always important to maintain healthy habits. Here’s how:

Eat a healthy diet high in vegetables, fruits, and whole grains and low in salt, trans fats, and saturated fats.

Manage your weight.

Get at least 30 minutes of moderate physical activity every day.

Avoid or limit alcohol.

Stop smoking.

Conduct regular health checks to monitor blood pressure, cholesterol, and diabetes.

With Francisco Lopez-Jimenez, M.D.

There is a problem with the information submitted for this request. Check/update the information highlighted below and resubmit the form. From the Mayo Clinic to your inbox Subscribe for free and stay up to date with research advances, health tips and hot topics in health such as COVID-19, as well as health management expertise. Email ErrorEmail field is required. ErrorPlease provide a valid email address. Learn more about how Mayo Clinic uses data. In order to provide you with the most relevant and helpful information and to understand what information is useful, we may combine your email and website usage information with other information we have about you. If you are a Mayo Clinic patient, this may include proprietary health information. If we combine this information with your Protected Health Information, we will treat all such information as Protected Health Information and will only use or disclose such information as described in our Privacy Practices Statement. You can unsubscribe from email communications at any time by clicking the unsubscribe link in the email. Subscribe to! Thank you for subscribing to our Housecall e-newsletter to keep you up to date with the latest health information. Sorry, there was an error with your subscription. Please try again in a few minutes. Try it again

Background data on blood pressure (BP) in young adults and long-term mortality are limited. In addition, screening and treatment guidelines for hypertension are primarily based on evidence for middle-aged and older populations. This study evaluates the relationships between blood pressure measured in young adult males and long-term mortality from coronary artery disease (CHD), cardiovascular disease (CVD), and all causes.

Methods This Chicago Heart Association Detection Project in Industry cohort included 10,874 men aged 18 to 39 years at baseline (1967-1973) who were not on antihypertensive drugs and without CHD or diabetes. The relationship of baseline blood pressure to 25-year CHD, CVD, and all-cause mortality was assessed.

Results The age-adjusted association between systolic blood pressure and CHD mortality was continuous and graded. Multivariate adjusted CAD hazard ratios (HRs) for 1 SD higher systolic blood pressure (15 mm Hg) and diastolic blood pressure (10 mm Hg) were 1.26 (95% confidence interval [CI], 1.11-1.44) and 1 .17 (95% CI, 1.01-1.35). Compared to the Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure, the strata with normal blood pressure (and the lowest mortality rates) in the large strata with high normal BP and stage 1 hypertension were 25 years absolute risks of death of 63 and 72 per 1000, respectively, and absolute excess risks of 10 and 20 per 1000, respectively; accounted for 59.8% of all excessive CHD, CVD and all-cause mortality; and it was estimated that life expectancy was reduced by 2.2 and 4.1 years, respectively.

Conclusions In young adult males, higher than normal blood pressure was significantly associated with increased long-term mortality from CHD, CVD, and all causes. Population-wide primary prevention, early detection and control of elevated blood pressure are indicated from young adulthood.

IN MIDDLE-AGED and older populations worldwide, blood pressure (BP) has been repeatedly shown to be a significant risk factor for major cardiovascular diseases (CVD), including coronary artery disease (CAD) and stroke.1-6 For systolic (SBP ) and diastolic BP (DBP), these relationships are continuous, graded, independent of other risk factors, consistent, predictive, and generally assessed as etiologically significant. The data show that SBP is a stronger predictor than DBP.7-10 at this age

In contrast, long-term observations of BP and mortality from CHD and CVD in young adults are limited. Because severe CVD events are rare before age 50 in males and before age 60 in females, studies of risk factors measured at a mean age of about 30 years require long-term follow-up or large sample sizes to ensure sufficient numbers of winning events. The few reports of prospective population-based studies come from nested case-control studies in alumni11-13 and analyzes of life insurance actuarial data.14-16 Other evidence comes from autopsy studies showing that coronary artery risk factors are associated with early atherosclerotic lesions in The context is young adults.17-19 Although treatment guidelines for hypertension typically apply to people aged 18 and older,20,21 there is limited documentation supporting the screening and treatment of young adults.

This report adds information on this topic. The Chicago Heart Association Detection Project in Industry (CHA) study is one of the largest and longest prospective studies providing CVD mortality data. About 11,000 men aged 18 to 39 at baseline were followed for an average of 25 years. The objectives of this research were to determine (1) whether SBP, DBP, and SBP/DBP categories of the Sixth Report of the Joint National Committee for Prevention, Detection, Evaluation, and Treatment of Hypertension (JNC-VI)20 are predictive of long-term mortality due to CHD, CVD and all causes for young men; (2) whether SBP is a better predictor than DBP in young males; and (3) Long-term absolute risks, excess absolute risks, and impairment of life expectancy in young men with higher blood pressure, comparing risks in young and middle-aged men.

Materials and methods

population

Methods of the CHA study have been described.22,23 Briefly, 39,573 men and women aged 18 years and older were screened from November 1967 to January 1973. All employees of 84 collaborating companies and organizations in the Chicago area with a workforce of approximately 75,000 people were invited to participate; The volunteer rate was 53%.

survey methods

The screening was performed by 2 trained and standardized field teams of 4. Data collected at baseline included age, gender, race, education, blood pressure, serum total cholesterol, smoking status, height and weight, resting electrocardiographic (ECG) findings, medical history, and current treatment for chronic diseases, including hypertension and diabetes. A single supine blood pressure measurement was taken by trained personnel using a standard mercury sphygmomanometer. Standardized, high-quality methods were used to determine serum total cholesterol levels.24 National Cooperative Pooling Project and Hypertension Detection and Follow-up Program criteria were used to encode ECG abnormalities.25

mortality endpoints

Vital status was assessed up to 1995, with a mean follow-up of 25 years. Deaths before and including 1979 were determined using direct mail, telephone, contact with employer, and comparison of cohort records with Social Security Administration files, and after 1979 by comparison of study records with National Death Index records. Several causes of death from death certificates were coded according to the International Classification of Diseases, Eighth Revision (ICD-8) by trained research personnel.26 Coding decisions were cross-checked by study team members. All coders were blinded to the baseline data. The underlying cause of death was used for this report. Mortality from CHD was defined as ICD-8 codes 410.0 to 414.9; that due to CVD, ICD-8 codes 400.0 to 445.9.

exclusions

Men aged 18 to 39 at baseline were 11,248. Of these, 374 were excluded for the following reasons: missing data at baseline or at follow-up (n=114); Baseline ECG evidence of myocardial infarction (n=5); history of myocardial infarction or other CAD (n=12); antihypertensive drug treatment at baseline (n=125); or previously diagnosed diabetes mellitus (n=118). Thus, this report is based on 10,874 men.

Statistical Analysis

Age-adjusted mortality rates per 10,000 person-years of follow-up and per 1,000 men were calculated for CAD, cardiovascular disease, and all-cause mortality. Mortality rates were calculated by SBP or DBP categories and by the following classification according to JNC-VI20: optimal (SBP < 120 mm Hg and DBP < 80 mm Hg); normal non-optimal (SBP of 120-129 mm Hg and DBP of < 85 mm Hg or SBP of < 130 mm Hg and DBP of 80-84 mm Hg); high normal (SBP of 130-139 mm Hg and DBP of < 90 mm Hg or SBP of < 140 mm Hg and DBP of 85-89 mm Hg); Stage 1 hypertension (SBP of 140-159 mm Hg and DBP of < 100 mm Hg or SBP of < 160 mm Hg and DBP of 90-99 mm Hg); Stage 2 hypertension (SBP of 160-179 mm Hg and DBP of < 110 mm Hg or SBP of < 180 mm Hg and DBP of 100-109 mm Hg); and stage 3 hypertension (SBP of ≥ 180 mm Hg or DBP of ≥ 110 mm Hg). Rates were age-adjusted using the direct method to account for the age distribution of the entire cohort. Cox proportional hazards regression was used to calculate multivariate fitted hazard ratios (HRs) of death and their 95% confidence intervals (CIs) for baseline BD categories and multivariate fitted coefficients for the ratio of BP to mortality to obtain. HRs were scored for age (years), race (African American or not), education (years), total serum cholesterol (millimoles per liter [milligrams per deciliter]), cigarette smoking (cigarettes/day), body mass index (BMI) (weight in kilograms divided by height in meters squared), BMI2 and any ECG abnormality (no or yes). Absolute excess mortality rates per 1000 at 25 years by JNC-VI stratum were calculated from age-adjusted mortality rates per 1000 at 25 years. The reference group was the shift with normal (non-optimal) blood pressure. The excess death count for other JNC-VI shifts was calculated from these absolute excess rates and the number of men on those shifts. The percentage of all excess deaths in each shift was also calculated. Cox multivariate proportional hazards regression coefficients for the ratio of JNC-VI strata to all-cause mortality were used to estimate the years of shorter life expectancy for men with higher baseline blood pressure compared to men with normal blood pressure. Detailed procedures for these calculations have been described elsewhere.23,27 Results basic findings Table 1 shows data on baseline variables. At baseline, 8.6% of the cohort had optimal blood pressure (JNC-VI criteria); 20.2%, normal (non-optimal) blood pressure; 25.5%, hypernormal blood pressure; and 36.4% stage 1 hypertension. Baseline sbp and dbp and mortality During follow-up, 197 men died from CAD; 257 from CVD; and 759 of all causes. Age-adjusted mortality rates With higher SBP, the age-adjusted mortality due to CHD and CVD increased continuously and significantly (Table 2). In DBP, mortality due to CHD and CVD was lower in men with DBP 70 to 79 mm Hg than in men with DBP less than 70 mm Hg. For strata with DBP greater than 70 to 79 mm Hg, mortality rates were progressive and significantly higher. For all-cause mortality, rates were lowest in males with an SBP of 120 to 129 mm Hg and a DBP of 70 to 79 mm Hg; for strata with higher levels, the rates were generally progressively higher. Multivariate adjusted HRs With an SBP of 120 to 129 mm Hg and a DBP of 70 to 79 mm Hg as a reference, heart rates for CAD, cardiovascular disease and all-cause mortality generally increased with higher SBP and DBP values ​​(Table 2). In men with a DBP of less than 70 mmHg, the HRs for all 3 endpoints (1.63, 1.32, and 1.22 for CHD, CVD, and all-cause mortality, respectively) were not significantly higher than in men with a DBP of 70 to 79 mmHg Multivariate fitted Cox coefficients For SBP and DBP, the Cox coefficients were statistically significant for all 3 mortality endpoints (Table 2). For CAD deaths, these coefficients yielded HRs—for 1 SD higher SBP (15.2 mmHg) and DBP (10.4 mmHg)—of 1.26 (95% CI, 1.11-1.44) for SBP and 1.17 (95% CI, 1.01-1.35) for DBP. For comparison, these estimates for the CHA cohort of middle-aged men (aged 40-59 years) were 1.23 (95% CI, 1.15-1.32) for SBP and 1.29 (95% CI , 1.21–1.38) for DBP (coefficients 0.0108). and 0.0223; 1 SD, 19.3 mmHg and 11.5 mmHg). Baseline sbp/dbp (jnc-vi criteria) and long-term mortality overall findings Age-adjusted death rates and multivariate-adjusted heart rates were lowest for the normal (but non-optimal) stratum (Table 3). Adjusted rates and HRs increased progressively for strata above normal BP, e.g. B. CHD HRs of 1.37 for the high normal stratum and of 1.62, 2.51 and 3.60 for hypertension stages 1, 2 and 3, respectively, compared to the normal stratum. HRs in men with optimal blood pressure In men with optimal blood pressure, the risks for CHD, CVD, and all causes were relatively (not significantly) higher than in men with normal blood pressure (Table 3). As noted in the JNC-V and JNC-VI optimal blood pressure guidelines, abnormally low blood pressures require clinical evaluation.20,28 Among men with optimal blood pressure in this cohort, 45 deaths (of 59 from all causes) were from non-cardiovascular causes , and about half of these deaths were due to neoplasms (Table 4). In another analysis, the age-adjusted rates for CHD and CVD in men with optimal blood pressure were equal to or lower than those in men with normal blood pressure (Table 5). Multivariate-adjusted heart rates, particularly for CHD and CVD, were lower than those in Table 3, ie, 1.08 (CHD), 1.06 (CVD), and 1.24 (all causes). Also excluding men with DBP of 60 to 64 mm Hg, the HR for all causes was reduced to 1.15 (95% CI, 0.79-1.68) (detailed data not shown). Absolute excess risks and excess deaths according to jnc-vi bp classification The absolute excess risks of cardiovascular death were 6.3, 10.8, 33.1, and 74.1 per 1000 at 25 years for men with hypernormal blood pressure and stage 1, 2, and 3 hypertension, respectively (Table 6). For all causes of death, the absolute excess risks ranged from 10.1 to 107.6 per 1000 in 25 years. In men with higher blood pressure values, i. H. hypertension and hypertension stages 1, 2 and 3, the estimated life expectancy was 2.2, 4.1, 8.4 and 12.2 years shorter than men with normal blood pressure, respectively.23 27 For each mortality endpoint, the highest proportion of all excess deaths—41.6% to 45.6%—was in the large stratum (3,963 of the 10,874 men) with Stage 1 hypertension (Table 6). Of all excess deaths, 15.6% to 16.9% occurred in the sizable high normal stratum (2773 men), more than in the small stratum (161 men) with stage 3 hypertension. Together, the high normal and hypertensive strata made up the stage 1 Accounted for 58.5% of excess cardiovascular deaths and 59.4% of excess deaths from all causes. comment Key findings on this cohort of young adult working men are as follows. (1) Even at their age (mean 30 years), SBP/DBP at optimal or normal levels predominated in only 28.8% (8.6% + 20.2%), whereas (2) SBP/DBP highly normal or hypertensive im Stage 1 was 61.9% (25.5% + 36.4%). These results almost certainly reflect the adverse effects of dietary and other lifestyle characteristics that lead to increases in blood pressure in most people from adolescence (e.g., the cohort was on average overweight [BMI, 26.0]). (3) Blood pressure measured in young adulthood predicted long-term risks for CHD, CVD, and all-cause mortality. As in middle-aged and older individuals, the relationships of SBP, DBP, and SBP/DBP (JNC-VI strata) with mortality were generally graded, strong, and independent. (4) Multivariate-adjusted HRs tended to be larger for SBP than for DBP and similar in size to those for middle-aged men. (5) For the 2 large strata with high normal blood pressure and stage 1 hypertension, the absolute 25-year risks and absolute excess risks for mortality - for the years from the mean age of 30 to 55 years - were significant, e.g. B. All-cause mortality rates of 63 and 72 per 1000 and absolute excess rates of 10 and 20 per 1000, leading to an estimated shorter life expectancy of 2.2 and 4.1 years. These 2 strata accounted for 59.4% of all excess deaths attributed to supernormal SBP/DBP. Observations on BP and CAD or all-cause cardiovascular mortality in young adults are limited, mainly because elucidation of this matter requires large sample sizes and long-term follow-up to collect enough events for statistical analysis. In the 1960s, Paffenbarger et al.11-13 reported nested case-control studies of 45,000 freshmen (mean age 19 years) from the University of Pennsylvania and Harvard University studied from 1921 to 1950. They showed that higher percentages of those who died, patients with CAD and stroke had a higher SBP (≥ 130 mm Hg) at baseline. However, analyzes of blood pressure and mortality were not multivariate adjusted, and detailed relationships by blood pressure strata were not examined. Other long-term cohort studies have examined cardiovascular risk factors in young adults on a smaller scale. 30-year follow-up data from participants in the Framingham Study aged 31 to 39 years at baseline did not provide blood pressure results29; 14- and 18-year follow-up reports of young adult Framingham participants aged 30 to 49 years combined.7,30 The Johns Hopkins Precursors Study of nearly 1000 young male medical students (mean age 22 years) reported a 30 -year CVD mortality related to serum cholesterol levels31 and vascular reactivity32, but these reports did not include data on blood pressure and subsequent cardiovascular events. Research by the Society of Actuaries produced detailed results on BP levels at entry and all-cause mortality in approximately 4 million freshmen aged 15-69 years, participants aged 20-29 and 30-39 years, but the data were not multivariate adjusted and can Have limitations in the accuracy of blood pressure measurement for insurance screening. Recently, a study from Glasgow, Scotland briefly reported a significant association between SBP in university students and subsequent cardiovascular mortality, but detailed relationships by BP strata were not reported Knowledge, the first detailed report from a large long-term study of young adults from the general population, showing a significant independent association between BP level and CHD or CVD mortality. Advanced coronary artery atherosclerosis was observed in most young American men who underwent autopsy during the Korean and Vietnam Wars.34,35 Other studies of the natural history of atherosclerosis indicate that in populations with high rates of premature coronary artery disease, advanced lesions with occurring with increasing frequency in childhood and young adulthood.36 In autopsy studies of the Bogalusa Heart Study in children and young adults who died prematurely from non-cardiac causes, the extent of involvement of the aortic and coronary artery walls with fatty streaks and fibrous plaques was associated with severely associated with coronary risk factors, including BP.17,18 Another autopsy study of adolescents showed a relationship between coronary artery atherosclerosis and an index of mean arterial pressure based on findings in small renal arteries.19 Correspondingly d a recent report of electron beam computed tomography showed that, in young adults, BP is associated with the presence of coronary artery calcification.37 It is reasonable to interpret our data as consistent, ie to suggest that such BP-related early atherosclerotic lesions lead to a greater risk of fatal cardiovascular disease in the decades from young adulthood to middle age. Our data indicate that SBP may be more useful than DBP in predicting future CHD and CVD deaths. Risk generally increased throughout the SBP range from 120 to 180 mm Hg and above. This finding for young adults supports current estimates, based on data for older adults, that SBP may be more important than DBP and that both (SBP/DBP) should be considered when assessing cardiovascular risk.7-10 Although not statistically significant, our low DBP (<70 mm Hg) data suggest that it may be related to increased long-term CHD, CVD, and all-cause mortality, and that low SBP (<120 mm Hg) may be related to an increase all-cause mortality. These results should be interpreted with caution for several reasons. First, HRs were not significant and 95% CIs were wide given the low number of deaths from CHD and CVD in these categories. Second, as indicated in the BD classification of JNC-V and JNC-VI20,28 people with very low BD, particularly very low DBP, may have medical abnormalities, e.g. g., aortic regurgitation or preclinical neoplastic disease, and therefore require medical evaluation. We could not completely exclude men with medical conditions. After excluding those with low DBP (< 60 mm Hg, also < 65 mm Hg), the risks for CHD and cardiovascular mortality were nearly identical in the optimal and normal blood pressure strata. Therefore, it is reasonable to conclude that these data do not challenge the conclusion that the relationship between SBP/DBP and CVD risks is generally continuous (monotonic) and that for healthy adults, including young and older adults, SBP Establishing /DBP less than 120/80 mm Hg (< 120/< 80 mm Hg) or less than or equal to 120/80 mm Hg (≤ 120/≤ 80 mm Hg) is optimal. A limitation of the present study is that the results were based on a single blood pressure measurement and therefore likely underestimate the true associations due to regression dilution bias which is strongly predictive of future CVD events. Since this workplace cohort was identified, the role of the "healthy worker effect" should be considered, i.e. because the working population tends to be healthier than the general population, the mortality rate of the CHA cohort was about 30% lower than expected for a similar sample of the general population. However, this phenomenon has little or no qualitative impact on the relationship between baseline risk factors (including BP) and long-term mortality, as many prospective studies with similar qualitative results on this topic have shown for workplace-based and community-based population samples.1,2 It is possible that Due to this phenomenon, our study quantitatively underestimated the absolute risk and the absolute excess risk for unfavorable blood pressure values ​​in young adult men. Therefore, it is a reasonable conclusion, supported by the limited data available from other studies in young adults, that these results are generalisable. Our results indicate that blood pressure above normal in young adults is a major unsolved medical and public health problem. The long-term absolute risks and absolute excess risks, ie, from mean age of 30 years at baseline to 55 years, were significant for these young adult males, who comprised 61.9% of this cohort, with 59.4% of all excess deaths in males with high-normal Stage 1 blood pressure and hypertension. This data strongly supports two strategic concepts. First of all, it is important to have population-wide primary prevention through safe nutritional hygiene measures for the secondary blood pressure values ​​that are currently widespread in middle-aged and older people. Such primary prevention can significantly increase the proportion of people in the population who have favorable blood pressure values ​​(and other risk factors) throughout their lives. Second, a population-wide effort should be made to identify children, adolescents, young adults, and others with unfavorable blood pressure early, so that early therapeutic measures can be initiated, primarily to improve lifestyle. Initial lifestyle recommendations for the prevention and treatment of high blood pressure included avoidance of high salt intake, inadequate potassium intake, excessive alcohol consumption, obesity, and sedentary lifestyles.38-40 Based on recent research advances, these recommendations have been expanded to include high consumption of fruits, vegetables, whole grains and legumes; fat-free and low-fat protein sources; and low intake of high-lipid foods (ie reduced total dietary fat, saturated fat and cholesterol) and sweets.20,41-43 Our findings also support the JNC-VI's recommendations for risk management for people aged 18 and older with high blood pressure. Because our study was observational and non-interventional, it did not provide direct data regarding the management of high blood pressure in young adults by lifestyle and (as indicated) pharmacological agents. For hypertensive males of this age there are no clinical trial data, no ongoing trials and, to the best of our knowledge, none planned because the sample size and duration are unacceptable. Therefore, the use of medicinal products for this age group must be based on an assessment of the likely benefit/risk balance over decades of treatment. Our data are important indicators of risk; They reiterate the JNC-VI recommendations to base drug treatment (along with lifestyle) on BP levels, findings for other risk factors and target organ damage, and response to the initial lifestyle intervention rather than age. Taken together, the data from this study in young adult males underscores the robustness of recommendations for population-wide lifestyle modifications to prevent unfavorable blood pressure, population-wide early detection efforts and lifestyle counseling for those who already have unfavorable blood pressure, and, for those with frankly high blood pressure in any adult age implementation of the JNC-VI guidelines for treatment. Accepted for publication November 7, 2000. The Chicago Heart Association's Industry Recognition Project was supported by the American Heart Association and its Chicago and Illinois affiliates; Chicago, Illinois; the Illinois Regional Medical Program, Chicago; Grant HL21010 from the National Heart, Lung, and Blood Institute, Bethesda, MD; the Chicago Health Research Foundation, Chicago; and private donors. Presented at the 18th Scientific Meeting of the International Society of Hypertension, Chicago, Illinois, August 23, 2000. The work of the Chicago Heart Association Detection Project in Industry Study was made possible thanks to the invaluable collaboration of 84 Chicago businesses and organizations and their officers, employees and employees whose volunteer efforts made the project possible. Credit also goes to all those at the Chicago Heart Association—staff and volunteers—who serve the project. Many of these individuals are cited by name in Stamler et al.22,23 Corresponding Author and Reprints: Martha L. Daviglus, MD, PhD, Northwestern University Medical School, Department of Preventive Medicine, 680 N Lake Shore Dr, Suite 1102, Chicago, IL 60611-4402 (email: [email protected]) .

overview

Vitamin D is a nutrient your body needs to build and maintain healthy bones. That’s because your body can’t absorb calcium, the main component of bones, unless vitamin D is present. Vitamin D also regulates many other cellular functions in your body. Its anti-inflammatory, antioxidant and neuroprotective properties support immune system health, muscle function and brain cell activity.

Vitamin D doesn’t occur naturally in many foods, but you can get it from fortified milk, fortified cereals, and oily fish like salmon, mackerel, and sardines. Your body also makes vitamin D when direct sunlight converts a chemical in your skin into an active form of the vitamin (calciferol).

The amount of vitamin D your skin makes depends on many factors, including time of day, season, latitude, and your skin pigmentation. Depending on where you live and your lifestyle, vitamin D production can decrease or be absent in the winter months. While sunscreen is important for preventing skin cancer, it can also decrease vitamin D production.

Many older adults don’t get regular sun exposure and have trouble absorbing vitamin D. If your doctor suspects you’re not getting enough vitamin D, a simple blood test can check the levels of this vitamin in your blood.

Taking a multivitamin supplement with vitamin D can help improve bone health. The recommended daily amount of vitamin D is 400 International Units (IU) for children up to 12 months of age, 600 IU for people aged 1 to 70 years and 800 IU for people over 70 years of age.

proof

Research into the use of vitamin D for certain medical conditions shows:

Cancer. Evidence on the benefits of vitamin D for cancer prevention is mixed. More studies are needed to determine whether vitamin D supplementation can reduce the risk of certain types of cancer.

Evidence on the benefits of vitamin D for cancer prevention is mixed. More studies are needed to determine whether vitamin D supplementation can reduce the risk of certain types of cancer. cognitive health. Research shows that low levels of vitamin D in the blood are linked to cognitive decline. However, more studies are needed to determine the benefits of vitamin D supplementation for cognitive health.

Research shows that low levels of vitamin D in the blood are linked to cognitive decline. However, more studies are needed to determine the benefits of vitamin D supplementation for cognitive health. Hereditary bone diseases. Vitamin D supplements can be used to treat hereditary disorders that result from an inability to absorb or process vitamin D, such as: B. Familial hypophosphatemia.

Vitamin D supplements can be used to treat hereditary disorders that result from an inability to absorb or process vitamin D, such as: B. Familial hypophosphatemia. Multiple sclerosis. Research suggests that long-term vitamin D supplementation reduces the risk of multiple sclerosis.

Research suggests that long-term vitamin D supplementation reduces the risk of multiple sclerosis. osteomalacia. Vitamin D supplements are used to treat adults with severe vitamin D deficiency leading to loss of bone mineral content, bone pain, muscle weakness, and soft bones (osteomalacia).

Vitamin D supplements are used to treat adults with severe vitamin D deficiency leading to loss of bone mineral content, bone pain, muscle weakness, and soft bones (osteomalacia). Osteoporosis. Studies suggest that people who get enough vitamin D and calcium in their diets can slow bone mineral loss, prevent osteoporosis, and reduce bone fractures. Ask your doctor if you need a calcium and vitamin D supplement to prevent or treat osteoporosis.

Studies suggest that people who get enough vitamin D and calcium in their diets can slow bone mineral loss, prevent osteoporosis, and reduce bone fractures. Ask your doctor if you need a calcium and vitamin D supplement to prevent or treat osteoporosis. Psoriasis. Applying vitamin D or a topical preparation containing a vitamin D compound called calcipotriene to the skin can treat plaque psoriasis in some people.

Applying vitamin D or a topical preparation containing a vitamin D compound called calcipotriene to the skin can treat plaque psoriasis in some people. Rickets. This rare condition occurs in children with vitamin D deficiency. Vitamin D supplementation can prevent and treat the problem.

Our opinion

Generally safe

Without vitamin D, your bones can become soft, thin, and brittle. A lack of vitamin D is also associated with osteoporosis. If you’re not getting enough vitamin D from sunlight or dietary sources, you may need vitamin D supplements.

safety and side effects

Taken in appropriate doses, vitamin D is generally considered harmless.

However, taking too much vitamin D in supplement form can be harmful. Children 9 years and older, adults, and pregnant and breastfeeding women who take more than 4,000 IU of vitamin D daily may experience:

nausea and vomiting

loss of appetite and weight loss

constipation

Weakness

confusion and disorientation

cardiac arrhythmias

kidney stones and kidney damage

interactions

Possible interactions are:

Aluminum. Taking vitamin D and aluminum-containing phosphate binders, which can be used to treat high serum phosphate levels in people with chronic kidney disease, can lead to harmful aluminum levels long-term in people with kidney failure.

Taking vitamin D and aluminum-containing phosphate binders, which can be used to treat high serum phosphate levels in people with chronic kidney disease, can lead to harmful aluminum levels long-term in people with kidney failure. anticonvulsants. The anticonvulsants phenobarbital and phenytoin (Dilantin, Phenytek) increase the breakdown of vitamin D and decrease calcium absorption.

The anticonvulsants phenobarbital and phenytoin (Dilantin, Phenytek) increase the breakdown of vitamin D and decrease calcium absorption. Atorvastatin (Lipitor). Taking vitamin D can affect the way your body processes this cholesterol drug.

Taking vitamin D can affect the way your body processes this cholesterol drug. Calcipotria (Dovonex, Sorilux). Do not take vitamin D with this psoriasis medication. The combination could increase the risk of too much calcium in the blood (hypercalcaemia).

Do not take vitamin D with this psoriasis medication. The combination could increase the risk of too much calcium in the blood (hypercalcaemia). Cholestyramine (Prevalit). Taking vitamin D along with this cholesterol-lowering drug may decrease your vitamin D absorption.

Taking vitamin D along with this cholesterol-lowering drug may reduce your vitamin D absorption. Cytochrome P-450 3A4 (CYP3A4) substrates. Use vitamin D cautiously if you are taking medications that are processed by these enzymes.

Use vitamin D cautiously if you are taking medications that are processed by these enzymes. Digoxin (Lanoxin). Avoid taking high doses of vitamin D with this heart medication. High doses of vitamin D can cause hypercalcemia, which increases the risk of fatal heart problems with digoxin.

Avoid taking high doses of vitamin D with this heart medication. High doses of vitamin D can cause hypercalcemia, which increases the risk of fatal heart problems with digoxin. Diltiazem (Cardizem, Tiazac, others). Avoid taking high doses of vitamin D with this blood pressure medication. High doses of vitamin D can cause hypercalcemia, which can reduce the drug’s effectiveness.

Avoid taking high doses of vitamin D with this blood pressure medication. High doses of vitamin D can cause hypercalcemia, which can reduce the drug’s effectiveness. Orlistat (Xenical, Alli). Taking this drug for weight loss may decrease your vitamin D absorption.

Taking this drug for weight loss may decrease your vitamin D absorption. thiazide diuretics. Taking these blood pressure medications with vitamin D increases the risk of hypercalcemia.

Taking these blood pressure medications with vitamin D increases the risk of hypercalcemia. steroids. Taking steroid mediations such as prednisone can decrease calcium absorption and interfere with your body’s processing of vitamin D.

Taking steroid medications such as prednisone can decrease calcium absorption and interfere with your body’s processing of vitamin D. Stimulant laxatives. Long-term use of high doses of stimulant laxatives can decrease absorption of vitamin D and calcium.

Long-term use of high doses of stimulant laxatives can decrease absorption of vitamin D and calcium. Verapamil (Verelan, Calan SR). Taking high doses of vitamin D along with this blood pressure drug can cause hypercalcemia and may also decrease the effectiveness of verapamil.

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According to cardiologist Steven Nissen, MD, despite claims from the nutrition industry and non-medical personnel about vitamin D’s ability to lower blood pressure, no high-quality scientific study can confirm these benefits.

“There are many other claims about the benefits of vitamin D for heart health, but they are not supported by high-quality scientific studies,” says Dr. nits.

In fact, a study of 25,871 participants published in the New England Journal of Medicine in 2019 concluded that vitamin D did not result in a lower incidence of cardiovascular events compared to participants given a placebo.

Overdressed

according to dr Nissen, vitamin D plays an important role in regulating blood pressure, but it’s a complicated process. And taking too much vitamin D can lead to excess calcium or hypercalcemia.

“Vitamin D enables calcium to be absorbed,” he says. “In theory, too high levels could potentially lead to calcium deposits on the walls of blood vessels, in heart valves and even in the liver and kidneys. Our advice is therefore not to use vitamin D as a means of lowering blood pressure.”

Safe vitamin D levels remain unclear

Vitamin D is an essential vitamin. Your body synthesizes vitamin D from exposure to natural sunlight. Most foods do not contain significant amounts of the nutrient. Therefore, it can be useful to take some vitamin D, especially in times of the year with less sunlight.

“That may be true, but be aware that there isn’t a clear consensus on how much vitamin D we ultimately need and, more importantly, what amounts could be harmful,” says Dr. nits. “This poses problems for anyone taking large amounts of vitamin D to improve their health. It’s like treating yourself blindfolded.”

An exception for vitamin D

Vitamin D helps women at risk of osteoporosis. For men, however, there is no clear evidence of benefit.

“The bottom line is, don’t take vitamin D supplements unless your doctor tells you to,” says Dr. nits.

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Fish Oil By Mayo Clinic staff

overview

Fish oil is a dietary source of omega-3 fatty acids. Your body needs omega-3 fatty acids for many functions, from muscle activity to cell growth.

Omega-3 fatty acids are obtained from food. They cannot be made in the body. Fish oil contains two omega-3 fatty acids called docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA). Dietary sources of DHA and EPA include fatty fish such as salmon, mackerel and trout, and shellfish such as mussels, oysters and crab. Some nuts, seeds, and vegetable oils contain another omega-3 called alpha-linolenic acid (ALA).

Fish oil supplements come in liquid, capsule, and pill forms.

People take fish oil for its anti-inflammatory effects.

proof

Research into the use of fish oil for certain conditions shows:

heart disease. While research shows that people who consume food sources containing fish oil at least twice a week have a lower risk of dying from heart disease, taking fish oil supplements appears to have little to no heart health benefits.

While research shows that people who consume food sources containing fish oil at least twice a week have a lower risk of dying from heart disease, taking fish oil supplements appears to have little to no heart health benefits. High blood pressure. Several studies report modest reductions in blood pressure in people taking fish oil supplements. There is some evidence that the beneficial effects of fish oil may be greater in people with moderate to severe hypertension than in those with mild hypertension.

Several studies report modest reductions in blood pressure in people taking fish oil supplements. There is some evidence that the beneficial effects of fish oil may be greater in people with moderate to severe hypertension than in those with mild hypertension. High triglycerides and cholesterol. There is strong evidence that omega-3 fatty acids can significantly lower blood triglyceride levels. There also appears to be a slight improvement in high-density lipoprotein (HDL or “good”) cholesterol, although an increase in low-density lipoprotein (LDL or “bad”) cholesterol has also been observed.

There is strong evidence that omega-3 fatty acids can significantly lower blood triglyceride levels. There also appears to be a slight improvement in high-density lipoprotein (HDL or “good”) cholesterol, although an increase in low-density lipoprotein (LDL or “bad”) cholesterol has also been observed. Rheumatoid arthritis. Studies suggest that fish oil supplements may help reduce pain, improve morning stiffness, and reduce joint tenderness in people with rheumatoid arthritis. While the relief is often modest, it might be enough to reduce the need for anti-inflammatory drugs.

Our opinion

Generally safe

Omega-3 fatty acids are essential for good health. Try eliminating them from your diet by eating fish — grilled or baked, not fried. Fish oil supplements may be helpful if you have high triglycerides or rheumatoid arthritis.

Fish oil appears to have almost no mercury, which can be a concern in certain fish species. While generally safe, taking too much fish oil can increase your risk of bleeding and impair your immune response. It’s not clear if fish oil is safe for people with a seafood allergy. Take fish oil supplements under medical supervision.

safety and side effects

When taken as recommended, fish oil supplements are generally considered safe.

However, fish oil supplements can cause mild side effects, including:

A fishy aftertaste

Bad breath

heartburn, nausea or diarrhea

rash

Taking high doses of fish oil supplements can increase your risk of bleeding and possibly your risk of stroke.

interactions

Possible interactions are:

Anticoagulants and antiplatelet agents, herbs and dietary supplements. These types of medications, herbs, and supplements reduce blood clotting. It’s possible that taking fish oil supplements may increase your risk of bleeding.

These types of medications, herbs, and supplements reduce blood clotting. It’s possible that taking fish oil supplements may increase your risk of bleeding. Blood Pressure Medicines, Herbs and Dietary Supplements. Taking fish oil supplements may slightly lower blood pressure. Taking these supplements with blood pressure medications may increase the effects on blood pressure.

Taking fish oil supplements may slightly lower blood pressure. Taking these supplements with blood pressure medications may increase the effects on blood pressure. contraceptives. Some birth control pills can interfere with the effect that fish oil typically has on triglycerides.

Some birth control pills can interfere with the effect that fish oil typically has on triglycerides. Orlistat (Xenical, Alli). Taking fish oil with this weight loss drug might decrease the absorption of fish oil fatty acids. Consider taking the supplement and medication two hours apart.

Taking fish oil with this weight loss drug might decrease the absorption of fish oil fatty acids. Consider taking the supplement and medication two hours apart. Vitamin E. Taking fish oil can lower vitamin E levels.

There is a problem with the information submitted for this request. Check/update the information highlighted below and resubmit the form. From the Mayo Clinic to your inbox Subscribe for free and stay up to date with research advances, health tips and hot topics in health such as COVID-19, as well as health management expertise. Email ErrorEmail field is required. ErrorPlease provide a valid email address. Learn more about how Mayo Clinic uses data. In order to provide you with the most relevant and helpful information and to understand what information is useful, we may combine your email and website usage information with other information we have about you. If you are a Mayo Clinic patient, this may include proprietary health information. If we combine this information with your Protected Health Information, we will treat all such information as Protected Health Information and will only use or disclose such information as described in our Privacy Practices Statement. You can unsubscribe from email communications at any time by clicking the unsubscribe link in the email. Subscribe to! Thank you for subscribing to our Housecall e-newsletter to keep you up to date with the latest health information. Sorry, there was an error with your subscription. Please try again in a few minutes. Try it again