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Calcium supplementation for the management of primary hypertension in adults

Lookup NU author(s): Dr Heather Dickinson, Donald Nicolson, Dr Julia Cook, Fiona Campbell, Fiona Beyer, Professor Gary Ford, Professor James Mason

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Abstract

Background Metabolic studies suggest calcium may have a role in the regulation of blood pressure. Some epidemiological studies have reported that people with a higher intake of calcium tend to have lower blood pressure. Previous systematic reviews and meta-analyses have reached conflicting conclusions about whether oral calcium supplementation can reduce blood pressure. Objectives To evaluate the effects of oral calcium supplementation as a treatment for primary hypertension in adults. Search strategy We searched the Cochrane Library, MEDLINE, EMBASE, Science Citation Index, ISI Proceedings, ClinicalTrials. gov, Current Controlled Trials, CAB abstracts, and reference lists of systematic reviews, meta-analyses and randomised controlled trials (RCTs) included in the review. Selection criteria Inclusion criteria were: 1) RCTs comparing oral calcium supplementation with placebo, no treatment, or usual care; 2) treatment and follow- up >= 8 weeks; 3) participants over 18 years old, with raised systolic blood pressure (SBP) >= 140 mmHg or diastolic blood pressure (DBP) >= 85 mmHg; 4) SBP and DBP reported at end of follow- up. We excluded trials where: participants were pregnant; received antihypertensive medication which changed during the study; or calcium supplementation was combined with other interventions. Data collection and analysis Two reviewers independently abstracted data and assessed trial quality. Disagreements were resolved by discussion or a third reviewer. Random effects meta-analyses and sensitivity analyses were conducted. Main results We included 13 RCTs (n = 485), with between eight and 15 weeks follow- up. The results of the individual trials were heterogeneous. Combining all trials, participants receiving calcium supplementation as compared to control had a statistically significant reduction in SBP (mean difference: -2.5 mmHg, 95% CI: - 4.5 to - 0.6, I-2 = 42%), but not DBP (mean difference: - 0.8 mmHg, 95% CI: - 2.1 to 0.4, I-2 = 48%). Sub- group analyses indicated that heterogeneity between trials could not be explained by dose of calcium or baseline blood pressure. Heterogeneity was reduced when poor quality trials were excluded. The one trial reporting adequate concealment of allocation and the one trial reporting adequate blinding yielded results consistent with the primary meta-analysis. Authors' conclusions In view of the poor quality of included trials and the heterogeneity between trials, the evidence in favour of causal association between calcium supplementation and blood pressure reduction is weak and is probably due to bias. This is because poor quality studies generally tend to over-estimate the effects of treatment. Larger, longer duration and better quality double-blind placebo controlled trials are needed to assess the effect of calcium supplementation on blood pressure and cardiovascular outcomes.


Publication metadata

Author(s): Dickinson HO, Nicolson DJ, Cook JV, Campbell F, Beyer FR, Ford GA, Mason J

Publication type: Review

Publication status: Published

Journal: Cochrane Database of Systematic Reviews

Year: 2006

Issue: 2

Pages: CD004639

ISSN (print):

ISSN (electronic): 1469-493X

URL: http://dx.doi.org/10.1002/14651858.CD004639.pub2

DOI: 10.1002/14651858.CD004639.pub2


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