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Clinician Article

Calcium supplementation for the management of primary hypertension in adults.



  • Dickinson HO
  • Nicolson DJ
  • Cook JV
  • Campbell F
  • Beyer FR
  • Ford GA, et al.
Cochrane Database Syst Rev. 2006 Apr 19;(2):CD004639. doi: 10.1002/14651858.CD004639.pub2. (Review)
PMID: 16625609
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Disciplines
  • Cardiology
    Relevance - 5/7
    Newsworthiness - 5/7
  • Internal Medicine
    Relevance - 5/7
    Newsworthiness - 4/7
  • Family Medicine (FM)/General Practice (GP)
    Relevance - 5/7
    Newsworthiness - 3/7
  • General Internal Medicine-Primary Care(US)
    Relevance - 5/7
    Newsworthiness - 3/7

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.


Clinical Comments

Cardiology

This review underlines the need for more high-quality clinical trials to answer the research question.

Family Medicine (FM)/General Practice (GP)

I was not aware of a possible link between calcium and primary hypertension. In the Netherlands, I have never seen an adult treated with calcium because of hypertension. Therefore, I see only a peripheral relevance and no newsworthiness.

General Internal Medicine-Primary Care(US)

This article demonstrates a possible trend that Calcium may help HTN. More research is needed to see if this is clinically relevant.

General Internal Medicine-Primary Care(US)

Very good article. Unfortunately, it really will not help on a daily basis since the results were inconclusive.

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