Assessment of cholecalciferol and antihypertensive therapy concominant use in people with arterial hypertension
Background. The purpose of the study was to assess the effect of cholecalciferol intake at a daily dose of 2,000 IU on the serum level of 25(ОН)D total and blood pressure (BP) against the background of antihypertensive therapy in people with arterial hypertension(AH) stage II. Materials and methods. We performed a prospective, single-center study of 115 individuals with AH stage II (91 females and 24 males), mean age 50.7 ± 7.1 years. The duration of the follow-up period averaged 15.8 ± 1.8 months (from 12 to 18 months). The patients were receiving antihypertensive therapy according to the European guidelines: angiotensin-converting enzyme inhibitors or angiotensin receptor antagonists — losartan, or diuretics (hydrochlorothiazide or indapamide) as a part of combination therapy, or calcium antagonists — amlodipine, or beta-adrenergic blockers, or their combination. Every second patient was recommended to take vitamin D in the form of cholecalciferol at a dose of 2000 IU/d daily. All subjects were performed full blood count, clinical urine examination, measure of fasting blood sugar, serum urea, serum creatinine, office systolic and diastolic blood pressure, anthropometric data, electrocardiography. Serum level of total vitamin D was determined using immunoenzymatic assay. Statistical analysis was done by using software package STATISTICA 10.0 (SN AXAR207F394425FA-Q). Results. It was found that intake of diuretics (hydrochlorothiazide at a dose of 12.5–25.0 mg or indapamide 1.5 mg) as part of combination antihypertensive therapy influenced the dynamics of serum 25(OH)D (F = 5.35; p = 0.02) and its level (F = 11.8; p = 0.0009). Dynamic SBP value was highest (–27.4 ± 17.9) in the group receiving a diuretic and cholecalciferol, which was significantly (p < 0.001) different from the comparison group. In the same group, we established a correlation relationship between dynamic SBP and length of cholecalciferol intake (R = 0.42; p = 0.023). A significant influence of both cholecalciferol (F = 4,1; p = 0.046), and diuretics (F = 14.3; p = 0.0003) on dynamic SBP was established. Conclusions. Thiazide/thiazide-like diuretics negatively influenced the improvement of serum 25(OH)D level. The combined use of cholecalciferol and diuretic at a dose of 2000 IU/day in the treatment of patients with AH II degree allowed to obtain the greatest hypotensive effect on SBP without the risk of vitamin D overdosing in the body.
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