Linking to a non-federal website does not constitute an endorsement by CDC or any of its employees of the sponsors or the information and products presented on the website. Abbreviations: CI, confidence interval; WMD, weighted mean difference. In addition, a meta-analysis synthesizing the results of 30 RCTs suggested that vitamin D supplementation at a dose of >800 IU/d reduced blood pressures significantly (14). Grenet O, Bobadilla M, Chibout SD, Steiner S. Evidence for the impairment of the vitamin D activation pathway by cyclosporine A. Reichel H, Grussinger A, Knehans A, Kuhn K, Schmidt-Gayk H, Ritz E. Long-term therapy with cyclosporin A does not influence serum concentrations of vitamin D metabolites in patients with multiple sclerosis. All other studies received a neutral rating. Vitamin D supplementation is ineffective to prevent hypertension. None of the studies reported significant alterations in 25(OH)D concentrations as a result of thiazide treatment. All information these cookies collect is aggregated and therefore anonymous. Interactions from Supplements and Other Medications. Of the few studies that reported the effects of specific AEDs on 25(OH)D concentrations, no statistically significant differences in 25(OH)D concentrations were observed between those on the CYP3A4 inducing AEDs compared to normal controls 66, or within individuals over time 107. Effects of vitamin D on blood pressure, arterial stiffness, and cardiac function in older people after 1 year: BESTD (Biochemical Efficacy and Safety Trial of Vitamin D). Wood AD, Secombes KR, Thies F, Aucott L, Black AJ, Mavroeidi A, et al. Xu Y, Hashizume T, Shuhart MC, et al. Herb-drug interactions in oncology: focus on mechanisms of induction. Vardenafil is used to treat male sexual function problems (impotence or erectile dysfunction-ED). FOIA Bethesda, MD 20894, Web Policies Plasma 1,25-dihydroxyvitamin D levels in patients receiving anticonvulsant drugs. Office of Dietary Supplements, National Institutes of Health. Quantitative results from meta-analyses of cohort studies showed that the risk of incident hypertension decreased by 7% (relative risk [RR] = 0.93; 95% CI, 0.890.98) per 25 nmol/L increment in 25(OH)D levels, with significant heterogeneity (I2 = 61.6%, Pheterogeneity = .004). Intestinal and hepatic CYP3A4 catalyze hydroxylation of 1alpha,25-dihydroxyvitamin D(3): implications for drug-induced osteomalacia. What is added by this report? Moshfegh A, Goldman J, Ahuja J, Rhodes D, LaComb R. What We Eat In America, NHANES 20052006: Usual nutrient intake from food and water compared to 1997 Dietary Reference Intakes for vitamin D, calcium, phosphorus and magnesium. Similar with our results, previous meta-analyses also showed no overall lowering effect of vitamin D supplementation on blood pressure (1416,57). In cases where the third author disagreed with classification and/or rating assigned by the primary reviewer, the study was discussed among the authors until a consensus was reached. Baer MT, Kozlowski BW, Blyler EM, Trahms CM, Taylor ML, Hogan MP. Hypertension 2015;66(3):56370. This study aims to determine whether long-term high-dose vitamin D taken for 18 months lowers BP. Supplemental vitamin D is available in two forms, cholecalciferol (vitamin D3) and ergocalciferol (vitamin D2). Too little vitamin D is bad for the bones, but what about the heart? Second, there are several trials that did not reach enough power (they were below 80%) to detect any weak difference between interventional and placebo groups because of the small sample size and high rate of noncompliance (13,20,53). We used the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analyses) checklist to perform the meta-analysis and report the results (25). Wolthers OD, Riis BJ, Pedersen S. Bone turnover in asthmatic children treated with oral prednisolone or inhaled budesonide. One time series study (Class C, negative quality) evaluated the effect of tacrolimus on vitamin D status in individuals who had undergone renal transplantation 139. Cohran VC, Griffiths M, Heubi JE. Bone mineral loss, bone histomorphometry and vitamin D metabolism in patients with rheumatoid arthritis on long-term glucocorticoid treatment. Morijiri Y, Sato T. Factors causing rickets in institutionalised handicapped children on anticonvulsant therapy. Osteoporosis is a common long-term side effect, especially among transplant patients who often receive both immunosuppressive agents and steroids. The course of biochemical parameters of bone turnover during treatment with corticosteroids. Recent evidence suggests that the vitamin may also play a role in a variety of other physiologic processes such as modulation of inflammatory pathways 1 and susceptibility to diabetes 2, cancer 3, and infectious 4 and cardiovascular 5 diseases. Few of these studies considered potential differences in the glucocorticoid-vitamin D association by body composition, dietary or supplemental vitamin D intake, or UV exposure. ; LifeLines Cohort Study investigators; International Consortium for Blood Pressure (ICBP); Cohorts for Heart and Aging Research in Genomic Epidemiology (CHARGE) consortium; Global Blood Pressure Genetics (Global BPGen) consortium; Caroline Hayward. We evaluated the association comprehensively and quantitatively. Sublingual administration involves placing a drug under your tongue to dissolve and absorb into your blood through the tissue there. Divergent effects of glucocorticoids on cortical and trabecular compartment BMD in childhood nephrotic syndrome. Publication bias was assessed with Eggers test (30). Zhou SF, Xue CC, Yu XQ, Li C, Wang G. Clinically important drug interactions potentially involving mechanism-based inhibition of cytochrome P450 3A4 and the role of therapeutic drug monitoring. This content does not have an Arabic version. Assistant Professor, University of Kansas Medical Center, School of Health Professions, Department of Dietetics & Nutrition, 3901 Rainbow Boulevard, Mail Stop 4019, 4093 DELP, Kansas City, KS 66160, Phone: 913-588-7650, Fax: 913-588-8946. Klein RG, Arnaud SB, Gallagher JC, Deluca HF, Riggs BL. A prospective study of serum 25-hydroxyvitamin D levels, blood pressure, and incident hypertension in postmenopausal women. Ke L, Graubard BI, Albanes D, Fraser DR, Weinstein SJ, Virtamo J, et al. Vitamin D deficiency has been associated with increased susceptibility to TB infection or reactivation of latent TB infections 51. Reddy Vanga S, Good M, Howard PA, Vacek JL. von Scheven E, Gordon CM, Wypij D, Wertz M, Gallagher KT, Bachrach L. Variable deficits of bone mineral despite chronic glucocorticoid therapy in pediatric patients with inflammatory diseases: a Glaser Pediatric Research Network study. Zerwekh JE, Emkey RD, Harris ED., Jr Low-dose prednisone therapy in rheumatoid arthritis: effect on vitamin D metabolism. 2Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Henan, China. Higgins BA, Nassim JR, Collins J, Hilb A. After duplicate checking and initial review of the titles and abstracts, 156 potentially relevant articles were obtained in full text for further evaluation. Vitamin D insufficiency and diabetes risks. Study-specific slope coefficients were examined by restricted cubic splines with three knots at 25%, 50%, and 75% of the distribution of circulating 25(OH)D levels. A one-year trial to assess the value of orlistat in the management of obesity. Plasma levels and therapeutic effect of 25-hydroxycholecalciferol in epileptic patients taking anticonvulsant drugs. Eur J Nutr 2013;52(7):17719. The quality criteria checklist includes questions in 10 categories relating to the reporting of the research methods and findings: a clear statement of the research question, potential for bias in selection of study participants, comparability of the study groups, methods for handling withdrawals, appropriateness of exposure assessment or the intervention, appropriateness of the outcome assessment, statistical analysis methods, whether the conclusions are supported by the data, and the potential for bias from the studys funding or sponsorship. Cansu A, Yesilkaya E, Serdaroglu A, et al. Kunutsor SK, Apekey TA, Steur M. Vitamin D and risk of future hypertension: meta-analysis of 283,537 participants. Plasma 1,25-dihydroxyvitamin D and the risk of developing hypertension: the Prevention of Renal and Vascular End-Stage Disease Study. It reduces systolic blood pressure and diastolic pressure in people with both vitamin D deficiency and hypertension. In total, 46 studies have evaluated the effect of AEDs on vitamin D status, however most were small single-institution reports, and only 4 of these studies included more than 100 participants 6366. Kim Robien, Associate Professor, Division of Epidemiology and Community Health; and Member, Cancer Outcomes and Survivorship Program, Masonic Cancer Center, University of Minnesota 1300 S. Second St., Suite 300, Minneapolis, MN 55454, Phone: 612-625-8279, Fax: 612-624-0315. Nonlinear doseresponse association between circulating 25(OH)D levels and hypertension risk, update meta-analysis of cohort studies of the effect of 25(OH)D levels on hypertension in the general population. Results from the analysis of restricted cubic splines indicated an approximate L-shaped correlation between circulating 25(OH)D levels and hypertension risk (Pnonlinearity = .04, Figure 1). Vitamin d3 is used to treat the following conditions: Prevention of Falls. extracted data and performed the data analysis. Vitamin D3 supplementation does not modify cardiovascular risk profile of adults with inadequate vitamin D status. However, evidence of HAART inhibiting vitamin D bioactivation in humans is currently limited, and inconclusive. CDC twenty four seven. Beveridge LA, Struthers AD, Khan F, Jorde R, Scragg R, Macdonald HM, et al. 8600 Rockville Pike Considering these findings, we still cannot rule out that the duration of vitamin D intervention is insufficient to detect any slight but significant reduction in blood pressures, especially in the apparently healthy subjects whose normal values are less likely to be further improved. government site. Given the small number of study participants in the studies to date, and the large number of different (often multi-agent) regimens used for cancer treatment, further research is needed. Inclusion in an NLM database does not imply endorsement of, or agreement with, Bressendorff I, Brandi L, Schou M, Nygaard B, Frandsen NE, Rasmussen K, et al. The urgent need to recommend an intake of vitamin D that is effective. Hoikka V, Savolainen K, Alhava EM, Sivenius J, Karjalainen P, Repo A. Osteomalacia in institutionalized epileptic patients on long-term anticonvulsant therapy. Chocano Bedoya P, Ronnenberg AG. Ramly M, Ming MF, Chinna K, Suboh S, Pendek R. Effect of vitamin D supplementation on cardiometabolic risks and health-related quality of life among urban premenopausal women in a tropical countrya randomized controlled trial. The standard deviations (SDs) were obtained as reported or calculated from 95% CIs, P values for t statistics, or individual standard errors (SE) from intervention and placebo groups. J Clin Endocrinol Metab 2001;86(4):16337. Jubiz W, Haussler MR, McCain TA, Tolman KG. a Not clear is defined as articles that did not specify whether the subjects were overweight/obese or vitamin D insufficient/deficient. We performed an update meta-analysis of both cohort studies and RCTs in a generally heathy population and found that the doseresponse relationship between circulating 25-hydroxyvitamin D level and hypertension risk was approximately L-shaped. Structural mechanism for statin inhibition of HMG-CoA reductase. Atorvastatin appears to increase 25(OH)D concentrations, while concurrent vitamin D supplementation decreases concentrations of atorvastatin. Inhibition of drug metabolism by blocking the activation of nuclear receptors by ketoconazole. Vitamin D, calcium, and bone status in children with developmental delay in relation to anticonvulsant use and ambulatory status. Overall, the studies evaluating the effect of glucocorticoids on vitamin D status suggest that 25(OH)D concentrations are not significantly affected by glucocorticoids, and that the observed association with osteoporosis/osteopenia may be related to drug effects on other parameters of bone metabolism 113. Vitamin D is derived from cholesterol, so by decreasing cholesterol synthesis, statins could also reduce vitamin D synthesis 40, 41. Four additional reports evaluated the effect of thiazide diuretics on serum 25(OH)D concentrations, including one RCT (Class A, negative quality 162), one non-randomized crossover trial (Class C, negative quality 163), and one before-after study 164 and one cross-sectional study 165 (both Class D, negative quality). It reduces systolic blood pressure in people with vitamin D deficiency that was older than 50 years old or obese. Thiazide Diuretics. Major GC, Alarie F, Dor J, Phouttama S, Tremblay A. Supplementation with calcium + vitamin D enhances the beneficial effect of weight loss on plasma lipid and lipoprotein concentrations. These findings have been attributed to sequestration of the fat-soluble vitamin D in adipose tissue, the major storage site for vitamin D 18. However, considering that the number of people with low vitamin D levels may be insufficient in our study, further trials are needed to verify this finding. Studies that appeared to be free from selection bias, applied appropriate randomization procedures, and had appropriate intervention methods/exposure assessment and outcome measurements received a positive rating. A total of five studies on statins and vitamin D status, including one RCT (Class A, negative quality 31), one nonrandomized trial (Class C, neutral quality 45) and two before-after studies (Class D, both negative quality 41, with data from one study published in two separate publications 46, 47), and one cross-sectional study (Class D, neutral quality 48) met the inclusion criteria. . An increasing body of evidence supports the presence of thresholds in vitamin D status (58). Kailajarvi ME, Salminen EK, Paija OM, Virtanent AM, Leino AE, Irjala KA. BMJ 1997;315(7109):62934. We excluded trials that have targeted patients with hypertension, diabetes, cardiovascular disease, or other diseases, because the known or unknown interaction between vitamin D and antihypertensive or cardiovascular medications may mask or attenuate the small effects of blood pressure reduction. Combining risk estimates from observational studies with different exposure cutpoints: a meta-analysis on body mass index and diabetes type 2. Princen HM, Meijer P, Wolthers BG, Vonk RJ, Kuipers F. Cyclosporin A blocks bile acid synthesis in cultured hepatocytes by specific inhibition of chenodeoxycholic acid synthesis. Learn how vitamin D affects bone health and other health conditions, and discover the possible side effects of taking too much of this supplement. This content does not have an English version. Exercise-induced respiratory infections. Developing research shows that taking 500 mg of quercetin twice . Mean or median baseline 25(OH)D concentrations varied from 25.6 nmol/L to 78.0 nmol/L, and 11 studies investigated the effects in individuals with vitamin D insufficiency, vitamin D deficiency, or both. Identification of glucocorticoid-inducible cytochromes P-450 in the intestinal mucosa of rats and man. Calcium plus vitamin D3 supplementation facilitated fat loss in overweight and obese college students with very-low calcium consumption: a randomized controlled trial. Careers, Unable to load your collection due to an error. Emerging evidence suggests that vitamin D deficiency is a widespread global problem (1). The following information was abstracted from each study: first author, year of publication, location of the study, study design, study population, sample size, duration of participant follow-up, drug dose and formulation, effect on 25(OH)D concentrations or drug level/activity, potential confounders evaluated in the study, and study limitations. We found that the heterogeneity decreased in studies of men, studies with overweight or obese individuals, studies with a large sample size (200), and studies with an intervention duration of 6 months or longer. Using predefined protocols, D.Z. Use WebMD's Drug Interaction Checker tool to find and identify potentially harmful and unsafe combinations of prescription medications by entering two or more drugs in question. Physicians have long noted a higher incidence of osteopenia and osteporosis among patients on antiepileptic drugs (AEDs), however the mechanism by which this occurs is not entirely clear. Bengoa JM, Bolt MJ, Rosenberg IH. However, osteoporosis is a well-known complication of corticosteroid therapy. Vitamin D regulates the amount of minerals such as calcium in the body 1. Nnoaham KE, Clarke A. The effect of a two-day treatment with chlorothiazide on the urinary excretion of calcium, phosphate and sodium in hyper- and hypocalcemia. HIV-protease inhibitors impair vitamin D bioactivation to 1,25-dihydroxyvitamin D. Ramayo E, Gonzalez-Moreno MP, Macias J, et al. Study characteristics and findings were abstracted, and quality was assessed for each study. Vimaleswaran KS, Cavadino A, Berry DJ, Jorde R, Dieffenbach AK, Lu C, et al. Accessed November 2, 2019. Reitsma JB, Castro Cabezas M, de Bruin TW, Erkelens DW. Based on articles identified during the initial search, the search terms colestyramine, statin, antibiotics, cimetidine, anticonvulsants, glucocorticoids, cyclosporins, mineral oils, hormone replacement therapy, weight reduction, mineral oils, diuretics, thiazides, hydroxymethylglutaryl-CoA reductase inhibitors, histamine H2 antagonists, HIV protease inhibitors, or immunosuppressive agents were added in subsequent searches. [A text description of this figure is available. Hydralazine. Importance Low levels of vitamin D are associated with elevated blood pressure (BP) and future cardiovascular events. Edwards BD, Davies M, Mawer EB, Chalmers RJ, Testa HJ, Ballardie FW. Perez-Castrillon JL, Abad L, Vega G, et al. European Multicentre Orlistat Study Group. NIST has also established a Vitamin D Metabolites Quality Assurance Program (VitDQAP, http://www.nist.gov/mml/analytical/vitdqap.cfm) in collaboration with the National Institutes of Health (NIH) Office of Dietary Supplements (ODS). Schwartz JB. Bischoff-Ferrari HA, Giovannucci E, Willett WC, Dietrich T, Dawson-Hughes B. Estimation of optimal serum concentrations of 25-hydroxyvitamin D for multiple health outcomes. One RCT (Class A, neutral quality 134) and five time series studies (Class C; one positive quality 135, one neutral quality 136, and three negative quality 137139) evaluated the effect of cyclosporine on vitamin D status. Hypertension 2010;55(3):7928. According to Eggers test, we found no evidence of publication bias in studies of SBP (P = .60) and DBP (P = .07). In silico and in vitro screening for inhibition of cytochrome P450 CYP3A4 by comedications commonly used by patients with cancer. Abstract. b Total number of studies in the subgroup is not equal to 27, because 2 trials supplemented vitamin D by single dose (49,54). Several studies show that 25(OH)D concentrations are higher in men than women, although the reasons for these differences are not known 20. Overall, these studies suggest that bile acid sequestrants do not alter vitamin D status. Design-of-experiment approach for HPLC analysis of 25-hydroxyvitamin D: a comparative assay with ELISA. If the lowest 25(OH)D level was not the reference, we recalculated the risk estimates by the method of Hamling et al (26). McDuffie JR, Calis KA, Booth SL, Uwaifo GI, Yanovski JA. Bikle DD, Halloran B, Fong L, Steinbach L, Shellito J. Elevated 1,25-dihydroxyvitamin D levels in patients with chronic obstructive pulmonary disease treated with prednisone. Serum 25(OH)D response to vitamin D3 supplementation: a meta-regression analysis. Nettekoven S, Strohle A, Trunz B, et al. One study comparing 31 adult RA patients on corticosteroids for at least six months (2.510 mg prednisone equivalents/day) to 38 healthy controls found that the corticosteroid users had significantly lower 25(OH)D concentrations compared to healthy controls 124. Accessibility If you need to go back and make any changes, you can always do so by going to our Privacy Policy page. Larger studies with stronger study designs are needed to clarify potential drug-vitamin D interactions. While it does not appear that cyclosporine or tacrolimus alter vitamin D status, osteopenia and osteoporosis are common among this patient population. However, our findings from subgroup analyses of RCTs suggested that response of blood pressure to vitamin D is independent of interventional duration (<6 months and 6 months). Figure 1. Funding: Support for S.J.O. Hypertension 2014;64(4):72530. Sluyter JD, Camargo CA Jr, Stewart AW, Waayer D, Lawes CMM, Toop L, et al. Decreased serum vitamin D levels in children with asthma are associated with increased corticosteroid use. 1.50 or free if you spend 15 or more from your choice of 2,200 stores. One study reported no statistically significant difference in 25(OH)D concentrations among individuals on CYP3A4-inducing AEDs compared to those on other AEDs 96. However, our subgroup analyses of the cohort studies produced inconsistent results, which indicated that the quantitative data failed to provide convincing evidence of the protective effect of vitamin D on hypertension. After reviewing the abstracts, 109 unique reports met the full inclusion criteria (Figure 3). ; D-PRESSURE Collaboration. Larsen T, Mose FH, Bech JN, Hansen AB, Pedersen EB. It might also be useful in preventing many chronic diseases including cancer 1. Role of 25-hydroxyvitamin D and corticosteroid dose. Finally, 119 articles were excluded and 37 publications (including 11 cohort studies in 10 publications [69,3540] and 27 trials [1013,1824,33,34,4154]) were eligible for inclusion. Skaaby T, Husemoen LL, Pisinger C, Jrgensen T, Thuesen BH, Fenger M, et al. Norman AW, Mizwicki MT, Norman DP. Am J Clin Nutr 2015;102(2):38592. Effect of isoniazid on vitamin D metabolism and hepatic monooxygenase activity. Saving Lives, Protecting People, National Center for Chronic Disease Prevention and Health Promotion, U.S. Department of Health & Human Services. 154200510010). Blood pressure medications: GABA may lower your blood pressure. van Ballegooijen AJ, Kestenbaum B, Sachs MC, de Boer IH, Siscovick DS, Hoofnagle AN, et al. While some of the studies considered the season in which vitamin D status was assessed, few considered dietary or supplemental vitamin D intake, and none assessed UV exposure or stratified by race/skin tone. 25-hydroxyvitamin D in patients with essential hypertension. Titles were reviewed for eligibility, and 912 manuscripts were excluded at this stage. We used fixed-effects models and forest plots to pool the weighted mean differences (WMDs) and corresponding 95% CIs of blood pressure across studies. Nutrition 2014;30(9):97585. D.Z., C.C., and S.Y. Individuals who are taking vitamin D supplements should do so for at least 6 months to reach the maximum attained 25(OH)D level (60). Vitamin supplements can also disrupt a carefully balanced dosage of medication. Health care providers should be aware of the potential for drug-vitamin D interactions. Wetzsteon RJ, Shults J, Zemel BS, et al. Hypercalcaemia following vitamin D and thiazide therapy in the elderly. Included studies are summarized in Supplementary Table 1 (available online). Golzarand M, Shab-Bidar S, Koochakpoor G, Speakman JR, Djafarian K. Effect of vitamin D3 supplementation on blood pressure in adults: an updated meta-analysis. Order by 10pm (subject to change during promotions), available 7 days a week for 4.95. Or tacrolimus alter vitamin D metabolism in patients with rheumatoid arthritis: effect on vitamin D 18 modify risk. Salminen EK, Paija OM, Virtanent AM, Leino AE, Irjala KA, Abad L, BI., McCain TA, Tolman KG, Hansen AB, Pedersen S. turnover! Of Dietary Supplements, National Center for chronic Disease Prevention and Health Promotion, U.S. of... For chronic Disease Prevention and Health Promotion, U.S. Department of Health & Human Services turnover. Sublingual administration involves placing a drug under your tongue to dissolve and into. Serdaroglu a, Trunz B, et al a meta-analysis on body mass index and diabetes 2! Aj, Mavroeidi a, et al effect on vitamin D regulates the of. Old or obese going to our Privacy Policy page the heart sequestration the. 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