Theoretical mechanisms of dietary calcium's antihypertensive action

Differential Effect of Renal Cortical and Medullary Interstitial Fluid Calcium on Blood Pressure Regulation in Salt-Sensitive Hypertension

BACKGROUND

Hypercalciuria is a frequent characteristic of hypertension. In this report we extend our earlier studies investigating the role of renal interstitial fluid calcium (ISF(Ca))(2+) as a link between urinary calcium excretion and blood pressure in the Dahl salt-sensitive (DS) hypertensive model.

METHODS

Dahl salt-sensitive and salt-resistant (DR) rats were placed on control (0.45%) and high (8%) salt diets to determine if changes in renal cortical and medullary ISF(Ca)(2+)correlated with changes in urinary calcium excretion and blood pressure.

RESULTS

We observed that renal ISFCa(2+) was predicted by urinary calcium excretion (P < 0.05) in DS rats but not DR rats. Renal cortical ISF(Ca)(2+) was negatively associated with blood pressure (P < 0.03) while renal medullary ISF(Ca)(2+) was positively associated with blood pressure in DS rats (P < 0.04). In contrast, neither urinary calcium excretion nor renal ISF(Ca)(2+) was associated with blood pressure in the DR rats under the conditions of this study.

CONCLUSION

We interpret these findings to suggest that decreased renal cortical ISF(Ca)(2+) plays a role in the increase in blood pressure following a high salt diet in salt hypertension perhaps by mediating renal vasoconstriction; the role of medullary calcium remains to be fully understood. Further studies are needed to determine the mechanism of the altered renal ISF(Ca)(2+) and its role in blood pressure regulation.

Association of calcitriol and blood pressure in normotensive men

The purpose of this study was to clarify the possible associations between the serum 1,25-dihydroxyvitamin D (calcitriol) level and blood pressure. Cross-sectional analysis of data was performed. Data collected included levels of serum calcitriol, parathyroid hormone, serum calcium, and blood lead; blood pressure; dietary history; and demographic and anthropometric variables. One hundred normotensive male industrial employees made up the study population. Systolic blood pressure and diastolic blood pressure were main outcome measures. After possible confounders were controlled for, multivariate analyses yielded an inverse, independent, and statistically significant association between calcitriol level and systolic blood pressure (standardized beta= -0.2704, P=.0051). A similar trend of borderline significance was found for the association between calcitriol and diastolic blood pressure (standardized beta= -0.1814, P=.0611). Parathyroid hormone, serum calcium, and blood lead levels were not associated with blood pressure. When subjects were divided into four groups by calcitriol level, those in the lowest quartile showed significantly higher systolic and diastolic blood pressures than those in the upper quartile (difference=11 mmHg, P=.007, and difference=4 mmHg, P=.071, respectively). There is an inverse association between serum calcitriol level and blood pressure. This suggests that in addition to its role in calcium homeostasis, the active metabolite of vitamin D may play a role in determining blood pressure. The differences in both systolic and diastolic blood pressures between the upper and lower quartiles of serum calcitriol were substantial and may be of clinical significance.

Lack of blood pressure effect with calcium and magnesium supplementation in adults with high-normal blood pressure. Results from Phase I of the Trials of Hypertension Prevention (TOHP). Trials of Hypertension Prevention (TOHP) Collaborative Research Group

Phase I of the Trials of Hypertension Prevention (TOHP) was a randomized, multicenter investigation that included double-blind, placebo-controlled testing of calcium and magnesium supplementation among 698 healthy adults (10.5% blacks and 31% women) aged 30 to 54 years with high-normal diastolic blood pressure (DBP) (80 to 89 mm Hg). Very high compliance (94 to 96% by pill counts) with daily doses of 1 g of calcium (carbonate), 360 mg of magnesium (diglycine), or placebos was corroborated for the active supplements by significant net increases in all urine and serum compliance measures in white men and for urine compliance measures in white women. Overall, neither calcium nor magnesium produced significant changes in blood pressure at 3 and 6 months. Analyses stratified by baseline intakes of calcium, magnesium, sodium, or initial blood pressures also showed no effect of supplementation. These analyses suggested that calcium supplementation may have resulted in a DBP decrease in white women and that response modifiers in this subgroup might have included lower initial urinary calcium levels, urinary sodium levels, or lower body mass index. However, overall analyses indicated that calcium and magnesium supplements are unlikely to lower blood pressure in adults with high-normal DBP. The subgroup analyses, useful to formulate hypotheses, raise the possibility of a benefit to white women, which requires testing in future trials.

Dietary calcium on vascular reactivity in normotensive and spontaneously hypertensive rats

Vascular reactivity and systolic blood pressure (SBP) were studied in tail artery rings isolated from stroke-prone spontaneously hypertensive rats (SHRSP) and normotensive, Wistar-Kyoto rats (WKY). After a control week on a diet with 1% of calcium, the animals were randomly assigned to three groups, which were fed with 1% (control), 0.4% (low) or 2.5% (high) dietary calcium. Both vascular reactivity and SBP were studied in the same animal during 9 weeks after changing diets. In the SHRSP rats on high Ca diet, maximal contractile responses to norepinephrine and serotonin (10(-10) to 10(-4) M) and to KCl (5 to 105 mM) were markedly decreased at the end of the study with respect to the control diet. These vascular changes were accompanied by a decrease of SBP in the same animals. Low calcium diet prevented the age-related increase of SBP in SHRSP rats and produced vascular changes of a lesser magnitude. WKY rats showed no significant modifications of SBP or vascular reactivity. Since plasmatic Ca2+ levels were not altered, the changes detected could not be attributed to a direct depressant effect of high calcium on the vascular smooth muscle cell (i.e. a "stabilizing action" of calcium). It is speculated that high dietary calcium could modulate the synthesis of calcium binding proteins of the plasma membrane, decreasing vascular reactivity and the elevated vascular resistance which is usually present in hypertension.

Effect of treatment with vitamin D3 on the responses of the duodenum of spontaneously hypertensive rats to bradykinin and to potassium

1. The diet of spontaneously hypertensive rats (SHR) and normotensive Wistar-Kyoto (WKY) and Wistar (NWR) rats was supplemented with either 2% calcium lactate in the drinking water or 12.5 micrograms vitamin D3 100 g-1 body weight daily by gavage, for 14 days. 2. The blood pressure of the SHR treated with either calcium or vitamin D decreased to the same levels as that of WKY and NWR. 3. The response to bradykinin of the SHR isolated duodenum, which is predominantly contractile, upon treatment with vitamin D (but not with calcium), became predominantly relaxant, approaching the normal behavior of the WKY and NWR duodenum. 4. The relaxant responses of the SHR and WKY duodenum to potassium were smaller than those of NWR, but treatment with vitamin D increased the response in all three rat strains. 5. It is concluded that, besides sharing the hypotensive effect of calcium, vitamin D treatment of SHR has an effect on the duodenum smooth muscle which might be due to calmodulin-dependent activation of calcium-dependent potassium channels.

Plasma ionized calcium and cardiovascular risk factors in mild primary hyperparathyroidism: effects of long-term treatment with active vitamin D (alphacalcidol)

Primary hyperparathyroidism (HPT) has been associated with hypertension, hyperinsulinaemia, hypertriglyceridaemia and hyperuricaemia. In the present study, plasma ionized calcium (Ca2+) was studied in relation to cardiovascular risk factors in 20 subjects with mild hypertension. Plasma Ca2+ was found to be negatively correlated with fasting serum insulin, triglycerides and urate, and with diastolic blood pressure (DBP). However, after the interaction of the different risk factors had been taken into account in the multiple regression analysis, only the relationship between Ca2+ and serum insulin was significant (r = 0.55, P less than 0.01). In a previous double-blind, placebo-controlled study 1 micrograms alphacalcidol, a synthetic analogue of 1,25 dihydroxy-vitamin D3, induced a decrease in blood pressure in mild HPT subjects. In the present study, the highest dose that did not further aggravate the hypercalcaemia was given in a long-term study over a 12-month period to 18 mild HPT subjects (average dose, 1.75 micrograms daily). The treatment induced a reduction in body weight of 0.9 kg (P less than 0.05) and an increase in serum urate from 330 +/- 92 to 380 +/- 104 mmol l-1 (P less than 0.01). A reduction in blood pressure was only observed at the end of the study, from 142 +/- 17/86.6 +/- 9.1 to 139 +/- 13/82.9 +/- 8.9 mmHg (P less than 0.05 for DBP). The reduction in systolic blood pressure was significantly correlated with the reduction in body weight induced by treatment (r = 0.63, P less than 0.02). No consistent changes in glucose or lipid metabolism were induced by treatment.

Dietary calcium and cell membrane abnormality in genetic hypertension

Adult stroke-prone spontaneously hypertensive rats (SHRSP) and Wistar-Kyoto (WKY) rats were maintained for 10 weeks on one of two diets: 1.0% calcium content and 2.5% calcium content. At the end of this time rats were anesthetized, and blood pressure was determined by means of aortic cannulation; then the rats were exsanguinated. Lymphocytes were isolated for determination of intracellular sodium and potassium concentrations, net sodium influx, net potassium efflux, and intracellular free calcium concentration. Serum ionized calcium was also measured. The increase in calcium content of their diet had no effect on intracellular sodium and potassium concentrations in lymphocytes from WKY rats and SHRSP. In lymphocytes from WKY rats, none of the parameters was affected by the change in dietary calcium intake. In contrast, in lymphocytes from SHRSP the increase in dietary calcium from 1.0 to 2.5% led to significant decreases in net potassium efflux (13.3 +/- 2.3 vs. 19.7 +/- 1.4 mmol/kg dry wt/hr, p less than 0.05, analysis of variance), intracellular free calcium concentration (114.5 +/- 10.2 vs. 166.2 +/- 11.2 nM, p less than 0.001), and systolic blood pressure (125.3 +/- 13.6 vs. 183.3 +/- 16.6 mm Hg, p less than 0.01). Serum ionized calcium increased in SHRSP (2.40 +/- 0.04 vs. 2.16 +/- 0.03, p less than 0.01) but not in WKY rats (2.34 +/- 0.05 vs. 2.31 +/- 0.05) fed the high calcium diet.(ABSTRACT TRUNCATED AT 250 WORDS)