title: Calcium supplementation for the management of primary hypertension in adults.
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.
  
  
  OBJECTIVE
  To evaluate the effects of oral calcium supplementation as a treatment for primary hypertension in adults.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  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.
  
  
  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.
authors.affiliation: University of Newcastle, National Guideline Research & Development Unit, 21 Claremont Place, Newcastle upon Tyne, Tyne & Wear, UK, NE2 4AA. heather.dickinson@newcastle.ac.uk
authors.forename: H O
authors.initials: HO
authors.lastname: Dickinson
authors.forename: D J
authors.initials: DJ
authors.lastname: Nicolson
authors.forename: J V
authors.initials: JV
authors.lastname: Cook
authors.forename: F
authors.initials: F
authors.lastname: Campbell
authors.forename: F R
authors.initials: FR
authors.lastname: Beyer
authors.forename: G A
authors.initials: GA
authors.lastname: Ford
authors.forename: J
authors.initials: J
authors.lastname: Mason
mesh_terms: D000328:Adult; D002136:Calcium, Dietary / Q000627:therapeutic use*; D019587:Dietary Supplements; D006801:Humans; D006973:Hypertension / Q000628:therapy*; D016032:Randomized Controlled Trials as Topic
chemical_list: D002136:Calcium, Dietary