Effects of treatment with an angiotensin 2 receptor blocker and/or vitamin D3 on parathyroid hormone and aldosterone: a randomized, placebo-controlled trial

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DOI

OBJECTIVE: Emerging evidence support a positive, bidirectional and clinical relevant interaction between parathyroid hormone (PTH) and the renin-angiotensin-aldosterone-system (RAAS). A beneficial effect of the widely used RAAS inhibitors might include a PTH lowering effect, as high PTH levels may be harmful to cardiovascular health. We aimed to investigate whether PTH levels are lowered by short-term treatment with an angiotensin 2 receptor blocker (valsartan) independently of co-administration of vitamin D3. Secondary end-points included effects blood pressure, cardiac conduction and concentrations of renin and aldosterone.

DESIGN AND METHODS: In a double-blind placebo-controlled trial, we included 81 otherwise healthy postmenopausal women with high PTH levels (>6.9 pmol/L) and vitamin D deficiency (25(OH)D <50 nmol/l). Participants received two-weeks of treatment with valsartan 80 mg/d, vitamin D3 70 μg/d, valsartan plus vitamin D3, or double-placebo.

RESULTS: Valsartan treatment did not affect plasma PTH, although treatment reduced diastolic blood pressure (p=0.01) and the aldosterone/renin ratio (p<0.001). We found no associations between calciotropic hormones and RAAS markers. Vitamin D3 supplementation reduced PTH by 3.4% (25th, 75th -9.0 to 8.7) compared to a 7.1% increase (25th, 75th -2.4 to 30.9) in the placebo group (p=0.01), but did not affect blood pressure, cardiac conduction or concentrations of renin and aldosterone.

CONCLUSIONS: Independently of vitamin D3, short-term valsartan treatment did not reduce PTH. Vitamin D3 reduced PTH but did not affect blood pressure, cardiac conduction or the RAAS. The study does not support a direct association between PTH and aldosterone or a blood pressure lowering effect of vitamin D3. This article is protected by copyright. All rights reserved.

OriginalsprogEngelsk
TidsskriftClinical Endocrinology
ISSN0300-0664
DOI
StatusE-pub ahead of print - 7 maj 2018
Eksternt udgivetJa

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