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      Blood Pressure Is Correlated with Vitamin D 3 Serum Levels in Dialysis Patients

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          Abstract

          Background/Aim: The blood pressure, the most influencing factor in cardiovascular disease in end-stage renal failure patients, follows a seasonal variation during the year. Since vitamin D<sub>3</sub> is known to be related to sun exposure, we wanted to evaluate the putative participation of the vitamin D<sub>3</sub> metabolism in blood pressure modifications. Methods: We studied 22 stable hemodialysis patients (11 females and 11 males, mean age ± SD 56 ± 1 year) who had been continuously treated in our dialysis unit for more than 1 year between 1994 and 1997 and did not receive pulse vitamin D<sub>3</sub> treatment. Supine systolic and diastolic blood pressures were measured before every dialysis session (>12,000 measurements) and the intact parathormone (iPTH), 25-hydroxyvitamin D<sub>3</sub> [25(OH)D<sub>3</sub>], and 1,25-dihydroxyvitamin D<sub>3</sub> [1,25(OH)<sub>2</sub>D<sub>3</sub>] levels every 3 months (>300 determinations). The mean values of blood pressure per season and per patient were taken for analysis using a 4-year longitudinal study design. Results: The blood pressure varied during the years studied following a seasonal trend. It was highest during autumn and tended to decrease during spring and warmer months. Systolic as well as diastolic blood pressures were significantly correlated with the 25(OH)D<sub>3</sub> levels (p = 0.0291 and p = 0.0327, respectively). No correlation was observed between blood pressure and 1,25(OH)<sub>2</sub>D<sub>3</sub> or iPTH levels. Conclusions: There is a link between blood pressure and 25(OH)D<sub>3</sub> level. This interrelation is not secondary to a iPTH modulation. Although it cannot be excluded that vitamin D<sub>3</sub> and blood pressure vary following a third factor with seasonal variations, since vitamin D<sub>3</sub> varies during the year, mainly following sun exposure, we suggest that vitamin D<sub>3</sub> is one of the factors participating in the seasonal variation of the blood pressure. Other factors known to control the blood pressure and particularly the extracellular volume overload may also participate.

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          Most cited references 4

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          Seasonal changes in blood pressure in patients with end-stage renal disease treated with hemodialysis.

          Many factors contribute to the regulation of blood pressure. The role of climate has received relatively little attention. During a four-year period, we determined the influence of climate on blood pressure in 53 patients with end-stage renal disease treated with hemodialysis. For each patient, blood pressure was measured before each of three dialysis treatments per week for an average of 31 months. The dose of dialysis (urea clearance multiplied by the length of dialysis and divided by the distribution volume of urea) and protein catabolism rate were assessed monthly. We then analyzed the monthly mean values for blood pressure, pulse, and body weight in relation to the monthly values for temperature, relative humidity, and atmospheric pressure recorded in Montpellier, France. The maximal monthly temperature varied from 10 degrees C in the winter to 31 degrees C in the summer, and the minimal monthly temperature from 1 degree to 20 degrees C. The mean (+/-SE) systolic and diastolic blood pressure was highest during the winter (153+/-3/82+/-2 mm Hg) and lowest during the summer (141+/-3/75+/-2 mm Hg). The seasonal pattern was evident throughout the four-year period. Blood pressure was correlated inversely with monthly maximal temperature (r= -0.65 and P<0.001 for systolic pressure; r= -0.71 and P<0.001 for diastolic pressure) and directly with minimal humidity (r=0.45 and P=0.002 for systolic pressure; r=0.43 and P=0.003 for diastolic pressure). Changes in protein catabolic rate, weight gain during dialysis, and dialysis dose were not related to changes in blood pressure. In patients with end-stage renal disease treated with hemodialysis, blood pressure varies seasonally, with higher values in the winter and lower values in the summer.
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            Randomised placebo-controlled study of atovaquone plus proguanil for malaria prophylaxis in children.

             D Luckner,  B Lell,  M Ndjavé (1998)
            The combination of atovaquone and proguanil is highly effective and safe for the treatment of Plasmodium falciparum malaria. We aimed in this randomised, double-blind, placebo-controlled study to assess the efficacy and safety of this combination for malaria prophylaxis. 320 children who lived in a hyperendemic area for P falciparum malaria were stratified by weight and randomly assigned atovaquone plus proguanil or placebo once daily for 12 weeks. All children received initial curative treatment with atovaquone and proguanil before the start of chemosuppression. We recorded adverse events daily and collected thick blood smears once a week. The primary endpoint was a positive blood smear. 25 of 140 children in the placebo group and none of the 125 children in the atovaquone plus proguanil group had positive smears during chemosuppression (p<0.001). Adverse events during the chemosuppression phase did not differ between the groups. The combination of atovaquone plus proguanil is a highly effective and well-tolerated chemosuppressive antimalarial in children. This drug combination could replace current regimens.
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              Acute cardiovascular effect of 1,25-dihydroxycholecalciferol in essential hypertension.

              A role for vitamin D in the pathophysiology of essential hypertension has frequently been suggested, but acute direct effects on blood pressure, cardiac output, renal hemodynamics, or hormones have not previously been demonstrated. The rapid effects of 1,25-dihydroxycholecalciferol (1,25-D) were assessed over 120 min after a bolus injection (0.02 microg/kg body weight) in eight men with essential hypertension and in nine healthy men. A placebo group of 10 healthy men was also included. Ionized calcium was monitored closely during the study, and was kept constant with a clamping technique. In the hypertensive patients, a transient increase in blood pressure and a reciprocal fall in cardiac output measured by a CO2 rebreathing technique (-15%, P < .05) were observed after 1,25-D injection. In the control group, both blood pressure and cardiac output remained unchanged. The glomerular filtration rate, effective renal plasma flow, and urinary sodium and water excretions were unchanged in both groups. Plasma levels of atrial natriuretic peptide at baseline were higher in the hypertensive patients than in the control subjects (P < .02); plasma levels of renin, aldosterone, norepinephrine, endothelin, and parathyroid hormone(1-84) were similar in the two groups. None of these hormones was affected during the observation time after the injection of 1,25-D. In conclusion, acute administration of 1,25-D caused a fast and likely nongenomic-mediated decrease in cardiac output in patients with essential hypertension, which together with a transient BP increase implies a 1,25-D-induced increase in total peripheral resistance. These data suggest an enhanced cardiovascular responsiveness to 1,25-D in hypertensive compared to healthy normotensive subjects.
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                Author and article information

                Journal
                BPU
                Blood Purif
                10.1159/issn.0253-5068
                Blood Purification
                S. Karger AG
                0253-5068
                1421-9735
                2002
                2002
                12 August 2002
                : 20
                : 4
                : 370-375
                Affiliations
                aInstitut de Génétique Humaine – CNRS UPR 1142, Montpellier, bAssociation pour l’Installation à Domicile des Epurations Rénales (AIDER), Montpellier, and Departments of cNuclear Medicine and dNephrology, University Hospital Lapeyronie, Montpellier, France
                Article
                63106 Blood Purif 2002;20:370–375
                10.1159/000063106
                12169847
                © 2002 S. Karger AG, Basel

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                Page count
                Figures: 3, Tables: 1, References: 23, Pages: 6
                Product
                Self URI (application/pdf): https://www.karger.com/Article/Pdf/63106
                Categories
                Original Paper

                Cardiovascular Medicine, Nephrology

                Sunlight exposure, Blood pressure, Vitamin D3

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