[Show abstract][Hide abstract] ABSTRACT: Background:
Low birth weight and unhealthy lifestyles in adulthood have been independently associated with an elevated risk of hypertension. However, no study has examined the joint effects of these factors on incidence of hypertension.
We followed 52,114 women from the Nurses' Health Study II without hypercholesterolemia, diabetes, cardiovascular disease, cancer, prehypertension, and hypertension at baseline (1991-2011). Women born preterm, of a multiple pregnancy, or who were missing birth weight data were excluded. Unhealthy adulthood lifestyle was defined by compiling status scores of body mass index, physical activity, alcohol consumption, the Dietary Approaches to Stop Hypertension diet, and the use of non-narcotic analgesics.
We documented 12,588 incident cases of hypertension during 20 years of follow-up. The risk of hypertension associated with a combination of low birth weight at term and unhealthy lifestyle factors (RR, 1.95; 95 % CI, 1.83-2.07) was more than the addition of the risk associated with each individual factor, indicating a significant interaction on an additive scale (P interaction <0.001). The proportions of the association attributable to lower term birth weight alone, unhealthy lifestyle alone, and their joint effect were 23.9 % (95 % CI, 16.6-31.2), 63.7 % (95 % CI, 60.4-66.9), and 12.5 % (95 % CI, 9.87-15.0), respectively. The population-attributable-risk for the combined adulthood unhealthy lifestyle and low birth weight at term was 66.3 % (95 % CI, 56.9-74.0).
The majority of cases of hypertension could be prevented by the adoption of a healthier lifestyle, though some cases may depend on simultaneous improvement of both prenatal and postnatal factors.
BMC Medicine 07/2015; 13:175. DOI:10.1186/s12916-015-0409-1 · 7.25 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Prospective data are scarce on the relation of red meat, seafood, and poultry consumption with hypertension risk. Although red and processed meats are generally considered to have adverse cardiovascular consequences, seafood is believed to be protective and poultry's effect is controversial.
We prospectively examined the independent association of long-term intake of animal flesh with incident hypertension in three longitudinal cohort studies of nonhypertensive individuals: Nurses' Health Study (NHS, n = 62 273 women), Nurses' Health Study II (NHS II, n = 88 831 women), and Health Professionals Follow-Up Study (HPFS, n = 37 414 men). We used multivariable Cox proportional hazards regression to study the associations of different types of animal flesh with the risk of developing hypertension while controlling for other hypertension risk factors. We then used fixed-effects meta-analysis to derive pooled estimates of effect.
Compared with participants whose consumption was less than 1 serving/month, the pooled hazard ratios among those whose intake was at least 1 serving/day were 1.30 (95% confidence interval 1.23-1.39) for total meat (a combination of processed and unprocessed red meat), 1.22 (1.12-1.34) for poultry, and 1.05 (0.98-1.13) for seafood. Seafood was associated with an increased risk of hypertension in HPFS and NHS II, but not NHS. Consumption of any animal flesh at least 1 serving/day was associated with an increased hypertension risk [pooled hazard ratio = 1.30 (1.16-1.47)].
Long-term intake of meat and poultry were associated with increased risk of hypertension. In contrast to our hypothesis, we found a weak but significant trend toward an increased risk of hypertension with increasing seafood consumption.
Journal of Hypertension 07/2015; 33(11). DOI:10.1097/HJH.0000000000000722 · 4.72 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objective:
Ambulatory blood pressure measurement allows quantification of diurnal changes in blood pressure. While decreased nocturnal blood pressure dipping and elevated morning blood pressure surge are associated with an increased risk of cardiovascular events, the utility of ambulatory blood pressure measurements to predict renal events is unclear. African Americans, in addition to having an increased risk of chronic kidney disease (CKD), also have an increased prevalence of hypertension. Thus, we selected an African American population to study the association of ambulatory blood pressure parameters with incidence of CKD.
Prospective cohort study of 603 participants with normal renal function enrolled in the Jackson Heart Study who underwent baseline 24-h ambulatory blood pressure monitoring between 2000 and 2004, with median follow-up of 8.1 years. We analyzed the association of nocturnal dipping and morning surge with both incident CKD [estimated glomerular filtration rate (eGFR) <60 ml/min per 1.73 m] and annual rate of eGFR decline. In additional analyses, we examined the relation of nocturnal, daytime, white-coat, and masked hypertension with CKD incidence.
We found that 10% higher nocturnal dipping was significantly associated with a decreased risk of incident CKD [odds ratio (OR) 0.55, 95% confidence interval (CI) 0.32-0.96] and a 0.4 ml/min per 1.73 m slower annual decline in eGFR. Morning surge was not associated with the incidence of CKD. Additional analyses revealed that isolated nocturnal hypertension and mean asleep SBP were associated with a nonsignificantly higher risk of CKD (OR 2.34, 95% CI 0.90-6.08) and (OR 1.31, 95% CI 0.99-1.72), respectively, in fully adjusted models.
Loss of nocturnal blood pressure dipping, but not morning blood pressure surge, may promote the decline in GFR and increase the risk for development of CKD in high-risk individuals.
Journal of Hypertension 06/2015; 33(9). DOI:10.1097/HJH.0000000000000638 · 4.72 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The purpose of this study was to evaluate whether antihypertensive medication use, including long-term use, is associated with increased breast cancer incidence in women. We studied 210,641 U.S. registered nurses participating in the Nurses' Health Study (NHS) and Nurses' Health Study II (NHS II). Information on antihypertensive medication use was collected on biennial questionnaires in both cohorts, and breast cancer cases were ascertained during this period. Multivariable-adjusted Cox proportional hazard models were used to estimate relative risks of invasive breast cancer over follow-up (1988-2012 in NHS, 1989-2011 in NHS II) across categories of overall antihypertensive medication use and use of specific classes (diuretics, beta blockers, calcium channel blockers, and angiotensin-converting enzyme inhibitors). During follow-up, 10,012 cases of invasive breast cancer developed (6718 cases in NHS and 3294 in the NHS II). Overall, current use of any antihypertensive medication was not associated with breast cancer risk compared with past/never use in NHS (multivariable-adjusted relative risk = 1.00, 95 % CI = 0.95-1.06) or NHS II (multivariable-adjusted relative risk = 0.94, 95 % CI = 0.86-1.03). Furthermore, no specific class of antihypertensive medication was consistently associated with breast cancer risk. Results were similar when we considered hypertensive women only, and when we evaluated consistency and duration of medication use over time. Overall, antihypertensive medication use was largely unrelated to the risk of invasive breast cancer among women in the NHS cohorts.
Breast Cancer Research and Treatment 02/2015; 150(1). DOI:10.1007/s10549-015-3311-9 · 3.94 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background
The healthiest dietary pattern for myocardial infarction (MI) survivors is not known. Specific long‐term benefits of a low‐carbohydrate diet (LCD) are unknown, whether from animal or vegetable sources. There is a need to examine the associations between post‐MI adherence to an LCD and all‐cause and cardiovascular mortality.
Methods and Results
We included 2258 women from the Nurses' Health Study and 1840 men from the Health Professional Follow‐Up Study who had survived a first MI during follow‐up and provided a pre‐MI and at least 1 post‐MI food frequency questionnaire. Adherence to an LCD high in animal sources of protein and fat was associated with higher all‐cause and cardiovascular mortality (hazard ratios of 1.33 [95% CI: 1.06 to 1.65] for all‐cause mortality and 1.51 [95% CI: 1.09 to 2.07] for cardiovascular mortality comparing extreme quintiles). An increase in adherence to an animal‐based LCD prospectively assessed from the pre‐ to post‐MI period was associated with higher all‐cause mortality and cardiovascular mortality (hazard ratios of 1.30 [95% CI: 1.03 to 1.65] for all‐cause mortality and 1.53 [95% CI: 1.10 to 2.13] for cardiovascular mortality comparing extreme quintiles). An increase in adherence to a plant‐based LCD was not associated with lower all‐cause or cardiovascular mortality.
Greater adherence to an LCD high in animal sources of fat and protein was associated with higher all‐cause and cardiovascular mortality post‐MI. We did not find a health benefit from greater adherence to an LCD overall after MI.
Journal of the American Heart Association 09/2014; 3(5). DOI:10.1161/JAHA.114.001169 · 4.31 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Introduction
Hydrochlorothiazide, an effective antihypertensive medication commonly prescribed to blacks, decreases urinary calcium excretion. Blacks have significantly higher rates of hypertension and lower levels of 25-hydroxyvitamin D. Thus, they are more likely to be exposed to vitamin D supplementation and thiazide diuretics. The risk for hypercalcemia among blacks using vitamin D and hydrochlorothiazide is undefined.
We assessed the frequency of hypercalcemia in HCTZ users in a post-hoc analysis of a randomized, double-blind, dose-finding trial of 328 blacks (median age, 51 years) assigned to either placebo, or 1000, 2000, or 4000 international units of cholecalciferol (vitamin D3) daily for 3 months during the winter (2007-2010).
Of the 328 participants, 84 reported hydrochlorothiazide use and had serum calcium levels assessed. Additionally, a comparison convenience group of 44 enrolled participants who were not taking hydrochlorothiazide had serum calcium measurements at 3-months but not at baseline. At 3-months, hydrochlorothiazide participants had higher calcium levels (0.2 mg/dL, p<.001) than non-hydrochlorothiazide participants, but only one participant in the hydrochlorothiazide group had hypercalcemia. In contrast, none of the non-hydrochlorothiazide participants had hypercalcemia. In linear regression model adjusted for age, sex, 25-hydroxyvitamin D at 3-months, and other covariates, only hydrochlorothiazide use [Estimate (SE):0.05(0.01) p=0.01] predicted serum calcium at 3-months.
In summary, vitamin D3 supplementation up to 4000 IU in hydrochlorothiazide users is associated with a rise in serum calcium but a low frequency of hypercalcemia. These findings suggest that participants of this population can use HCTZ with up to 4000 IU of vitamin D3 daily and experience a low frequency of hypercalcemia.
The American journal of medicine 08/2014; 127(8). DOI:10.1016/j.amjmed.2014.02.044 · 5.00 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Increased systolic blood pressure variability between outpatient visits is associated with increased incidence of cardiovascular end points. However, few studies have examined the association of visit-to-visit variability in systolic blood pressure with clinically relevant kidney disease outcomes. We analyzed the association of systolic blood pressure visit-to-visit variability with renal and cardiovascular morbidity and mortality among individuals with diabetes and nephropathy.
American Journal of Kidney Diseases 07/2014; 64(5). DOI:10.1053/j.ajkd.2014.06.008 · 5.90 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Objective
To determine whether daytime sleepiness is independently associated with coronary heart disease (CHD) and stroke or whether the positive association is explained by short sleep duration, disturbed sleep, and circadian disruption, conditions that are associated with cardiometabolic risk factors for vascular events.
Longitudinal analyses of data from the Nurses’ Health Study II comprising 84,003 female registered nurses aged 37 to 54 at baseline in 2001 with follow-up until 2009. Multivariate Cox regression was used to explore the relationship between reported daytime sleepiness and the incidence of either CHD or stroke (n = 500 cases).
Women who reported daytime sleepiness almost every day, compared with rarely/never, had an elevated adjusted risk for cardiovascular disease (CVD) (HR = 1.58, 95% CI 1.15-2.17). Controlling for sleep variables (sleep duration, snoring, shift work, and sleep adequacy) or potential metabolic biological mediators of disrupted sleep (diabetes, hypercholesterolemia, and hypertension) appreciably attenuated the relationship (HR = 1.17, 95% CI 0.84 – 1.65; and HR = 1.34, 95% CI 0.97 – 1.85, respectively). Controlling for both sleep variables and metabolic risk factors eliminated an independent association (HR = 1.09, 95% CI 0.77 – 1.53). A similar pattern was observed for CHD and stroke individually.
Daytime sleepiness was not an independent risk factor for CVD in this cohort of women, but rather, was associated with sleep characteristics and metabolic abnormalities that are risk factors for CVD
Sleep Medicine 07/2014; 15(7). DOI:10.1016/j.sleep.2014.04.001 · 3.15 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To evaluate the associations of dietary fiber after myocardial infarction (MI) and changes in dietary fiber intake from before to after MI with all cause and cardiovascular mortality.
Prospective cohort study.
Two large prospective cohort studies of US women and men with repeated dietary measurements: the Nurses' Health Study and the Health Professionals Follow-Up Study.
2258 women and 1840 men who were free of cardiovascular disease, stroke, or cancer at enrollment, survived a first MI during follow-up, were free of stroke at the time of initial onset of MI, and provided food frequency questionnaires pre-MI and at least one post-MI.
Associations of dietary fiber post-MI and changes from before to after MI with all cause and cardiovascular mortality using Cox proportional hazards models, adjusting for drug use, medical history, and lifestyle factors.
Higher post-MI fiber intake was significantly associated with lower all cause mortality (comparing extreme fifths, pooled hazard ratio 0.75, 95% confidence interval 0.58 to 0.97). Greater intake of cereal fiber was more strongly associated with all cause mortality (pooled hazard ratio 0.73, 0.58 to 0.91) than were other sources of dietary fiber. Increased fiber intake from before to after MI was significantly associated with lower all cause mortality (pooled hazard ratio 0.69, 0.55 to 0.87).
In this prospective study of patients who survived MI, a greater intake of dietary fiber after MI, especially cereal fiber, was inversely associated with all cause mortality. In addition, increasing consumption of fiber from before to after MI was significantly associated with lower all cause and cardiovascular mortality.
[Show abstract][Hide abstract] ABSTRACT: Blood pressure normally declines during the night ('dipping'); a blunted nocturnal decline is an important cardiovascular risk factor. Marriage may be associated with lower ambulatory blood pressure, although this may be confounded by socio-economic and dietary factors. We examined the association of marital status with nocturnal dipping and night-time SBP amongst individuals on a controlled diet.
We analysed 325 individuals enrolled in the Dietary Approaches to Stop Hypertension trial who had available 24-h SBP data and who ingested a control diet. Logistic and linear regression models were fit to estimate the association of marital status with nocturnal dipping and mean night-time SBP.
Of the 325 individuals, 52.9% were men, the average age was 45.1 years and 48.9% reported being married. Compared with nonmarried individuals, those who were married had greater adjusted odds of dipping [odds ratio (OR) 2.26; 95% confidence interval (CI) 1.26-4.03; P = 0.01]. In adjusted models, being married was associated with lower night-time SBP (-2.4 mmHg; 95% CI -3.8 to -0.9 mmHg; P = 0.002), with the suggestion of a greater association in married men compared with married women (-3.1 vs. -1.7 mmHg); there was less difference for married nonblacks compared with married blacks (-2.7 and -2.4 mmHg, respectively).
Being married is independently associated with a greater likelihood of nocturnal dipping and with lower night-time SBP among individuals participating in a controlled dietary intervention; the association was particularly strong in married men. Marital status is a variable that may be considered in future analyses of ambulatory blood pressure.
Journal of Hypertension 02/2014; 32(4). DOI:10.1097/HJH.0000000000000107 · 4.72 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: IMPORTANCE Information about diet after myocardial infarction (MI) and mortality is limited, despite the growing number of MI survivors in the United States. OBJECTIVE To examine the association of post-MI dietary quality and changes from pre- to post-MI with all-cause and cardiovascular mortality among MI survivors. DESIGN, SETTING, AND PARTICIPANTS We included 2258 women from the Nurses' Health Study and 1840 men from the Health Professionals Follow-up Study. Participants had survived an initial MI during the study follow-up period and completed the pre- and post-MI food frequency questionnaire. Diet quality was measured using Alternative Healthy Eating Index 2010 (AHEI2010), which consists of food and nutrients associated with the risk of chronic disease reported in the literature. We adjusted for medication use, medical history, and lifestyle risk factors using Cox proportional hazards regression models. MAIN OUTCOMES AND MEASURES All-cause and cardiovascular mortality. RESULTS During follow-up, we confirmed 682 all-cause deaths for women and 451 for men. The median survival time after the initial MI onset was 8.7 years for women and 9.0 years for men. When the results were pooled, the adjusted hazard ratio (HR) was 0.76 (95% CI, 0.60-0.96) for all-cause mortality and 0.73 (95% CI, 0.51-1.04) for cardiovascular mortality, comparing the extreme quintiles of post-MI AHEI2010. A greater increase in the AHEI2010 score from pre- to post-MI was significantly associated with lower all-cause mortality (pooled HR, 0.71; 95% CI, 0.56-0.91) and cardiovascular mortality (pooled HR, 0.60; 95% CI, 0.41- 0.86), comparing the extreme quintiles. The adjusted HRs associated with post-MI AHEI2010 were 0.73 (95% CI, 0.58-0.93) for all-cause mortality and 0.81 (95% CI, 0.64-1.04) for cardiovascular mortality when the alcohol component was excluded. CONCLUSIONS AND RELEVANCE Myocardial infarction survivors who consume a higher-quality diet, which has been associated with a lower risk of coronary heart disease in primary prevention, have lower subsequent all-cause mortality.
JAMA Internal Medicine 09/2013; 173(19). DOI:10.1001/jamainternmed.2013.9768 · 13.12 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Several biomarkers of metabolic acidosis, including lower plasma bicarbonate, have been associated with prevalent hypertension in cross-sectional studies. We sought to examine prospectively whether lower plasma bicarbonate is associated with incident hypertension.
We conducted a prospective case-control study nested within the Nurses' Health Study II. Plasma bicarbonate was measured in 695 nonobese women without hypertension at time of blood draw who subsequently developed hypertension during 6 years of follow-up. Control subjects were matched to case subjects according to age, race, time and day of blood draw, and day of menstrual cycle. We used unconditional logistic regression to generate odds ratios (ORs) for development of hypertension by quintile of baseline plasma bicarbonate.
After adjusting for matching factors, body mass index, family history of hypertension, plasma creatinine, and dietary and lifestyle factors, higher plasma bicarbonate was associated with lower odds of developing hypertension across quintiles (P for linear trend = 0.04). Those in the highest compared with the lowest quintile of plasma bicarbonate had 31% lower odds of developing hypertension (OR = 0.69; 95% confidence interval = 0.48-0.99). Further adjustment for diet-estimated net endogenous acid production, plasma insulin, 25-hydroxyvitamin D, and uric acid did not alter these findings.
Our case-control study is consistent with a modest association between higher plasma bicarbonate and reduced odds of developing hypertension among nonobese women, although our findings are of borderline statistical significance. Further research is required to confirm this finding as part of a larger prospective cohort study and to elucidate the mechanism for this relation.
American Journal of Hypertension 08/2013; 26(12). DOI:10.1093/ajh/hpt133 · 2.85 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Exogenous melatonin ameliorates insulin resistance in animals, while among humans, polymorphisms in the melatonin receptor gene are associated with insulin resistance. We aimed to investigate the association of endogenous nocturnal melatonin secretion with insulin resistance in humans. We analyzed the association between endogenous nocturnal melatonin secretion, estimated by measuring the main melatonin metabolite, 6-sulfatoxymelatonin, from the first morning urinary void, and the prevalence of insulin resistance based on fasting blood samples collected in a cross-sectional study of 1,075 US women (1997-1999) without diabetes, hypertension, or malignancy. Urinary 6-sulfatoxymelatonin level was standardized to urinary creatinine level; insulin resistance was defined as an insulin sensitivity index value (using the McAuley formula) less than 7.85. Logistic regression models included adjustment for age, body mass index, smoking, physical activity, alcohol intake, dietary glycemic index, family history of diabetes mellitus, blood pressure, plasma total cholesterol, uric acid, and estimated glomerular filtration rate. Higher nocturnal melatonin secretion was inversely associated with insulin levels and insulin resistance. In fully adjusted models, the odds ratio for insulin resistance was 0.45 (95% confidence interval: 0.28, 0.74) among women in the highest quartile of urinary 6-sulfatoxymelatonin:creatinine ratio compared with women in the lowest quartile. Nocturnal melatonin secretion is independently and inversely associated with insulin resistance.
American journal of epidemiology 06/2013; 178(2). DOI:10.1093/aje/kws470 · 5.23 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background:
Acute sleep restriction has been shown to increase blood pressure and sympathetic nervous system activity.
We investigated the relationships between sleep duration and hypertension among women whose sleep durations were self-reported in 1986 (n = 82,130) and 2000 (n = 71,658) in the Nurses' Health Study I (NHS-I) and in 2001 (n = 84,674) in the Nurses' Health Study II (NHS-II).
After controlling for multiple risk factors in logistic regression models, the prevalence of hypertension was significantly higher among women in all 3 groups who slept ≤5 hours (odds ratio = 1.19, 95% confidence interval [CI] = 1.14-1.25) per night compared with 7 hours. In prospective analyses using Cox regression shorter sleep duration of ≤5 hours per night was significantly associated with a higher incidence of hypertension only in younger women (hazard ratio [HR] =1.20, 95% CI = 1.09-1.31 for those aged <50 years; HR = 1.11, 95% CI = 1.00-1.23 for those aged 50-59 years). In both prevalent and incident analyses, results were consistent with obesity acting as a partial mediator. Results were not consistent with diabetes or hypercholesterolemia acting as mediators or with shift work, snoring, menopause, or postmenopausal hormone therapy acting as effect modifiers.
Sufficient sleep could represent a lifestyle practice worthy of investigation as an approach to reduce hypertension incidence and prevalence.
American Journal of Hypertension 04/2013; 26(7). DOI:10.1093/ajh/hpt044 · 2.85 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Loss-of-function mutations in the melatonin receptor are associated with insulin resistance and type 2 diabetes. Additionally, in a cross-sectional analysis of persons without diabetes, lower nocturnal melatonin secretion was associated with increased insulin resistance.
To study the association between melatonin secretion and the risk of developing type 2 diabetes.
Case-control study nested within the Nurses' Health Study cohort. Among participants without diabetes who provided urine and blood samples at baseline in 2000, we identified 370 women who developed type 2 diabetes from 2000-2012 and matched 370 controls using risk-set sampling.
Associations between melatonin secretion at baseline and incidence of type 2 diabetes were evaluated with multivariable conditional logistic regression controlling for demographic characteristics, lifestyle habits, measures of sleep quality, and biomarkers of inflammation and endothelial dysfunction.
The median urinary ratios of 6-sulfatoxymelatonin to creatinine were 28.2 ng/mg (5%-95% range, 5.5-84.2 ng/mg) among cases and 36.3 ng/mg (5%-95% range, 6.9-110.8 ng/mg) among controls. Women with lower ratios of 6-sulfatoxymelatonin to creatinine had increased risk of diabetes (multivariable odds ratio, 1.48 [95% CI, 1.11-1.98] per unit decrease in the estimated log ratio of 6-sulfatoxymelatonin to creatinine). Compared with women in the highest ratio category of 6-sulfatoxymelatonin to creatinine, those in the lowest category had a multivariable odds ratio of 2.17 (95% CI, 1.18-3.98) of developing type 2 diabetes. Women in the highest category of melatonin secretion had an estimated diabetes incidence rate of 4.27 cases/1000 person-years compared with 9.27 cases/1000 person-years in the lowest category.
Lower melatonin secretion was independently associated with a higher risk of developing type 2 diabetes. Further research is warranted to assess if melatonin secretion is a modifiable risk factor for diabetes within the general population.
JAMA The Journal of the American Medical Association 04/2013; 309(13):1388-96. DOI:10.1001/jama.2013.2710 · 35.29 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Blacks have significantly higher rates of hypertension than whites, and lower circulating levels of 25-hydroxyvitamin D. There are few data about the effect of vitamin D3 (cholecalciferol) supplementation on blood pressure in blacks. During 2 winters from 2008 to 2010, 283 blacks (median age, 51 years) were randomized into a 4-arm, double-blind trial for 3 months of placebo, 1000, 2000, or 4000 international units of cholecalciferol per day. At baseline, 3 months, and 6 months, systolic and diastolic pressure and 25-hydroxyvitamin D were measured. The 3-month follow-up was completed in 250 (88%) participants. The difference in systolic pressure between baseline and 3 months was +1.7 mm Hg for those receiving placebo, -0.66 mm Hg for 1000 U/d, -3.4 mm Hg for 2000 U/d, and -4.0 mm Hg for 4000 U/d of cholecalciferol (-1.4 mm Hg for each additional 1000 U/d of cholecalciferol; P=0.04). For each 1-ng/mL increase in plasma 25-hydroxyvitamin D, there was a significant 0.2-mm Hg reduction in systolic pressure (P=0.02). There was no effect of cholecalciferol supplementation on diastolic pressure (P=0.37). Within an unselected population of blacks, 3 months of oral vitamin D3 supplementation significantly, yet modestly, lowered systolic pressure. Future trials of vitamin D supplementation on blood pressure are needed to confirm these promising results, particularly among blacks, a population for whom vitamin D deficiency may play a more specific mechanistic role in the pathogenesis of hypertension.