Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Blood pressure response to calcium supplementation: a meta-analysis of randomized controlled trials

Journal of Human Hypertension volume 20, pages 571–580 (2006)Cite this article

Abstract

Calcium plays a role in blood pressure (BP) regulation, but the importance of supplemental calcium intake for the prevention of hypertension is still debated. We conducted a meta-analysis of randomized controlled trials to determine the effect of calcium supplementation on BP. A systematic search for randomized trials of calcium supplementation and BP in non-pregnant subjects was performed in Medline from 1966 to June 2003. Seventy-one trials were identified, 40 of which met the criteria for meta-analysis (total of 2492 subjects). Two persons independently extracted data from original publications on changes in calcium intake and BP. In addition, data were collected on subjects' characteristics, that is, age, gender, initial BP and initial calcium intake. A random effects model was used to obtain the effect of calcium supplementation on BP, overall and in predefined population subgroups. Calcium supplementation (mean daily dose: 1200 mg) reduced systolic BP by −1.86 mm Hg (95% confidence interval: −2.91 to −0.81) and diastolic BP by −0.99 mm Hg (−1.61 to −0.37). In people with a relatively low calcium intake (⩽800 mg per day) somewhat larger BP estimates were obtained, that is, −2.63 (−4.03 to −1.24) for systolic BP and −1.30 (−2.13 to −0.47) for diastolic BP. Our study suggests that an adequate intake of calcium should be recommended for the prevention of hypertension. More research on BP in people with calcium-deficient diets is warranted.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2
Figure 3

Similar content being viewed by others

References

  1. Van den Hoogen PC, Feskens EJ, Nagelkerke NJ, Menotti A, Nissinen A, Kromhout D . The relation between blood pressure and mortality due to coronary heart disease among men in different parts of the world. Seven Countries Study Research Group. N Engl J Med 2000; 342: 1–8.

    Article  CAS  PubMed  Google Scholar 

  2. Kawano Y, Yoshimi H, Matsuoka H, Takishita S, Omae T . Calcium supplementation in patients with essential hypertension: assessment by office, home and ambulatory blood pressure. J Hypertens 1998; 16: 1693–1699.

    Article  CAS  PubMed  Google Scholar 

  3. Hamet P . The evaluation of the scientific evidence for a relationship between calcium and hypertension. J Nutr 1995; 125 (Suppl): 311s–400s.

    CAS  PubMed  Google Scholar 

  4. Allender PS, Cutler JA, Follmann D, Cappuccio FP, Pryer J, Elliott P . Dietary calcium and blood pressure: a meta-analysis of randomized clinical trials. Ann Intern Med 1996; 124: 825–831.

    Article  CAS  PubMed  Google Scholar 

  5. Bucher HC, Cook RJ, Guyatt GH, Lang JD, Cook DJ, Hatala R et al. Effects of dietary calcium supplementation on blood pressure. A meta-analysis of randomized controlled trials. JAMA 1996; 275: 1016–1022.

    Article  CAS  PubMed  Google Scholar 

  6. Griffith LE, Guyatt GH, Cook RJ, Bucher HC, Cook DJ . The influence of dietary and nondietary calcium supplementation on blood pressure: an updated metaanalysis of randomized controlled trials. Am J Hypertens 1999; 12 (Part 1): 84–92.

    Article  CAS  PubMed  Google Scholar 

  7. Sowers JR, Zemel MB, Standley PR, Zemel PC . Calcium and hypertension. J Lab Clin Med 1989; 114: 338–348.

    CAS  PubMed  Google Scholar 

  8. Cappuccio FP, Siani A, Strazzullo P . Oral calcium supplementation and blood pressure: an overview of randomized controlled trials. J Hypertens 1989; 7: 941–946.

    Article  CAS  PubMed  Google Scholar 

  9. Grobbee DE, Waal Manning HJ . The role of calcium supplementation in the treatment of hypertension. Current evidence. Drugs 1990; 39: 7–18.

    Article  CAS  PubMed  Google Scholar 

  10. Mikami H, Ogihara T, Tabuchi Y . Blood pressure response to dietary calcium intervention in humans. Am J Hypertens 1990; 3 (Part 2): 147s–151s.

    Article  CAS  PubMed  Google Scholar 

  11. Geleijnse JM, Grobbee DE . Calcium intake and blood pressure: an update. J Cardiovasc Risk 2000; 7: 23–29.

    Article  CAS  PubMed  Google Scholar 

  12. Cappuccio FP . Calcium and magnesium. In: Swales JD (ed). Textbook of Hypertension. Blackwell Scientific Publications: Oxford, 1994, pp 551–566.

    Google Scholar 

  13. Belizan JM, Villar J, Pineda O, Gonzalez AE, Sainz E, Garrera G et al. Reduction of blood pressure with calcium supplementation in young adults. JAMA 1983; 249: 1161–1165.

    Article  CAS  PubMed  Google Scholar 

  14. Bierenbaum ML, Wolf E, Bisgeier G, Maginnis WP . Dietary calcium. A method of lowering blood pressure. Am J Hypertens 1988; 1 (Part 3): 149S–152S.

    Article  CAS  PubMed  Google Scholar 

  15. Bloomfield RL, Young LD, Zurek G, Felts JH, Straw MK . Effects of oral calcium carbonate on blood pressure in subjects with mildly elevated arterial pressure. J Hypertens Suppl 1986; 4: S351–S354.

    Article  CAS  PubMed  Google Scholar 

  16. Bostick RM, Fosdick L, Grandits GA, Grambsch P, Gross M, Louis TA . Effect of calcium supplementation on serum cholesterol and blood pressure. A randomized, double-blind, placebo-controlled, clinical trial. Arch Fam Med 2000; 9: 31–38.

    Article  CAS  PubMed  Google Scholar 

  17. Cappuccio FP, Markandu ND, Singer DR, Smith SJ, Shore AC, MacGregor GA . Does oral calcium supplementation lower high blood pressure? A double blind study. J Hypertens 1987; 5: 67–71.

    Article  CAS  PubMed  Google Scholar 

  18. Davis IJ, Grim C, Dwyer K, Nicholson L, Dwyer J . The effects of calcium supplementation on ambulatory blood pressure in African-American adolescents.J Natl Med Assoc 1996; 88: 774–778.

    CAS  PubMed  PubMed Central  Google Scholar 

  19. Dwyer JH, Dwyer KM, Scribner RA, Sun P, Li L, Nicholson LM et al. Dietary calcium, calcium supplementation, and blood pressure in African American adolescents. Am J Clin Nutr 1998; 68: 648–655.

    Article  CAS  PubMed  Google Scholar 

  20. Galloe AM, Graudal N, Moller J, Bro H, Jorgensen M, Christensen HR . Effect of oral calcium supplementation on blood pressure in patients with previously untreated hypertension: a randomised, double-blind, placebo-controlled, crossover study. J Hum Hypertens 1993; 7: 43–45.

    CAS  PubMed  Google Scholar 

  21. Gillman MW, Hood MY, Moore LL, Nguyen US, Singer MR, Andon MB . Effect of calcium supplementation on blood pressure in children. J Pediatr 1995; 127: 186–192.

    Article  CAS  PubMed  Google Scholar 

  22. Hilary Green J, Richards JK, Bunning RL . Blood pressure responses to high-calcium skim milk and potassium-enriched high-calcium skim milk. J Hypertens 2000; 18: 1331–1339.

    Article  CAS  PubMed  Google Scholar 

  23. Grobbee DE, Hofman A . Effect of calcium supplementation on diastolic blood pressure in young people with mild hypertension. Lancet 1986; 2: 703–707.

    Article  CAS  PubMed  Google Scholar 

  24. Jespersen B, Brock A, Pedersen EB . Lack of effect of calcium carbonate supplementation on 24 h blood pressure, angiotensin II reactivity and PTH(1-84) in essential hypertension. J Hum Hypertens 1993; 7: 103–104.

    CAS  PubMed  Google Scholar 

  25. Johnson NE, Smith EL, Freudenheim JL . Effects on blood pressure of calcium supplementation of women. Am J Clin Nutr 1985; 42: 12–17.

    Article  CAS  PubMed  Google Scholar 

  26. Kynast Gales SA, Massey LK . Effects of dietary calcium from dairy products on ambulatory blood pressure in hypertensive men. J Am Diet Assoc 1992; 92: 1497–1501.

    CAS  PubMed  Google Scholar 

  27. Lijnen P, Petrov V . Blood pressure and cationic transport systems during combined calcium channel blocker and calcium administration in males. Methods Find Exp Clin Pharmacol 1996; 18: 287–294.

    CAS  PubMed  Google Scholar 

  28. Lyle RM, Melby CL, Hyner GC, Edmondson JW, Miller JZ, Weinberger MH . Blood pressure and metabolic effects of calcium supplementation in normotensive white and black men. JAMA 1987; 257: 1772–1776.

    Article  CAS  PubMed  Google Scholar 

  29. Lyle RM . Does baseline serum total calcium level influence the blood pressure response to calcium supplementation? A double-blind study. Neth J Med 1992; 41: 48–55.

    CAS  PubMed  Google Scholar 

  30. Olivan Martinez J, Perez Cano R, Miranda Garcia MJ, Montoya Garcia MJ, Moruno Garcia R, Cuenca Lopez L et al. Influencia de un suplemento oral de calcio en el tratamiento de la hipertension arterial esencial ligera-moderada. An Med Interna 1989; 6: 192–196.

    CAS  PubMed  Google Scholar 

  31. McCarron DA, Morris CD . Blood pressure response to oral calcium in persons with mild to moderate hypertension. A randomized, double-blind, placebo-controlled, crossover trial. Ann Intern Med 1985; 103: 825–831.

    Article  CAS  PubMed  Google Scholar 

  32. Meese RB, Gonzales DG, Casparian JM, Ram CV, Pak CM, Kaplan NM . The inconsistent effects of calcium supplements upon blood pressure in primary hypertension. Am J Med Sci 1987; 294: 219–224.

    Article  CAS  PubMed  Google Scholar 

  33. Morris CD, Karanja N, McCarron DA . Dietary vs supplemental calcium to reduce blood pressure. Clin Res 1988; 36: 139A.

    Google Scholar 

  34. Nowson C, Morgan T . Effect of calcium carbonate on blood pressure in normotensive and hypertensive people. Hypertension 1989; 13: 630–639.

    Article  CAS  PubMed  Google Scholar 

  35. Orwoll ES, Oviatt S . Relationship of mineral metabolism and long-term calcium and cholecalciferol supplementation to blood pressure in normotensive men. Am J Clin Nutr 1990; 52: 717–721.

    Article  CAS  PubMed  Google Scholar 

  36. Pan WH, Wang CY, Li LA, Kao LS, Yeh SH . No significant effect of calcium and vitamin D supplementation on blood pressure and calcium metabolism in elderly Chinese. Chin J Physiol 1993; 36: 85–94.

    CAS  PubMed  Google Scholar 

  37. Sacks FM, Willett WC, Smith A, Brown LE, Rosner B, Moore TJ . Effect on blood pressure of potassium, calcium, and magnesium in women with low habitual intake. Hypertension 1998; 31: 131–138.

    Article  CAS  PubMed  Google Scholar 

  38. Sanchez M, de la Sierra A, Coca A, Poch E, Giner V, Urbano Marquez A . Oral calcium supplementation reduces intraplatelet free calcium concentration and insulin resistance in essential hypertensive patients. Hypertension 1997; 29: 531–536.

    Article  CAS  PubMed  Google Scholar 

  39. Siani A, Strazzullo P, Guglielmi S, Mancini M . Clinical studies of the effects of different oral calcium intakes in essential hypertension. J Hypertens 1987; 5: S311–S313.

    Article  Google Scholar 

  40. Siani A, Strazzullo P, Guglielmi S, Pacioni D, Giacco A, Iacone R et al. Controlled trial of low calcium versus high calcium intake in mild hypertension. J Hypertens 1988; 6: 253–256.

    Article  CAS  PubMed  Google Scholar 

  41. Strazzullo P, Siani A, Gugliemi S, Di Carlo A, Galletti F, Cirillo M et al. Controlled trial of long-term oral calcium supplementation in essential hypertension. Hypertension 1986; 8: 1084–1088.

    Article  CAS  PubMed  Google Scholar 

  42. Takagi Y, Fukase M, Takata S, Fujimi T, Fujita T . Calcium treatment of essential hypertension in elderly patients evaluated by 24 h monitoring. Am J Hypertens 1991; 4: 836–839.

    Article  CAS  PubMed  Google Scholar 

  43. Tanji JL, Lew EY, Wong GY, Treguboff C, Ward JA, Amsterdam EA . Dietary calcium supplementation as a treatment for mild hypertension. J Am Board Fam Pract 1991; 4: 145–150.

    CAS  PubMed  Google Scholar 

  44. Thomsen K, Nilas L, Christiansen C . Dietary calcium intake and blood pressure in normotensive subjects. Acta Med Scand 1987; 222: 51–56.

    Article  CAS  PubMed  Google Scholar 

  45. van Beresteyn EC, Schaafsma G, de Waard H . Oral calcium and blood pressure: a controlled intervention trial. Am J Clin Nutr 1986; 44: 883–888.

    Article  CAS  PubMed  Google Scholar 

  46. Vinson JA, Mazur T, Bose P . Comparison of different forms of calcium on blood pressure of normotensive young males. Nutr Rep Int 1987; 36: 497–505.

    CAS  Google Scholar 

  47. Waal-Manning HJ, McNab M, Paulin JM, Simpson FO . Dietary interventions in treated hypertensives. New Zealand Med J 1987; 100: 252.

    Google Scholar 

  48. Weinberger MH, Wagner UL, Fineberg NS . The blood pressure effects of calcium supplementation in humans of known sodium responsiveness. Am J Hypertens 1993; 6: 799–805.

    Article  CAS  PubMed  Google Scholar 

  49. Yamamoto ME, Applegate WB, Klag MJ, Borhani NO, Cohen JD, Kirchner KA et al. 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. Ann Epidemiol 1995; 5: 96–107.

    Article  CAS  PubMed  Google Scholar 

  50. Zhou C, Fan S, Zhou L, Ni Y, Huang T, Shi Y . Clinical observation of treatment of hypertension with calcium. Am J Hypertens 1994; 7: 363–367.

    Article  CAS  PubMed  Google Scholar 

  51. Zoccali C, Mallamaci F, Delfino D, Ciccarelli M, Parlongo S, Iellamo D et al. Double-blind randomized, crossover trial of calcium supplementation in essential hypertension. J Hypertens 1988; 6: 451–455.

    Article  CAS  PubMed  Google Scholar 

  52. Nowson C, Morgan T . Effect of calcium carbonate on blood pressure. J Hypertens 1986; 4: S673–S675.

    Google Scholar 

  53. Follmann D, Elliott P, Suh I, Cutler J . Variance imputation for overviews of clinical trials with continuous response. J Clin Epidemiol 1992; 45: 769–773.

    Article  CAS  PubMed  Google Scholar 

  54. DerSimonian R, Laird N . Meta-analysis in clinical trials. Control Clin Trials 1986; 7: 177–188.

    Article  CAS  PubMed  Google Scholar 

  55. Van Houwelingen HC, Arends LR, Stijnen T . Advanced methods in meta-analysis: multivariate approach and meta-regression. Stat Med 2002; 21: 589–624.

    Article  PubMed  Google Scholar 

  56. Duval S, Tweedie R . Trim and Fill: A simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics 2000; 56: 455–463.

    Article  CAS  PubMed  Google Scholar 

  57. McCarron DA, Reusser ME . Finding consensus in the dietary calcium-blood pressure debate. J Am Coll Nutr 1999; 18 (Suppl): 398s–405s.

    Article  CAS  PubMed  Google Scholar 

  58. Cutler JA, Brittain E . Calcium and blood pressure. An epidemiologic perspective. Am J Hypertens 1990; 3: 137s–146s.

    Article  CAS  PubMed  Google Scholar 

  59. Conlin PR, Chow D, Miller III ER, Svetkey LP, Lin PH, Harsha DW et al. The effect of dietary patterns on blood pressure control in hypertensive patients: results from the Dietary Approaches to Stop Hypertension (DASH) trial. Am J Hypertens 2000; 13 : 949–955.

    Article  CAS  PubMed  Google Scholar 

  60. Hajjar IM, Grim CE, George V, Kotchen TA . Impact of diet on blood pressure and age-related changes in blood pressure in the US population: analysis of NHANES III. Arch Intern Med 2001; 161: 589–593.

    Article  CAS  PubMed  Google Scholar 

  61. MacMahon S, Peto R, Cutler J, Collins R, Sorlie P, Neaton J et al. Blood pressure, stroke, and coronary heart disease. Part 1, Prolonged differences in blood pressure: prospective observational studies corrected for the regression dilution bias. Lancet 1990; 335: 765–774.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

All authors made a significant contribution to the study and approved the final version of the manuscript. JMG, DEG and FJK designed the study. LJAM and JMG performed data collection and drafted the article. LJAM and MTS conducted data analysis. LRA and MPAZ gave methodological advice and assisted in data analysis. All authors contributed to data interpretation and critically revised the manuscript for important intellectual content. None of the authors had an existing or potential conflict of interest with this article.

Author information

Authors and Affiliations

  1. Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands

    L A J van Mierlo, M T Streppel, F J Kok & J M Geleijnse

  2. Department of Epidemiology & Biostatistics, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands

    L R Arends

  3. Department of Epidemiology, Maastricht University, Maastricht, The Netherlands

    M P A Zeegers

  4. Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands

    D E Grobbee

Authors
  1. L A J van Mierlo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. L R Arends
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M T Streppel
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M P A Zeegers
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. F J Kok
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. D E Grobbee
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. J M Geleijnse
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to J M Geleijnse.

Additional information

Conflicts of interest: None

Source of funding: No external funding organizations were involved in this study.

Rights and permissions

Reprints and permissions

About this article

Cite this article

van Mierlo, L., Arends, L., Streppel, M. et al. Blood pressure response to calcium supplementation: a meta-analysis of randomized controlled trials. J Hum Hypertens 20, 571–580 (2006). https://doi.org/10.1038/sj.jhh.1002038

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.jhh.1002038

Keywords

This article is cited by

Search

Advanced search

Quick links