Tremendous disparities are known to exist in cardiovascular disease and its related outcomes. Much of this can be traced to poorly controlled hypertension and its attendant, pressure-related consequences, especially target-organ cardiac damage. The latter, which occurs prematurely and disproportionately in African- Americans, reduces both quality and quantity of life. The risk of target-organ cardiac damage is particularly high among inner-city African-Americans with hypertension, particularly those who utilize the emergency department for chronic blood pressure management. Like cardiovascular disease, vitamin D deficiency disproportionately affects African-Americans. Vitamin D is thought to be an important modifier of cardiovascular disparities through its direct (and, via parathyroid hormone, indirect) myocardial (hypertrophy, fibrosis) and vascular (increased resistance, loss of compliance) effects. Vitamin D repletion in those who are deficient has been postulated as mechanism to reduce the cardiovascular disease burden experienced by African- Americans, especially if initiated early before irreversible damage has occurred, but this has yet to be tested in a prospective clinical trial. Accordingly, this proposal was designed to investigate the relationship between vitamin D and subclinical target-organ cardiac damage (as identified on cardiac magnetic resonance imaging) in a cohort of African-American, vitamin D deficient hypertensive patients without prior history of heart disease. Specifically, we seek to ascertain the effect of adjunct vitamin D therapy on left ventricular hypertrophy (primary aim), myocardial fibrosis and central vascular function (secondary aims) at one-year using a placebo controlled, randomized design. Antihypertensive treatment in both study arms will be standardized and our focus will be recruitment of patients who present to our safety-net institution with poorly controlled blood pressure - a high-risk, high-reward subset who would stand to benefit tremendously from identification of an inexpensive intervention, which could effectively reduce the adverse impact of hypertension.

Public Health Relevance

African-Americans die younger and more often from hypertension and hypertensive heart disease than other races. Regression of left ventricular hypertrophy, a cardinal manifestation of elevated blood pressure, which disproportionately affects African-Americans, can reduce adverse events and, accordingly, has become a focal point of secondary prevention. Vitamin D deficiency may be an important contributor to racial differences in hypertensive heart disease but whether adjunct vitamin D therapy provides benefit is unknown.

Agency
National Institute of Health (NIH)
Institute
National Institute on Minority Health and Health Disparities (NIMHD)
Type
Research Project (R01)
Project #
5R01MD005849-04
Application #
8588253
Study Section
Special Emphasis Panel (ZMD1-MLS (01))
Program Officer
Rajapakse, Nishadi
Project Start
2011-05-14
Project End
2015-11-30
Budget Start
2013-12-01
Budget End
2014-11-30
Support Year
4
Fiscal Year
2014
Total Cost
$342,000
Indirect Cost
$117,000
Name
Wayne State University
Department
Emergency Medicine
Type
Schools of Medicine
DUNS #
001962224
City
Detroit
State
MI
Country
United States
Zip Code
48202
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