Skip to main content
Top
Published in: BMC Geriatrics 1/2021

Open Access 01-12-2021 | Care | Research

The effect of ultraviolet irradiation compared to oral vitamin D supplementation on blood pressure of nursing home residents with dementia

Authors: Bistra I. Veleva, Monique A. A. Caljouw, Astrid Muurman, Jenny T. van der Steen, Victor G. M. Chel, Mattijs E. Numans, Rosalinde K. E. Poortvliet

Published in: BMC Geriatrics | Issue 1/2021

Login to get access

Abstract

Background

Observational studies have reported an inverse association between ultraviolet (UV) radiation and hypertension. The aim of this study was to assess differences in blood pressure changes between persons with dementia receiving UV light versus vitamin D (VD) supplementation.

Methods

Post-hoc analysis of randomized controlled trial data concerning nursing home residents with dementia (N = 61; 41 women, mean age 84.8 years). The participants received half-body UV irradiation, twice weekly over 6 months, at one standard erythema dose (UV group, n = 22) or 5600 international units of cholecalciferol once a week (VD group, n = 39). Short-term effects were evaluated after 1 month and long-term effects after 3 and 6 months. Differences in blood pressure changes were assessed using linear mixed models.

Results

With the VD group as a reference, the estimated difference in mean change of systolic blood pressure was − 26.0 mmHg [95% confidence interval (CI) -39.9, − 12.1, p = .000] at 1 month, 4.5 mmHg (95% CI -6.8, 15.9, p = 0.432) at 3 months, and 0.1 (95% CI -14.1, 14.3, p = 0.83) at 6 months. The estimated difference in diastolic blood pressure was − 10.0 mmHg (95% CI -19.2, − 0.7, p = 0.035) at 1 month, 3.6 mmHg (95% CI -4.1, 11.2, p = 0.358) at 3 months, and 2.7 (95% CI -6.8, 12.1, p = 0.580) at 6 months.

Conclusions

UV light had only a short-term effect but not a long-term effect on blood pressure reduction compared to VD use in this sample of normotensive to mild hypertensive nursing home residents with dementia. Future studies will be needed to determine the effect of UV light in different samples of the population and especially in a population with hypertension.
Appendix
Available only for authorised users
Literature
1.
go back to reference Wilson PW. Established risk factors and coronary artery disease: the Framingham study. Am J Hypertens. 1994;7(7 Pt 2):7S–12S.PubMedCrossRef Wilson PW. Established risk factors and coronary artery disease: the Framingham study. Am J Hypertens. 1994;7(7 Pt 2):7S–12S.PubMedCrossRef
2.
go back to reference Lacruz ME, Kluttig A, Hartwig S, Loer M, Tiller D, Greiser KH, et al. Prevalence and incidence of hypertension in the general adult population: results of the CARLA-cohort study. Medicine (Baltimore). 2015;94(22):e952.CrossRef Lacruz ME, Kluttig A, Hartwig S, Loer M, Tiller D, Greiser KH, et al. Prevalence and incidence of hypertension in the general adult population: results of the CARLA-cohort study. Medicine (Baltimore). 2015;94(22):e952.CrossRef
3.
go back to reference Aubert CE, Streit S, Da Costa BR, Collet TH, Cornuz J, Gaspoz JM, et al. Polypharmacy and specific comorbidities in university primary care settings. Eur J Intern Med. 2016;35:35–42.PubMedCrossRef Aubert CE, Streit S, Da Costa BR, Collet TH, Cornuz J, Gaspoz JM, et al. Polypharmacy and specific comorbidities in university primary care settings. Eur J Intern Med. 2016;35:35–42.PubMedCrossRef
4.
go back to reference Rostand SG. Ultraviolet light may contribute to geographic and racial blood pressure differences. Hypertension. 1997;30(2 Pt 1):150–6.PubMedCrossRef Rostand SG. Ultraviolet light may contribute to geographic and racial blood pressure differences. Hypertension. 1997;30(2 Pt 1):150–6.PubMedCrossRef
5.
go back to reference Lindqvist PG, Epstein E, Nielsen K, Landin-Olsson M, Ingvar C, Olsson H. Avoidance of sun exposure as a risk factor for major causes of death: a competing risk analysis of the melanoma in southern Sweden cohort. J Intern Med. 2016;280(4):375–87.PubMedCrossRef Lindqvist PG, Epstein E, Nielsen K, Landin-Olsson M, Ingvar C, Olsson H. Avoidance of sun exposure as a risk factor for major causes of death: a competing risk analysis of the melanoma in southern Sweden cohort. J Intern Med. 2016;280(4):375–87.PubMedCrossRef
6.
7.
go back to reference Wright JT Jr. The benefits of detecting and treating mild hypertension: what we know, and what we need to learn. Ann Intern Med. 2015;162(3):233–4.PubMedCrossRef Wright JT Jr. The benefits of detecting and treating mild hypertension: what we know, and what we need to learn. Ann Intern Med. 2015;162(3):233–4.PubMedCrossRef
8.
go back to reference Shu L, Huang K. Effect of vitamin D supplementation on blood pressure parameters in patients with vitamin D deficiency: a systematic review and meta-analysis. J Am Soc Hypertens. 2018;12(7):488–96.PubMedCrossRef Shu L, Huang K. Effect of vitamin D supplementation on blood pressure parameters in patients with vitamin D deficiency: a systematic review and meta-analysis. J Am Soc Hypertens. 2018;12(7):488–96.PubMedCrossRef
9.
go back to reference Pfeifer M, Begerow B, Minne HW, Nachtigall D, Hansen C. Effects of a short-term vitamin D(3) and calcium supplementation on blood pressure and parathyroid hormone levels in elderly women. J Clin Endocrinol Metab. 2001;86(4):1633–7.PubMed Pfeifer M, Begerow B, Minne HW, Nachtigall D, Hansen C. Effects of a short-term vitamin D(3) and calcium supplementation on blood pressure and parathyroid hormone levels in elderly women. J Clin Endocrinol Metab. 2001;86(4):1633–7.PubMed
10.
go back to reference Feneis JF, Arora RR. Role of vitamin D in blood pressure homeostasis. Am J Ther. 2010;17(6):e221–9.PubMedCrossRef Feneis JF, Arora RR. Role of vitamin D in blood pressure homeostasis. Am J Ther. 2010;17(6):e221–9.PubMedCrossRef
11.
go back to reference Brennan PJ, Greenberg G, Miall WE, Thompson SG. Seasonal variation in arterial blood pressure. Br Med J (Clin Res Ed). 1982;285(6346):919–23.CrossRef Brennan PJ, Greenberg G, Miall WE, Thompson SG. Seasonal variation in arterial blood pressure. Br Med J (Clin Res Ed). 1982;285(6346):919–23.CrossRef
12.
go back to reference Oplander C, Volkmar CM, Paunel-Gorgulu A, van Faassen EE, Heiss C, Kelm M, et al. Whole body UVA irradiation lowers systemic blood pressure by release of nitric oxide from intracutaneous photolabile nitric oxide derivates. Circ Res. 2009;105(10):1031–40.PubMedCrossRef Oplander C, Volkmar CM, Paunel-Gorgulu A, van Faassen EE, Heiss C, Kelm M, et al. Whole body UVA irradiation lowers systemic blood pressure by release of nitric oxide from intracutaneous photolabile nitric oxide derivates. Circ Res. 2009;105(10):1031–40.PubMedCrossRef
13.
go back to reference Liu D, Fernandez BO, Hamilton A, Lang NN, Gallagher JMC, Newby DE, et al. UVA irradiation of human skin vasodilates arterial vasculature and lowers blood pressure independently of nitric oxide synthase. J Invest Dermatol. 2014;134(7):1839–46.PubMedCrossRef Liu D, Fernandez BO, Hamilton A, Lang NN, Gallagher JMC, Newby DE, et al. UVA irradiation of human skin vasodilates arterial vasculature and lowers blood pressure independently of nitric oxide synthase. J Invest Dermatol. 2014;134(7):1839–46.PubMedCrossRef
14.
go back to reference Krause R, Roth HJ, Kaase H, Stange R, Holick MF. Vitamin D status in chronic kidney disease - UVB irradiation is superior to Oral supplementation. Anticancer Res. 2016;36(3):1397–401.PubMed Krause R, Roth HJ, Kaase H, Stange R, Holick MF. Vitamin D status in chronic kidney disease - UVB irradiation is superior to Oral supplementation. Anticancer Res. 2016;36(3):1397–401.PubMed
15.
go back to reference St John A, Dick I, Hoad K, Retallack R, Welborn T, Prince R. Relationship between calcitrophic hormones and blood pressure in elderly subjects. Eur J Endocrinol. 1994;130(5):446–50.PubMedCrossRef St John A, Dick I, Hoad K, Retallack R, Welborn T, Prince R. Relationship between calcitrophic hormones and blood pressure in elderly subjects. Eur J Endocrinol. 1994;130(5):446–50.PubMedCrossRef
16.
go back to reference Vaidya A, Forman JP. Vitamin D and hypertension: current evidence and future directions. Hypertension. 2010;56(5):774–9.PubMedCrossRef Vaidya A, Forman JP. Vitamin D and hypertension: current evidence and future directions. Hypertension. 2010;56(5):774–9.PubMedCrossRef
17.
go back to reference Rostand SG, McClure LA, Kent ST, Judd SE, Gutierrez OM. Associations of blood pressure, sunlight, and vitamin D in community-dwelling adults. J Hypertens. 2016;34(9):1704–10.PubMedCrossRef Rostand SG, McClure LA, Kent ST, Judd SE, Gutierrez OM. Associations of blood pressure, sunlight, and vitamin D in community-dwelling adults. J Hypertens. 2016;34(9):1704–10.PubMedCrossRef
18.
go back to reference Cabrera SE, Mindell JS, Toledo M, Alvo M, Ferro CJ. Associations of blood pressure with geographical latitude, solar radiation, and ambient temperature: results from the Chilean health survey, 2009-2010. Am J Epidemiol. 2016;183(11):1071–3.PubMedCrossRef Cabrera SE, Mindell JS, Toledo M, Alvo M, Ferro CJ. Associations of blood pressure with geographical latitude, solar radiation, and ambient temperature: results from the Chilean health survey, 2009-2010. Am J Epidemiol. 2016;183(11):1071–3.PubMedCrossRef
19.
go back to reference Ke L, Ho J, Feng J, Mpofu E, Dibley MJ, Feng X, et al. Modifiable risk factors including sunlight exposure and fish consumption are associated with risk of hypertension in a large representative population from Macau. J Steroid Biochem Mol Biol. 2014;144 Pt A:152–5.PubMedCrossRef Ke L, Ho J, Feng J, Mpofu E, Dibley MJ, Feng X, et al. Modifiable risk factors including sunlight exposure and fish consumption are associated with risk of hypertension in a large representative population from Macau. J Steroid Biochem Mol Biol. 2014;144 Pt A:152–5.PubMedCrossRef
20.
go back to reference Scragg R, Rahman J, Thornley S. Association of sun and UV exposure with blood pressure and cardiovascular disease: a systematic review. J Steroid Biochem Mol Biol. 2019;187:68–75.PubMedCrossRef Scragg R, Rahman J, Thornley S. Association of sun and UV exposure with blood pressure and cardiovascular disease: a systematic review. J Steroid Biochem Mol Biol. 2019;187:68–75.PubMedCrossRef
21.
go back to reference Krause R, Stange R, Roth HJ, Kaase H, Michalsen A, Holick MF. Partial body UV exposure in chronic kidney disease and Extrarenal Vitamin D metabolism. Anticancer Res. 2018;38(2):1217–9.PubMed Krause R, Stange R, Roth HJ, Kaase H, Michalsen A, Holick MF. Partial body UV exposure in chronic kidney disease and Extrarenal Vitamin D metabolism. Anticancer Res. 2018;38(2):1217–9.PubMed
22.
go back to reference Krause R, Buhring M, Hopfenmuller W, Holick MF, Sharma AM. Ultraviolet B and blood pressure. Lancet. 1998;352(9129):709–10.PubMedCrossRef Krause R, Buhring M, Hopfenmuller W, Holick MF, Sharma AM. Ultraviolet B and blood pressure. Lancet. 1998;352(9129):709–10.PubMedCrossRef
23.
go back to reference Scragg R, Wishart J, Stewart A, Ofanoa M, Kerse N, Dyall L, et al. No effect of ultraviolet radiation on blood pressure and other cardiovascular risk factors. J Hypertens. 2011;29(9):1749–56.PubMedCrossRef Scragg R, Wishart J, Stewart A, Ofanoa M, Kerse N, Dyall L, et al. No effect of ultraviolet radiation on blood pressure and other cardiovascular risk factors. J Hypertens. 2011;29(9):1749–56.PubMedCrossRef
24.
go back to reference Muggeridge DJ, Sculthorpe N, Grace FM, Willis G, Thornhill L, Weller RB, et al. Acute whole body UVA irradiation combined with nitrate ingestion enhances time trial performance in trained cyclists. Nitric Oxide. 2015;48:3–9.PubMedCrossRef Muggeridge DJ, Sculthorpe N, Grace FM, Willis G, Thornhill L, Weller RB, et al. Acute whole body UVA irradiation combined with nitrate ingestion enhances time trial performance in trained cyclists. Nitric Oxide. 2015;48:3–9.PubMedCrossRef
25.
go back to reference Reid IR, Vitamin D. Effect on bone mineral density and fractures. Endocrinol Metab Clin N Am. 2017;46(4):935–45.CrossRef Reid IR, Vitamin D. Effect on bone mineral density and fractures. Endocrinol Metab Clin N Am. 2017;46(4):935–45.CrossRef
26.
go back to reference Dhaliwal R, Aloia JF. Effect of Vitamin D on falls and physical performance. Endocrinol Metab Clin N Am. 2017;46(4):919–33.CrossRef Dhaliwal R, Aloia JF. Effect of Vitamin D on falls and physical performance. Endocrinol Metab Clin N Am. 2017;46(4):919–33.CrossRef
27.
go back to reference Rai V, Agrawal DK. Role of Vitamin D in cardiovascular diseases. Endocrinol Metab Clin N Am. 2017;46(4):1039–59.CrossRef Rai V, Agrawal DK. Role of Vitamin D in cardiovascular diseases. Endocrinol Metab Clin N Am. 2017;46(4):1039–59.CrossRef
28.
go back to reference Lois J, Cutler RAK. As great as all outdoors. J Hous Elder. 2006;19(3–4):29–48. Lois J, Cutler RAK. As great as all outdoors. J Hous Elder. 2006;19(3–4):29–48.
29.
go back to reference Veleva BI, Caljouw MAA, van der Steen JT, Mertens BJA, Chel VGM, Numans ME. The effect of ultraviolet B irradiation compared with Oral Vitamin D supplementation on the well-being of nursing home residents with dementia: a randomized controlled trial. Int J Environ Res Public Health. 2020;17(5):1684. https://doi.org/10.3390/ijerph17051684. PMID: 32150855; PMCID: PMC7084916. Veleva BI, Caljouw MAA, van der Steen JT, Mertens BJA, Chel VGM, Numans ME. The effect of ultraviolet B irradiation compared with Oral Vitamin D supplementation on the well-being of nursing home residents with dementia: a randomized controlled trial. Int J Environ Res Public Health. 2020;17(5):1684. https://​doi.​org/​10.​3390/​ijerph17051684. PMID: 32150855; PMCID: PMC7084916.
30.
go back to reference He SY, McCulloch CE, Boscardin WJ, Chren MM, Linos E, Arron ST. Self-reported pigmentary phenotypes and race are significant but incomplete predictors of Fitzpatrick skin phototype in an ethnically diverse population. J Am Acad Dermatol. 2014;71(4):731–7.PubMedPubMedCentralCrossRef He SY, McCulloch CE, Boscardin WJ, Chren MM, Linos E, Arron ST. Self-reported pigmentary phenotypes and race are significant but incomplete predictors of Fitzpatrick skin phototype in an ethnically diverse population. J Am Acad Dermatol. 2014;71(4):731–7.PubMedPubMedCentralCrossRef
31.
go back to reference Volicer L, Hurley AC, Lathi DC, Kowall NW. Measurement of severity in advanced Alzheimer's disease. J Gerontol. 1994;49(5):M223–6.PubMedCrossRef Volicer L, Hurley AC, Lathi DC, Kowall NW. Measurement of severity in advanced Alzheimer's disease. J Gerontol. 1994;49(5):M223–6.PubMedCrossRef
32.
go back to reference Galindo-Garre F, Hendriks SA, Volicer L, Smalbrugge M, Hertogh CM, van der Steen JT. The Bedford Alzheimer nursing-severity scale to assess dementia severity in advanced dementia: a nonparametric item response analysis and a study of its psychometric characteristics. Am J Alzheimers Dis Other Dement. 2014;29(1):84–9.CrossRef Galindo-Garre F, Hendriks SA, Volicer L, Smalbrugge M, Hertogh CM, van der Steen JT. The Bedford Alzheimer nursing-severity scale to assess dementia severity in advanced dementia: a nonparametric item response analysis and a study of its psychometric characteristics. Am J Alzheimers Dis Other Dement. 2014;29(1):84–9.CrossRef
33.
go back to reference Witham MD, Nadir MA, Struthers AD. Effect of vitamin D on blood pressure: a systematic review and meta-analysis. J Hypertens. 2009;27(10):1948–54.PubMedCrossRef Witham MD, Nadir MA, Struthers AD. Effect of vitamin D on blood pressure: a systematic review and meta-analysis. J Hypertens. 2009;27(10):1948–54.PubMedCrossRef
34.
35.
go back to reference Divakaran S, Loscalzo J. The role of nitroglycerin and other nitrogen oxides in cardiovascular therapeutics. J Am Coll Cardiol. 2017;70(19):2393–410.PubMedPubMedCentralCrossRef Divakaran S, Loscalzo J. The role of nitroglycerin and other nitrogen oxides in cardiovascular therapeutics. J Am Coll Cardiol. 2017;70(19):2393–410.PubMedPubMedCentralCrossRef
36.
go back to reference Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, et al. 2018 ESC/ESH guidelines for the management of arterial hypertension. Eur Heart J. 2018;39(33):3021–104.PubMedCrossRef Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, et al. 2018 ESC/ESH guidelines for the management of arterial hypertension. Eur Heart J. 2018;39(33):3021–104.PubMedCrossRef
37.
go back to reference Irace C, Ceravolo R, Notarangelo L, Crescenzo A, Ventura G, Tamburrini O, et al. Comparison of endothelial function evaluated by strain gauge plethysmography and brachial artery ultrasound. Atherosclerosis. 2001;158(1):53–9.PubMedCrossRef Irace C, Ceravolo R, Notarangelo L, Crescenzo A, Ventura G, Tamburrini O, et al. Comparison of endothelial function evaluated by strain gauge plethysmography and brachial artery ultrasound. Atherosclerosis. 2001;158(1):53–9.PubMedCrossRef
38.
go back to reference Hermann M, Flammer A, Luscher TF. Nitric oxide in hypertension. J Clin Hypertens (Greenwich). 2006;8(12 Suppl 4):17–29.CrossRef Hermann M, Flammer A, Luscher TF. Nitric oxide in hypertension. J Clin Hypertens (Greenwich). 2006;8(12 Suppl 4):17–29.CrossRef
39.
go back to reference Claassen J, Thijssen DHJ, Panerai RB, Faraci FM. Regulation of cerebral blood flow in humans: physiology and clinical implications of autoregulation. Physiol Rev. 2021;101(4):1487–559.PubMedCrossRefPubMedCentral Claassen J, Thijssen DHJ, Panerai RB, Faraci FM. Regulation of cerebral blood flow in humans: physiology and clinical implications of autoregulation. Physiol Rev. 2021;101(4):1487–559.PubMedCrossRefPubMedCentral
40.
go back to reference Beckett NS, Peters R, Fletcher AE, Staessen JA, Liu L, Dumitrascu D, et al. Treatment of hypertension in patients 80 years of age or older. N Engl J Med. 2008;358(18):1887–98.PubMedCrossRef Beckett NS, Peters R, Fletcher AE, Staessen JA, Liu L, Dumitrascu D, et al. Treatment of hypertension in patients 80 years of age or older. N Engl J Med. 2008;358(18):1887–98.PubMedCrossRef
41.
go back to reference Boshuizen HC, Izaks GJ, van Buuren S, Ligthart GJ. Blood pressure and mortality in elderly people aged 85 and older: community based study. BMJ. 1998;316(7147):1780–4.PubMedPubMedCentralCrossRef Boshuizen HC, Izaks GJ, van Buuren S, Ligthart GJ. Blood pressure and mortality in elderly people aged 85 and older: community based study. BMJ. 1998;316(7147):1780–4.PubMedPubMedCentralCrossRef
42.
go back to reference Mossello E, Pieraccioli M, Nesti N, Bulgaresi M, Lorenzi C, Caleri V, et al. Effects of low blood pressure in cognitively impaired elderly patients treated with antihypertensive drugs. JAMA Intern Med. 2015;175(4):578–85.PubMedCrossRef Mossello E, Pieraccioli M, Nesti N, Bulgaresi M, Lorenzi C, Caleri V, et al. Effects of low blood pressure in cognitively impaired elderly patients treated with antihypertensive drugs. JAMA Intern Med. 2015;175(4):578–85.PubMedCrossRef
43.
go back to reference Streit S, Poortvliet RKE, Gussekloo J. Lower blood pressure during antihypertensive treatment is associated with higher all-cause mortality and accelerated cognitive decline in the oldest-old. Data from the Leiden 85-plus study. Age Ageing. 2018;47(4):545–50.PubMedCrossRef Streit S, Poortvliet RKE, Gussekloo J. Lower blood pressure during antihypertensive treatment is associated with higher all-cause mortality and accelerated cognitive decline in the oldest-old. Data from the Leiden 85-plus study. Age Ageing. 2018;47(4):545–50.PubMedCrossRef
44.
go back to reference Benetos A, Petrovic M, Strandberg T. Hypertension Management in Older and Frail Older Patients. Circ Res. 2019;124(7):1045–60.CrossRefPubMed Benetos A, Petrovic M, Strandberg T. Hypertension Management in Older and Frail Older Patients. Circ Res. 2019;124(7):1045–60.CrossRefPubMed
Metadata
Title
The effect of ultraviolet irradiation compared to oral vitamin D supplementation on blood pressure of nursing home residents with dementia
Authors
Bistra I. Veleva
Monique A. A. Caljouw
Astrid Muurman
Jenny T. van der Steen
Victor G. M. Chel
Mattijs E. Numans
Rosalinde K. E. Poortvliet
Publication date
01-12-2021
Publisher
BioMed Central
Published in
BMC Geriatrics / Issue 1/2021
Electronic ISSN: 1471-2318
DOI
https://doi.org/10.1186/s12877-021-02538-7

Other articles of this Issue 1/2021

BMC Geriatrics 1/2021 Go to the issue
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.