Adjunct vitamin D therapy as a means to reduce the disparity in subclinical targe

描述（由申请人提供）：已知心血管疾病及其相关结局存在巨大差异。这在很大程度上可以追溯到控制不良的高血压及其伴随的压力相关后果，特别是靶器官心脏损伤。后者在非裔美国人中过早发生且不成比例，降低了生活的质量和数量。靶器官心脏损伤的风险在患有高血压的市中心非洲裔美国人中特别高，特别是那些利用急诊室进行慢性血压管理的人。像心血管疾病一样，维生素D缺乏症不成比例地影响非洲裔美国人。维生素D被认为是心血管差异的重要调节剂，通过其直接（以及通过甲状旁腺激素间接）心肌（肥大，纤维化）和血管（阻力增加，顺应性丧失）作用。维生素D缺乏者的维生素D补充被认为是减少非裔美国人经历的心血管疾病负担的机制，特别是如果在不可逆损伤发生之前早期开始，但这还有待于在前瞻性临床试验中进行测试。因此，本提案旨在研究维生素D和亚临床靶器官心脏损伤（如心脏磁共振成像所确定）之间的关系，在一个队列的非洲裔美国人，维生素D缺乏高血压患者没有心脏病史。具体而言，我们试图确定辅助维生素D治疗对左心室肥大（主要目的），心肌纤维化和中央血管功能（次要目的）的影响，在一年内使用安慰剂对照，随机设计。两个研究组的抗高血压治疗将标准化，我们的重点将是招募到我们的安全网机构的血压控制不佳的患者-这是一个高风险，高回报的子集，他们将从确定一种廉价的干预措施中受益匪浅，这可以有效地减少高血压的不良影响。

DESCRIPTION (provided by applicant): 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.