Myroslava Sharabun, PharmD Candidate 2017

 are loaded with essential vitamins and minerals and proven to reduce high blood pressure (BP).

A daily multivitamin can provide low levels of essential vitamins and nutrients. However, little is known about multivitamin use and associated prevention or development of hypertension, especially in women.

An OTC preventive strategy for hypertension would benefit the general population and allow for more opportunity for patient education and counseling. Conversely, some researchers wonder whether vitamins increase BP, which would discourage use in patients with preexisting hypertension.

This topic was the focus of research published in the August 2016 issue of the 

The first study of its kind, it examined long-term use of multivitamins in older women and its potential effects on BP.

Essential vitamins and nutrients can potentially alter hypertension risk in multiple ways. Nutrients with antioxidant properties can reduce oxidative stress. Magnesium, potassium, and vitamin D are all part of BP regulation, and low levels of these essential nutrients may elevate risk for high BP.

This prospective cohort study included 28,157 women from the Women’s Health Study who were 45 years or older and free of cardiovascular disease, cancer, and hypertension; 38% of the participants were taking a multivitamin at the start of the study.

At the end of the study, the researchers determined baseline multivitamin use didn’t elevate risk of hypertension. This was consistent across all potential risk factors for hypertension (eg, age, BMI). There was also no association with incident hypertension even when multivitamin use changed during the study.  

However, this study had several limitations. For instance, it only enrolled females who were disease-free at baseline, and most of the study population was highly educated and had better health status than the general population.

Although multivitamins aren’t recommended as a preventive strategy for hypertension in this patient population, further randomized, controlled trials and observational studies are needed to confirm these findings. 

Articles

Little is known about multivitamin use and associated prevention or development of hypertension, especially in women.

Can Multivitamins Curb Hypertension?

The banana bag has been a long-standing treatment for vitamin and electrolyte deficiencies in patients with chronic alcohol use disorder (AUD) admitted to the intensive care unit (ICU). It contains a combination of 100 mg of thiamine, 1 mg of folic acid, 1-2 g of magnesium, and a multivitamin formulation in either normal saline or dextrose in water solution.

It’s unclear whether everything in the banana bag meet the needs of critically ill patients or those with underlying medical conditions, such as Wernicke’s encephalopathy (WE). This was the focus of research published in the August 2016 issue of the 

, and its findings are essential knowledge for pharmacists as preparations for critically ill patients undergo changes.

This essential vitamin is often low in patients with alcohol abuse histories, and its deficiency can also lead to WE. Usually, WE’s sole symptom is mental status change, a nonspecific marker that’s common in critically ill patients. In addition, much higher thiamine doses are needed to treat or prevent WE compared with what’s needed in other conditions, so the 100-mg dose may be insufficient to treat WE patients and prevent further complications.

Deficiency of this nutrient is also common in chronic AUD patients. It can lead to psychosis, agitation, and sleep disturbances in high-risk individuals. Intravenous (IV) folate is preferred because oral absorption is decreased in critically ill patients. Thus, IV folic acid at 400 mcg to 1000 mcg is appropriate for these patients.

This mineral plays an important role in most cell processes, including cointeracting with thiamine. Little evidence indicates that magnesium supplementation is important in chronic AUD patients; however, other benefits of magnesium supplementation, such as suppression of cardiac arrhythmias, supports its use in this patient population.

This provides low doses of daily vitamins that normal patients would need; however, critically ill patients may have more severe vitamin deficiencies that won’t respond to low-dose vitamins. Its use in the banana bag appears to be arbitrary.

Clinicians should choose IV fluids based on the patient’s nutritional status. If a patient is in alcoholic ketoacidosis, then dextrose in water is appropriate. If a patient is dehydrated, however, then normal saline is the better IV fluid.

Chronic AUD patients may be deficient in several vitamins, nutrients, and electrolytes. The banana bag may not provide enough vitamins and nutrients to treat severe deficiencies. Clinicians should treat patients based on their individual nutritional/vitamin needs and give higher doses of many vitamins and minerals in general.

The banana bag has been a long-standing treatment for vitamin and electrolyte deficiencies in patients with chronic alcohol use disorder admitted to the intensive care unit.