The relationship of vitamin D levels with blood pressure regulation in hypertensive patiens using renin-angiotensin system blocker

Abstract

Purpose: In this study, we aimed to investigate the effect of vitamin D levels on blood pressure regulation, non-dipper status and cardiac hypertrophy in patients using renin-angiotensin system blockers.
Materials and methods: A total of 74 patients, 39 women and 35 men, who had been using renin-angiotensin system blockers for at least one year due to essential hypertension, who applied to Pamukkale University Faculty of Medicine Cardiology Department between April 10, 2013 and May 14, 2014, were included in the study. The groups were classified as vitamin D deficiency with a vitamin D level <10 ng/mL, vitamin D deficiency with 10-20 ng/mL, and normal vitamin D if >20 ng/mL. Of these, 29 (39.2%) patients had vitamin D deficiency, 26 (35.1%) had vitamin D eficiency, and 19 (25.7%) had normal vitamin D.
After standard echocardiographic examination, left ventricular mass index was calculated using the M-mode technique in grams/m2. After 24-hour ambulatory blood pressure monitoring, day and night systolic-diastolic blood pressure averages and 24-hour systolic-diastolic blood pressure averages were calculated for all subjects The non-dipper pattern is defined as less than 10% difference between daytime and nighttime blood pressure.
Results: While there was no statistically significant difference in blood pressure parameters between the groups, left ventricular mass index was found to be statistically significantly increased in the group with vitamin D deficiency (p=0.01). No significant correlation was found between blood pressure parameters and vitamin D levels. Those with non-dipper hypertension had a statistically significant lower vitamin D level and a higher left ventricular mass index (vitamin D level, left ventricular mass index, p=0.020, p=0.010, respectively).
Conclusion: Although vitamin D levels are not associated with blood pressure control in patients using renin-angiotensin system blockers, it can be said that vitamin D deficiency may increase the risk for non-dipper status and cardiac hypertrophy. More comprehensive studies are needed to examine the optimal vitamin D levels for hypertension patients and the effect of vitamin D supplementation on these parameters.

Keywords

• Essential hypertension
• vitamin D
• left ventricular mass index
• renin-angiotensin system

Renin-anjiotensin sistem blokeri kullanan hipertansif hastalarda D vitamini düzeylerinin kan basıncı regülasyonu ile ilişkisi

Abstract

Amaç: Bu çalışmada, D vitamini düzeylerinin renin-anjiyotensin sistem blokeri alan hastalarda kan basıncı regülasyonu, non-dipper durum ve kardiyak hipertrofiye olan etkisini araştırmayı amaçladık.
Gereç ve yöntem: Çalışmaya 10 Nisan 2013 ile 14 Mayıs 2014 tarihleri arasında Pamukkale Üniversitesi Tıp Fakültesi Kardiyoloji Anabilim Dalı polikliniğine başvuran esansiyel hipertansiyon nedeniyle en az bir yıldır renin-anjiyotensin sistem blokeri kullanan 39’u kadın, 35’i erkek toplam 74 hasta dahil edildi. Gruplar, D vitamini düzeyi <10 ng/mL olanlar D vitamini eksikliği, 10-20 ng/mL olanlar D vitamini yetersizliği, >20 ng/mL olanlar D vitamini normal olarak sınıflandırıldı. Bunların 29 (%39,2)’u D vitamini eksikliği olan hastalar, 26 (%35,1)’sı D vitamini yetersizliği ve 19 (%25,7)’u D vitamini normal olan gruptan oluşmaktaydı. Standart ekokardiyografik inceleme sonrasında M-mod tekniği kullanılarak gram/m2 cinsinden sol ventrükül kütle indeksi hesaplandı. 24 saatlik ambulatuvar kan basıncı monitörizasyonu sonrası tüm olguların gündüz ve gece sistolik-diyastolik kan basıncı ortalamaları ve 24 saatlik sistolik-diyastolik kan basıncı ortalamaları hesaplandı. Non-dipper patern, gündüz ve gece saatlerinde ortalama kan basıncı düşüşünün %10’dan az olması olarak tanımlandı.
Bulgular: Gruplar arasında kan basıncı parametrelerinde istatistiksel olarak anlamlı fark saptanmazken sol ventrikül kütle indeksi, D vitamini eksikliği olan grupta istatistiksel olarak anlamlı olacak şekilde artmış olarak bulunmuştur (p=0,01). Kan basıncı parametreleri ile D vitamini düzeyleri arasında anlamlı korelasyon saptanmamıştır. Non-dipper hipertansiyonu olanların D vitamini düzeyi istatistiksel olarak anlamlı olacak şekilde daha düşük ve sol ventrikül kitle indeksi daha yüksek saptanmıştır (sırasıyla D vitamini düzeyi, sol ventrikül kütle indeksi, p=0,020, p=0,010).
Sonuç: Renin-anjiyotensin sistem blokeri kullanan hastalarda D vitamini düzeyleri kan basıncı kontrolü ile ilişkilendirilmese de, D vitamini eksikliğinin non-dipper durum ve kardiyak hipertrofi için riski arttırabileceği söylenebilir. Hipertansiyon hastaları için olması gereken optimal D vitamini düzeyleri ve D vitamini takviyesinin bu parametreler üzerine etkisini incelemek için daha geniş kapsamlı çalışmalara ihtiyaç vardır.

Keywords

• Esansiyel hipertansiyon
• D vitamini
• sol ventrikül kütle indeksi
• renin-anjiyotensin sistemi

References

1. 1Kunutsor SK, Apekey TA, Steur M. Vitamin D and risk of future hypertension: meta-analysis of 283,537 participants. Eur J Epidemiol 2013;28:205-221 https://doi.org/10.1007/s10654-013-9790-2
2. Unger T, Borghi C, Charchar F, et al. 2020 International Society of Hypertension global hypertension practice guidelines. J Hypertens 2020;38:982-1004 https://doi.org/10.1097/HJH.0000000000002453
3. Pearce SH, Cheetham TD. Diagnosis and management of vitamin D deficiency. BJM 2010;340:142-147 https://doi.org/10.1136/bmj.b5664
4. Guidelines Subcommittee of The World Health Organization. 1999 World Health Organization-International Society of Hypertension guidelines for the management of hypertension. J Hypertens 1999;17:151-183
5. Kannel WB. Blood pressure as a cardiovascular risk factor: prevention and treatment. JAMA 1996;275:1571-1576
6. Scragg R, Sowers M, Bell C. Serum 25-hydroxyvitamin D, ethnicity, and blood pressure in the Third National Health and Nutrition Examination Survey. Am J Hypertens 2007;20:713-719 https://doi.org/10.1016/j.amjhyper.2007.01.017
7. Zhao G, Ford ES, Li C, Kris Etherton PM, Etherton TD, Balluz LS. Independent associations of serum concentrations of 25-hydroxyvitamin D and parathyroid hormone with blood pressure among US adults. J Hypertens 2010;28:1821-1828 https://doi.org/10.1097/HJH.0b013e32833bc5b4
8. Kunutsor SK, Burgess S, Munroe PB, Khan H. Vitamin D and high blood pressure: causal association or epiphenomenon? Eur J Epidemiol 2014;29:1-14 https://doi.org/10.1007/s10654-013-9874-z

9. Li, Y. Vitamin D and vitamin D analogs or derivatives as new anti-hypertensive agents.US20100222307 A1, Patent Application Publication Available at: https://patentimages.storage.googleapis.com/b8/95/50/7e2de3d421f5d4/US20100222307A1.pdf. Accessed Sep 2, 2010
10. Tsujimoto T, Sairenchi T, Iso H, et al. Impact of obesity on incident hypertension independent of weight gain among nonhypertensive Japanese: the Ibaraki Prefectural Health Study (IPHS). J Hypertens 2012;30:1122-1128 https://doi.org/10.1097/HJH.0b013e328352b879
11. Nguyen NT, Magno CP, Lane KT, Hinojosa MW, Lane JS. Association of hypertension, diabetes, dyslipidemia, and metabolic syndrome with obesity: findings from the National Health and Nutrition Examination Survey, 1999 to 2004. J Am Coll Surg 2008;207:928-934 https://doi.org/10.1016/j.jamcollsurg.2008.08.022
12. Mokdad AH, Ford ES, Bowman BA, et al. Prevalence of obesity, diabetes, and obesity-related health risk factors, 2001. JAMA 2003;289:76-79 https://doi.org/10.1001/jama.289.1.76
13. Adamczak M, Surma S, Więcek A. Vitamin D and arterial hypertension: facts and myths. Curr Hypertens Rep. 2020;22:57 https://doi.org/10.1007/s11906-020-01059-9
14. Verdecchia P, Porcellati C, Schillaci G, et al. Ambulatory blood pressure. An independent predictor of prognosis in essential hypertension. Hypertension 1994;24:793-801 https://doi.org/10.1161/01.hyp.24.6.793
15. Yilmaz S, Sen F, Ozeke O, et al. The relationship between vitamin D levels and non-dipper hypertension. Blood Press Monit. 2015;20:330-334 https://doi.org/10.1097/MBP.0000000000000146
16. Lavie CJ, Patel DA, Milani RV, Ventura HO, Shah S, Gilliland Y. Impact of echocardiographic left ventricular geometry on clinical prognosis Prog Cardiovasc Dis, 2014;57:3-9 https://doi.org/10.1016/j.pcad.2014.05.003
17. Levin ER, Gardner DG, Samson WK. Natriuretic peptides. N Engl J Med 1998;339:321-328 https://doi.org/10.1056/NEJM199807303390507
18. Norman PE, Powell JT. Vitamin D and cardiovascular disease. Circ Res 2014;114:379-393 https://doi.org/10.1161/CIRCRESAHA.113.301241
19. Al Ishaq RK, Kubatka P, Brozmanova M, Gazdikova K, Caprnda M, Büsselberg D. Health implication of vitamin D on the cardiovascular and the renal system. Arch Physiol Biochem 2021;127:195-209 https://doi.org/10.1080/13813455.2019.1628064
20. Beveridge LA, Struthers AD, Khan F, et al. Effect of vitamin D supplementation on blood pressure: a systematic review and meta-analysis incorporating individual patient data. JAMA Intern Med 2015;175:745-754 https://doi.org/10.1001/jamainternmed.2015.0237
21. Margolis KL, Ray RM, Van Horn L, et al. Women's Health Initiative Investigators. Effect of calcium and vitamin D supplementation on blood pressure: The Women's Health Initiative Randomized Trial. Hypertension 2008;52:847-855 https://doi.org/10.1161/HYPERTENSIONAHA.108.114991