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

Year 2022, , 513 - 520, 01.07.2022

Saadet Avunduk , Halil Tanrıverdi , İpek Büber

https://doi.org/10.31362/patd.1032245

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

Supporting Institution

Pamukkale Üniversitesi Bilimsel Araştırma Projeleri Koordinasyon Birimi

Project Number

2013TPF014

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

Project Number

2013TPF014

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