Hypertension and vitamin D

Hypertension associated with genes which reduce vitamin D – meta-analysis June 2014

What Do We Know and Do Not Know About Vitamin D and hypertension – Sept 2014

What Do We Know and Do Not Know About Vitamin D and hypertension – Sept 2014

Hypertension 3X more likely if less than 15 ng of vitamin D – Nov 2010

Confirmed hypertension and plasma 25(OH)D concentrations amongst elderly men.
J Intern Med. 2011 Feb;269(2):211-8. doi: 10.1111/j.1365-2796.2010.02309.x. Epub 2010 Nov 23.
Burgaz A, ann.burgaz at ki.se Byberg L, Rautiainen S, Orsini N, Håkansson N, Arnlöv J, Sundström J, Lind L, Melhus H, Michaëlsson K, Wolk A.
From the Institute of Environmental Medicine, Karolinska Institiute, Stockholm Department of Surgical Sciences, Section of Orthopaedics Department of Public Health and?Caring Sciences/Geriatrics, Uppsala University, Uppsala School of Health and Social Studies, Dalarna University, Falun Department of Medical Sciences, Uppsala University Hospital, Uppsala, Sweden.

Objectives.? The results of experimental studies suggest that vitamin D deficiency activates the renin-angiotensin system and predisposes to hypertension. Results of previous epidemiological studies investigating the association between 25-hydroxyvitamin D [25(OH)D] status and hypertension have not been consistent, perhaps because of their sole reliance on office blood pressure (BP) measurements leading to some misclassification of hypertension status. No previous studies have examined the association between 25(OH)D status and confirmed hypertension assessed with both office and 24-h BP measurements.

Design.? In this cross-sectional study, we investigated 833 Caucasian men, aged 71?±?0.6?years, to determine the association between plasma 25(OH)D concentrations, measured with high-pressure liquid chromatography mass spectrometry, and the prevalence of hypertension. We used both supine office and 24-h BP measurements for classifying participants as normotensive or confirmed hypertensive; participants with inconsistent classifications were excluded.

Results.? In a multivariable adjusted logistic regression model, men with 25(OH)D concentrations <37.5 nmol?L(-1) had a 3-fold higher prevalence of confirmed hypertension compared to those with ?37.5?nmol?L(-1) 25(OH)D (odds ratio?=?3.3, 95% CI: 1.0-11.0).

Conclusions.? Our results show that low plasma 25(OH)D concentration is associated with a higher prevalence of confirmed hypertension.
© 2010 The Association for the Publication of the Journal of Internal Medicine. PMID: 21091810

Current evidence from clinical studies and potential mechanisms.

by: M. Iftekhar Ullah, Gabriel I. Uwaifo, William C. Nicholas, Christian A. Koch
International journal of endocrinology, Vol. 2010 (2010), pp. 1-12.

Vitamin D deficiency is widely prevalent across all ages, races, geographical regions, and socioeconomic strata.
In addition to its important role in skeletal development and calcium homeostasis, several recent studies suggest its association with diabetes, hypertension, cardiovascular disease, certain types of malignancy, and immunologic dysfunction. Here, we review the current evidence regarding an association between vitamin D deficiency and hypertension in clinical and epidemiological studies. We also look into plausible biological explanations for such an association with the renin-angiotensin-aldosterone system and insulin resistance playing potential roles.

Taken together, it appears that more studies in more homogeneous study populations are needed before a firm conclusion can be reached as to whether vitamin D deficiency causes or aggravates hypertension and whether vitamin D supplementation is safe and exerts cardioprotective effects. The potential problems with bias and confounding factors present in previous epidemiological studies may be overcome or minimized by well designed randomized controlled trials in the future.

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Blood 25-hydroxyvitamin D concentration and hypertension: a meta-analysis

Journal of Hypertension:
28 December 2010 doi: 10.1097/HJH.0b013e32834320f9

Objectives: Increasing evidence indicates that vitamin D may influence the risk of hypertension, which is a major risk factor for cardiovascular disease. We conducted a meta-analysis to quantitatively review and summarize the results on the association between blood 25-hydroxyvitamin D concentrations and hypertension.

Methods: Relevant studies were identified by a search of PubMed and EMBASE databases until November 2010. We also reviewed the references of retrieved articles. We included prospective and cross-sectional studies with blood 25-hydroxyvitamin D concentrations as the exposure and hypertension as the outcome. Studies had to report results as a relative risk or an odds ratio. We used random-effects model.

Results: Of the 18 studies included in the meta-analysis, 4 were prospective studies and 14 were cross-sectional studies. The pooled odds ratio of hypertension was 0.73 [95% confidence interval (CI) 0.63-0.84] for the highest versus the lowest category of blood 25-hydroxyvitamin D concentration. In a dose-response meta-analysis, the odds ratio for a 40 nmol/l (16 ng/ml) (approximately 2 SDs) increment in blood 25-hydroxyvitamin D concentration was 0.84 (95% CI 0.78-0.90).

Conclusion: Findings from this meta-analysis indicate that blood 25-hydroxyvitamin D concentration is inversely associated with hypertension.
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Increase chance of Metabolic Syndrome?

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Overview Diabetes and vitamin D
Overview Cholesterol and vitamin D

See also at VitaminDWiki

Far fewer heart problems for those with hypertension if they have > 15 ng of vitamin D

see wikipage:http://www.vitamindwiki.com/tiki-index.php?page_id=1742

Linus Pauling Institute on Vitamin D and Blood Pressure: Dec 2011

Blood Pressure Regulation

The renin-angiotensin system plays an important role in the regulation of blood pressure (13). Renin is an enzyme that catalyzes the cleavage (splitting) of a small peptide (Angiotensin I) from a larger protein (angiotensinogen) produced in the liver. Angiotensin converting enzyme (ACE) catalyzes the cleavage of angiotensin I to form angiotensin II, a peptide that can increase blood pressure by inducing the constriction of small arteries and by increasing sodium and water retention. The rate of angiotensin II synthesis is dependent on renin (14). Research in mice lacking the gene encoding the VDR indicates that 1,25-dihydroxyvitamin D decreases the expression of the gene encoding renin through its interaction with the VDR (15). Since inappropriate activation of the renin-angiotensin system is thought to play a role in some forms of human hypertension, adequate vitamin D levels may be important for decreasing the risk of high blood pressure.

2360 IU average reduced Systolic blood pressure in Clinical Trial

Role of vitamin d supplementation in hypertension.
by: R. K. Goel, Harbans Lal
Indian journal of clinical biochemistry : IJCB, Vol. 26, No. 1. (29 January 2011), pp. 88-90. doi:10.1007/s12291-010-0092-0 Key: citeulike:8626469

Role of Vitamin D supplementation was studied in patients with hypertension.
One hundred hypertensive patients (group I) were given conventional antihypertensive drugs
while another 100 patients (group II), in addition, were supplemented with Vitamin D(3) (33,000 IU, after every 2 weeks, for 3 months).

Besides diastolic and systolic blood pressure, serum calcium, phosphorous, alkaline phosphatase, albumin, albumin-corrected calcium, and 24 h urinary creatinine levels were estimated in both the groups before the start of treatment and after 3 months.

Vitamin D supplementation showed a more significant decrease in systolic blood pressure.
This group also showed a significant increase in serum calcium as well as albumin-corrected calcium with a decrease in phosphorous.
Results of the study confirm that Vitamin D supplementation has a role in reducing blood pressure in hypertensive patients and that it should be supplemented with the antihypertensive drugs. More extensive studies with a larger group, to draw a definite conclusion, are in progress.

Clinical Trials

Clinical trials for Hypertension and "Vitamin D" 50 as of June 2014
DAYLIGHT 4,000 IU of vitamin D, completion data July 2013
Reduce Cardiac Damage 50,000 IU vitamin D every 2 weeks
Patients With Hypertension 3,000 IU daily for 6 weeks
Search hypertension, intervention, vitamin D 20 studies as of Feb 2014

Prehypertension Feb 2012

__Letter to the Editor: Prehypertension: To Treat or Not To Treat Should No Longer Be the Question))

We read with great interest the article by Selassie et al1 that progression from prehypertension to full-blown hypertension occurs more rapidly in blacks, with 50% transitioning to hypertension within 1.7 years compared with 2.7 years in whites. Although the authors highlight the importance of controlling prehypertension, we feel that the authors missed an opportunity to stress the feasibility of using antihypertensive drugs to control prehypertension. As we argued previously,2 the recommendation by the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure to treat prehypertension only with lifestyle changes3 is unlikely to work. Our view that prehypertension should be treated pharmacologically is supported by a recent meta-analysis of 16 trials involving 70664 patients.4 This analysis found that prehypertensive patients randomized to the active treatment arm had a 22% reduction in the risk of stroke as compared with the placebo group. In addition, treatment of prehypertension with an angiotensin receptor blocker reduced the risk of incident hypertension.5 Thus, the debate of whether to treat prehypertension should end. Treating prehypertension is medically sound and economically viable,2 and benefits of treatment are now apparent.

Shawn G. Kwatra, Wake Forest University School of Medicine, Winston-Salem, NC
Amanda E. Kiely, Department of Ophthalmology, The Johns Hopkins University School of Medicine, Baltimore, MD
Madan M. Kwatra, Department of Anesthesiology, Duke University Medical Center, Durham, NC

(Note from VitaminDWiki: Vitamin D reduces both hypertension and prehypertension)

Blood pressures not dropping at night associated with very low level of vitamin D – May 2012

Relationship between Vitamin D Deficiency and Nondipper Hypertension
Clinical and Experimental Hypertension May 17, 2012. (doi:10.3109/10641963.2012.689045)
Mehmet Demir, Tufan Günay, Gökhan Özmen, Mehmet Melek
Cardiology Department, Bursa Yüksek ?htisas Education and Research Hospital, Bursa, Turkey
Address correspondence to Dr. Mehmet Demir, MD, Cardiology Department, Bursa Yüksek ?htisas Education and Research Hospital, Yasemin Park sit 4E D11, Osmangazi, 16100 Bursa, Turkey. E-mail: drmehmetmd at gmail.com

Nondipper hypertension is associated with increased cardiovascular morbidity and mortality. Vitamin D deficiency is associated with cardiovascular diseases such as coronary artery disease, heart failure, and hypertension. Vitamin D deficiency activates the renin–angiotensin–aldosterone system, which affects the cardiovascular system. For this reason, a relationship between vitamin D deficiency and nondipper hypertension could be suggested. In this study, we compared 25-OH vitamin D levels between dipper and nondipper hypertensive patients. The study included 80 hypertensive patients and they were divided into two groups: 50 dipper patients (29 male, mean age 51.5 ± 8 years) and 30 nondipper patients (17 male, mean age 50.6 ± 5.4 years). All the patients were subjected to transthoracic echocardiography and ambulatory 24-hour blood pressure monitoring. In addition to routine tests, 25-OH vitamin D and parathormone (PTH) levels were analyzed. All the patients received antihypertensive drug therapy for at least 3 months prior to the evaluations. 25-OH vitamin D and PTH levels were compared between the two groups. No statistically significant difference was found between the two groups in terms of basic characteristics.

The average PTH level of hypertensive dipper patients was lower than that of nondipper patients (65.3 ± 14.2 vs. 96.9 ± 30.8 pg/mL, P < .001).

The average 25-OH vitamin D level of hypertensive dipper patients was higher than that of nondipper patients (21.9 ± 7.4 vs. 12.8 ± 5.9 ng/mL, P = .001).

The left ventricular mass and left ventricular mass index were lower in the dipper patients than in the nondipper patients (186.5 ± 62.1 vs. 246.3 ± 85.3 g, P = .022; and 111.6 ± 21.2 vs.147 ± 25.7 g/m2, P < .001, respectively).

Other conventional echocardiographic parameters were similar between the two groups. Daytime systolic and diastolic blood pressure measurements were similar between dippers and nondippers, but there was a significant difference between the two groups with regard to nighttime measurements (nighttime systolic 118.5 ± 5.8 vs.130.2 ± 9.6 mm Hg, P < .001; and nighttime diastolic 69.3 ± 4.8 vs.78.1 ± 7.2 mm Hg, P < .001, respectively).

Our results suggest that vitamin D deficiency has a positive correlation with blood pressure and vitamin D deficiency could be related to nondipper hypertension. The measurement of vitamin D may be used to indicate increased risk of hypertension-related adverse cardiovascular events.
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Hypertension drop at night: 22 nanograms
Hypertension NOT drop at night: 13 nanograms

Wikipedia May 2012

Ambulatory blood pressure monitoring allows blood pressure to be intermittently monitored during sleep, and is useful to determine whether the patient is a dipper or non-dipper--that is to say whether or not blood pressure falls at night compared to daytime values. A night time fall is normal. It correlates with relationship depth but other factors such as sleep quality, age, hypertensive status, marital status, and social network support.[2] Absence of a night time dip is associated with poorer health outcomes, including increased mortality in one recent study.[3] In addition, nocturnal hypertension is associated with end organ damage[4] and is a much better indicator than the daytime blood pressure reading.

Hypertension reduced 6.8 mmHg with 3,000 IU of vitamin D daily – RCT May 2012

22nd European Meeting on Hypertension and Cardiovascular Protection. April 2012, Oral 7A.02
T. Larsen1, F. Mose1, E. Pedersen 1, O. Aagaard 2.
I Department of Medical Research, Holstebro Hospital, Holstebro, Denmark,
2 Department of Medical Biochemistry, Holstebro Hospital, Holstebro, Denmark

Objective: In the northern hemisphere vitamin D deficiency is highly prevalent during winter months, and observational studies have associated hypertension with poor vitamin D status. We tested the hypothesis that vitamin D supplementation in the winter lowers blood pressure (BP) in patients with hypertension.

Design: Randomized, placebo-controlled, double-blind study.

Method: 130 patients with hypertension were randomized to a daily oral dose of 75 ug cholecalciferol or placebo for 20 weeks. The study population consisted of Caucasians residing in Denmark at the 56th northern latitude. Baseline examinations took place from October to November where cutaneous vitamin D synthesis is absent. Primary endpoints were 24-h ambulatory BP, pulse wave velocity (PWV) and central BP obtained by applanation tonometry. Other endpoints were p-25(OH)D, p-Ca++, p-iPTH and components of the renin-angiotensin system. Plasma concentrations of renin, angiotensin II and aldosterone were measured using RIAs. Data were analyzed using unpaired t-test and Mann-Whitney test when appropriate.

Results: 112 patients (mean age 61 ± 10) with a baseline p-25(OH)D of 57 ± 26 nmol/l completed the study. Compared with placebo, cholecalciferol caused a significant increase in p-25(OH)D (62 nmol/l, p < 0.001) and p-Ca++ (0.01 mmol/l, p < 0.05), and a significant suppression of p-PTH (0.97 pmol/l, p < 0.001). No significant differences were observed in 24-h ambulatory BP.

However, in patients with p-25(OH)D <75 nmol/l (n = 92), the cholecalciferol group showed a borderline reduction in both systolic BP (3.7 mmHg, p = 0.08) and diastolic BP (2.7 mmHg, p = 0.02) compared to placebo.

Furthermore, in all patients, central systolic and diastolic BP was reduced 6.8 mmHg (p = 0.007) and 1.7 mmHg (p = 0.15), respectively, compared to placebo. No statistically significant difference between groups was observed in pulse wave velocity.

Conclusion: In hypertensive Caucasians residing at the 56th northern latitude, 75 ug of cholecalciferol daily during winter months caused a significant reduction in central systolic blood pressure. In a sub-analysis of patients with p-25(OH)D <75 nmol/l, a marginal reduction in both systolic and diastolic 24-h ambulatory BP was observed.

Should Hypertensive Patients Take Vitamin D? They are finally asking the question

Curr Hypertens Rep. 2012 May 22.
Wuerzner G, Burnier M, Waeber B.
Service of nephrology and hypertension, Lausanne University Hospital, Lausanne, Switzerland.

The prevalence of both hypertension and vitamin D deficiency is high. The discovery of the vitamin D receptor and its possible effects on components of the cardiovascular system influencing blood pressure, such as the renin angiotensin system, the heart, the kidney and the blood vessels, has generated the hope that vitamin D therapy could be a new target for the treatment for hypertensive patients.
Cross-sectional studies have clearly shown an association between low levels of vitamin D and hypertension.
This association is not as clear in longitudinal studies.
Finally, evidence from randomized controlled trials specifically designed to test the hypothesis of a blood pressure lowering effect of vitamin D is weak.
Therefore, there is actually not enough evidence to recommend giving vitamin D to reduce blood pressure in hypertensive patients.
PMID: 22648128

Effect of Vitamin D Supplementation on Blood Pressure in Blacks Hypertension Journal, Clinical Trial, June 2013

4,000 IU reduced Diastolic pressure −4.0 mm Hg in Blacks

Hypertension Review at Vitamin D Council April 2014

  • Worldwide, about 4 out of 10 people have hypertension.
  • In the United States, 1 out of every 3 adults has hypertension.
  • Recent research: For each 10 ng/ml more vitamin D, 12% lower risk of developing hypertension.
  • Key points from the research
  1. Research has shown that people with higher vitamin D levels are more likely to have lower blood pressure and are less likely to develop hypertension.
  2. Studies have shown that taking a vitamin D supplement can reduce blood pressure in people with hypertension.
  3. Some research has shown that taking a vitamin D supplement helps regulate the blood pressure system in the body.
  4. However, not all trials show reduced blood pressure after taking vitamin D.
    This means that we can’t say for sure if vitamin D is a main factor in preventing hypertension or in lowering blood pressure.

Hypertension also reduced by probiotics

See also web

  • Are Blood Pressure Drugs Worth the Falls? NYT April 2014
    more than 70 % of those over age 70 contend with high blood pressure
    85% of Medicare patients with hypertension took at least one type of blood pressure drug
    risk of serious fall injuries was significantly higher among those who took anti-hypertensives than among those who didn’t. (study of 5,000 patients avg age 80
    moderate users of hypertensives: serious fall injuries were 40 % higher than among people who didn’t take anti-hypertensives.

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Health Problems and D

  # of studies as of 12/20/14