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Vitamin D status and arterial hypertension: a systematic review

Abstract

Vitamin D deficiency is common and is primarily caused by a lack of ultraviolet-B (UVB) radiation from reduced sun exposure, and the consequent limiting of vitamin D production in the skin. The vitamin D endocrine system regulates about 3% of the human genome. Observational data support the concept that vitamin D is involved in the pathogenesis of cardiovascular diseases and arterial hypertension. The antihypertensive properties of vitamin D include renoprotective effects, suppression of the renin–angiotensin–aldosterone system, direct effects on vascular cells, and effects on calcium metabolism, including prevention of secondary hyperparathyroidism. The results of clinical studies largely, but not consistently, favor the hypothesis that vitamin D sufficiency promotes lowering of arterial blood pressure. Randomized, placebo-controlled trials are greatly needed to clarify and definitively prove the effect of vitamin D on blood pressure. In general, the antihypertensive effects of vitamin D seem to be particularly prominent in vitamin-D-deficient patients with elevated blood pressure. Thus, in view of the relatively safe and inexpensive way in which vitamin D can be supplemented, we believe that vitamin D supplementation should be prescribed to patients with hypertension and 25-hydroxyvitamin D levels below target values.

Key Points

  • Vitamin D deficiency is common and can be attributed to reduced sun exposure, which limits ultraviolet-B (UVB)-induced vitamin D production in the skin

  • Most cells express the vitamin D receptor (VDR) as well as 1α-hydroxylase, which underlies several regulatory mechanisms and converts 25-hydroxyvitamin D (25[OH]D; used to classify vitamin D status) to 1,25-dihydroxyvitamin D (1,25[OH]2D)

  • 1,25(OH)2D has high affinity for the VDR, but circulates in lower concentrations than 25(OH)D and is more an indicator of calcium homeostasis and kidney function than vitamin D status

  • About 3% of the human genome is directly or indirectly regulated by the vitamin D endocrine system

  • The antihypertensive effects of vitamin D include renoprotective effects, suppression of the renin–angiotensin–aldosterone system, effects on calcium homeostasis including the prevention of secondary hyperparathyroidism, and vasculoprotection

  • Accumulating evidence—from insights into molecular mechanisms to the outcome of randomized trials—favors the hypothesis that vitamin D deficiency contributes to arterial hypertension, but further data are needed

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Figure 1: Sources and metabolism of vitamin D.
Figure 2: The antihypertensive effects of vitamin D.

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Charles P. Vega, University of California, Irvine, CA, is the author of and is solely responsible for the content of the learning objectives, questions and answers of the MedscapeCME-accredited continuing medical education activity associated with this article.

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S. Pilz has received Speaker's Bureau honoraria from Diasorin. The other authors declare no competing interests.

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Pilz, S., Tomaschitz, A., Ritz, E. et al. Vitamin D status and arterial hypertension: a systematic review. Nat Rev Cardiol 6, 621–630 (2009). https://doi.org/10.1038/nrcardio.2009.135

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