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Mokhtari E, Hajhashemy Z, Saneei P. Serum Vitamin D Levels in Relation to Hypertension and Pre-hypertension in Adults: A Systematic Review and Dose–Response Meta-Analysis of Epidemiologic Studies. Front Nutr 2022; 9:829307. [PMID: 35360696 PMCID: PMC8961407 DOI: 10.3389/fnut.2022.829307] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 02/04/2022] [Indexed: 02/03/2023] Open
Abstract
Background Findings of observational studies that evaluated the association of serum vitamin D status and high blood pressure were contradictory. This meta-analysis of epidemiologic studies assessed the relation of serum vitamin D levels to hypertension (HTN) and pre-hypertension in adults. Methods We conducted a systematic search of all published articles up to March 2021, in four electronic databases (MEDLINE (PubMed), Web of Science (ISI), Embase and Scopus), and Google scholar. Seventy epidemiologic studies (10 prospective cohort, one nested case–control, and 59 cross-sectional investigations) that reported relative risks (RRs), odds ratios (ORs), hazard ratios, or prevalence ratios with 95% CIs for HTN or pre-hypertension in relation to serum vitamin D concentrations in adults were included in the analysis. Results In prospective studies, a 16% decrease in risk of hypertension was observed in participants with high levels of serum vitamin D compared to low levels (RR: 0.84; 95%CI: 0.73, 0.96; 12 effect sizes). Dose–response analysis in prospective studies revealed that each 25 nmol/L increase in serum vitamin D concentrations resulted in 5% reduced risk of HTN (RR: 0.95; 95% CI: 0.90, 1.00). Also, a significant nonlinear relationship between serum vitamin D levels and HTN was found (Pnonlinearity < 0.001). In cross-sectional investigations, highest vs. lowest level of serum vitamin D was related to reduced odds of HTN (OR: 0.84; 95%CI: 0.79, 0.90; 66 effect sizes) and pre-hypertension (OR: 0.75; 0.95%CI: 0.68, 0.83; 9 effect sizes). Dose–response analysis in these studies showed that each 25 nmol/L increase in serum vitamin D levels was related to a significant 6% reduction in odds of hypertension in all populations (RR: 0.94; 95%CI: 0.90, 0.99) and 3% in studies with representative populations (RR: 0.97; 95%CI: 0.95, 0.99). Conclusion This meta-analysis of epidemiologic studies disclosed that serum vitamin D concentrations were inversely related to the risk of HTN in adults, in a dose–response manner in both prospective cohort and cross-sectional studies. Systematic Review Registration:http://www.crd.york.ac.uk/Prospero, identifier: CRD42021251513.
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Affiliation(s)
- Elahe Mokhtari
- Students' Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran
- Department of Community Nutrition, School of Nutrition and Food Science, Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Zahra Hajhashemy
- Students' Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran
- Department of Community Nutrition, School of Nutrition and Food Science, Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Parvane Saneei
- Department of Community Nutrition, School of Nutrition and Food Science, Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
- *Correspondence: Parvane Saneei ;
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Amirkhizi F, Pishdadian A, Asghari S, Hamedi-Shahraki S. Vitamin D status is favorably associated with the cardiovascular risk factors in adults with obesity. Clin Nutr ESPEN 2021; 46:232-239. [PMID: 34857202 DOI: 10.1016/j.clnesp.2021.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 09/10/2021] [Accepted: 10/02/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS Previous investigations have been indicated that vitamin D deficiency is an amendable risk for cardiovascular disease (CVD) in the general populations. Limited data is available concerning the relationship of vitamin D status and risk factors of CVD in the individuals with obesity and the existing data are highly controversial. We investigated whether serum vitamin D situation is related to multiple traditional CVD risk factors in Iranian obese subjects. METHODS A cross-sectional study was done among 214 Iranian adults with obesity (94 males and 120 females) aged 20-60 years, who attended the specialized outpatient clinics in Zabol city. Participants were categorized as vitamin D sufficient, insufficient, and deficient according to their serum 25(OH)D concentrations. Afterward, the presence of hypercholesterolemia, hypertriglyceridemia, low high-density lipoprotein cholesterol (HDL-C), high low-density lipoprotein cholesterol (LDL-C) as well as diabetes, hypertension, and high serum concentrations of high-sensitivity C-reactive protein (hs-CRP) as CVD risk factors were evaluated in the participants. RESULTS There was a noticeable regular trend regarding hypercholesterolemia (p = 0.008), high LDL-C (p = 0.024), hypertension (p = 0.021), and high hs-CRP (p < 0.0001) across various categories of vitamin D status. In adjusted model, vitamin D-deficient subjects were at higher risk for having hypercholesterolemia (OR: 3.22, p = 0.031), high LDL-C (OR: 2.37, p = 0.047), hypertension (OR: 2.32, p = 0.042), and high hs-CRP (OR: 5.49, p = 0.001) than ones with sufficient vitamin D status. CONCLUSIONS Vitamin D deficiency in obese subjects was found to be strongly related to higher risk of unfavorable lipid profile, hypertension, and high hs-CRP.
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Affiliation(s)
- Farshad Amirkhizi
- Department of Nutrition, Faculty of Public Health, Zabol University of Medical Sciences, Zabol, Iran
| | - Abbas Pishdadian
- Department of Immunology, Faculty of Medicine, Zabol University of Medical Sciences, Zabol, Iran
| | - Somayyeh Asghari
- Department of Clinical Nutrition, Faculty of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Soudabeh Hamedi-Shahraki
- Department of Epidemiology and Biostatistics, Faculty of Public Health, Zabol University of Medical Sciences, Zabol, Iran.
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Karadeniz Y, Özpamuk-Karadeniz F, Ahbab S, Ataoğlu E, Can G. Vitamin D Deficiency Is a Potential Risk for Blood Pressure Elevation and the Development of Hypertension. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:medicina57121297. [PMID: 34946242 PMCID: PMC8703486 DOI: 10.3390/medicina57121297] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 11/11/2021] [Accepted: 11/19/2021] [Indexed: 12/28/2022]
Abstract
Background and objectives: Hypertension is a global health problem and a major risk factor for cardiovascular diseases. Vitamin D deficiency is closely related to high blood pressure and the development of hypertension. This study investigated the relationship between the vitamin D and blood pressure status in healthy adults, and their 8-year follow-up was added. Materials and Methods: A total of 491 healthy middle-aged participants without any chronic illness, ages 21 to 67 at baseline, were divided into two groups as non-optimal blood pressure (NOBP) and optimal blood pressure (OBP). NOBP group was divided into two subgroups: normal (NBP) and high normal blood pressure (HNBP). Serum 25-hydroxy vitamin D levels were measured with the immunoassay method. 8-year follow-up of the participants was added. Results: The average vitamin D level was detected 32.53 ± 31.50 nmol/L in the OBP group and 24.41 ± 14.40 nmol/L in the NOBP group, and a statistically significant difference was found (p < 0.001). In the subgroup analysis, the mean vitamin D level was detected as 24.69 ± 13.74 and 24.28 ± 14.74 nmol/L in NBP and HNBP, respectively. Together with parathyroid hormone, other metabolic parameters were found to be significantly higher in the NOBP. During a median follow-up of 8 years, higher hypertension development rates were seen in NOBP group (p < 0.001). Conclusions: The low levels of vitamin D were significantly associated with NBP and HNBP. The low levels of vitamin D were also associated with the development of hypertension in an 8-year follow-up.
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Affiliation(s)
- Yusuf Karadeniz
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, Necmettin Erbakan University, Konya 42010, Turkey;
| | - Fatma Özpamuk-Karadeniz
- Department of Cardiology, Private Büyükşehir Hospital, Konya 42060, Turkey
- Correspondence: ; Tel.: +90-0507-233-4020
| | - Süleyman Ahbab
- Department of Internal Medicine, University of Health Sciences, Haseki Training and Research Hospital, Istanbul 34270, Turkey; (S.A.); (E.A.)
| | - Esra Ataoğlu
- Department of Internal Medicine, University of Health Sciences, Haseki Training and Research Hospital, Istanbul 34270, Turkey; (S.A.); (E.A.)
| | - Günay Can
- Departments of Public Health, Cerrahpaşa Medical Faculty, Istanbul University, Istanbul 34098, Turkey;
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Sanz R, Mazzei L, Santino N, Ingrasia M, Manucha W. Vitamin D-mitochondria cross-talk could modulate the signaling pathway involved in hypertension development: a translational integrative overview. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS 2020; 32:144-155. [PMID: 32456803 DOI: 10.1016/j.arteri.2020.02.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 02/12/2020] [Accepted: 02/27/2020] [Indexed: 12/25/2022]
Abstract
Vitamin D deficiency is a worldwide pandemic and results in osteoporosis, hypertension, and other cardiovascular diseases. At the cellular level, it produces significant oxidative stress, inflammatory markers, and mitochondrial damage. There is increasing evidence about the role of vitamin D in the regulation of the renin-angiotensin-aldosterone system (RAAS). Moreover, there is evidence of involvement in cardiovascular complications, as well as in the immune system disorders. Vitamin D values below 25ng/mL are related to an increase in vascular tone mediated by smooth muscle contraction. Furthermore, it can produce direct effects on vascular smooth muscle cells, RAAS over-regulation, modulation of calcium metabolism, and secondary hyperparathyroidism. All this predisposes patients to develop hypertrophy of the left ventricle and vascular wall, causing hypertension. In this work, a review is presented of the main mechanisms involved in the development of hypertension due to vitamin D deficiency. Among them are the link established between the levels of extra-mitochondrial inorganic phosphate, its main regulatory hormones -such as vitamin D-, the cardiovascular system, reactive oxygen species, and mitochondrial metabolism. The role of the mitochondrial vitamin D receptor and the regulation of the respiratory chain could influence arterial remodelling since its activation would reduce oxidative damage and preserve cell life. However, there are aspects not yet understood about the intricate signalling network that appeared simple in experimental trials, but complex in clinical studies. In this way, the completion of new studies as VITAL, could clarify, and thus support or refute the possible benefits of vitamin D in hypertensive cardiovascular disease.
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Affiliation(s)
- Raúl Sanz
- Laboratorio de Farmacología Experimental Básica y Traslacional, Área de Farmacología, Departamento de Patología, Facultad de Ciencias Médicas, Universidad Nacional de Cuyo, Centro Universitario, Mendoza, Argentina
| | - Luciana Mazzei
- Laboratorio de Farmacología Experimental Básica y Traslacional, Área de Farmacología, Departamento de Patología, Facultad de Ciencias Médicas, Universidad Nacional de Cuyo, Centro Universitario, Mendoza, Argentina; Instituto de Medicina y Biología Experimental de Cuyo, Consejo Nacional de Investigación Científica y Tecnológica (IMBECU-CONICET), Mendoza, Argentina
| | - Nicolás Santino
- Laboratorio de Farmacología Experimental Básica y Traslacional, Área de Farmacología, Departamento de Patología, Facultad de Ciencias Médicas, Universidad Nacional de Cuyo, Centro Universitario, Mendoza, Argentina
| | - Marco Ingrasia
- Laboratorio de Farmacología Experimental Básica y Traslacional, Área de Farmacología, Departamento de Patología, Facultad de Ciencias Médicas, Universidad Nacional de Cuyo, Centro Universitario, Mendoza, Argentina
| | - Walter Manucha
- Laboratorio de Farmacología Experimental Básica y Traslacional, Área de Farmacología, Departamento de Patología, Facultad de Ciencias Médicas, Universidad Nacional de Cuyo, Centro Universitario, Mendoza, Argentina; Instituto de Medicina y Biología Experimental de Cuyo, Consejo Nacional de Investigación Científica y Tecnológica (IMBECU-CONICET), Mendoza, Argentina.
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Effect of vitamin D supplementation on blood pressure parameters in patients with vitamin D deficiency: a systematic review and meta-analysis. ACTA ACUST UNITED AC 2018; 12:488-496. [PMID: 29776759 DOI: 10.1016/j.jash.2018.04.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 04/20/2018] [Accepted: 04/25/2018] [Indexed: 12/31/2022]
Abstract
Evidence suggests that supplementation of vitamin D cannot decrease blood pressure in normal populations. However, in randomized controlled trials (RCTs) with vitamin D deficient participants (defined as baseline serum 25[OH]D levels <30 ng/mL or 50 nmol/L), this effect is inconsistent and under debate. Thus, we performed this systematic review and meta-analysis to evaluate whether vitamin D supplementation could affect blood pressure parameters in vitamin D-deficient subjects. The PubMed, Web of Science, ScienceDirect, and Cochrane library databases were searched. Extracted data were pooled as weighted mean differences with 95% confidence intervals to evaluate the effects. Subgroup analysis was further conducted according to the characteristics of included studies. Seven RCTs that contained 560 participants were included in our meta-analysis. The pooled weighted mean difference of peripheral diastolic blood pressure was -1.65 mm Hg (95% confidence interval: -3.05 to -0.25, I2 = 30.3%). No significant effect of vitamin D supplementation was found on other parameters. Subgroup analysis showed a significant decrease in peripheral systolic blood pressure and diastolic blood pressure in Asia, 8 weeks of intervention, and more than 5000 IU of daily vitamin D supplementation subgroups. For vitamin D-deficient patients, there is a small but significant fall in peripheral blood pressure but no significant fall in other blood pressure parameters with vitamin D supplementation. Further RCTs with large numbers of participants is still warranted to confirm these effects.
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Abstract
Vitamin D has been traditionally recognized as a vitamin quintessential for bone-mineral health. In the past 2 decades, numerous experimental and observational studies have highlighted the role of vitamin D in immunity, metabolic syndrome (obesity and diabetes), cancers, renal disease, memory, and neurological dysfunction. In this article, we review important studies that focused on the impact of vitamin D on blood pressure, myocardial infarction, peripheral arterial disease, heart failure, and statin intolerance. Amidst the current pool of ambiguous evidence, we intend to discuss the role of vitamin D in "high-value cardiovascular health care".
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Vishnu A, Ahuja V. Vitamin D and Blood Pressure Among U.S. Adults: A Cross-sectional Examination by Race/Ethnicity and Gender. Am J Prev Med 2017; 53:670-679. [PMID: 28928036 DOI: 10.1016/j.amepre.2017.07.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 06/14/2017] [Accepted: 07/10/2017] [Indexed: 12/21/2022]
Abstract
INTRODUCTION The cross-sectional association of serum vitamin D levels with blood pressure and hypertension status among a representative sample of U.S. adults was examined. METHODS Participants of the National Health and Nutrition Examination Survey from 2001 to 2010 were included in these analyses. Harmonizing of the vitamin D levels from 2001 to 2006 with vitamin D measurement from 2007 to 2010 was done using regression equations released by the Centers for Disease Control and Prevention. Use of vitamin D supplements was assessed for all participants. Statistical analyses included examination of linear association of vitamin D levels with blood pressure and non-linear cubic splines with hypertension in overall population, by gender, and by race/ethnicity. RESULTS With every 10 nmol/L higher vitamin D, systolic blood pressure decreased by 0.19 mmHg in this population (p<0.01). In fully adjusted stratified analyses, this association was present among females (-0.25 mmHg, p<0.01) and non-Hispanic whites (0.22 mmHg, p<0.01). After race/ethnic and gender stratification, this association was observed among non-Hispanic white females (0.26 mmHg, p=0.01), non-Hispanic black females (0.65 mmHg, p=0.02), and marginally significant among Hispanic males (0.33 mmHg, p=0.07). Non-parametric assessment with cubic splines show that vitamin D has an inverse association with odds of hypertension up to 100 nmol/L with no apparent benefit at higher levels in overall population, and even lower threshold levels of vitamin D in non-Hispanic blacks (50 nmol/L) and Hispanic Americans (70 nmol/L). CONCLUSIONS Significant race/ethnic and gender differences exist in the association of vitamin D and systolic blood pressure. Odds for hypertension are reduced significantly at higher vitamin D levels, but this benefit plateaus at very high vitamin D levels.
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Affiliation(s)
- Abhishek Vishnu
- Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania.
| | - Vasudha Ahuja
- Department of Community Medicine, Andaman and Nicobar Institute of Medical Sciences, Andaman and Nicobar Islands, India
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Waist circumference modifies the association between serum 25(OH)D and systolic blood pressure: results from NHANES 2001-2006. J Hypertens 2016; 34:637-45. [PMID: 26828785 DOI: 10.1097/hjh.0000000000000840] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Results on the association between vitamin D and blood pressure are conflicting and little is known about how their relationship may be affected by obesity. Thus, we explored whether waist circumference modified the association between serum 25-hydroxyvitamin D (25(OH)D) and blood pressure in participants of the U.S. National Health and Nutrition Examination Surveys 2001-2006. METHODS We included 10 331 nonpregnant participants aged 20 years or older. The association of serum 25(OH)D with systolic and diastolic blood pressure, in the total sample and stratified by waist circumference category (abdominal overweight: 80 to <88 cm in females / 94 to <102 cm in males; abdominal obesity: ≥88 cm in females/ ≥102 cm in males), was examined using multiple linear regression. Effect modification by waist circumference was assessed through a cross-product interaction term between 25(OH)D category and waist circumference category. RESULTS Waist circumference significantly modified the inverse association between 25(OH)D and systolic blood pressure (SBP) (P value for interaction: 0.09). A stronger association of 25(OH)D levels below 15 ng/ml (reference: ≥30 ng/ml) with SBP was found in abdominally obese (β = 3.5 mmHg) than in abdominally overweight (β = 2.0 mmHg) and normal waist participants (β = 1.2 mmHg), but this interaction was only significant in participants without antihypertensive treatment. No significant effect modification was found for diastolic blood pressure. CONCLUSION Results from this large, cross-sectional sample suggest that the association between 25(OH)D and SBP is stronger in individuals with abdominal obesity than in those with a normal waist or with abdominal overweight.
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Chen S, Sun Y, Agrawal DK. Vitamin D deficiency and essential hypertension. JOURNAL OF THE AMERICAN SOCIETY OF HYPERTENSION : JASH 2015; 9:885-901. [PMID: 26419755 PMCID: PMC4641765 DOI: 10.1016/j.jash.2015.08.009] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 07/14/2015] [Accepted: 08/11/2015] [Indexed: 12/19/2022]
Abstract
Essential hypertension (EH) results when the balance between vasoconstriction and vasodilation is shifted in favor of vasoconstriction. This balance is controlled by the interaction of genetic and epigenetic factors. When there is an unstable balance, vitamin D deficiency as an epigenetic factor triggers a shift to the side of vasoconstriction. In this article, we critically analyze clinical findings on the effect of vitamin D on blood pressure, combined with progress in molecular mechanisms. We find that vitamin D repletion exerts a clinically significant antihypertensive effect in vitamin D-deficient EH patients. Of note, a few trials reported no antihypertensive effect from vitamin D due to suboptimal study design. Short-term vitamin D supplementation has no effect on blood pressure in normotensive subjects. This could explain the mixed results and may provide a theoretical basis for future trials to identify beneficial effects of vitamin D in intervention for EH.
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Affiliation(s)
- Songcang Chen
- Center for Clinical & Translational Science and Department of Biomedical Sciences, Creighton University School of Medicine, Omaha, NE, USA.
| | - Yingxian Sun
- Department of Cardiology, First Affiliated Hospital, China Medical University, Shenyang, People's Republic of China
| | - Devendra K Agrawal
- Center for Clinical & Translational Science and Department of Biomedical Sciences, Creighton University School of Medicine, Omaha, NE, USA
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Wanner M, Richard A, Martin B, Linseisen J, Rohrmann S. Associations between objective and self-reported physical activity and vitamin D serum levels in the US population. Cancer Causes Control 2015; 26:881-91. [PMID: 25791130 DOI: 10.1007/s10552-015-0563-y] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 03/12/2015] [Indexed: 12/31/2022]
Abstract
PURPOSE Both low levels of vitamin D and of physical activity are associated with all-cause, cancer, and cardiovascular disease mortality. There is some evidence based on self-reported activity levels that physically more active individuals have higher vitamin D serum levels. The aim was to investigate associations between objectively measured and self-reported physical activity, respectively, and vitamin D serum concentrations in the US population. METHODS Data from NHANES 2003-2006 (n = 6,370, aged ≥ 18 years) were analyzed using multiple regression analyses. A total of 6,370 individuals aged 18 years and older with valid data on vitamin D serum levels and physical activity were included. Objective physical activity was assessed using accelerometers; self-reported physical activity was based on the NHANES physical activity questionnaire. RESULTS An increase of 10 min of objectively measured and self-reported moderate-to-vigorous activities per day was associated with an increase in circulating vitamin D of 0.32 ng/ml (95% CI 0.17, 0.48) and of 0.18 ng/ml (95% CI 0.12, 0.23), respectively. The odds ratio for being vitamin D deficient (< 20 ng/ml) if being insufficiently active compared with being sufficiently active was 1.32 (1.11, 1.57). Associations were not stronger for self-reported outdoor activities compared with indoor activities. CONCLUSIONS Physical activity may be a way to achieve higher vitamin D serum levels in the population. Factors other than sun exposure that may be responsible for higher vitamin D levels in more active individuals need further investigation.
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Affiliation(s)
- Miriam Wanner
- Division of Chronic Disease Epidemiology, Department of Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Seilergraben 49, 8001, Zurich, Switzerland
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Carbone F, Mach F, Vuilleumier N, Montecucco F. Potential pathophysiological role for the vitamin D deficiency in essential hypertension. World J Cardiol 2014; 6:260-276. [PMID: 24944756 PMCID: PMC4062123 DOI: 10.4330/wjc.v6.i5.260] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Revised: 03/24/2014] [Accepted: 04/11/2014] [Indexed: 02/06/2023] Open
Abstract
Vitamin D deficiency has been indicated as a pandemic emerging public health problem. In addition to the well-known role on calcium-phosphorus homeostasis in the bone, vitamin D-mediated processes have been recently investigated on other diseases, such as infections, cancer and cardiovascular diseases. Recently, both the discovery of paracrine actions of vitamin D (recognized as “local vitamin D system”) and the link of vitamin D with renin-angiotensin-aldosterone system and the fibroblast growth factor 23/klotho pathways highlighted its active cardiovascular activity. Focusing on hypertension, this review summarizes the more recent experimental evidence involving the vitamin D system and deficiency in the cardiovascular pathophysiology. In particular, we updated the vascular synthesis/catabolism of vitamin D and its complex interactions between the various endocrine networks involved in the regulation of blood pressure in humans. On the other hand, the conflicting results emerged from the comparison between observational and interventional studies emphasize the fragmentary nature of our knowledge in the field of vitamin D and hypertension, strongly suggesting the need of further researches in this field.
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Sypniewska G, Pollak J, Strozecki P, Camil F, Kretowicz M, Janikowski G, Mankowska-Cyl A, Pater A, Manitius J. 25-hydroxyvitamin D, biomarkers of endothelial dysfunction and subclinical organ damage in adults with hypertension. Am J Hypertens 2014; 27:114-21. [PMID: 24042165 DOI: 10.1093/ajh/hpt174] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The mechanism that underlies the association between low 25-hydroxyvitamin D [25(OH)D] and hypertension is not well understood; it seems to involve regulation of the renin-angiotensin-aldosterone system and the impact on endothelial function, cardiac remodeling, and subclinical organ damage. Vitamin D supplementation presents an ambiguous effect on endothelial function and arterial stiffness. We assess serum 25(OH)D3, biomarkers of endothelial dysfunction (soluble intercellular adhesion molecule [sICAM], C-reactive protein [CRP], homocysteine [Hcy]) and subclinical organ damage in adults with newly diagnosed untreated hypertension. METHODS Patients were classified based on ambulatory blood pressure monitoring: 98 had hypertension, whereas in 60 persons BP was normal. Laboratory assays including serum 25(OH)D3, hsCRP, Hcy, sICAM, glucose, insulin, lipids, echocardiography, pulse wave velocity (PWV), intima-media thickness (IMT), and left-ventricular mass (LVM) measurements were performed. RESULTS 25(OH)D3 was significantly lower in hypertensive patients. The logistic regression analysis indicated that 25(OH)D3 reduced the probability of hypertension occurrence after adjusting for body mass index (BMI). 25(OH)D3 in those with hypertension correlated significantly with systolic BP (SBP; r = -0.39), PWV, IMT (r = -0.33), and diastolic BP (r = -0.26). Multiple regression analysis in patients with hypertension revealed that 25(OH)D3 and sICAM accounted for up to 27% of SBP variation after adjusting for age, BMI, and smoking. 25(OH)D3 and either PWV or IMT accounted for 23% of SBP variation. The impact of 25(OH)D3 was 10%. CONCLUSION The impact of 25(OH)D3 on SBP variation, mediated by its effect on endothelial dysfunction and subclinical organ damage, is modest but significant.
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Affiliation(s)
- Grazyna Sypniewska
- Department of Laboratory Medicine, Nicolaus Copernicus University, Collegium Medicum, Bydgoszcz, Poland
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Sulistyoningrum DC, Gasevic D, Green TJ, Lear SA, Devlin AM. Adiposity and the relationship between vitamin D and blood pressure. Metabolism 2013; 62:1795-802. [PMID: 23987237 DOI: 10.1016/j.metabol.2013.07.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Revised: 07/06/2013] [Accepted: 07/17/2013] [Indexed: 01/28/2023]
Abstract
OBJECTIVE Circulating vitamin D (25OHD) concentrations are negatively associated with blood pressure (BP) but little is known about the mechanisms for this relationship. Adiposity is positively associated with BP and inversely with circulating 25OHD concentrations but no studies have assessed the relationship between plasma 25OHD and adiposity on BP. The goal of this study is to investigate if the association between plasma 25OHD and BP is mediated by adiposity. MATERIALS/METHODS The relationship between plasma 25OHD, systolic and diastolic BP, and adiposity [BMI, waist circumference, visceral adipose tissue (VAT)] was assessed in a multi-ethnic cross-sectional study of Aboriginal (n=151), Chinese (n=190), European (n=170), and South Asian (n=176) participants by linear regression models. RESULTS Plasma 25OHD concentrations were negatively associated with systolic (standardized B=-0.191, P<0.001) and diastolic BP (standardized B=-0.196, P<0.001) in models adjusted for age, sex, ethnicity, family history of CVD, smoking status, alcohol consumption, and physical activity. The negative relationship between plasma 25OHD concentrations and systolic and diastolic BP was attenuated after the addition of BMI, waist circumference, and VAT to the models, but the relationship remained significant. Plasma 25OHD concentrations accounted for 0.7% and 0.8% of the variance in systolic and diastolic BP, respectively. CONCLUSION These findings suggest that the relationship between vitamin D and BP is independent of adiposity. Further studies are required to determine the mechanisms by which vitamin D affects BP.
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Affiliation(s)
- Dian C Sulistyoningrum
- Department of Pathology and Laboratory Medicine, University of British Columbia, Child and Family Research Institute, Vancouver, Canada
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Abstract
PURPOSE OF REVIEW Both vitamin D deficiency and hypertension are highly prevalent. It is unclear whether vitamin D modulates blood pressure and therefore whether vitamin D testing and therapy should become part of routine hypertension prevention and management. This article provides an overview of the data, with special emphasis on the work published in the last 2 years. RECENT FINDINGS Several animal studies corroborate the strong effect of vitamin D on the renin-angiotensin-aldosterone axis. Small and large observational studies have found associations between vitamin D, increased blood pressure, and the risk of developing hypertension. In contrast, recent data from randomized trials are mixed. Two randomized trials with approximately 1 year of follow-up detected no association between vitamin D treatment and blood pressure, whereas another study of active vitamin D reported a 9-mmHg decrease in systolic blood pressure. Meta-analyses have linked vitamin D levels with blood pressure, but the effect of vitamin D administration on blood pressure remains controversial. SUMMARY Vitamin D deficiency is asociated with high blood pressure in observational studies. This effect is thought to be partly mediated through regulation of the renin-angiotensin-aldosterone axis. However, randomized clinical trials and their meta-analyses have yielded inconclusive results. Large randomized trials focusing on patients with severe vitamin D deficiency and hypertension are needed before vitamin D can be recommended for the prevention or treatment of hypertension.
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Gupta AK, Brashear MM, Johnson WD. Predisease conditions and serum vitamin D levels in healthy Mexican American adults. Postgrad Med 2013; 124:136-42. [PMID: 23095433 DOI: 10.3810/pgm.2012.09.2599] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS To elucidate the relationship between low circulating serum vitamin D levels and predisease conditions (ie, prediabetes and prehypertension) in healthy Mexican American adults. METHODS Analyses were conducted using data from the United States National Health and Nutrition Examination Survey (NHANES) from 2001 through 2006. Free-living (ie, community-dwelling, nonimprisoned) adult Mexican American subjects (N = 788; men, n = 443; women, n = 345) who had provided written informed consent and had no history of diabetes, hypertension, dyslipidemia, metabolic syndrome, and/or cardiovascular disease were included in this report. Participants were not ingesting any prescription medications, nor did they exhibit any evidence of malabsorption. Participants were determined to be disease free. RESULTS The mean serum vitamin D level for Mexican American adults (N = 788) of 50.5 nmol/L was significantly higher (P < 0.0001) than the mean of 35.9 nmol/L for non-Hispanic black adults (n = 621), and significantly lower (P < 0.0001) than the mean of 65.0 nmol/L for non-Hispanic white adults (n = 1711). Although age, sex, and body mass index were all significantly associated with prehypertension and prediabetes, no such association was found for serum vitamin D levels. CONCLUSION A successive, incremental shift of approximately 15 nmol/L in vitamin D distribution was seen in the transition from the dark-skinned non-Hispanic black population to the brown-skinned Mexican American population, and from the brown-skinned Mexican American population to the non-Hispanic white population. In contrast to the non-Hispanic black and non-Hispanic white populations, wherein previous studies found that serum vitamin D levels below the 75th percentile were associated with prediabetes and prehypertension, no such association was detected among the Mexican American population. The reason for this lack of association among the Mexican American population is unclear.
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Affiliation(s)
- Alok K Gupta
- Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge, LA 70808, USA.
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