Hypertension not reduced by drugs (Resistant Hypertension) in patients with low vitamin D

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Assessment of 25-Hydroxyvitamin D Levels in Patients with Resistant Hypertension - Aug 2015

Med Princ Pract. 2015 Aug 12. [Epub ahead of print]
Belen E1, Şahin İ, Güngör B, Ayça B, Avcı İİ, Avşar M, Yıldız SS, Akın F, Bozbeyoglu E, Okuyan E.
1Department of Cardiology at Okmeydanı Training and Research Hospital, Istanbul, Turkey.

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OBJECTIVE:
To investigate the possible correlation between serum 25-hydroxyvitamin D levels and resistant hypertension (RH).

SUBJECTS AND METHODS:
Patients who had undergone ambulatory blood pressure measurements (ABPM) during outpatient controls were enrolled. Fifty subjects with RH, 50 with controlled hypertension (CHT) and 50 normotensive subjects (NT) were included in the study. RH was defined as 'suboptimal blood pressure control despite using 3 antihypertensive agents including a diuretic or need for 4 or more drugs to control blood pressure'. The 25-hydroxyvitamin D and parathormone levels were compared between the groups. Pearson's correlation coefficient test was applied to assess the correlation between 25-hydroxyvitamin D levels and office blood pressure (BP) and ABPM. Logistic regression analysis was used to determine the independent correlates of RH.

RESULTS:
The 25-hydroxyvitamin D level was significantly lower in the RH group (17.02 ± 5.4 ng/ml) compared to the CHT (24.9 ± 4.8 ng/ml) and NT groups (28.0 ± 5.7 ng/ml, p < 0.001).
In univariate correlation analysis, 25-hydroxyvitamin D levels had a significant negative correlation with
office systolic BP (r = -0.329, p < 0.001),

• office diastolic BP (r = -0.395, p < 0.001),
• systolic ambulatory BP (r = -0.844, p = 0.004), and
• diastolic ambulatory BP (r = -0.567, p = 0.005).

ROC analysis revealed that 25-hydroxyvitamin D levels <21.50 ng/ml predicted the presence of RH with a sensitivity of 78% and a specificity of 79% (AUC = 0.89, 95% CI 0.83-0.94). In the multivariate logistic regression analysis, 25-hydroxyvitamin D level was independently correlated with the presence of RH (β 0.660, 95% CI 0.572-0.760, p < 0.001).

CONCLUSION:
There was an independent correlation between lower 25-hydroxyvitamin D levels and presence of RH. © 2015 S. Karger AG, Basel.

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The association between vitamin D deficiency and the risk of resistant hypertension – April 2019

Clinical and Experimental Hypertension https://doi.org/10.1080/10641963.2019.1601204
Shiran Alagacone, Emanuele Verga ORCID Icon, Roberto Verdolini & Shaik Mohammed Saifullah

Background: Previous studies have already shown a link between vitamin D deficiency and hypertension. The impact of vitamin D deficiency in resistant hypertension is currently unknown. This study examined whether an association between the two entities exists.

Method: We analysed 2953 known hypertensive subjects surveyed by NHANES (National Health and Nutrition Examination Survey) among the United States population between 2003 and 2006. Subjects were categorized as having either resistant hypertension or hypertension based on the number of anti-hypertensives in use and their overall blood pressure control. Subjects were also categorized as vitamin D deficient if they had 25(OH)D (25-hydroxycholecalciferol) levels less than 20ng/ml.

Results: Out of the 2953 subjects, 362 (12%) were found to have resistant hypertension and 2591 (88%) had controlled hypertension. The prevalence of vitamin D deficiency in resistant hypertension and controlled hypertension groups was 61% and 46% respectively. Following adjustments for other variables such as age, renal function, obesity and ethnicity, the odds ratio (OR) for concomitant presence of resistant hypertension and vitamin D deficiency was 3.49 (95% confidence interval [CI] 1.69–7.17; P < 0.009). The OR for having resistant hypertension and chronic kidney disease, older age and obesity were 2.5 (95% CI 1.5–4; P < 0.0003), 1.034 (95% CI 1.02–1.07; P < 0.0001) and 1.048 (95% CI 1.02–1.07; P < 0.0001) respectively.

Conclusion: This study found a statistically significant association between vitamin D deficiency and resistant hypertension.

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