Assessment of Vitamin D

Status in Patients
with Essential Hypertension

‫تقييم مستوي فيتامين د في مرضي ارتفاع ضغط‬

‫الدم االولي‬
 Acknowledgement
I wish to express my deepest thanks, gratitude and
appreciation to Prof. Youssef Khalel Ahmad, Prof. of Internal
Medicine, Faculty of Medicine, Al-Azhar University, for his
meticulous supervision and generous help.
I would like also to express my sincere appreciation and
gratitude to Dr.Salow Tawfik, Assistant Prof. of Internal
Medicine National Research Center for her continuous
directions and support throughout the whole work.
I am also grateful to Dr. Esam Mohamed Ghamry, Assistant
Prof. of Internal Medicine, Faculty of Medicine, Al-Azhar
University, for his support and effort to accomplish this work.
 I am deeply thankful to Dr. Wael Mohamed Atia, Assistant
Prof. of Cardiology, Faculty of Medicine, Al-Azhar University,
for his great help and outstanding support.
I would like also to express my sincere appreciation and
gratitude to Dr. Mohammad Abd Elhameed Kheder, Assistant
Prof. Clinical Pathology, Faculty of Medicine, Al-Azhar
University for his continuous directions and support
throughout the whole work.
6
• Vitamin D is a molecule displaying an important
physiological impact. Average human diet is
neither rich in vitamin D2 (of plant origin) nor in
vitamin D3 (of animal origin). Therefore, humans
have to rely on the endogenous production of
vitamin D3 in Ultraviolet ß (UVß) exposed skin.
(Carsten, 2014)
• Exposure of skin to sunlight is the major source of
vitamin D for human, which provides
approximately 95% of daily requirement.
(Rammos et al., 2008)
• Vitamin D deficiency has been found to contribute
to various cardiac conditions, such as
hypertension, coronary artery disease, stroke and
atherosclerosis.
(Schneider et al., 2015)
• Hypertension, also known as high blood pressure
or arterial hypertension is a chronic medical
condition in which the blood pressure in the
arteries is elevated. Hypertension is present if the
blood pressure is persistently at or above 140/90
millimeters mercury (mmHg) for most adults;
different criteria apply to children.
(James et al., 2013)
• Studies about blood pressure and factors
affecting it are one of the important topics in
medical sciences. Vitamin D is one of the factors
that can affect blood pressure.
(Paknahad et al., 2008)
• The renin-angiotensin-aldosterone system
(RAAS) is a main regulator of blood pressure and
plays a critical role in the regulation of volume
and electrolyte homeostasis. Increased
activation of RAAS is associated with
hypertension.
• It is well known that renin is produced in
juxtaglomerular cells of the kidney and that it
stimulates angiotensin II and aldosterone
production. Their increased production elevates
blood pressure by vasoconstriction and water
retention.
(Li et al., 2002)
• Experimental evidence shows that calcitriol
inhibits renin synthesis in the kidney. In a very
good study demonstrated that vitamin D, i.e.
calcitriol, is a potent inhibitor of renin synthesis.
(Li et al., 2002)
This study aims to throw light on:

(1) The role of vitamin D in patients with essential

hypertension.

(2) Evaluation of the level of vitamin D in patient’s serum

and its effect to develop essential hypertension and its
vascular complications.

(3) The relation between vitamin D deficiency and the

severity of the hypertension and its vascular complications.
This study was conducted on 80 subjects of both sexes. This
study was conducted at Al-Hussein University Hospital.

Group A
(patients • 60 individuals have essential
group) hypertension.

Group B • comprising 20 apparently

(control healthy individuals with age
group) and sex matched.
Methods:
All patients and controls were subjected to the following:
1- Complete history and physical exam. to evaluate
exclusion criteria
2- CBC, liver enzymes (AST and ALT) and renal function tests
(urea and creatinine)
3- Fasting blood glucose
4- Lipid profile (LDL, HDL, Cholesterol and Triglycerides)
5- Serum vitamin D (25hydroxycholecalciferol), measured by
radioimmunoassay (Hollis, 2004).
6- Doppler study on carotid artery to assess vascular
complications
7- Echocardiography to assess ventricular mass
8- Serum Ca & Ph
 Statistical Analysis
• Data was reported as mean ± SD where designated.
Comparison between numerical data in two studied groups
was performed using t test. Comparison between categorical
data was performed using Chi square test.
Table 1: Comparison between groups as regard laboratory finding

Groups Patients Control T-test

Variable N = (60) N = (20) T p-value
Hb(g/dl) Mean ± SD 13.4±1.3 13.9 ±1.1 1.5 0.1
Platelet(x103/cmm) Mean ± SD 191.8±53.5 214.1±70.9 1.4 0.1
WBCs(x103/cmm) Mean ± SD 6.3 ±1.6 5.9±1.9 0.9 0.4
AST(U/L) Mean ± SD 18.8 ±5.02 18.5±4.5 0.3 0.8
ALT(U/L) Mean ± SD 18.9±4.9 19.7±3.9 0.7 0.5
Creat.(mg/dl) Mean ± SD 0.7 ±0.2 0.8 ±0.1 0.3 0.7
Urea(mg/dl) Mean ± SD 24.01 ±8.4 23.6 ±6.7 0.1 0.9
FBS(mg/dl) Mean ± SD 81.2 ±10.3 80.3 ±9.1 0.3 0.7
Ca(mg/dl) Mean ± SD 8.6 ±0.9 10.5 ±1.2 6.5 < 0.001**
PH(mg/dl) Mean ± SD 3.2 ±0.8 3.6 ±0.5 3.08 <0.003*
T.G(mg/dl) Mean ± SD 130.2 ±27.6 122.1 ±33.3 1.09 0.2
LDL(mg/dl) Mean ± SD 95.5 ±18.2 89.9 ±26.9 1.04 0.3
HDL(mg/dl) Mean ± SD 44.2 ±11.4 46.3 ±8.05 0.8 0.4
 There was statistically high significant difference (p-
value < 0.001) between studied groups as regard
serum calcium and statistically significant difference
(p-value < 0.05) between studied groups as regard
serum phosphorous.
Figure (1): Comparison between studied groups as
regard serum Ca and Ph.
 Table (2): Comparison between studied groups as regard vitamin D
level, Carotid intimal thickness, ventricular Mass and blood pressure.

Groups Patients Control T-test

Variable N = (60) N = (20) T p-value

Mean
Vit. D 24.1±16.3 39.8±21.1 3.4 0.001*
±SD

Mean <
Intimal thickness; ml 0.7±0.2 0.4±0.1 8.5
±SD 0.001**

Ventricular mass; Mean <

124.1±26.9 89.7±19.9 5.2
gram ±SD 0.001**

Mean <
Systolic BP; mmHg 171.2±15.2 110.1±9.7 16.8
±SD 0.001**

Mean <
Diastolic BP; mmHg 109.7±16.4 76.9±7.5 8.6
±SD 0.001**
 There was statistically significant difference (p-
value < 0.05) between studied groups as regards
vitamin D level, while there was statistically high
significant difference (p-value < 0.001) between
studied groups as regards carotid intimal thickness,
ventricular mass and blood pressure (systolic and
diastolic).
Figure (2): Comparison between studied groups as
regards vitamin D level.
Figure (3): Comparison between studied groups as
regards carotid intimal thickness.
Figure (4): Comparison between studied groups as
regards ventricular mass.
Figure (5): Comparison between studied groups as
regards blood pressure.
Table (3): Correlation study between serum vitamin D and (intimal
thickness, ventricular Mass and blood pressure) in patients’ groups.

Significance
Items
(r) p-value

Intimal thickness; ml - 0.5 < 0.001**

Ventricular mass; gram - 0.4 < 0.001**

Systolic blood pressure; mmHg - 0.3 <0.006*

Diastolic blood pressure; mmHg - 0.7 < 0.001**

This table shows:

 Statistically highly significant (p-value < 0.001) Negative

correlation between vitamin D and (intimal thickness,
ventricular mass and diastolic blood pressure) in patients’
groups.

 Statistically significant (p-value < 0.05) Negative

correlation between vitamin D and systolic blood pressure
in patients’ groups.
Figure (6): Negative correlation between vitamin D and
intimal thickness.
Figure (7): Negative correlation between vitamin D and
Ventricular mass.
Figure (8): Negative correlation between vitamin D and
systolic blood pressure.
Figure (9): Negative correlation between vitamin D and
diastolic blood pressure.
Table (4): Comparison between intimal thickness and ventricular mass
in hypertensive patients with and without vitamin D deficiency.

Groups Patients with low Patients with T-test

vit. D < 30ng/ml normal vit. D >30ng/ml
Variable N = (36) N = (24) T p-value

Intimal
Mean± SD 0.8±0.1 0.6 ±0.1 7.2 <0.01**
thickness; ml

Ventricular
Mean ± SD 131.8±33.5 104.1±30.9 6.7 < 0.01**
mass; gram

Carotid intimal thickness and ventricular mass were significantly

higher in patients with essential hypertension with low vitamin D
than those with normal vitamin D levels (P < 0.01).
This study concluded the following:
1- Vitamin D deficiency occurs in the majority of
essential hypertension patients and therefore a
decreased serum vitamin D level is considered an
additional risk factor for cardiovascular morbidity
and mortality.

2-There is a strong inverse relationship between

serum vitamin D and essential hypertension.
This study recommended the following:

1- For better assessment of Vitamin D status, future studies

should evaluate serum levels of Ca, Ph and PTH to assess the
cause of deficiency which will help in better management.

2- It is recommended that to consider vitamin D

supplementation and its efficacy as a new important line of
treatment in patients with essential hypertension, thereby
prophylactic administration of vitamin D could be useful and
researches have to be done to approve this theory.