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Am J Hypertens. 2015 Feb;28(2):266-72. doi: 10.1093/ajh/hpu136. Epub 2014 Aug 19.

Relationship among 25-hydroxyvitamin D concentrations, insulin action, and cardiovascular disease risk in patients with essential hypertension.

Author information

1
Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California; fahim@stanford.edu.
2
Division of Endocrinology, Gerontology, and Metabolism, Department of Medicine, Stanford University School of Medicine, Stanford, California;
3
Quest Diagnostics Nichols Institute, San Juan Capistrano, California.
4
Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California;

Abstract

BACKGROUND:

Although low plasma 25-hydroxyvitamin D (25(OH)D) concentrations have been shown to predict risk of hypertension and associated cardiovascular disease (CVD), vitamin D repletion has not consistently lowered blood pressure or decreased CVD. One possibility for this discrepancy is the presence of considerable metabolic heterogeneity in patients with hypertension. To evaluate this possibility, we quantified relationships among insulin resistance, 25(OH)D concentration, and CVD risk factor profile in patients with essential hypertension.

METHODS:

Measurements were made of 25(OH)D concentrations, multiple CVD risk factors, and insulin resistance by the steady-state plasma glucose concentration during the insulin suppression test in 140 otherwise healthy patients with essential hypertension.

RESULTS:

As a group, the patients were overweight/obese and insulin resistant and had low 25(OH)D concentrations. The more insulin resistant the patients were, the worse the CVD risk profile was. In addition, the most insulin-resistant quartile had significantly lower 25(OH)D concentrations than the most insulin-sensitive quartile (20.3±1.4 vs. 25.8±1.4ng/ml; P = 0.005). In the entire group, 25(OH)D concentration significantly correlated with magnitude of insulin resistance (steady-state plasma glucose concentration; r = -0.20; P = 0.02).

CONCLUSIONS:

There was considerable metabolic heterogeneity and substantial difference in magnitude of conventional CVD risk factors in patients with similar degrees of blood pressure elevation. The most insulin-resistant quartile of subjects had the lowest 25(OH)D concentration and the most adverse CVD risk profile, and they may be the subset of patients with essential hypertension most likely to benefit from vitamin D repletion.

KEYWORDS:

blood pressure; cardiovascular disease; hypertension; insulin action; vitamin D.

PMID:
25138785
PMCID:
PMC4357801
DOI:
10.1093/ajh/hpu136
[Indexed for MEDLINE]
Free PMC Article

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