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.
KeywordsEssential Hypertension; Vitamin D; Clinical Trial; Molecular Mechanism
Essential Hypertension (EH)One billion people worldwide suffer from hypertension (HTN) [1]. Of these patients, 95% have hypertension of unknown etiology, called essential hypertension (EH), and cannot maintain normal blood pressure (BP) without daily treatment [2]. Many signaling pathways are involved in BP regulation in EH. These include the angiotensin II (Ang II)-sympathetic nerve-CD4 + T cell system [3], a pathway consisting of a series of genes participating in the control of renal salt handling [4], and pathways mediating constriction and dilation of vascular smooth muscle (VSM) cells [5,6]. Dysfunction of any one of these pathways leads to increased VSM tone and remodeling in resistance arteries, resulting in high BP. However, Address correspondence to: Songcang Chen MD, Assistant Professor, Center for Clinical & Translational Science, 2500 California Plaza, Omaha, NE USA 68178, Ph: (402) 280-3488, SongcangChen@creighton.edu. Potential conflicts of interest/financial disclosure: None All authors have read the journal's authorship agreement and publication policy and declare no conflict of interest.Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
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Author Manuscript Author ManuscriptAuthor ManuscriptAuthor Manuscript the exact etiology and pathogenesis of EH is poorly understood, leading to nonspecific and less-effective treatment. In America, 50% of hypertensive patients (∼68 million) do not have their BP well-controlled and about 5 million patients are resistant to antihypertensive treatment with a c...