Vitamin D and Hypertension Risk

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The MD Magazine Peer Exchange “Amassing the Clinical Evidence for Optimized Dyslipidemia Management: Vitamin D, Long-Term Statin Outcomes, and PCSK9 Inhibition” features expert insight and analysis of the latest information on managing hypertension and hyperlipidemia, and in-depth discussion on the use of PCSK9 inhibitors in practice.

This Peer Exchange is moderated by Peter Salgo, MD, professor of medicine and anesthesiology at Columbia University and an associate director of surgical intensive care at the New York-Presbyterian Hospital in New York City.

The panelists are:

• Christie Ballantyne, MD, Co-director of the Lipid Metabolism and Atherosclerosis Clinic at The Methodist Hospital, Director of the Center for Cardiovascular Disease Prevention at the Methodist DeBakey Heart Center, and the Chief of Cardiology at Baylor College of Medicine
• Keith C. Ferdinand, MD, Immediate Past Chair of the National Forum for Heart Disease and Stroke Prevention, and Professor of Clinical Medicine at the Heart and Vascular Institute at Tulane University School of Medicine
• Jennifer G. Robinson, MD, MPH, Professor in the Departments of Epidemiology & Medicine and Director of the Prevention Intervention Center, Department of Epidemiology at the College of Public Health, University of Iowa
• Karol E. Watson, MD, PhD, Professor of Medicine and Cardiology, Co-director of the UCLA Program in Preventive Cardiology, and Director of the UCLA Barbra Streisand Women’s Heart Health Program

In this opening segment of the Peer Exchange, the panelists begin by discussing the relationship between vitamin D supplementation and hypertension, and how to interpret observational data that suggest vitamin D may have a beneficial effect in cardiovascular disease.

Dr. Ferdinand noted that although the existing evidence showing a causal relationship between vitamin D and hypertension is rather weak, “if you’re looking at the biomarker of blood pressure, there may be some benefit” to vitamin D supplementation, at least according to some studies. He cited a study published in 2013 in Hypertension by Forman et al. that found a modest but statistically significant lowering of systolic blood pressure in African-American patients who received 3 months of oral vitamin D3 supplementation.

In response, Dr. Salgo asked “If the relationship between vitamin D levels and hypertension was really causal, not just associative, we could do this study tomorrow, right? We could go to patients, people of all colors who lived in northern latitudes or extreme latitudes, for that matter. And there should be more hypertension in those latitudes because the Vitamin D levels should be lower because they’re not getting a lot of sunlight if they’re not supplemented. Do we see that?”

Dr. Ferdinand responded by saying that “hypertension is such a polyfactorial type of disease, that even if you pulled out Vitamin D, you still have obesity, physical inactivity, stress, and sodium/salt” to consider when looking at hypertension risk.

Dr. Ballantyne advocated a measured approach to vitamin D supplementation and hypertension, saying, “I think it’s reasonable to check the Vitamin D level and if they’re low to supplement and to correct that. The trials are ongoing.” He also said that with patients who have difficulty with myalgias and statins he will measure their vitamin D levels and suggest to them they might better tolerate their statin therapy if they took vitamin D supplements to get their levels up into the normal range.

Dr. Robinson asked “What’s the right dose? What’s a safe dose of vitamin D?” She said that when you look at the epidemiologic data and adjust for obesity and other factors, the relationship between vitamin D and hypertension mostly disappears.