Hypertension L), and insufficiency is defined asHypertension L), and insufficiency is defined as

Hypertension is a chronic
disease in which the blood vessels have persistently raised pressure and putting
them under increased stress.

Normal adult blood
pressure is defined as a blood pressure of 120 mm Hg when the heart beats (systolic) and a
blood pressure of 80 mm Hg when the heart relaxes (diastolic). When systolic
blood pressure is equal to or above 140 mm Hg and/or a diastolic blood pressure
equal to or above 90 mm Hg, the blood pressure is considered to be high. (1)

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Hypertension is the most common condition seen in primary care and
leads to myocardial infarction, stroke, renal failure, and death if not
detected early and treated appropriately. (2)


Vitamin D is a fat-soluble vitamin that is naturally present in
very few foods, and available as a dietary supplement. Ultraviolet rays from
sunlight strike the skin and trigger vitamin D synthesis and production also. Vitamin
D promotes calcium absorption in
the gut and maintains adequate serum calcium and phosphate concentrations to
enable normal mineralization of bone and to prevent hypocalcemic tetany. It is
also needed for bone growth remodeling through osteoblasts and osteoclasts. (26)

In adults, vitamin D deficiency is defined as a serum
25-hydroxyvitamin D level of less than 20 ng per mL (50 nmol per L), and
insufficiency is defined as a serum 25-hydroxyvitamin D level of 20 to 30 ng
per mL (50 to 75 nmol per L). (3)


More than 1 in 5 adults
worldwide have raised blood pressure. (1) Prevalence of  hypertension is increasing in Saudi Arabia
affecting more than one fourth of the adult Saudi population. (4) A group of
international experts concluded that approximately 50 percent of persons 65
years and older in North America and 66 percent of persons internationally (all
ages) failed to maintain healthy bone density and tooth attachment because of
inadequate vitamin D levels. (3) In Saudi Arabia, over-all prevalence of vitamin D deficiency
in 2014 is 78.1% in females and 72.4% in males. (5)1.   McMullan CJ study (USA, 2016) conducted a double-blind
randomized control trial on 84 participants to assess the effect of vitamin D
on renin-angiotensin system activation and blood pressure level. It reported
that there was no benefit from correcting vitamin D deficiency on RAS activity.
(7) 2.   Salari A study (Iran, 2016) conducted a case-control study on 127
patients with newly recognized hypertension and the 120 normal participants to
assess the effect of nutritional intake, depressive symptoms and vitamin D
status in hypertensive patients. It reported that vitamin D status was lower in
the most individuals and it causes a considerable increase in the risk of
hypertension. (8) 3.   Beveridge LA study (Scotland, 2015) conducted a systematic review
and meta-analysis incorporating individual patient data to assess the effect of
vitamin D supplementation on blood pressure. It reported that there was the
Vitamin D supplementation  ineffective as
an agent for lowering BP and thus should not be used as an antihypertensive
agent. (9) 4.   Qi D study (China, 2017) conducted a randomized controlled clinical
trials, a systemic review and meta-analysis on total 917 participant to assess
the effect of vitamin D supplementation on hypertension in non-CKD populations
. It reported that vitamin D was not an antihypertensive agent although it has
a moderate SBP lowering effect. (10)     5.   Akbari R study (Iran, 2016 ) conducted a case-control study on 100
Participant to assess the Serum vitamin D in hypertensive patients versus
healthy controls . It found that serum 25-OHD level in cases was higher than
controls. The results contradict with earlier studies indicating an association
between vitamin D deficiency and HTN. (11)  6.   Arora P study (Birmingham, 2015) 
conducted a double-blind, randomized, controlled trial was conducted at
4 sites in the United States on 534 Participant 
to assess the effect of  Vitamin D
therapy in individuals with prehypertension or hypertension .  It reported that Vitamin D supplementation
did not reduce blood pressure in individuals with prehypertension or stage I
hypertension and vitamin D deficiency. (12) 7.   Godala M study (Poland, 
2016) conducted on  268 participants
to assess the plasma 25(OH)D vitamin deficiency in patients with metabolic
syndrome. It reported that plasma 25(OH)D vitamin deficiency was very high in
patients with metabolic syndrome, especially in men, people over 55 years and
during winter months. (13)   8.   Mojto V study (Bratislava, 2016 ) conducted  on  92
adult participants  to assess the non-skeletal
effects of vitamin D3 and the threshold limit associated with the risk of
health complications.  It reported that
the limit value of vitamin D3, 16 ng/ml, confirmed the association between
vitamin D3 insufficiency and the presence of hypertension, ischemic heart
disease, renal insufficiency and diabetes mellitus. (14) 9.   Nargesi AA study (Iran, 2016) conducted a study type cohort on  1586 patients 
to assess the Contribution of vitamin D deficiency to the risk of
coronary heart disease in subjects with essential hypertension. It reported
that the serum 25-Hydroxy-Vitamin-D is independently associated with future
hard CHD events and improves its prediction in patients with essential
hypertension. (15) 10.              
Shin JH
study (Korea, 2015)  conducted a  analyzed data from the Korean National Health
and Nutrition Examination Survey 5 database on 4107 postmenopausal  women to assess the vitamin D deficiency and
Its relationship to hypertension in postmenopausal Korean women. It found that
vitamin D deficiency 25(OH)D <15?ng/mL was a significant risk factor for HTN in postmenopausal women. (16) 11.               Jorde R study (Tromso, 2000) conducted  on 7543 men and 8053 women to assess the relation between calcium intake from dairy products and the intake of vitamin D on systolic and diastolic blood pressure. It reported that there was a negative association between calcium intake from dairy products and blood pressure. However, although the effect of calcium on blood pressure appears to be small, calcium could have a significant effect on primary prevention of cardiovascular diseases. (17) 12.               Al-Nozha MM study (Saudi Arabia, 2007)  conducted  on 17,230 participant ,and it was a community-based study conducted by examining subjects in the age group of 30-70 years of selected households during a 5-year period between 1995 and 2000 in Saudi Arabia  to assess the prevalence of hypertension among Saudis of both gender in rural as well as urban communities .  It reported that hypertension was increasing in prevalence in KSA affecting more than one fourth of the adult Saudi population  and The urban population showed significantly higher prevalence of hypertension compared to rural population's prevalence. (18) 13.               Hashemipour S study (Iran, 2004)  conducted  a randomly selected on 1210 participant to assess the vitamin D deficiency and causative factors in the population of Tehran .  It reported that vitamin D deficiency had a high prevalence. In order to avoid complications of vitamin D deficiency, supplemental dietary intake seems essential. (19) 14.               Malçok Gürel Ö study (Turkey, 2016 ) conducted  on 123 participants to assess the relationship between 25-hydroxyvitamin D levels and ambulatory arterial stiffness index in newly diagnosed and never-treated hypertensive patients.  It reported that arterial stiffness was measured in newly diagnosed and untreated patients with essential hypertension were significantly related to vitamin D levels. (20) 15.               Ardawi MS1 study (Saudi Arabia. 2012 ) conducted  a  cross-sectional study  on 834 men  who were randomly selected to assess the relationship between vitamin D status, intact parathyroid hormone (intact PTH), and lifestyle factors among Saudi Arabian men.  It reported that there was  the   Functionally significant vitamin D deficiency affects BMD and bone turnover markers among Saudi Arabian men and is largely attributed to older age, obesity, sedentary lifestyle, no education, poor exposure to sunlight, smoking, and poor dietary vitamin D supplementation,The data suggest that an increase in PTH cannot be used as a marker for vitamin D deficiency. (21) 16.               Rucker D1 study (Alta . 2002 )  conducted  a collected fasting overnight blood samples every 3 months from 60 men and 128 women  to assess the  Vitamin D insufficiency in a population of healthy western Canadians .  It reported that there was  the vitamin D insufficiency, defined as 25(OH)D less than 40 nmol/L, was recorded at least once out of the 4 sampling times , and documented a high prevalence of vitamin D insufficiency, which warrants consideration of dietary vitamin D supplementation. (22) 17.               Wang TJ (USA.  2008 ) studied 1739 Framingham Offspring Study participants to assess the Vitamin D deficiency level and risk of cardiovascular disease.  It reported that there was  the  Vitamin D deficiency is associated with incident cardiovascular disease. It notices that further clinical and experimental studies to determine whether correction of vitamin D deficiency could contribute to the prevention of cardiovascular disease may be warranted. (23) 18.               Pfeifer M study (Germany, 2001)  conducted  on 148 women to assess the  Effects of a short-term vitamin D(3) and calcium supplementation on blood pressure and parathyroid hormone levels in elderly women. It reported that short-term supplementation with vitamin D(3) and calcium was more effective in reducing SBP than calcium alone. Inadequate vitamin D(3) and calcium intake could play a contributory role in the pathogenesis and progression of hypertension and cardiovascular disease in elderly women. (24)  19.               Forman JP study (USA, 2005) conducted  on  participants of 3 large and independent prospective cohorts  to assess the vitamin D intake and risk of incident hypertension.  It reported that a higher intake of vitamin D was not associated with a lower risk of incident hypertension. (25)