Evaluation of the Effectiveness of Adding Vitamin D3 to Antihypertensive Therapy in Patients with Arterial Hypertension and Vitamin D Deficiency

Arterial hypertension (AH) is a serious burden on healthcare system and a major risk factor for myocardial infarction, heart and renal failure, and stroke. One of the key causes of its development is endothelial dysfunction. Experimental studies have confirmed the role of vitamin D in regulation of endothelial function and blood pressure (BP) through the interaction with the renin-angiotensin-aldosterone system. The objective: to analyze the effectiveness of comprehensive antihypertensive therapy with the addition of vitamin D3 in patients with AH on the background of vitamin D deficiency or insufficiency. Materials and methods. The study included 205 patients with uncomplicated non-resistant AH of stage II, grade 1 and 2. They were divided into groups depending on the concentration of vitamin D according to the Endocrine Practice Guidelines Committee. For further analysis 70 patients with vitamin D deficiency or insufficiency were selected, who were divided into 2 study groups by the envelope method: the main group (MG) and the comparison group (CG), 35 persons in each group. The patients in the MG received antihypertensive therapy: valsartan (80–160 mg) in combination with a calcium channel antagonist (amlodipine – 5–10 mg per day) or a diuretic (hydrochlorothiazide – 12.5 mg per day). In addition to this therapy, vitamin D3 was prescribed at a dose of 4000 IU in case of insufficiency and 6000 IU in case of deficiency. The patients in the CG received similar antihypertensive therapy without vitamin D3. The effectiveness of treatment was assessed in 6 months after the initial examination by daily blood pressure monitoring, assessment of the structural and functional state of the myocardium and diastolic function of the left ventricle (LV). Results. After 6 months of treatment, a pronounced positive effect of combined antihypertensive therapy was observed in MG patients. Target office BP levels were achieved in 33 (94.3%) patients versus 27 (77.1%) patients in the CG. Office systolic BP (SBP) decreased by 13.9% (p < 0.05), office diastolic BP (DBP) – by 13.2% (p < 0.05), and pulse BP – by 13.8% (p < 0.05). In MG, a decrease in average daily SBP by 11.7% and DBP by 10.7% (p < 0.01) was observed, while in CG it occurred with less significant dynamics – 5.6 and 7.2%, respectively (p < 0.05), the change in the daily BP profile to a more favorable one – 2 times (p < 0.05). There was an increased number of patients with the most favorable BP profile “Dippers” against the background of an 85.7% decrease (p < 0.05) number of patients with the most unfavorable profile “Night-peakers”. In patients in the MG, a decreased frequency of detection of severe left ventricular hypertrophy (LVH) was found by 52% (p < 0.05), as well as eccentric LVH with LV dilation – by 35.7% (p < 0.05). Against the background of treatment, an increased E/A ratio by 22.2% (p < 0.01) was determined, which indicates an improvement in LV diastolic function. Conclusions. Adding vitamin D to combined antihypertensive therapy in patients with its decrease is safe and can contribute to increasing the effectiveness of treatment. The target blood pressure level was achieved in 94% of patients in the MG versus 77% of the patients in the CG. The combined treatment with vitamin D and restoration of its optimal level leads to an improvement in the circadian BP profile, a more pronounced regression of LV hypertrophy, a decreased number of concentric and eccentric hypertrophy with LV dilation, and an improvement in LV diastolic function. The effectiveness of combined antihypertensive therapy in patients is determined by the degree of vitamin D decrease: a correction of its deficiency, compared with its insufficiency, is associated with a more pronounced antihypertensive and antihypertrophic effect.