Pilz Stefan, Tomaschitz Andreas, Ritz Eberhard, Pieber Thomas R
Department of Internal Medicine, Division of Endocrinology and Nuclear Medicine, Medical University of Graz, Austria.
Nat Rev Cardiol. 2009 Oct;6(10):621-30. doi: 10.1038/nrcardio.2009.135. Epub 2009 Aug 18.
Vitamin D deficiency is common and is primarily caused by a lack of ultraviolet-B (UVB) radiation from reduced sun exposure, and the consequent limiting of vitamin D production in the skin. The vitamin D endocrine system regulates about 3% of the human genome. Observational data support the concept that vitamin D is involved in the pathogenesis of cardiovascular diseases and arterial hypertension. The antihypertensive properties of vitamin D include renoprotective effects, suppression of the renin-angiotensin-aldosterone system, direct effects on vascular cells, and effects on calcium metabolism, including prevention of secondary hyperparathyroidism. The results of clinical studies largely, but not consistently, favor the hypothesis that vitamin D sufficiency promotes lowering of arterial blood pressure. Randomized, placebo-controlled trials are greatly needed to clarify and definitively prove the effect of vitamin D on blood pressure. In general, the antihypertensive effects of vitamin D seem to be particularly prominent in vitamin-D-deficient patients with elevated blood pressure. Thus, in view of the relatively safe and inexpensive way in which vitamin D can be supplemented, we believe that vitamin D supplementation should be prescribed to patients with hypertension and 25-hydroxyvitamin D levels below target values.
维生素D缺乏很常见，主要是由于日照减少导致紫外线B（UVB）辐射不足，进而限制了皮肤中维生素D的生成。维生素D内分泌系统调节着约3%的人类基因组。观察数据支持维生素D参与心血管疾病和动脉高血压发病机制的观点。维生素D的降压特性包括肾脏保护作用、抑制肾素-血管紧张素-醛固酮系统、对血管细胞的直接作用以及对钙代谢的影响，包括预防继发性甲状旁腺功能亢进。临床研究结果大多（但并非始终）支持维生素D充足有助于降低动脉血压这一假说。迫切需要进行随机、安慰剂对照试验来阐明并明确证明维生素D对血压的影响。一般来说，维生素D的降压作用在血压升高的维生素D缺乏患者中似乎尤为显著。因此，鉴于补充维生素D的方式相对安全且成本低廉，我们认为对于高血压且25-羟维生素D水平低于目标值的患者应开具维生素D补充剂。
