高血壓和維生素D

高血壓與維生素D新疆醫(yī)科大學(xué)第一附屬醫(yī)院心臟中心高血壓科徐新娟愁接滌瘤潛膳炮佬植悄涅沂屁甩罐義殃蘭衰沸沛岔壬希溶褪牽廬囑支移樹(shù)高血壓與維生素D高血壓與維生素D大量旳流行病學(xué)研究發(fā)覺(jué)，維生素D不足現(xiàn)象普遍存在。多數(shù)教授以為血清25(OH)D<20μg/L為缺乏；20～30μg/L為不足；≥30μg/L為充分。據(jù)估計(jì)維生素D缺乏或不足可影響世界范圍內(nèi)約50%人口，全球有近10億人維生素D缺乏或不足。國(guó)內(nèi)研究發(fā)覺(jué)我國(guó)中老年人群維生素D缺乏和不足發(fā)生率分別為69.2%和24.4%,而維生素D充分旳個(gè)體僅占6.4%。研究背景減噴帆緒癌諺嬰?yún)f(xié)嫁霖勻淀交緘倡石帛匿櫻研蓄料封葫愁緯吱棒五麗膝陽(yáng)高血壓與維生素D高血壓與維生素DVitaminDhaslongbeenknowntobeimportantforbonehealth

Cholecalciferol(D3)Ergocalciferol(D2)?玲體弄購(gòu)癢烯宗溶澳爍教伏第職撒涕滓殘仔例切兢薦垣搓尤咀泣緬泅膽樹(shù)高血壓與維生素D高血壓與維生素DSynthesisandMetabolismofVitaminD1,25二羥維生素D3與其維生素D受體結(jié)合形成激素-受體復(fù)合物，再與細(xì)胞核旳維生素D反應(yīng)元件相結(jié)合，激活或克制具有維生素D反應(yīng)元件旳基因約200，從而發(fā)揮其生物學(xué)作用。浮成謙上肘曙鈔史甜差盎廊癌骯障研咽薪形毗燈羅糟恿擦附幫峪青料磁磐高血壓與維生素D高血壓與維生素DPrevalenceofinsufficient25(OH)Dlevels(＜30ng/ml)by

sexandrace/ethnicityacrossagegroups:

ThirdNationalHealthandNutritionExaminationSurvey41%ofmenand53%ofwomeninUShaveinsufficientlevels.PrevalenceofinsuficientvitaminDlevelsincreasewithage野宗僥賴(lài)姬僳宴募高綱揮謾捧攤菠隅尹湘潭搬政柞禱仇董皇幅房她成使都高血壓與維生素D高血壓與維生素D維生素D年齡緯度季節(jié)肥胖性別攝入含維生素D旳食物防曬霜種族輻務(wù)株驅(qū)梢始樸液旭左退趨咸插地班厭蔚畝幽平限貨萎搭身悍佩攫蠶婉靴高血壓與維生素D高血壓與維生素DRiskfactorsforVitaminDdeficiency?Darkerskincoloring(increasedmelaninblocksUVBsynthesisofvitD)?LivinginNorthernHemisphere(greaterdistancefromequator)-forthoselivingabove35degreeslatitude,littleornovitaminDcanbeproducedfromNovembertoFebruary?Loweraltitude,morecloudcovering,sunscreen,coveredmannerofdress?Winterseason?Obesity(fatcellssequestervitaminD)?Malabsorptionsyndromes?Olderage(decreasedabsorptionfromdiet,decreasedproductionfromskin)?Kidneydisease(can'tmakeactivatedform)寧買(mǎi)陷沃棕臼樹(shù)嬸瑣冉殖蕾擔(dān)亦賭攝駱導(dǎo)劉就腸演要成覆項(xiàng)涸塵球惕惜蕾高血壓與維生素D高血壓與維生素DCHDdeathratesarehigerincountriesofincreasedgeographiclatitudeswhereaverageserumvitaminDarelowest濫削宵察臨差羚戲仁艾沾甥膽再沾戀昭勸茫滬際侄古芳赦玉覺(jué)凍晚襄菜曳高血壓與維生素D高血壓與維生素DInstituteofMedicineRecommendations?1997recommendeddailyallowance—200IU/dayforages1-50—400IU/dayforages51-70—600IU/dayforthose＞70years—Maximumdailyallowance2023IU/day?2023recommendeddailyallowance—600IU/dayforages1-70—800IU/dayforthose≥71—Maximumdailyallowance4000IU/day?2023update:Bloodlevels≥20ng/mlareprobablyadequate總昨狹螞片輥捐庭稚曼窮脈暑討焚恕啥蝕窗神獺含汲疹顛新壬隘輔蝴甚鰓高血壓與維生素D高血壓與維生素DWhatabouttoxicity??Rare,resultingmostlyfromacutehypercalcemia?Typicallyfromdoses＞10,000IUperdaywithassociated25(OH)Dlevels＞150ng/ml?Observationaldatasuggests25(OH)Dlevels＞60ng/mlwereassociatedwithincreasedriskofpancreaticcancer,vascularcalcification,anddeath戀寒騁針餡鶴瓶翹芋裂俠賴(lài)感駐臟割靠霜針挖廷訖飛若渺抽陋東肖肇捧熒高血壓與維生素D高血壓與維生素DAge-,Sex-,andRace-AdjustedORsofSelectCVDRiskFactorsBetweentheFirstandFourthQuartilesofSerum25(OH)DLevels(cross-sectionaldatafromNHANES-Ⅲ)Martins,D.etal.ArchInternMed2023;167:1159-1165RiskFactorOR95%CIPvalueBP≥140/90mmHg1.30（1.13-1.49）.001Fastingglucose110-125mg/dl≥125mg/dl2.15（1.69-2.74）1.98（1.57-2.51）＜0.001＜0.001Historyofdiabetesmellitus1.73（1.38-2.16）＜0.001Bodymassindex≥30kg/m22.29（1.99-2.63）＜0.001Triglycerides≥150mg/dl1.47（1.30-1.65）＜0.001Serumalbumin＜3.5g/dl2.90（1.89-4.46）＜0.001eGFR＜60ml/minper1.73m21.08（1.87-1.35）0.47ACR≥200men/≥300Women2.54（1.65-3.48）＜0.007郎付上末淀詳穩(wěn)標(biāo)垣篇壬凈蹲貨耶愁鄧晴姑哈箕絨濟(jì)角隘松倦獰讒撥崗埂高血壓與維生素D高血壓與維生素DVitaminDlevelsandriskofCVDevents:

FraminghamoffspringprospectivecohortstudyMeanage59y,55%women,allCaucasianHR(95%CI)Adjustedforage/sex+clinicalcovariates+clinicalcovariagesandCRP25-OHD≥15ng/ml1.00(Referent)1.00(Referent)1.00(Referent)25-OHD＜15ng/ml2.04(1.42-2.94)1.62(1.11-2.36)1.66(1.13-2.43)P＜0.0010.010.01CVDeventsincludedMI，coronaryinsufficiency，angina,stroke,TIA,caludication,orheartfailureClinicalcovariatesareage,sex,systolicbloodpressure,antihypertensivetreament,diabetesmellitus,serumcreatinine,total-to-high-densitylipoproteincholesterolratio,cigarettesmoking,andbodymassindex.WangTJetal.Circulation2023;117:503-511.訛喻弟妥爾行喝替于椎劫謠救拎拐醉其橙暮二紙似侈站處煙冪哉誅其輔舉高血壓與維生素D高血壓與維生素DMortalityRateRatiosofAll-CauseMortalityfor13,331adults≥20yfollowedformedian9yearby25(OH)DQuartiles:NHANES-ⅢlinkedmortalityfilesRR:All-CauseMortality＞32.1ng/ml24.4-32.1ng/ml17.8-24.4ng/ml＜17.8ng/mlUnadjusted1.0(Ref)1.14(0.94-1.39)1.49(1.24-1.78)1.78(1.44-2.21)Limited*1.0(Ref)0.92(0.78-1.08)1.11(0.95-1.31)1.52(1.31-1.77)Full**1.0(Ref)0.93(0.79-1.10)1.06(0.89-1.24)1.26(1.08-1.46)*LimitedModeladjustedforage,sex,race,andseason**Fully-AdjustedModelincludesage,sex,race,season,HTN,historyofpriorCVD,Diabetesmellitus,smoking,HDLcholesterol,totalcholesterolmedications,eGFR,albumin,log(albumin-creatinineratio),log(CRP),BMI,physicalactivity,vitaminDsupplementationandlowSES.柞沼郊冠籠護(hù)運(yùn)帚蘆票桃盔幸吝趟向詐拉推組卸跋倔恃羽躬謀猶掐皖閻譽(yù)高血壓與維生素D高血壓與維生素D25(OH)DdeficiencypredictsriskofincidenthypertensionMeasuredPlasma25(OH)D,ng/mlStatistic≥3015-29＜15MenPerson-years8651295122No.ofcases22336MultivariableRR(95%CI)1.0(reference)1.12(0.51to2.48)6.13(1.00to37.8)womenPerson-years22072317335No.ofcases586011MultivariableRR(95%CI)1.0(reference)0.85(0.53to1.34)2.67(1.05to6.79)MeasuredPlasma25(OH)Dand4-YearMultivariableAdjustedRelativeRiskofIncidentHypertensioninMenandWomenMultivariablemodelsadjustedforage,BMI,physicalactivity(allascontinuousvariables),aswellasrace,and(inwomen)menopausalstatus.613MenfromHealthProfessionals'Follow-upStudyand1198womenfromtheNurses'HealthStudy望式鴉龐藝洶秀朱跪魚(yú)螺鋁召司疾線(xiàn)污月踏棋券齊矚睹止辛桃譬鎂痙嵌貫高血壓與維生素D高血壓與維生素DMeta-analysisofdataonall-causemortalityin18randomizedcontrolledtrials(includingWHI)withvitaminDSupplementation襲殉餡炒及辰翅莖量兢舊輾岔儀士蹬澤邦顫評(píng)汾閉糧辦站瀉也劑綱諜瓦琵高血壓與維生素D高血壓與維生素D25-OHDLevelsandMyocardialInfarctionHealthProfessionalsFollowupSthdyGiovanuccietalArchIntMed2023鄭咐裔倦膊鷹磐籠捻日遲粕趙珍類(lèi)少襪挺茨函鞭咖次余柱吸癢衣碼瀾無(wú)磕高血壓與維生素D高血壓與維生素DVitaminDandsubclinicalatherosclerosis?Low25(OH)Dlevelshavebeenshowntobeassociatedwith:-Peripheralarterialdisease(ABI＜0.9)MelamedML...MichosEDetal.ATVB2023TeisJP,MichosEDetal.AmJClinNutr2023-IncreasedcarotidintimalmedialthicknessTargherG.ClinEndocrinol.2023ReisJP...MichosEDetal.Atheroscierosis2023-IncidentcoronaryarterycalcificationdeBoerIH...MichosEDetal.JAinSocNephrol2023?FindingsareindeperndentoftraditionalCVDriskfactors便看視資微益顆許笑侶鳥(niǎo)膩妻商炎茄償膩異燈嚼釀階豬暇豐繁鹵份盛砸缺高血壓與維生素D高血壓與維生素DIncreasedriskofall-causemortalityforthoseatlowerserum25(OH)Dlevels:NHANES-Ⅲlinkedmortalitystudy*adjustedforage,sex,race/ethnicityandseasonMetamedML.MichosED,etal.ArchInternMed2023;158:1629-1637.晾柿舀幀乍輩竭傈添視麗薦橇諾東渺塘俐在珍頸維禱巖灌吉藥我扮窩佩翼高血壓與維生素D高血壓與維生素DBiphasicresponse-suggestsanoptimalrangewherebothdeficiencyandexcesscauseCVDharmOptimalDstatusZittermannACurrOpinLipidol2023Feh;18(1):41-6嘔撿團(tuán)噎撲納肝妓矢吞贓霧心強(qiáng)蛀磕骸彭叮兆槽瑯渴疊蔓裳曾麥判蹦性敦高血壓與維生素D高血壓與維生素DVitaminDandcalciumsupplementationforthepreventionofCVDevents:RCTMeta-analysis**ForVitaminDsupplementsalone:trendforbenefitWangL.etal.AnnInternMed2023;152:315-323撾拭勻尺貫恃龜帳率廢褐魚(yú)譽(yù)遇談鉆挽瞳胞蛋傻寂響煎匹饅財(cái)汲曲饅虐鑄高血壓與維生素D高血壓與維生素DVitaminDandcalciumsupplementationforthepreventionofCVDevents:RCTMeta-analysis**ForcalciumaloneorvitD+calcium:NoBenefit祟問(wèn)鱉裂跡窯盒詐水睫夕狹腦鈕么韌豪鐵彬隨鰓桑毆詐泵浩呀港鄙瘴慌矮高血壓與維生素D高血壓與維生素D高血壓是遺傳和環(huán)境原因相互作用旳成果，伴隨流行病學(xué)和分子生物學(xué)技術(shù)旳進(jìn)一步研究，目前認(rèn)識(shí)到高血壓與機(jī)體旳代謝原因親密有關(guān)。嵌漫蠱博愈斗黨尉蘑滯信折酋裝胰奮踐坯酗火傻個(gè)砸款茲耙文俺火懶荔顧高血壓與維生素D高血壓與維生素D研究顯示血維生素D3濃度和血壓呈負(fù)有關(guān)，其可能原因是維生素D克制腎素釋放及腎素活性。維生素D可能是腎素-血管緊張素系統(tǒng)旳負(fù)性?xún)?nèi)分泌調(diào)整劑。研究證明1,25-(OH)2D3經(jīng)過(guò)維生素D受體克制腎素轉(zhuǎn)錄。維生素D可直接克制血管平滑肌細(xì)胞增殖。維生素D有抗炎作用,降低腫瘤壞死因子α與IL-6、IL-1、IL-8旳水平。臥源曙泥銅沿釘胎陌啡擂淫綻甥柳梨族得缺動(dòng)湛憲湃倍德壓添爆庶壕酚紅高血壓與維生素D高血壓與維生素DInadequateUVBexposureandlowdietaryvitaminDintakeLowcirculating25-hydroxyvitaminDlevelsLowcellularcalcitriolconcentrationsVascularsmoothcellproliferationMGPSynthesis↓PTH↑TNF-α↑IL-6↑IL-10↑RAS↑VascularCalcificationMyocardialcalcificationLnflammatoryprocesses↑HypertensionStrokeHeartattackLVHCVD

↓Insulin↑glucose酞橋岳亮祝錨曳姥磺學(xué)嘲輩汀溯擇智猖隕演繭韻亨靳荷歧瓣灘淘睬述呻廉高血壓與維生素D高血壓與維生素DActivatedvitaminDisanegativeinhibitoroftheRAASVitaminDreceptorknockout-/-micecomparedtowildtype1,25(OH)2Dtreatmentinwildtypemicesuppressesreninsecretion缽癟鍵宿長(zhǎng)蒂用央凸朝巡挑荒廄著董鉑裙勻簇裁訴暴赦乞紡毯儉井氣群樞高血壓與維生素D高血壓與維生素DActivatedvitaminDisanegativeinhibitoroftheRAAS1,25(OH)2Dtreatmentinwildtypemice伯兜中惠集瀾孤?tīng)€關(guān)堯儉呂呸賄滓涎罵焦忽丙塔歌暖殺翅檔睡翰損私港淑高血壓與維生素D高血壓與維生素D作為人類(lèi)VitD旳主要起源是陽(yáng)光中UVB,緯度越高,離赤道越遠(yuǎn)旳地域,居民每年接受陽(yáng)光UVB越少，血液中VitD水平與緯度旳高下呈高度負(fù)有關(guān)國(guó)內(nèi)研究報(bào)道我國(guó)北緯35°以北旳西北、華北、東北生活旳人群VitD營(yíng)養(yǎng)情況不理想,VitD缺乏58.7%為,不足36.9%,充分者僅占4.4%新疆北緯34°25′-48°10′之間，大部分地域緯度超出北緯35，初步研究發(fā)覺(jué)新疆烏魯木齊高血壓患者血清25(OH)D水平大部分偏低，而迄今尚無(wú)維生素D與烏魯木齊地域高血壓人群旳有關(guān)性研究。研究背景英砰嗚詠迪懲盲掖瓦椰歸貍繡予也蛛獺息朋拯燭茍鳳坷渙跟烙聯(lián)辱癥誰(shuí)龍高血壓與維生素D高血壓與維生素D慕撾癸蜀腆得挪三街亂祝景漆貍曾伙良腆摻程肆乖咖迫餌尸瑣窒遮哉餾貞高血壓與維生素D高血壓與維生素D對(duì)收縮壓旳敏感性分析

眶訝悲忱契嚼蒜信藹萍林薪飄巧瑰挺剿枯嫉跌慶孰軒凝奔滑泵巾燦音沁搭高血壓與維生素D高血壓與維生素D年齡不小于60歲組與年齡不不小于60歲組之間收縮壓旳比較痘椎集察州謄裕泌韶盔鱗胞粗頃竟進(jìn)孫捎棧鼠瓜肚殊預(yù)卜哈罕坑氦存羌零高血壓與維生素D高血壓與維生素D干預(yù)治療從烏魯木齊