Racial Disparity in Blood Pressure: is Vitamin D a Factor?
Purchase on Springer.com
$39.95 / €34.95 / £29.95*
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.
Higher prevalence of hypertension among African Americans is a key cause of racial disparity in cardiovascular morbidity and mortality. Explanations for the difference in prevalence are incomplete. Emerging data suggest that low vitamin D levels may contribute.
To assess the contribution of vitamin D to racial disparity in blood pressure.
Adult non-Hispanic Black and White participants from the National Health and Nutrition Examination Survey 2001–2006.
We assessed Black-White differences in systolic blood pressure (SBP) controlling for conventional risk factors, and then additionally, for vitamin D (serum 25[OH]D).
The sample included 1984 and 5156 Black and White participants ages 20 years and older. The mean age-sex adjusted Black-White SBP difference was 5.2 mm Hg. This difference was reduced to 4.0 mm Hg with additional adjustment for socio-demographic characteristics, health status, health care, health behaviors, and biomarkers; adding 25(OH)D reduced the race difference by 26% (95% CI 7–46%) to 2.9 mm Hg. This effect increased to 39% (95% CI 14–65%) when those on antihypertensive medications were excluded. Supplementary analyses that controlled for cardiovascular fitness, percent body fat, physical activity monitoring, skin type and social support yielded consistent results.
In cross-sectional analyses, 25(OH)D explains one quarter of the Black-White disparity in SBP. Randomized controlled trials are required to determine whether vitamin D supplementation could reduce racial disparity in BP.
- Fryar CD, Hirsch R, Eberhardt MS, Yoon SS, Wright JD. Hypertension, High Serum Total Choleseterol, and Diabetes: Racial and Ethnic Prevalence Differences in U.S. Adults, 1999–2006. Hyattsville, MD: National Center for Health Statistics, 2010.
- Forrester T, Cooper RS, Weatherall D. Emergence of Western diseases in the tropical world: the experience with chronic cardiovascular diseases. Br Med Bull. 1998;54:463–473.
- Okosun IS, Boltri JM, Anochie LK, Chandra KM. Racial/ethnic differences in prehypertension in American adults: Population and relative attributable risks of abdominal obesity. J Hum Hypertens. 2004;18:849–855. CrossRef
- Brondolo E, Libby DJ, Denton EG, et al. Racism and ambulatory blood pressure in a community sample. Psychosom Med. 2008;70:49–56. CrossRef
- Holick MF. Vitamin D deficiency. N Engl J Med. 2007;357:266–281. CrossRef
- Li YC, Kong J, Wei M, Chen ZF, Liu SQ, Cao LP. 1,25-Dihydroxyvitamin D(3) is a negative endocrine regulator of the renin-angiotensin system. J Clin Invest. 2002;110:229–238.
- Mantell DJ, Owens PE, Bundred NJ, Mawer EB, Canfield AE. 1 alpha,25-dihydroxyvitamin D(3) inhibits angiogenesis in vitro and in vivo. Circ Res. 2000;87:214–220.
- Beer TM, Venner PM, Ryan CW, et al. High dose calcitriol may reduce thrombosis in cancer patients. Br J Haematol. 2006;135:392–394. CrossRef
- Xiang W, Kong J, Chen S, et al. Cardiac hypertrophy in vitamin D receptor knockout mice: role of the systemic and cardiac renin-angiotensin systems. Am J Physiol Endocrinol Metabol. 2005;288:E125–E132. CrossRef
- Perkovic V, Hewitson TD, Kelynack KJ, Martic M, Tait MG, Becker GJ. Parathyroid hormone has a prosclerotic effect on vascular smooth muscle cells. Kidney Blood Pres Res. 2003;26:27–33. CrossRef
- Holick MF. Sunlight and vitamin D: both good for cardiovascular health. J Gen Intern Med. 2002;17:733–735. CrossRef
- Pilz S, Tomaschitz A, Ritz E. Pieber TR. Medscape. Vitamin D status and arterial hypertension: a systematic review. Nature Rev Cardiol. 2009;6:621–630.
- Chen TC, Chimeh F, Lu Z, et al. Factors that influence the cutaneous synthesis and dietary sources of vitamin D. Arch Biochem Biophys. 2007;460:213–217. CrossRef
- Jablonski NG, Chaplin G. The evolution of human skin coloration. J Hum Evol. 2000;39:57–106. CrossRef
- Signorello LB, Williams SM, Zheng W et al. Blood vitamin D levels in relation to genetic estimation of African ancestry. Cancer Epidemiol Biomarkers Prev. 2010.
- Judd SE, Nanes MS, Ziegler TR, Wilson PW, Tangpricha V. Optimal vitamin D status attenuates the age-associated increase in systolic blood pressure in white Americans: results from the third National Health and Nutrition Examination Survey. Am J Clin Nutr. 2008;87:136–141.
- Scragg R, Sowers M, Bell C. Serum 25-hydroxyvitamin D, ethnicity, and blood pressure in the Third National Health and Nutrition Examination Survey. Am J Hypertens. 2007;20:713–719. CrossRef
- Grey A, Bolland M. Vitamin D: a place in the sun? Arch Intern Med. 2010;170:1099–1100. CrossRef
- Miller WG. Estimating glomerular filtration rate. Clin Chemistry Lab Med. 2009;47:1017–1019. CrossRef
- National Health and Nutrition Examination Survey. National Health and Nutrition Examination Survey. Physician examination procedures manual (original 1999, revised 2000). http://www.cdc.gov/nchs/data/nhanes/nhanes_01_02/physician_year_3.pdf acccessed 3/18/2011.
- Lewington S, Clarke R, Qizilbash N, Peto R, Collins R, Prospective SC. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet. 2002;360:1903–1913. CrossRef
- Wang TJ, Pencina MJ, Booth SL, et al. Vitamin D deficiency and risk of cardiovascular disease. Circulation. 2008;117:503–511. CrossRef
- Halder I, Yang BZ, Kranzler HR, Stein MB, Shriver MD, Gelernter J. Measurement of admixture proportions and description of admixture structure in different U.S. populations. Hum Mutat. 2009;30:1299–1309. CrossRef
- Wang CY, Haskell WL, Farrell SW, et al. Cardiorespiratory fitness levels among US adults 20–49 years of age: findings from the 1999–2004 National Health and Nutrition Examination Survey. Am J Epidemiol. 2010;171:426–435. CrossRef
- Ham SA, Ainsworth BE. Disparities in data on Healthy People 2010 physical activity objectives collected by accelerometry and self-report. Am J Public Health. 2010;100:Suppl-8.
- Li C, Ford ES, Zhao G, Balluz LS, Giles WH. Estimates of body composition with dual-energy X-ray absorptiometry in adults. Am J Clin Nutr. 2009;90:1457–1465. CrossRef
- Fitzpatrick TB. The validity and practicality of sun-reactive skin types I through VI. Arch Dermatol. 1988;124:869–871. CrossRef
- Clogg CC, Petkova E, Haritou A. Statistical methods for comparing regression coefficients between models. Am J Sociol. 1995;100:1261–1293. CrossRef
- Looker AC. Body fat and vitamin D status in black versus white women. J Clin Endocrinol Metabol. 2005;90:635–640. CrossRef
- Bell NH, Epstein S, Greene A, Shary J, Oexmann MJ, Shaw S. Evidence for alteration of the vitamin D-endocrine system in obese subjects. J Clin Invest. 1985;76:370–373. CrossRef
- Jamerson KA. The disproportionate impact of hypertensive cardiovascular disease in African Americans: getting to the heart of the issue. J Clin Hypertens. 2004;6:Suppl-10.
- Forman JP, Giovannucci E, Holmes MD, et al. Plasma 25-hydroxyvitamin D levels and risk of incident hypertension. Hypertension. 2007;49:1063–1069. CrossRef
- Jorde R, Figenschau Y, Emaus N, Hutchinson M, Grimnes G. Serum 25-hydroxyvitamin D levels are strongly related to systolic blood pressure but do not predict future hypertension. Hypertension. 2010;55:792–798. CrossRef
- Forouhi NG, Luan J, Cooper A, Boucher BJ, Wareham NJ. Baseline serum 25-hydroxy vitamin d is predictive of future glycemic status and insulin resistance: the Medical Research Council Ely Prospective Study 1990–2000. Diabetes. 2008;57:2619–2625. CrossRef
- Witham MD, Nadir MA, Struthers AD. Effect of vitamin D on blood pressure: a systematic review and meta-analysis. J Hypertens. 2009;27:1948–1954. CrossRef
- Reinivuo H, Valsta LM, Laatikainen T, Tuomilehto J, Pietinen P. Sodium in the Finnish diet: II trends in dietary sodium intake and comparison between intake and 24-h excretion of sodium. Eur J Clin Nutr. 2006;60:1160–1167. CrossRef
- Leiba A, Vald A, Peleg E, Shamiss A, Grossman E. Does dietary recall adequately assess sodium, potassium, and calcium intake in hypertensive patients? Nutrition. 2005;21:462–466. CrossRef
- Bosworth HB, Dudley T, Olsen MK, et al. Racial differences in blood pressure control: potential explanatory factors. Am J Med. 2006;119:70–15.
- Bosworth HB, Bartash RM, Olsen MK, Steffens DC. The association of psychosocial factors and depression with hypertension among older adults. Int J Geriatr Psychiatry. 2003;18:1142–1148. CrossRef
- Lepore SJ, Revenson TA, Weinberger SL, et al. Effects of social stressors on cardiovascular reactivity in Black and White women. Ann Behav Med. 2006;31:120–127. CrossRef
- Hersch J. Profiling the new immigrant Worker: the effects of skin color and height. J Labor Econom. 2008;26:345–386. CrossRef
- Hersch J. Skin-Tone effects among African Americans: perceptions and reality. The Am Econom Rev. 2006;96:251–255. CrossRef
- Harrison MS, Thomas KM. The hidden prejudice in selection: A research investigation on skin color bias. J Applied Soc Psych. 2009;39:134–168. CrossRef
- Klag MJ, Whelton PK, Coresh J, Grim CE, Kuller LH. The association of skin color with blood pressure in US blacks with low socioeconomic status. JAMA. 1991;265:599–602. CrossRef
- Sweet E, McDade TW, Kiefe CI, Liu K. Relationships between skin color, income, and blood pressure among African Americans in the CARDIA Study. Am J Public Health. 2007;97:2253–2259. CrossRef
- Wong MD, Shapiro MF, Boscardin WJ, Ettner SL. Contribution of major diseases to disparities in mortality. N Engl J Med. 2002;347:1585–1592. CrossRef
- Fiscella K, Holt K. Racial disparity in hypertension control: The death toll. Ann Fam Med. 2008;6:486–489. CrossRef
- Diaz VA, Mainous AG III, Carek PJ, Wessell AM, Everett CJ. The association of vitamin D deficiency and insufficiency with diabetic nephropathy: implications for health disparities. J Am Board Fam Med. 2009;22:521–527. CrossRef
- Reis JP, Michos ED. von MD, Miller ER, III. Differences in vitamin D status as a possible contributor to the racial disparity in peripheral arterial disease. Am J Clin Nutr. 2008;88:1469–1477. CrossRef
- Melamed ML, Astor B, Michos ED, Hostetter TH, Powe NR, Muntner P. 25-hydroxyvitamin D levels, race, and the progression of kidney disease. J Am Soc Nephrol. 2009;20:2631–2639. CrossRef
- Fiscella K, Franks P. Vitamin D, race, and cardiovascular mortality: findings from a national US sample. Ann Fam Med. 2010;8:11–18. CrossRef
- Houghton JL, Philbin EF, Strogatz DS, et al. The presence of African American race predicts improvement in coronary endothelial function after supplementary L-arginine. Am J Cardiol. 2002;39:1314–1322. CrossRef
- Campia U, Choucair WK, Bryant MB, Waclawiw MA, Cardillo C, Panza JA. Reduced endothelium-dependent and -independent dilation of conductance arteries in African Americans. J Am Coll Cardiol. 2002;40:754–760. CrossRef
- Tarcin O, Yavuz DG, Ozben B, et al. Effect of vitamin D deficiency and replacement on endothelial function in asymptomatic subjects. J Clin Endocrinol Metabol. 2009;94:4023–4030. CrossRef
- Sugden JA, Davies JI, Witham MD, Morris AD, Struthers AD. Vitamin D improves endothelial function in patients with Type 2 diabetes mellitus and low vitamin D levels. Diabet Med. 2008;25:320–325. CrossRef
- London GM, Guerin AP, Verbeke FH, et al. Mineral metabolism and arterial functions in end-stage renal disease: potential role of 25-hydroxyvitamin D deficiency. J Am Soc Nephrol. 2007;18:613–620. CrossRef
- Ngo DT, Sverdlov AL, McNeil JJ, Horowitz JD. Does vitamin D modulate asymmetric dimethylarginine and C-reactive protein concentrations? Am J Med. 2010;123:335–341. CrossRef
- Alborzi P, Patel NA, Peterson C, et al. Paricalcitol reduces albuminuria and inflammation in chronic kidney disease: a randomized double-blind pilot trial. Hypertension. 2008;52:249–255. CrossRef
- Wilson TW, Hollifield LR, Grim CE. Systolic blood pressure levels in black populations in sub-Sahara Africa, the West Indies, and the United States: a meta-analysis. Hypertension. 1991;18:Suppl-91.
- Franks P, Fiscella K. Reducing disparities downstream: prospects and challenges. J Gen Intern Med. 2008;23:672–677. CrossRef
- Hall LM, Kimlin MG, Aronov PA, et al. Vitamin D intake needed to maintain target serum 25-hydroxyvitamin D concentrations in participants with low sun exposure and dark skin pigmentation is substantially higher than current recommendations. J Nutr. 2010;140:542–550. CrossRef
- Racial Disparity in Blood Pressure: is Vitamin D a Factor?
Journal of General Internal Medicine
Volume 26, Issue 10 , pp 1105-1111
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- vitamin D
- blood pressure
- African continental ancestry
- Industry Sectors
- Author Affiliations
- 1. Departments of Family Medicine and Community & Preventive Medicine, University of Rochester School of Medicine, 1381 South Ave, Rochester, NY, 14620, USA
- 2. Department of Family Medicine, University of Rochester School of Medicine, 1381 South Ave, Rochester, NY, 14620, USA
- 3. Center for Healthcare Policy and Research, Department of Pediatrics, University of California at Davis, Sacramento, CA, USA
- 4. Center for Healthcare Policy and Research, Department of Family & Community Medicine, University of California at Davis, Sacramento, CA, USA