The effect of vitamin D treatment on clinical and biochemical outcomes of primary aldosteronism

• Published in: Clinical endocrinology (Oxford) 2020-06, Vol.92 (6), p.509-517
• Main Authors: Ismail, Noor Ashikin, Kamaruddin, Nor Azmi, Azhar Shah, Shamsul, Sukor, Norlela
• Format: Article
• Language: English
• Subjects: 25-Hydroxyvitamin D; Aldosterone; Blood pressure; bone density; Calcium (blood); Calcium (urinary); Calcium homeostasis; Cardiovascular diseases; cholecalciferol; Endocrine disorders; Epidermal growth factor receptors; Homeostasis; hyperaldosteronism; hypertension; Nutrient deficiency; Parathyroid; Parathyroid hormone; Patients; Renal function; Renin; renin‐angiotensin‐aldosterone system; Vitamin D; vitamin D deficiency; Vitamin deficiency
• ISSN: 0300-0664; 1365-2265
• DOI: 10.1111/cen.14177

Introduction Primary aldosteronism (PA) contributed to the cardiovascular disease and metabolic alterations independent of the blood pressure level. Evidence exists that aldosterone excess also affects calcium and mineral homeostasis. PA subjects have been shown to have greater prevalence of vitamin D deficiency. However, the impact of vitamin D treatment in this population has never been assessed. Objective This study aimed to evaluate the effect of vitamin D treatment on clinical and biochemical outcomes of PA patients. Methods Two hundred forty hypertensive subjects were screened, 31 had positive ARR, and 17 patients with newly confirmed PA following positive confirmatory test that has not been subjected for definitive treatment were enrolled. Clinical parameter (blood pressure) and biochemical parameters (renal profile, plasma aldosterone concentration, plasma renin activity, serum calcium, vitamin D, intact parathyroid hormone, 24‐hour urinary calcium) were measured at baseline and 3 months of treatment with Bio‐D3 capsule. Primary outcomes were the changes in the blood pressure and biochemical parameters. Results About 70% of our PA subjects have low vitamin D levels at baseline. Three months following treatment, there were significant: (a) improvement in 25(OH)D levels; (b) reduction in systolic blood pressure and plasma aldosterone concentration; and (c) improvement in the eGFR. The vitamin D deficient subgroup has the greatest magnitude of the systolic blood pressure reduction following treatment. Conclusions This study demonstrated significant proportion of PA patients has vitamin D insufficiency. Vitamin D treatment improves these interrelated parameters possibly suggesting interplay between vitamin D, aldosterone, renal function and the blood pressure.