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ISSN: 2319-7064
ResearchGate Impact Factor (2018): 0.28 | SJIF (2018): 7.426
Affiliation: Family Medicine Department, King Abdulaziz National Guard Hospital, Al Ahsa, King Abdullah International Medical
Research Center, Al Ahsa, Saudi Council for Health Specialties – Family Medicine Residency Program ER – Al Ahsa
Abstract: Objective: This study aimed to determine the prevalence of vitamin D deficiency in patients with hypertension and investigate
the association between vitamin D level and blood pressure control. Methods: A cross-sectional study was conducted on patients with
hypertension who visited family medicine clinics of King Abdulaziz National Guard Hospital, Al Ahsa, in 2017. Data were collected
through self-administrated questionnaire that included both demographic and lifestyle factors with blood pressure and vitamin D level,
which were measured through a medical chart review. Results: Of the 246 patients who participated in the study, 51.6% had
uncontrolled hypertension. Current intake of vitamin D was noted in 56.9% of patients with hypertension. A majority of patients with
hypertension (78.6%) had vitamin D insufficiency, whereas 10% had vitamin D deficiency. There was a statistically significant mild
negative correlation between systolic blood pressure (SBP) and vitamin D level (r=-0.14, p=0.04). Conclusion: Vitamin D
insufficiency/deficiency is particularly common among patients with hypertension, with mild negative correlation between vitamin D
level and SBP. It is recommended to maintain optimal vitamin D level to control blood pressure.
To collect the sample, study investigators coordinated with Table 2 presents the association of the general characteristics
patient services employees who received all patients. They of patients with hypertension and BP control. None of the
were informed about the purpose of the study and were studied variables were significantly associated with SBP,
explained how to answer and how and when to distribute although higher uncontrolled BP (SBP >140 mmHg) was
and collect the questionnaires from the patients. They were reported in patients aged >60 years (57%), female patients
also instructed to ask the patients during registration about (53%), and illiterate patients (56%) compared to their
the presence of hypertension. Every other patient with counterparts. Patients who were diagnosed ≥10 years were
hypertension was included to generate randomness in the more likely to have uncontrolled hypertension compared to
sample collection process. Hence, the inclusion criteria were those diagnosed more recently (<5 years) (55% versus 44%).
confirmed hypertension and age of at least 18 years. However, the difference was not statistically significant.
Moreover, vitamin D intake and level were not significantly
Data was collected through a self-designed questionnaire associated with SBP.
based on some previous studies. The study questionnaire had
the following two main sections: (1) self-administered Table 3 shows the association between lifestyle
Arabic questions, including personal characteristics, such as characteristics of patients with hypertension and SBP.
age, sex, and lifestyle characteristics (e.g., physical activity, Regarding body mass index, almost two-thirds (67.9%) of
nutrition, and smoking); medical history; and compliance to severely obese patients had SBP >140 mmHg compared to
medications and (2) chart review, which was filled by the 23.5% of underweight patients (P=0.04). As shown in Table
investigator from the BESTCare system and included the 4 and Figure 1, there was a mild negative correlation
SBP and DBP during the last vitamin D level laboratory between SBP and vitamin D level (r=-0.14, P=0.04), which
request, other comorbidities, and the most recent vitamin D is statistically significant.
level.
Table 1: General characteristics of patients with
Ethical approval for the study was obtained from the Saudi hypertension (No. 246)
Council for Health Specialties after reviewing the study Item Categories No. %
proposal. After obtaining ethical approval, Family Medicine Age ≤60 years 121 51.5%
and Patient Services departments were requested to provide (Missed 11) >60 years 114 48.5%
Sex Male 145 59.2%
an access to patient files. The purpose of the study was
(Missed 1) Female 100 40.8%
explained to the patients, and written consent was obtained
Illiterate 116 47.2%
before providing the questionnaire to them. Participation
Educational level Low 88 35.8%
was voluntary, and anyone can refuse participation. High 42 17.1%
DM 189 76.8%
Data was collected, cleaned, coded, and analyzed using Chronic diseases Dyslipidemia 74 30.1%
Statistical Package for Social Sciences (version 21) Family history (Missed 2) 142 58.2%
software. Categorical data were expressed as frequency and >140 mmHg 127 51.6%
percentage, whereas continuous variables were presented SBP
<140 mmHg 119 48.4%
mean and standard deviation. The chi-square test was used Time of HTN <5 years 75 32.6%
to evaluate the association between categorized BP and diagnosis 5–9 years 55 23.9%
possible associated factors, including categorized vitamin D (Missed 16) ≥10 years 100 43.5%
level. Pearson correlation was used to find the association Yes, currently 140 56.9%
between SBP and vitamin D level. The level of statistical Vitamin D intake Yes, previously 34 13.8%
significance was determined at P=0.05. No 72 29.3%
Deficiency 23 10%
Vitamin D level
Insufficiency 180 78.6%
3. Results (Missed 17)
Sufficiency 26 11.4%
Table 3: Distribution of lifestyle factors in patients with hypertension based on systolic blood pressure (mmHg)
SBP >140 (127) SBP ≤140 (119)
Item Categories Total P-value OR
No. % No. %
No* 16 64% 9 36% 25 1
Fruit and vegetables per week 1–3 69 55.6% 55 44.4% 124 0.08 0.71
≥4 42 43.3% 55 56.7% 97 0.43
1– 2* 66 58.4% 47 41.6% 113
Meals/day 0.05 0.6
3–4 61 45.9% 72 54.1% 133
Usually* 6 37.5% 10 62.5% 16 1
Unhealthy food Sometimes 70 52.2% 64 47.8% 134 0.5 1.8
Never 51 53.1% 45 46.9% 96 1.9
Usually* 10 38.5% 16 61.5% 26 1
Nutritional diet Sometimes 50 53.8% 43 46.2% 93 0.4 1.9
Never 67 52.8% 60 47.2% 127 1.8
Yes* 11 45.8% 13 54.2% 24
Heavy physical activity/weak 0.6 1.3
No 116 52.3% 106 47.7% 222
No 90 56.3% 70 43.8% 160 2.2
Moderate physical activity/weak <150 min 19 51.4% 18 48.6% 37 0.05 1.8
≥150 min* 18 36.7% 31 63.3% 49 1
Yes * 9 52.9% 8 47.1% 17
Gym membership 0.9 0.94
No 118 51.5% 111 48.5% 229
<6 h 48 57.1% 36 42.9% 84 2.67
Sleep hours/day 6–8 h 73 50.7% 71 49.3% 144 0.2 2.06
>8 h* 6 33.3% 12 66.7% 18 1
No 113 53.8% 97 46.2% 210 2.04
Tobacco use Previously 10 40% 15 60% 25 0.25 1.17
Yes* 4 36.4% 7 63.6% 11 1
Never* 10 47.6% 11 52.4% 21 1
Coffee drink/day (Missed 2) 1–2 times 60 52.2% 55 47.8% 115 0.9 1.20
≥3 times 56 51.9% 52 48.1% 108 1.18
Usually 92 53.2% 81 46.8% 173
Medication compliance 0.5 1.2
Never/sometimes* 35 47.9% 38 52.1% 73
Usually 90 52% 83 48% 173
Appointments compliance 0.8 1.1
Never/sometimes* 37 50.7% 36 49.3% 73
Underweight* 4 23.5% 13 76.5% 17 1
Healthy weight 35 55.6% 28 44.4% 63 4.1
BMI
Overweight 44 53% 39 47% 83 0.04 3.7
(Missed 2)
Obese 23 43.4% 30 56.6% 53 2.5
Severely obese 19 67.9% 9 32.1% 28 6.9
Figure 1: Scatter plot elaborates of corelation between SBP and Vit. D level for hypertensive patients (r= -0.14)