Comment on: The current practice of using angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers in diabetic hypertensive and non-hypertensive patients. Is there a room for vitamin D?

To the Editor

Sukkarieh et al,1 answer to the question they raise in their recent article that there is a room for recommending vitamin D supplements in using angiotensin-converting enzyme inhibitors (ACEi) and angiotensin II receptor blockers (ARBs) in diabetic hypertensive and non-hypertensive patients.

The literature is full of data indicating a higher risk of many diseases such as immune mediated conditions, infections, diabetes mellitus, cardiovascular diseases, and cancer, if 25-hydroxyvitamin D (25[OH] D) levels are <20 ng/mL (50 nmol/L) and the risk decreases with higher level.2-5 There is little evidence for a linear causal association between vitamin D levels and risk of these diseases. There are no randomized controlled trials that show that adding vitamin D will lead to decreasing this risk or alter the outcome of these conditions. More research is needed to clarify the role of vitamin D in the prevention and management of extra skeletal diseases.

In conclusion, it is inappropriate to recommend vitamin D supplements in diabetic patients with or without hypertension using ACEi and ARBs medication. The Scientific Advisory Committee on Nutrition (SACN) has recommended a reference nutrient intake, the amount that is sufficient to meet the needs of 97.5% of the population, for vitamin D of 10µg (400 IU) a day to protect musculoskeletal health in people aged 4 years or older.6 Lastly, vitamin D intoxication may cause hypercalcemia with confusion, polyuria, and polydipsia, muscle weakness and pain, nephrocalcinosis and bone demineralization.

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