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?
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* Ali S. Jawad

*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.

***Reply from the Author***

**No reply received from the Author**.

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## References

1.  Sukkarieh HH, Bustami RT, Abdu MN, Khokhar AA, Salih AA, Abdalla HK (2020) 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? Saudi Med J 41:1083–1089.
    
    [Abstract/FREE Full Text](http://smj.org.sa/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6Mzoic21qIjtzOjU6InJlc2lkIjtzOjEwOiI0MS8xMC8xMDgzIjtzOjQ6ImF0b20iO3M6MjA6Ii9zbWovNDEvMTIvMTM4MS5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=) 

2.  World Health Organization. International Agency for Research on Cancer. Vitamin D and Cancer. IARC Working Group Reports, Updated 2008 November. 2020 October 12, Available from URL: [http://www.iarc.fr/en/publications/pdfs-online/wrk/wrk5/Report\_VitD.pdf](http://www.iarc.fr/en/publications/pdfs-online/wrk/wrk5/Report_VitD.pdf), 5.
    
    

3.  Rosen CJ, Adams JS, Bikle DD, Black DM, Demay MB, Manson JE, et al. (2012) The nonskeletal effects of vitamin D: an Endocrine Society scientific statement. Endocr Rev 33:456–492.
    
    [CrossRef](http://smj.org.sa/lookup/external-ref?access_num=10.1210/er.2012-1000&link_type=DOI) 
    
    [PubMed](http://smj.org.sa/lookup/external-ref?access_num=22596255&link_type=MED&atom=%2Fsmj%2F41%2F12%2F1381.atom) 
    
    [Web of Science](http://smj.org.sa/lookup/external-ref?access_num=000305089000005&link_type=ISI) 

4.  Kupferschmidt K (2012) Uncertain verdict as vitamin D goes on trial. Science 337:1476–1478.
    
    [Abstract/FREE Full Text](http://smj.org.sa/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6Mzoic2NpIjtzOjU6InJlc2lkIjtzOjEzOiIzMzcvNjEwMS8xNDc2IjtzOjQ6ImF0b20iO3M6MjA6Ii9zbWovNDEvMTIvMTM4MS5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=) 

5.  Bouillon R, Marcocci C, Carmeliet G, Bikle D, White JH, Dawson-Hughes B, et al. (2019) Skeletal and extraskeletal actions of vitamin d: current evidence and outstanding questions. Endocr Rev 40:1109–1551.
    
    [PubMed](http://smj.org.sa/lookup/external-ref?access_num=http://www.n&link_type=MED&atom=%2Fsmj%2F41%2F12%2F1381.atom) 

6.  Scientific Advisory Committee on Nutirion (SACN) (2016) Vitamin D and Health, Updated 2016 July, Available from URL: [https://www.gov.uk/government/uploads/system/uploads/attachment\_data/file/537616/SACN\_Vitamin\_D\_and\_Health\_report.pdf](https://www.gov.uk/government/uploads/system/uploads/attachment\_data/file/537616/SACN\_Vitamin\_D_and_Health_report.pdf). Accessed 2020 October 16.