Perspective Review: Vitamin D Supplementation and Blood Pressure Control in Obese Children: Exploring the Role of Endothelin-1

Abstract

Vitamin D deficiency is a common condition observed in children with obesity. Vitamin D insufficiency has been associated with various adverse outcomes, one of which is an increased risk of cardiovascular disease mediated through elevated blood pressure. Numerous studies have explored the relationship between vitamin D deficiency and hypertension in obese children, with mechanisms involving impaired calcium metabolism, activation of the renin-angiotensin-aldosterone system (RAAS), and increased oxidative stress that may lead to endothelial dysfunction. Based on these mechanisms, vitamin D supplementation is theoretically expected to reduce the risk of hypertension through improvements in vascular function. However, findings from interventional studies have so far been inconsistent, and the effectiveness of vitamin D supplementation in lowering blood pressure in this population remains debatable. One aspect that has been relatively underexplored is the role of endothelin-1, a potent vasoconstrictor known to be elevated in children with obesity, and its potential association with vitamin D status. This review aims to examine the potential relationship between vitamin D levels and endothelin-1 expression in obese children, as an alternative pathway that may explain the inconsistent effects of vitamin D supplementation on blood pressure.