Independent cardiovascular risk factors: hyperhomocysteinemia and vascular stiffness in patients with hypertension
Keywords:homocysteine, H-type hypertension, pulse wave velocity, arterial stiffness
Background. Identification of risk factors and preliminary assessment of overall cardiovascular risk in patients with hypertension is the most important task in clinical practice. Most patients, in addition to high blood pressure (BP), have other cardiovascular risk factors that aggravate each other, leading to an increase in overall cardiovascular risk. One of the cardiovascular risk factors is an increased arterial stiffness. Arterial stiffness is evaluated using pulse wave velocity (PWV). The other independent risk factor for cardiovascular diseases is elevated level of total homocysteine in the blood. The purpose was to evaluate the relationship between hyperhomocysteinemia (HHc) and vascular stiffness in patients with hypertension. Materials and methods. Our research was carried out as a part of the ХІПСТЕР trial in Ukraine. The study included 40 patients with hypertension stage 1 and 2 (average office systolic (SBP)/diasto-lic blood pressure (DBP) was 155.88/92.60 ± 1.63/1.43 mmHg, heart rate — 71.40 ± 1.29 bpm). The average age of the patients was 55.85 ± 2.09 (26–74) years. Individuals with homocysteine levels ≥ 10 μmol/l were referred to as those with HHc
(H-type hypertension). Arterial stiffness was determined by PWV. Results. We found that at the beginning of the study, 75 %
of patients (30 individuals with mild and moderate hypertension) had H-type hypertension with an increased level of homocysteine. Patients with H-type hypertension (HHc) and hypertension without HHc did not differ in terms of age, duration of hypertension. At the same time, patients with H-type hypertension had higher body weight and body mass index. Office SBP in patients with H-type hypertension at baseline and after 6 months of treatment was higher compared to patients without HHc (156.45 ± 1.04 mmHg and 152.55 ±1.41 mmHg (p < 0.05) at baseline vs 130.65 ± 0.96 mmHg and 126.97 ± 1.08 mmHg (p < 0.05) in 6 months). At the beginning of the study, body mass index was 30.72 ± 0.39 kg/m2 in patients with H-type hypertension vs 28.34 ± 0.69 kg/m2 in those without HHc (p < 0.05). Patients with H-type hypertension less often achieved target blood pressure levels during treatment and initially had higher blood pressure values. Individuals with H-type hypertension compared to patients without HHc had a more severe insulin resistance (according to the homeostatic model assessment), lower glomerular filtration rate, both at baseline and by the end of treatment. According to ambulatory blood pressure monitoring data, before the start of treatment, patients with H-type hypertension compared to those with hypertension without HHc had a significantly higher SBP level. After regression analysis, homocysteine level was associated with PWVel, regardless of the degree of BP reduction (PWVel (6 months), m/s, b = 0.307, P = 0.001). Conclusions. Male gender, body mass index, glomerular filtration rate, blood glucose, office and central blood pressure were associated with elevated serum homocysteine levels.
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