Association between H-type Hypertension and Asymptomatic Extracranial Artery Stenosis

Abstract

Asymptomatic extracranial artery stenosis (ECAS) is a well-known risk factor for stroke and H-type hypertension, which is defined as hypertension with hyperhomocysteinemia, is associated with cardio-cerebrovascular diseases. However, the impact of H-type hypertension on ECAS is mostly unknown. We designed this study to investigate the association between H-type hypertension and prevalence of ECAS. We included 2330 participants in this study and classified them into four groups: the control group without hypertension or hyperhomocysteinemia, isolated hypertension group, isolated hyperhomocysteinemia group and H-type hypertension group. We measured the baseline plasma total homocysteine levels and assessed ECAS by carotid duplex sonography twice at baseline and during follow up. We used a Cox regression model to analyse the association between H-type hypertension and ECAS. At baseline, 608 subjects suffered from H-type hypertension. Within two years of follow-up, asymptomatic ECAS occurred in 250 (10.73%) participants. After adjusting for relevant risk factors, we found H-type hypertension to be an independent risk factor for asymptomatic ECAS (relative risk (RR) 3.16, 95% confidence interval (95% CI) 2.00–5.00). Our findings provide direct evidence for the importance of H-type hypertension in the occurrence of ECAS and as a potential therapeutic target for carotid atherosclerosis.

Value of plasma homocysteine to predict stroke, cardiovascular diseases, and new-onset hypertension

“…As a result, blood pressure increases. [ 18 , 20 ] Many studies have shown that Hcy is associated with elevated blood pressure. [ 5 , 17 , 18 , 20 ] For every 5 μmol/L increase in Hcy, the SBP and DBP increase by 0.7/1.2 mm Hg and 0.5/0.7 mm Hg in women and men, respectively.…”

“…[ 18 , 20 ] Many studies have shown that Hcy is associated with elevated blood pressure. [ 5 , 17 , 18 , 20 ] For every 5 μmol/L increase in Hcy, the SBP and DBP increase by 0.7/1.2 mm Hg and 0.5/0.7 mm Hg in women and men, respectively. [ 49 ] In addition, in 2016, a meta-analysis of 11 published epidemiological studies demonstrated that Hcy contributed to the risk of essential hypertension (OR = 1.36, 95% CI: 1.02–1.80, random-effects model).…”

“…[ 5 , 17 ] In China, due to the lack of folic acid and B vitamin intake in the diet and a high mutation rate of the methylenetetrahydrofolate reductase gene (the C677T single nucleotide polymorphism), which can cause an increase in Hcy, the proportion of patients with hypertension and Hhcy, which is known as H-type hypertension, is higher than that in other populations. [ 18 – 20 ] A study showed that Hhcy in Chinese hypertensive patients is associated with the risk of ischemic stroke, but not with the risk of coronary heart disease. [ 21 ] In Chinese populations, multivitamin supplementation containing folic acid decreases the risk of stroke, but not of coronary heart disease.…”

Atherosclerosis at Extracranial Carotid Vessels and Serum Homocysteine

“…In other studies, serum homocysteine was significantly associated with carotid artery stenosis in internal carotid arteries and external carotid arteries as well as the degree of stenosis [83,84]. The hypertensive patients who had raised serum homocysteine were reported to have higher risk of developing asymptomatic extracranial carotid artery stenosis [85]. However, other studies showed conflicting results [86][87].…”

Association between H-type hypertension and Cognitive impairment in Kailuan community of China: A cross-sectional study.

“…Assessment of H-type hypertension H-type HTN was defined as HTN combined with HHcy [19]. The blood pressure of each participant was twice measured by a mercury sphygmomanometer, and the average of the 2 readings was calculated.…”