Homocysteine predicts vascular target organ damage in hypertension and may serve as guidance for first‐line antihypertensive therapy

Abstract

Homocysteine is an independent risk factor for cardiovascular and cerebrovascular disease and has been proposed to contribute to vascular dysfunction. We sought to determine in a real‐world clinical setting whether homocysteine levels were associated with hypertension mediated organ damage (HMOD) and could guide treatment choices in hypertension. We performed a cross‐sectional analysis of prospectively collected data in 145 hypertensive patients referred to our tertiary hypertension clinic at Royal Perth Hospital and analyzed the association of homocysteine with HMOD, renin‐angiotensin‐aldosterone system (RAAS), and RAAS blockade. The average age of participants was 56 ± 17 years, and there was a greater proportion of males than females (89 vs. 56). Regression analysis showed that homocysteine was significantly associated with PWV (β = 1.99; 95% CI 0.99‐3.0; p < .001), albumin‐creatinine ratio (lnACR: β = 1.14; 95% CI 0.47, 1.8; p < .001), 24 h urinary protein excretion (β = 0.7; 95% CI 0.48, 0.92; p < .001), and estimated glomerular filtration rate (β = −29.4; 95% CI −36.35, −22.4; p < .001), which persisted after adjusting for potential confounders such as age, sex, 24 h BP, inflammation, smoking, diabetes mellitus (DM), and dyslipidemia. A positive predictive relationship was observed between plasma homocysteine levels and PWV, with every 1.0 µmol/L increase in homocysteine associated with a 0.1 m/s increase in PWV. Homocysteine was significantly associated with elevated aldosterone concentration (β = 0.26; p < .001), and with attenuation of ACEi mediated systolic BP lowering and regression of HMOD compared to angiotensin receptor blockers in higher physiological ranges of homocysteine. Our results indicate that homocysteine is associated with hypertension mediated vascular damage and could potentially serve to guide first‐line antihypertensive therapy.

Time to Change Our Viewpoints to Assess Renal Risks in Patients with Solitary Kidneys beyond Traditional Approaches?

“…In one study, homocysteine was associated with a non-dipping pattern, a strong predictor of cardiovascular mortality and morbidity in hypertensive individuals [48]. Although there was no significant correlation with dipping status in our study, its correlation with nSyst supported this.…”

“…Although the decrease in GFR and the increase in homocysteine and UA levels were found to be significantly higher in renal donors at the 36-month follow-up, no difference was detected between both groups in ABPM measurement followups [49]. In the study of Carnagarin et al, homocysteine was found to be compatible with pulse wave velocity, which is an important cardiovascular risk factor [48]. With all these findings, the question arises of whether or not the endothelial damaging effect of homocysteine may be more potent in Nx(−) patients with SFK than it is in Nx(+) patients.…”

Preliminary Consequences of Blood Pressure Management and Blood Homocysteine Levels with Perindopril in Newly Diagnosed Hypertensive Patients in the Vietnamese Population

“…Newly Diagnosed Hypertensive Patients. Recent years have seen an increase in the number of studies examining the infuence of antihypertensive medications on blood Hcy levels used to prevent cardiovascular disease [10,33,34]. Potential mechanisms by which Hcy may facilitate the development of hypertension include impaired vascular endothelial and smooth muscle cell function [31].…”

Development of a colloidal gold strip assay for the detection of total homocysteine in serum samples

“…3,4 This can greatly increase the risk of coronary heart disease (CHD), peripheral vascular disease (PVD) and cerebrovascular disease (CVD). 5–7 Therefore, blood Hcy is an important indicator of human health and when levels in plasma reach 6.3 μM, it represents a high risk of cardiovascular or cerebrovascular events and when these levels reach 10 μM, the incidence of the above events increases 2-fold. Moreover, some studies have reported an association between high serum Hcy levels and Parkinson's disease (PD) 8 or Alzheimer's disease (AD).…”