Curgunlu Asli, Karter Yesari, Uzun Hafize, Aydin Seval, Ertürk Nurver, Vehid Suphi, Simsek Gönül, Kutlu Ayse, Oztürk Esin, Erdine Serap
Department of Internal Medicine, Cerrahpasa Medical Faculty, Taksim Public Hospital, Istanbul University, Eminonu, Turkey.
Int Heart J. 2005 Mar;46(2):245-54. doi: 10.1536/ihj.46.245.
The association between homocysteine and sustained hypertension (HT) has been studied. The aim of this study was to assess homocysteine levels in white coat hypertension (WCH) as an indicator of increased risk in the development of cardiovascular diseases. WCH was defined as clinical hypertension and a daytime ambulatory blood pressure of < 135/85 mmHg. Plasma levels of homocysteine were determined in patients with WCH, hypertension, and normotension (NT). The study group included 100 subjects, 33 with WCH (16 males, 17 females) aged 49.1 +/- 1.9; 35 sustained hypertensives (17 males,18 females) aged 48.5 +/- 1.7 and 32 normotensive control subjects (15 males, 17 females) aged 48.8 +/- 2.2. The subjects were matched for age, gender, and body mass index. Patients with a smoking habit, dyslipidemia, or diabetes mellitus were not included in the study. Homocysteine levels were analyzed by ELISA. Plasma homocysteine levels were significantly higher in the WCH group compared to the controls (12.32 +/- 1.07 versus 5.35 +/- 1.38 micromol/L; P < 0.001) and the WCH group had significantly lower homocysteine values than the hypertensives (19.03 +/- 0.76 micromol/L P < 0.001). Total cholesterol and tri-glycerides were not different among the groups. There were no statistically significant differences in urinary albumin excretion (UAE) or creatinine clearance between the three groups. Hypertensive retinopathy was observed in the WCH group, but was less severe and less frequent compared to HTs. LVMI was greater in the WCH group compared to the NTs, but significantly less than HTs. The data demonstrate that WCH is associated with high levels of homocysteine. The increase in homocysteine level in WCH is not as high as in SHT. Since an elevated plasma homocysteine level is a strong risk factor for coronary artery disease and there was target organ damage in our WCH group, we conclude that WCH should not be considered to be an innocent trait.
同型半胱氨酸与持续性高血压（HT）之间的关联已得到研究。本研究的目的是评估白大衣高血压（WCH）患者的同型半胱氨酸水平，将其作为心血管疾病发生风险增加的一个指标。WCH被定义为临床高血压且日间动态血压<135/85 mmHg。测定了WCH患者、高血压患者和血压正常者（NT）的血浆同型半胱氨酸水平。研究组包括100名受试者，33例WCH患者（16例男性，17例女性），年龄49.1±1.9岁；35例持续性高血压患者（17例男性，18例女性），年龄48.5±1.7岁；32例血压正常对照者（15例男性，17例女性），年龄48.8±2.2岁。受试者在年龄、性别和体重指数方面相匹配。有吸烟习惯、血脂异常或糖尿病的患者未纳入本研究。采用酶联免疫吸附测定法（ELISA）分析同型半胱氨酸水平。与对照组相比，WCH组的血浆同型半胱氨酸水平显著更高（12.32±1.07对5.35±1.38 μmol/L；P<0.001），且WCH组的同型半胱氨酸值显著低于高血压患者（19.03±0.76 μmol/L，P<0.001）。各组间总胆固醇和甘油三酯无差异。三组间尿白蛋白排泄量（UAE）或肌酐清除率无统计学显著差异。WCH组观察到高血压性视网膜病变，但与高血压患者相比，病情较轻且发生率较低。与血压正常者相比，WCH组的左心室质量指数（LVMI）更大，但显著小于高血压患者。数据表明，WCH与高水平的同型半胱氨酸有关。WCH中同型半胱氨酸水平的升高不如持续性高血压（SHT）中高。由于血浆同型半胱氨酸水平升高是冠状动脉疾病的一个强风险因素，且我们的WCH组存在靶器官损害，我们得出结论，WCH不应被视为一种无害的特征。
