Faculty of Medicine, Dentistry & Health Sciences, School of Medicine - Royal Perth Hospital Unit, Dobney Hypertension Centre, Royal Perth Hospital Research Foundation, The University of Western Australia, Perth, WA, Australia.
Department of Vascular Surgery, Royal Perth Hospital, Perth, WA, Australia.
J Clin Hypertens (Greenwich). 2021 Jul;23(7):1380-1389. doi: 10.1111/jch.14265. Epub 2021 Jun 17.
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.
同型半胱氨酸是心血管和脑血管疾病的独立危险因素，据推测它与血管功能障碍有关。我们试图在真实临床环境中确定同型半胱氨酸水平是否与高血压介导的器官损伤（HMOD）相关，并指导高血压的治疗选择。我们对在皇家珀斯医院的三级高血压诊所就诊的 145 名高血压患者前瞻性收集的数据进行了横断面分析，并分析了同型半胱氨酸与 HMOD、肾素-血管紧张素-醛固酮系统（RAAS）和 RAAS 阻断之间的关系。参与者的平均年龄为 56±17 岁，男性比例明显高于女性（89 比 56）。回归分析表明，同型半胱氨酸与脉搏波速度（PWV）显著相关（β=1.99；95%CI 0.99-3.0；p<0.001），与白蛋白-肌酐比值（lnACR：β=1.14；95%CI 0.47,1.8；p<0.001）、24 小时尿蛋白排泄（β=0.7；95%CI 0.48,0.92；p<0.001）和估算肾小球滤过率（β=-29.4；95%CI -36.35，-22.4；p<0.001）相关，在调整年龄、性别、24 小时血压、炎症、吸烟、糖尿病（DM）和血脂异常等潜在混杂因素后，这种相关性仍然存在。观察到血浆同型半胱氨酸水平与 PWV 之间存在正预测关系，同型半胱氨酸每增加 1.0µmol/L，PWV 就增加 0.1m/s。同型半胱氨酸与醛固酮浓度升高显著相关（β=0.26；p<0.001），与血管紧张素受体阻滞剂相比，在同型半胱氨酸较高生理范围内，同型半胱氨酸与 ACEi 介导的收缩压降低和 HMOD 消退的减弱相关。我们的研究结果表明，同型半胱氨酸与高血压介导的血管损伤相关，可能有助于指导一线降压治疗。
