Evaluation of Homocysteine, hsCRP and Microalbuminuria in Hypertensives without and with end Organ Damage-A Case Control Study

Abstract

Background : Homocysteine considered to be a marker of endothelial dysfunction is formed from a sulfur-containing amino acid, methionine. The total plasma homocysteine levels are between 5-15 µmol / L in healthy individuals. As reported by various prevalence studies, the rate is found to be comparitively higher in Indians with a mean level of 19.5-23.2 µmol / L. Hyperhomocysteinemia is the most common risk factor for stroke and cardiovascular diseases by causing vascular dysfunction. Elevated levels of homocysteine could also lead to alterations in mediators of endothelial vasodilatation. Methods : A total of 496 individuals between the age group of 20-55 years of age, from both sexes who were attending the Hypertensive clinic and Master health check up programme in Sri Ramachandra Medical College & Research Institute were enrolled for the study .They were grouped as three-Group I being controls, group II being hypertensives without complications and group III being hypertensives with end organ damage. After overnight fasting, blood and spot urine samples were collected. All the biochemical parameters were estimated by standard methodologies.The plasma homocysteine was determined by ELISA method (Axis Shield, UK ), urinary microalbumin and hsCRP was determined by Immunoturbidimetric method. Albumin Creatinine Ratio (ACR) was also calculated. Results The results are expressed as Mean ± SD. The mean values of SBP, DBP and BMI showed a statistically highly significant difference between the 3 groups (p<0.001). Regarding the biochemical parameters LDL c, Chol /HDL ratio , the renal parameters microalbumin, ACR and the markers plasma homocysteine and the hsCRP levels showed a statistically highly significant A strong positive correlation was detected between hsCRP and DBP between the group 2 & 3. Results : The inflammatory marker hsCRP was found to show a strong positive association with DBP among hypertensives with and without end organ damage indicating that the process of inflammation starts early in the disease. Homocysteine correlates with urinary microalbumin and albumin /creatinine ratio indicating that renal dysfunction could be due to hyperhomocysteinemia Conclusion: A significant increase in microalbumin, hsCRP and homocysteine in essential hypertensives suggests that monitoring the levels of these parameters would be of great value in assessing the onset of end organ damage in essential hypertensives. Hyperhomocysteinemia plays a role in the setting of endothelial morphology and function.