Abstract
OBJECTIVES:To explore the risk factors of essential hypertension with hyperhomocysteinemia (H-type hypertension) and design a nomogram to predict this risk.METHODS:A hospital-based study was conducted on 1,712 individuals, including 282 patients with H-type hypertension, 105 patients with simple hypertension, 645 individuals with hyperhomocysteinemia, and 680 healthy controls. Logistic regression and nomogram models were applied to evaluate the risk factors.RESULTS:Logistic regression showed that advanced age, male sex, high body mass index (BMI), high total cholesterol levels, high glucose levels, and high creatinine levels were risk factors of H-type hypertension in the healthy population and were integrated into the nomogram model. Advanced age, male sex, high BMI, high total cholesterol levels, and high glucose levels were shown to be risk factors of H-type hypertension in the hyperhomocysteinemia population. Male sex and high creatinine levels were shown to be risk factors of H-type hypertension in the hypertension population. Nomogram analysis showed that the total factor score ranged from 106 to 206, and the corresponding risk rate ranged from 0.05 to 0.95.CONCLUSIONS:Men are more likely to have H-type hypertension, and advanced age, high BMI, high total cholesterol levels, and high glucose levels are risk factors of H-type hypertension in healthy and hyperhomocysteinemia populations. Furthermore, high creatinine level is a risk factor of H-type hypertension in healthy and hypertension populations. Nomogram models may be used to intuitively evaluate H-type hypertension risk and provide a basis for personalized interventions.
Highlights
H-type hypertension, a type of essential hypertension with hyperhomocysteinemia (HHcy), is a major risk factor of cardiovascular and cerebrovascular diseases, especially stroke [1,2,3]
Logistic regression analysis of age, sex, body mass index (BMI), and levels of total cholesterol (TC), TGs, glucose, high-density lipoprotein (HDL), low-density lipoprotein (LDL), uric acid, creatinine, AST, and alanine transaminase (ALT) by forward selection showed that advanced age (odds ratio [OR], 1.087; 95% confidence interval [CI], 1.065–1.111; po0.001], male sex (OR, 7.879; 95% CI, 4.270–14.537; po0.001), high BMI (OR, 1.193; 95% CI, 1.107–1.286; po0.001), high TC levels (OR, 1.591; 95% CI, 1.252–2.020; po0.001), high glucose levels (OR, 1.843; 95% CI, 1.195– 2.841; p=0.006), and high creatinine levels (OR=1.038; 95% CI, 1.015–1.061; p=0.001) were risk factors of H-type hypertension in the healthy population compared to healthy controls (Table 2, Figure 1)
Based on the comparisons of patients with H-type hypertension and healthy controls, H-type hypertension and HHcy, and H-type hypertension and simple hypertension, we found that advanced age, male sex, high BMI, high TC levels, high glucose levels, and high creatinine levels were risk factors of H-type hypertension in the healthy population; advanced age, male sex, high BMI, high TC levels, and high glucose levels were risk factors of H-type hypertension in the HHcy population; and male sex and high creatinine levels were risk factors of H-type hypertension in the hypertension population
Summary
H-type hypertension, a type of essential hypertension with hyperhomocysteinemia (HHcy), is a major risk factor of cardiovascular and cerebrovascular diseases, especially stroke [1,2,3]. It has been reported that the risk of incident stroke is 12.7 times and that of stroke-related death is 11.7 times in patients with H-type hypertension compared with those in healthy controls [4]. As a common complex chronic disease, the association between high homocysteine (Hcy) levels and high blood pressure may be concomitant and affected by numerous factors such as age, sex, body mass index (BMI), and biochemical indicators [5,6]. No potential conflict of interest was reported. Received for publication on July 14, 2020. Accepted for publication on November 10, 2020
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