Abstract
ObjectiveElevated plasma total homocysteine (tHcy) acts synergistically with hypertension to exert a multiplicative effect on cardiovascular diseases risk. The aim of this study was to determine the relationship between tHcy concentration and blood pressure, and to evaluate the role of plasma tHcy in arterial stiffness and wave reflection in hypertension.MethodsIn this cross-sectional study, a community-based sample of 1680 subjects (mean age 61.6 years) was classified into four groups according to tHcy level (<21.6 vs. ≥21.6 µmol/l) and blood pressure (hypertensive vs. normotensive). Levels of plasma tHcy and other biochemical parameters (e.g., lipids, glucose) were determined. Central arterial blood pressure, reflected pressure wave, and carotid-femoral pulse wave velocity (cf-PWV) were assessed by tonometry within 2 days of obtaining the blood specimen.ResultsNeither peripheral nor central blood pressure differed according to tHcy levels in normotensive and hypertensive subjects. Differences in cf-PWV according to tHcy were observed only in hypertensive subjects; differences in cf-PWV in normotensive subjects were not significant after adjusting for confounding factors. Central augmentation index did not differ according to tHcy level in either normotensive or hypertensive subjects. Results of univariate analysis revealed significant correlations between blood pressure parameters and tHcy concentration only among normotensive subjects; however, these correlations were not significant in a partial correlation analysis. Results of multiple regression analysis showed that plasma tHcy levels were independently correlated with cf-PWV in hypertensive subjects (β = 0.713, P = 0.004). The independent relationship between tHcy and central augmentation index was not significant by further multiple analyses in normotensive or hypertensive individuals.ConclusionsPlasma tHcy level is strongly and independently correlated with arterial stiffness measured as cf-PWV only in hypertensive subjects. Thus, hypertension is a major link between tHcy and aortic arterial stiffness.
Highlights
Recent studies have reported that elevated total homocysteine (tHcy) may be deleterious in individuals with hypertension or other risk factors, with which it acts synergistically to exert a multiplicative effect on cardiovascular disease (CVD) risk [1,2]
Clinical Characteristics of Subjects Categorized by blood pressure (BP) and tHcy Level
The analysis showed that for hypertensive subjects tHcy was an independent determinant of carotid-femoral pulse wave velocity (cf-pulse wave velocity (PWV)); other parameters entered in the model were age, Mean arterial blood pressure (MAP), fasting blood glucose, high-density lipoprotein (HDL) cholesterol, and height
Summary
Recent studies have reported that elevated tHcy may be deleterious in individuals with hypertension or other risk factors (e.g., cigarette smoking, hypercholesterolemia), with which it acts synergistically to exert a multiplicative effect on cardiovascular disease (CVD) risk [1,2]. In patients with coronary heart disease, those with both hypertension and high tHcy levels had more severe coronary atherosclerosis and more diffuse atherosclerosis than those without this association [3]. This combination of elevated tHcy and hypertension has been described as ‘‘H-type hypertension’’ [4,5]. Few prospective studies have investigated the role of tHcy and hypertension on arterial stiffness in Asian populations [6], which have patterns of cerebrovascular disease and CVD that are distinct from those of Caucasians and African Americans. Further investigation is needed to clarify the relationship between plasma tHcy and arterial stiffness in hypertension
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