H-type Hypertension Group Research Articles

Relationship between the methylenetetrahydrofolate reductase (MTHFR) rs1801133 SNP and serum homocysteine levels of Zhuang hypertensive patients in the central region of Guangxi

BackgroundThe relationship between the methylenetetrahydrofolate reductase (MTHFR) single nucleotide polymorphism (SNP) and serum homocysteine (Hcy) levels or H-type hypertension in different populations is inconsistent. This study aimed to explore the association between the MTHFR rs1801133 SNP and serum Hcy levels of Zhuang hypertensive patients in the central region of Guangxi.MethodsA total of 606 Zhuang inpatients with essential hypertension were recruited in our hospital from August 2016 to December 2018. The patients were divided into H-type hypertension (Hcy > 10 µmol/L, n = 528) and non–H-type hypertension (Hcy ≤ 10 µmol/L, n = 78) groups. At the same time, an age- and sex-matched group of 379 subjects with normal physical examination in our hospital were selected as the control group. Blood biochemical measurements and genotyping of the MTHFR rs1801133 SNP were performed.ResultsThe prevalence of H-type hypertension was 87.13%. The levels of serum Hcy in patients with hypertension were higher than those in control group (14.20 ± 5.78 μmol/L vs. 11.97 ± 5.39 μmol/L, P < 0.001), especially in patients with H-type hypertension (15.08 ± 5.65 μmol/L, P < 0.001). The frequencies of TT genotype (22.73%) and T allele (46.21%) in patients with H-type hypertension were significantly higher than those in control group (11.35% and 30.47%, respectively) and non–H-type hypertension group (10.26% and 28.85%, respectively; P < 0.001 for all). Multivariate linear regression analysis showed that serum Hcy levels were significantly correlated with creatinine, low-density lipoprotein cholesterol, endogenous creatinine clearance rate, and the MTHFR rs1801133 genotypes in control group, while serum Hcy levels were significantly correlated with creatinine, triglyceride, low-density lipoprotein cholesterol, endogenous creatinine clearance rate, glycosylated hemoglobin, and the MTHFR rs1801133 genotypes in H-type hypertension group (P < 0.05–0.001). Serum Hcy levels in the T allele carriers were higher than those in the T allele noncarriers in both H-type hypertension and control groups.ConclusionsThere was closely related between the MTHFR rs1801133 SNP and serum Hcy levels in Zhuang patients with H-type hypertension in the central region of Guangxi. The MTHFR SNP may be an important reason for the increase of serum Hcy levels in Zhuang patients with H-type hypertension in this region.

Correlation analysis of structural and functional changes in the carotid artery in patients with H-type hypertension using ultrasound radiofrequency.

To perform a correlation analysis on the structural and functional changes of the carotid artery in patients with H-type hypertension. Outpatients and inpatients with hypertension in our hospital between 2017 and 2018 were selected and divided into the H-type hypertension group (primary hypertension + plasma homocysteine ≥ 10umol/l) (n = 30) and the simple hypertension group (primary hypertension + plasma Hcy < 10umol/l) (n = 30) based on the plasma homocysteine (Hcy), and 30 healthy people were included in the control group. Thickness and stiffness parameters of the intima of the carotid artery (compliance coefficient [CC], stiffness index [β], and pulse wave velocity [PWV]) were measured for all study participants using ultrasound radiofrequency signal-based quality intima-media thickness (QIMT) and quantitative arterial stiffness (QAS) for contrast analysis. Indexes such as QIMT, β, and PWV of the carotid artery were significantly higher, and the CC was significantly lower in the H-type hypertension group and simple hypertension group than the control group (p < .05), and the difference was statistically significant; these indexes were significantly higher in the H-type hypertension group than in the simple hypertension group, and the CC was significantly lower than in the control group (p < .05), and the difference was statistically significant. Hypertension can accelerate structural and functional changes of the carotid artery intima, with these changes being more significant in H-type hypertension. The ultrasound radiofrequency technique can be used to quantitatively evaluate the structure and function of the carotid artery in patients with H-type hypertension.

Metabolomics reveals serum metabolic signatures in H-type hypertension based on mass spectrometry multi-platform.

H-type hypertension (HHT) is a disease combined with hyperhomocysteinaemia and hypertension (HT). This study aims to find specific metabolic changes and reveal the pathophysiological mechanism of HHT, which provide the theoretical basis for the early prevention and treatment of HHT. Serum samples from three groups including 53 HHT patients, 36 HT patients and 46 healthy controls (HC) were collected. The targeted and untargeted metabolomics analyses were performed to determine the metabolic changes. Based on multivariate statistical analysis, the serum potential metabolites were screened and different metabolic pathways were explored. Our results demonstrated that there were 28 important potential metabolites for distinguishing HT from HHT patients. Metabolic pathway analysis showed that the different metabolic pathways between HHT and HC group were arginine biosynthesis, arginine and proline metabolism, and tyrosine metabolism. The changed metabolic pathway of HT and HC group included linoleic acid metabolism. The specific metabolic pathways of HT-HHT comparison group had phenylalanine metabolism; phenylalanine, tyrosine and tryptophan biosynthesis; glycine, serine and threonine metabolism. Metabolomics analysis by mass spectrometry multi-platform revealed the differences of metabolic profiles between HHT and HT subjects. This work laid the groundwork for understanding the aetiology of HHT, and these findings may provide the useful information for explaining the HHT metabolic alterations and try to prevent HHT.

Association of small dense low-density lipoprotein cholesterol with H-type hypertension and MTHFR gene polymorphism

To investigate the expression of small dense low-density lipoprotein cholesterol (sdLDL-C) in patients with H-type hypertension and its association with H-type hypertension and methylenetetrahydrofolate reductase (MTHFR) gene polymorphisms. The retrospective study method was used,and a total of 207 hospitalized hypertensive patients (76 males and 131 females, aged 40-82 years, median age 66 years) admitted to the Zibo First Hospital from March 2021 to March 2022 were enrolled in this study. The levels of homocysteine (Hcy), sdLDL-C, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), total cholesterol (TC), triglyceride (TG) and lipoprotein (a) [Lp(a)] were measured. The patients were divided into H-type hypertensive group (n=105, 40 males and 65 females) and non-H-type hypertensive group (n=102, 36 males and 66 females) according to Hcy levels. The C677T polymorphism of methylenetetrahydrofolate reductase (MTHFR) gene was detected in each group. Logistic regression analysis was performed for the related factors of H-type hypertension. The serum sdLDL-C levels were (0.92±0.31) and (0.65±0.28) mmol/L in H-type hypertension group and non-H-type hypertension group, respectively. The sdLDL-C levels in H-type hypertension group were significantly higher than those in non-H-type hypertension group (t=6.500, P<0.01). There was no significant difference in the serum sdLDL-C levels between males and females in H-type hypertension group (t=-1.543, P=0.129). The CC, CT, TT genotypes and C and T allele frequencies of MTHFR C677T in H-type hypertension group were significantly different from those in non-H-type hypertension group (P<0.05). The Hcy and sdLDL-C levels in different genotypes of MTHFR in H-type hypertension group were significantly different (H=12.742, P=0.002; F=3.345, P=0.042). Among them, Hcy levels were higher in TT genotype than in CT and CC genotypes, respectively (Z=-28.099, P=0.003; Z=-16.112, P=0.040), and sdLDL-C levels were higher in TT genotype than in CC genotype (t=-2.587, P=0.012). Logistic regression analysis showed that age, sdLDL-C, and MTHFRC677T TT genotypes were associated with the development for H-type hypertension. In conclusion, the level of sdLDL-C is associated with MTHFR gene polymorphisms and may be associated with the development of H-type hypertension.

Effect of MTHFRC677 T Gene Polymorphism on Early Morning Blood Pressure in Elderly Female Patients with H-Type Hypertension.

The distribution characteristics of Methylenetetrahydrofolate Reductase (MTHFR) gene C677 T polymorphism and its influence on early morning blood pressure in elderly female patients with H-type hypertension are investigated. A total of 220 elderly female patients with hypertension who received diagnosis and treatment in our hospital from March to September 2021 are selected. All patients received serum index detection in our hospital and are grouped according to blood homocysteine (Hcy) level. Patients with Hcy>10 μmol/L are classified as H-type hypertension and included in H-type hypertension group (n = 166). Patients with Hcy≤10 μmol/L are included in the non-H-type hypertension group (n = 54). Both groups underwent 24-hour ambulatory blood pressure monitoring. Base frequency and allele distribution of MTHFR gene C677 T locus are compared between the two groups, and the relationship between different bases of MTHFR gene C677 T locus and morning blood pressure and Hcy level is analyzed. The risk factors of morning hypertension in patients with H-type hypertension are analyzed by binary logistic regression. Binary logistic regression analysis shows that smoking history, drinking history, high-salt diet, MTHFR gene C677 T genotype, and abnormal 24 h systolic blood pressure are the risk factors for the occurrence of morning hypertension in H-type hypertension patients. The frequency of TT homozygous mutation at the C677 T site of the MTHFR gene is high in patients with H-type hypertension, and the mutation of the C677 T site of the MTHFR gene had an effect on systolic blood pressure and Hcy level.

Gender difference in association between H-type hypertension and subcortical ischemic vascular disease.

BackgroundSubcortical ischemic vascular disease (SIVD) is a leading cause of vascular dementia. The present study tries to explore not only the gender-specific association between H-type hypertension and SIVD but also the indirect effects of H-type hypertension on cognition through the ischemic brain injury caused by SIVD.Materials and methodsA total of 601 SIVD patients were included, comprising 322 males and 279 females. H-type hypertension was defined as hypertension accompanied with elevated serum total homocysteine (tHcy) level. The imaging manifestations of ischemic brain injury caused by SIVD were also evaluated, including white matter lesions (WML), lacunar infarction (LI) and brain atrophy (BA). Gender-specific subgroup analyses in association between H-type hypertension and SIVD were conducted, followed by a structural equation model based evaluation of the gender-specific mediating effects of SIVD on the relationship between H-type hypertension and cognition.ResultsFor males, there was no noticeable difference in WML, LI and BA scores among control group, isolated hypertension group, isolated high tHcy group, and H-type hypertension group in most brain regions, but significant difference was found in all brain regions for females. Multiple regression analyses showed that H-type hypertension was significantly associated with WML, LI and BA for females, but not for males. For males, H-type hypertension mainly affected cognition through direct effect, while the H-type hypertension effect was mediated by ischemic brain injury caused by SIVD for females.ConclusionH-type hypertension was more closely related to SIVD for females than males, suggesting a gender-specific difference in association patterns between H-type hypertension and cognition.

Effect of methylenetetrahydrofolate reductase C677T polymorphism on serum folate but not vitamin B12 levels in patients with H-type hypertension.

Hyperhomocysteinemia (HHcy) is a common complication in Chinese hypertensive patients and associated with methylenetetrahydrofolate reductase (MTHFR) C677T polymorphism, folate, and vitamin B12 (Vit B12) status. This study evaluated the associations of MTHFR C677T polymorphism, folate, and Vit B12 with H-type hypertension. 887 eligible patients with essential hypertension were included. Patients were divided into two groups according to the Hcy level, the H-type hypertension group and the normal hypertension group. Related risk factors such as MTHFR polymorphism, folate and Vit B12 status were analyzed in the two groups. Age, gender, SBP, DBP, MTHFR C677T genotype, folate and Vit B12 differed significantly between H-type hypertension and normal hypertension groups (P < 0.05). MTHFR 677TT variant, gender, folate, and Vit B12 were independent risk factors for the occurrence of H-type hypertension. The risk for TT carriers was 8 times higher than that of CC and CT carriers [OR (95% CI) 8.248 (5.274-12.899)]. Male patients had almost fivefold higher odds than female patients [OR (95% CI) 4.923 (2.741-8.842)]. Folate level of patients with H-type hypertension decreased with the C to T substitution of MTFHR C677T gene (P < 0.05), while Vit B12 level was not associated with the gene (P > 0.05). MTHFR 677TT variant, gender, folate, and Vit B12 were risk factors for the occurrence of H-type hypertension. Folate but not Vit B12 was associated with MTFHR C677T polymorphism in patients with H-type hypertension. Accordingly, the above factors may be considered in the prevention and treatment of hypertension.

Association between MTHFR gene polymorphism and primary hypertension in children

To study the distribution characteristics of methylenetetrahydrofolate reductase (MTHFR) C677T gene polymorphism in children with primary hypertension, and to explore the association between MTHFR C677T gene polymorphism and H-type hypertension in children. A total of 121 children with primary hypertension who were hospitalized in the department of cardiovascular medicine from January to July 2021, newly diagnosed, and untreated were retrospectively selected as the subjects. The children were divided into three groups: CC genotype (19 children), CT genotype (51 children), and TT genotype (51 children). According to the serum homocysteine (Hcy) level, they were divided two groups: H-type hypertension (47 children) and simple hypertension (74 children). The medical data were compared between the groups. The association between MTHFR C677T gene polymorphism and H-type hypertension was evaluated. The mutation frequency of T allele in children with primary hypertension was significantly higher than that in healthy adults in Beijing and Chinese Han adults (P<0.001). The serum Hcy level in the TT genotype group was significantly higher than that in the CC and CT genotype groups (P<0.001). The serum Hcy level in the H-type hypertension group was significantly higher than that in the simple hypertension group (P<0.001), and MTHFR C677T was mostly TT genotype, which was associated with the risk of H-type hypertension (OR=12.71, P<0.001). There was no significant difference in the incidence rate of target organ damage between the H-type hypertension and simple hypertension groups (P>0.05). However, multiple organ involvement was observed in the H-type hypertension group at diagnosis, accounting for 11% (5/47). The mutation rate of MTHFR C677T T allele in children with primary hypertension is high and associated with the serum Hcy level. TT genotype is an independent risk factor for H-type hypertension in children, and it may be related to the severity of early target organ damage.

Value of neutrophil-to-lymphocyte ratio as a marker of renal damage in patients with H-type hypertension.

Aim: To explore the relationship between the neutrophil-to-lymphocyte ratio (NLR) and renal damage in patients with H-type hypertension. Materials & methods: A total of 618 patients between 2017 and 2019 were analyzed retrospectively. Results: NLR was significantly correlated with renal damage in hypertension patients. Appropriate cut-off value for NLR (2.247) was determined by receiver operating characteristic curve; linear regression analysis showed that NLR and estimated glomerular filtration rate, blood urea nitrogen/creatinine has a significant negative correlation in H-type hypertension group (p<0.05); logistic regression analysis showed that the risk of renal damage increased by 10% for each 1umol/l increase of homocysteine, and 51% for each 1.0 increase of NLR in H-type hypertension patients. Conclusion: NLR worth popularizing in prediction of renal damage in patients with H-type hypertension.

Impact of H-Type Hypertension on Intraplaque Neovascularization Assessed by Contrast-Enhanced Ultrasound.

Aim: H-type hypertension is connected with carotid atherosclerotic plaques and stroke, whereas neovascularization is a dominant contributor to plaque vulnerability. However, the correlation between H-type hypertension and plaque vulnerability remains unclear. This study aims to explore the influence of H-type hypertension on intraplaque neovascularization (IPN). Methods: We enrolled 235 patients with carotid plaques into the investigation and classified them into four groups: H-type hypertension group, simple hypertension group, isolated hyperhomocysteinemia group, and control group. Contrast-enhanced ultrasound (CEUS) was performed on them and IPN was evaluated using semi-quantitative visual grading: grade 1 (no microbubbles or microbubbles limited to the adventitial side and/or shoulder of plaque) and, grade 2 (diffused microbubbles within plaque or microbubbles enter plaque core). To analyze the correlation between H-type hypertension and the degree of plaque enhancement, logistic regression was used. Results: Compared with those with CEUS grade 1 plaques, those with CEUS grade 2 plaques had higher frequency of ischemic stroke (29.0% vs. 45.1%, P ＜0.05), hypertension (41.0% vs. 56.3%, P ＜0.05), and H-type hypertension (18.0% vs. 29.6%, P ＜0.05). No significant differences existed in plaque morphology, plaque echogenicity, and the severity of carotid artery stenosis between the degree of plaque enhancement (all P ＞0.05). H-type hypertension (multivariate-adjusted OR: 3.036, 95% CI: 1.258–7.329) was independently connected with the degree of plaque enhancement even after adjusting for other covariates. Conclusion: H-type hypertension is expressly connected with the degree of plaque enhancement and may facilitate plaque vulnerability. Our findings may offer a new insight for treating vulnerable plaque, lowering blood pressure, and lowering homocysteine equally crucial.

The association between retinal vessel abnormalities and H-type hypertension

BackgroundThis study aimed to investigate the relationship between H-type hypertension and retinal vessel abnormalities.MethodsHypertensive patients were retrospectively enrolled in this study. According to plasma homocysteine (HCY), patients were divided into isolated hypertension and H-type hypertension groups. The diameter of retinal vessels and retinopathy were evaluated by retinal fundus photography. The differences of retinal vessel abnormalities between H-type hypertension and isolated hypertension were investigated by univariate and multivariate regression.ResultsA total of 191 hypertensive patients were included, of which 86 were with isolated hypertension and 105 with H-type hypertension. The H-type hypertension group had a higher ratio of retinopathy(P = 0.004) and higher degree of retinal arteriosclerosis (P = 0.005) than the isolated hypertension group. CRAE (107.47 ± 13.99µ m vs. 113.49 ± 11.72µ m, P = 0.002) and AVR (0.55 ± 0.06 vs. 0.58 ± 0.06, P = 0.001) were smaller in H-type hypertension group than those in isolated hypertension group. Multivariate analysis showed that after adjusting for age, sex, course of hypertension and diabetes, H-type hypertension was an independent risk factor of retinopathy (OR, 2.259; 95%CI, 1.165—4.378; P = 0.016), CRAE (β=-5.669; 95%CI, -9.452—-1.886; P = 0.004), and AVR (β=-0.023; 95%CI, -0.039—-0.007; P = 0.005).ConclusionsH-type hypertension is closely related to more retinal vessel abnormalities than isolated hypertension. Controlling H-type hypertension may reduce the risk of small vascular damage.

H-Type Hypertension Is a Risk Factor for Cerebral Small-Vessel Disease.

Background The correlation between H-type hypertension and cerebral small-vessel diseases (CSVD) remains uncertain. Objective The present study was designed to explore the possible relationship between H-type hypertension and CSVD spectrum and total burden. Method We included 329 patients in the present study and divided them into four groups: the H-type hypertension group, isolated hypertension group, isolated hyperhomocysteinemia (HHcy) group, and control group. Clinical variables of interest and the MR examination sequences were obtained. We counted the presence of each CSVD feature and rated the total burden of CSVD on an ordinal scale from 0 to 4 according to a recent described score rule. Result The results showed that H-type hypertension was associated with the presence of cerebral microbleeds (CMBs), and the severity of white-matter hyperintensities (WMHs) and peripheral vascular space (PVS). CSVD total burden was significantly related to age (OR: 1.059, 95% CI: 1.037–1.082), systolic pressure (OR: 1.122, 95% CI: 1.007–1.136), triglycerides (OR: 1.386, 95% CI: 1.037–1.854), isolated HHcy (OR: 4.154, 95% CI 1.836–9.401), and H-type hypertension (OR: 5.028, 95% CI: 2.323–10.883). Also, we further observed hypertension and HHcy had a synergistic effect on CSVD total burden (OR: 2.776, 95% CI: 1.564–4.927). Conclusion H-type hypertension was associated with CSVD total burden and CSVD spectrum, which deserves further prevention measures. Furthermore, hypertension and HHcy had a synergistic effect on CSVD total burden.

Correlations of plasma homocysteine with cerebral white matter lesion severity and cognitive impairment in elderly patients with hypertension

Objective To investigate the correlations of plasma homocysteine(Hcy)levels with cerebral white matter lesion(WML)severity and cognitive impairment in elderly hypertension patients. Methods A retrospective case-control study was conducted.Ninty-eight elderly patients with hypertension were enrolled.Based on the presence or absence of hyperhomocysteinemia(hypertension with plasma Hcy levels ≥10 μmol/L was defined as H-type hypertension), patients were divided into two groups: a control group(n=48)and an H-type hypertension group(n=50). The degree of WML was rated by the Fazekas scale using magnetic resonance imaging(MRI)analysis.Neuropsychological examinations including mini-mental state examination(MMSE)and Montreal cognitive assessment(MoCA)were taken to assess cognitive function.The degree of WML and cognitive impairment were compared between the two groups.Correlations of plasma Hcy levels with the degree of WML and cognitive impairment were analyzed. Results Compared with the control group, scores of the Fazekas scale(3.2±1.0 vs.2.5±1.0, P<0.05)and deep white matter hyperintensity on MRI(1.7±0.8 vs.1.3±0.7, P<0.05)increased, and scores of MMSE(24.9±3.3 vs.27.7±1.8, P<0.05)and MoCA(18.6±3.9 vs.25.0±3.0, P<0.05)decreased in the H-type hypertension group.Plasma Hcy levels were positively correlated with the degree of WML(r=0.430, P<0.01)and negatively correlated with cognitive function(r=-0.406 in MMSE and-0.663 in MoCA, P<0.01). Multivariate logistic regression showed that Hcy, fasting blood-glucose, deep WML, low-density lipoprotein cholesterolin, age and systolic pressure were influencing factors for cognitive impairment(P<0.01). Conclusions WML and cognitive function are worse in elderly H-type hypertension patients than in hypertension patients with normal Hcy levels.WML and cognitive impairment are aggravated with increased plasma Hcy levels.The plasma Hcy level may be an effective clinical indicator of cognitive function in elderly people with hypertension. Key words: Hypertension; Cysteine; Leukoencephalopathies; Cognitive disorders

Association of H-Type Hypertension with Stroke Severity and Prognosis

Background. The correlation between H-type hypertension and acute ischemic stroke remains uncertain. Objective. The present study was designed to explore the possible relationship between H-type hypertension and severity and prognosis of acute ischemic stroke. Method. We included 372 patients with acute ischemic stroke and divided them into four groups: H-type hypertension group, simple hypertension group, simple hyperhomocysteinemia (HHcy) group, and the control group. NIHSS score was measured at both admission and two weeks later. mRS score, stroke recurrence, cardiovascular event, or all-cause mortality was recorded at 3-month and 1-year follow-up. Result. The results showed that the NIHSS score on admission in the H-type hypertension group (6.32 ± 5.91) was significantly higher than that in the control group (3.97 ± 3.59) (P < 0.05), while there was no obvious association between H-type hypertension and NIHSS score after 2-week treatment (P = 0.106). Endpoint events incidence in H-type hypertension group was the highest; however, in the cox regression model of multiple factor analysis, H-type hypertension was not an independent risk factor. Conclusion. H-type hypertension may result in early functional deterioration and higher incidence rate of endpoint events but not act as an independent risk factor.

Association between H-type Hypertension and Asymptomatic Extracranial Artery Stenosis

Asymptomatic extracranial artery stenosis (ECAS) is a well-known risk factor for stroke and H-type hypertension, which is defined as hypertension with hyperhomocysteinemia, is associated with cardio-cerebrovascular diseases. However, the impact of H-type hypertension on ECAS is mostly unknown. We designed this study to investigate the association between H-type hypertension and prevalence of ECAS. We included 2330 participants in this study and classified them into four groups: the control group without hypertension or hyperhomocysteinemia, isolated hypertension group, isolated hyperhomocysteinemia group and H-type hypertension group. We measured the baseline plasma total homocysteine levels and assessed ECAS by carotid duplex sonography twice at baseline and during follow up. We used a Cox regression model to analyse the association between H-type hypertension and ECAS. At baseline, 608 subjects suffered from H-type hypertension. Within two years of follow-up, asymptomatic ECAS occurred in 250 (10.73%) participants. After adjusting for relevant risk factors, we found H-type hypertension to be an independent risk factor for asymptomatic ECAS (relative risk (RR) 3.16, 95% confidence interval (95% CI) 2.00–5.00). Our findings provide direct evidence for the importance of H-type hypertension in the occurrence of ECAS and as a potential therapeutic target for carotid atherosclerosis.

Analysis of metabolism-related indicators and MTHFR gene polymorphism in patients with H-type hypertension.

This study aims to analyze the polymorphism of the methylene tetrahydrofolate reductase (MTHFR) gene in patients with hypertension, and explore the correlation between H-type hypertension and metabolic biochemical indicators such as homocysteine (Hcy). One hundred patients with H-type hypertension and 100 patients with common hypertension were selected as the study subjects. Plasma Hcy and blood lipids, blood glucose, and other biochemical indicators were detected in the two groups. Then, the polymorphism of the MTHFR gene was compared between these two groups. Hcy, uric acid (UA) and creatinine (Cr) levels in the H-type hypertension group were significantly higher than those of the common hypertension group (t=4.832-14.989, P<0.05). The T allele was predominant in the MTHFR 677C/T genotype frequency distribution in the H-type hypertension group, while the C allele was predominantly in the frequency distribution in the common hypertension group (P<0.05). High levels of Hcy, UA and Cr are closely related to the occurrence of H-type hypertension. Homozygous mutant TT genotype of 677C/T of the MTHFR gene may be an important genetic factor of H-type hypertension.

Association of High Homocysteine Levels With the Risk Stratification in Hypertensive Patients at Risk of Stroke

PurposeWe aimed to investigate the association between stroke morbidity and different stratifications of classic risk factors, such as increasing age, body mass index (BMI), blood lipids, and blood glucose, in hypertensive patients with high homocysteine levels. MethodsA cross-sectional study of 2258 patients with primary hypertension were enrolled in this study, including 871 stroke cases (62.89%) in 1385 hypertensive patients without hyperhomocysteinemia (HHcy) and 647 (74.11%) stroke cases in 873 hypertensive patients with HHcy. Basic information of patients were collected, including age, sex, height, weight, smoking, alcohol consumption, and disease history. Blood chemical assays were performed to determine the levels of glucose, triglycerides, high-density lipoprotein cholesterol (HDL-C), total cholesterol, and homocysteine. Subsequently, comparison of stroke morbidity between the 2 groups was performed after the stratification of risk factors. Moreover, the correlation between the stroke morbidity and the risk factors was analyzed using a trend test in patients with H-type hypertension. Univariate and multivariate logistic regression analyses were used to evaluate the association between baseline factors and prevalence of stroke in H-type hypertensive patients. FindingsAfter the stratification of risk factors, a statistical difference was noted in age (range, 45-74 yrs), glucose ranges (<6.1 and ≥7.0 mmol/L), BMI, systolic blood pressure (SBP), diastolic blood pressure (DBP), non–HDL-C, and triglyceride level of <200 mg/dL (P<0.05) in the H-type hypertension group compared with those in non–H-type hypertension group. Gradual elevation of stroke morbidity was identified with the increase of fasting glucose, SBP, and DBP. In multivariate logistic regression analysis, only higher SBP, DBP, fasting glucose level, homocysteine, and history of diabetes mellitus were the independent predictors for the stroke morbidity. ImplicationsComprehensive evaluation and strict management of multiple risk factors have become increasingly important in the alleviation of stroke morbidity for H-type hypertensive patients because these patients were more sensitive to the classic risk factors.

Correlation of H-type hypertension with serum uric acid and fibrinogen in the elderly

Objective To discuss the correlation of high homocysteine (Hcy) hypertension (H-type hypertension) with serum levels of uric acid (UA) and fibrinogen (FIB) in the elderly. Methods A total of 188 elderly in- and out-patients with essential hypertension were selected in our heart medicine outpatient and ward from April 2013 to April 2014. They were divided into H-type hypertension group (n=136, Hcy value≥10μmol/L) and primary hypertension group (n=52, Hcy value<10μmol/L). Another 160 elderly individuals without hypertension taking physical examination in our hospital during same period served as controls. General information were colleted, and the serum Hcy, UA and FIB were detected in all the patients to compare the differences among different groups. Logistic regression analysis was adopted to seek affecting factors of H-type hypertension patients . Results Compared with control group, there were statistical increases in the levels of UA and FIB for primary hypertension group and H-type hypertension group(P<0.01). Compared with primary hypertension group, there were statistical differences in the level of UA and FIB(P<0.01). The influence factors analysis showed that H-type hypertension was positively correlated with the serum level of UA and FIB(P<0.01). Conclusions H-type hypertension is closely associated with UA and FIB. It's good for management of hypertension patients to monitor UA and FIB levels. Key words: Homocysteine; Uric acid; Fibrinogen

Association between polymorphism of acetaldehyde dehydrogenase 2 gene and H-type hypertension in the elderly

Objective To explore the association between the polymorphism rs671 site of the acetaldehyde dehydrogenase 2 (ALDH2) gene and H-type hypertension in the elderly in Han nationality in Qingdao. Methods Totally 406 patients aged 60-90 years with primary hypertension were randomly selected in the study. Serum levels of homocysteine(Hcy), folate and vitamin B12 were determined and all patients were divided into H-type hypertension group and non H-type hypertension group. Gene chip technology was used to analyze the ALDH2 (rs671) polymorphism, and the association between ALDH2 gene and H-type hypertension was evaluated. Results Of all hypertensive participants, 82.0% (333/406) were in H-type hypertension, 87.4% (221/253) in male and 73.2% (112/153) in female. The GA/AA genotype and A allele frequency were higher in H-type hypertension group than in non H-type hypertension group 〔37.2%(124/333) vs. 16.4%(12/73) and 21.3%(71/333) vs. 9.6%(7/73), P=0.001 and 0.021〕. Serum Hcy level and the prevalence of H-type hypertension were higher in GA/AA genotype group than in GG genotype group(both P<0.05). Logistic regression analysis showed that GA/AA genotype, gender (male), drinking, folate deficiency and increased systolic pressure were the risk factors for H-type hypertension (OR=3.17, 2.14, 2.37, 0.75, 1.03, respectively, all P<0.05). Conclusions The genetic variation of ALDH2(rs671)may increase Hcy level by decreasing the levels of folate and vitamin B12. GA/AA genotype is a risk factor for H-type hypertension, and it contributes to H-type hypertension together with gender, drinking history, folate levels and systolic pressure. Key words: Adehyde oxidoreductases; Polymorphism, single nucleotide; Hypertension

Coronary flow velocity reserve is impaired in hypertensive patients with hyperhomocysteinemia

Hyperhomocysteinemia (HHcy) is an independent risk factor for coronary artery disease. Chronic HHcy induces coronary endothelial injury, and homocysteine (Hcy) inhibits insulin sensitivity by inducing endoplasmic reticulum stress in adipose tissue. However, the combined effects of chronic HHcy and hypertension on coronary artery endothelial function have still remained unclear. Fifty-one patients with essential hypertension (HT) were recruited, and were divided into nHT group (without HHcy) and H-type HT group (with HHcy). Forty healthy subjects were enrolled as controls. We assessed coronary artery endothelial function by coronary flow velocity reserve (CFVR). Hcy levels were significantly higher (15.60±6.58 vs 13.08±4.13 μmol l(-1), P<0.05), whereas CFVR values were significantly lower in the HT patients than in the control group (2.88±0.70 vs 3.23±0.54, P<0.05). Hcy levels were negatively correlated with CFVR value (r=-0.578, P<0.01, 95% confidence interval -0.085 to -0.046). The homeostasis model assessment-insulin resistance values were significantly higher (3.92±2.16 vs 2.72±1.50, P<0.05) , whereas CFVR values were significantly lower in H-type HT group than in nHT group (2.31±0.31 vs 3.25±0.62, P<0.01). Coronary artery endothelial function may be impaired in essential hypertensive patients with HHcy, and insulin resistance induced by HHcy may contribute to this damage.