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Carnagarin R, Nolde JM, Ward NC, Lugo-Gavidia LM, Chan J, Robinson S, Jose A, Joyson A, Azzam O, Galindo Kiuchi M, Mwipatayi BP, Schlaich MP. Homocysteine predicts vascular target organ damage in hypertension and may serve as guidance for first-line antihypertensive therapy. J Clin Hypertens (Greenwich) 2021; 23:1380-1389. [PMID: 34137162 PMCID: PMC8678735 DOI: 10.1111/jch.14265] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 04/22/2021] [Accepted: 04/24/2021] [Indexed: 12/27/2022]
Abstract
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.
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Affiliation(s)
- Revathy Carnagarin
- 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
| | - Janis M Nolde
- 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
| | - Natalie C Ward
- 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
| | - Leslie Marisol Lugo-Gavidia
- 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
| | - Justine Chan
- 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
| | - Sandi Robinson
- 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
| | - Ancy Jose
- 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
| | - Anu Joyson
- 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
| | - Omar Azzam
- 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
| | - Márcio Galindo Kiuchi
- 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
| | - Bibombe P Mwipatayi
- Department of Vascular Surgery, Royal Perth Hospital, Perth, WA, Australia.,Faculty of Medicine, School of Surgery, Dentistry and Health Sciences, University of Western Australia, Perth, WA, Australia
| | - Markus P Schlaich
- 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.,Departments of Cardiology and Nephrology, Royal Perth Hospital, Perth, WA, Australia.,Neurovascular Hypertension & Kidney Disease Laboratory, Baker Heart and Diabetes Institute, Melbourne, Vic., Australia
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Qin X, Li Y, Sun N, Wang H, Zhang Y, Wang J, Li J, Xu X, Liang M, Nie J, Wang B, Cheng X, Li N, Sun Y, Zhao L, Wang X, Hou FF, Huo Y. Elevated Homocysteine Concentrations Decrease the Antihypertensive Effect of Angiotensin-Converting Enzyme Inhibitors in Hypertensive Patients. Arterioscler Thromb Vasc Biol 2017; 37:166-172. [PMID: 27834686 DOI: 10.1161/atvbaha.116.308515] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 10/25/2016] [Indexed: 11/16/2022]
Abstract
Objective—
We aimed to examine whether baseline homocysteine (Hcy) concentrations affect antihypertensive responses to enalapril treatment among previously untreated hypertensive patients (n=10 783) in the CSPPT (China Stroke Primary Prevention Trial).
Approach and Results—
After a 3-week run-in treatment with a daily dose of 10 mg enalapril, eligible hypertensive patients were randomly assigned to a double-blind daily treatment of a tablet of either enalapril (10 mg) and folic acid (0.8 mg) or enalapril (10 mg) alone for a median of 4.5 years. After the 3-week treatment period with enalapril alone, the systolic blood pressure–lowering effect was significantly reduced by 1.39 (95% confidence interval 0.40–2.37) and 3.25 (95% confidence interval 1.98–4.52) mm Hg, respectively, in those with baseline Hcy concentrations of 10 to 15 and ≥15 μmol/L (
P
for trend <0.001) as compared with those with Hcy concentration of <10 μmol/L. Similar results were observed after a 15-week treatment period with enalapril alone. After a median 4.5-year enalapril-based antihypertensive treatment period, compared with those with Hcy concentration of <10 μmol/L, the systolic blood pressure–lowering effect was still significantly reduced by 0.77 (95% confidence interval 0.01–1.53) and 1.70 (95% confidence interval 0.72–2.68) mm Hg, respectively, in those with Hcy concentrations of 10 to 15 and ≥15 μmol/L (
P
for trend <0.001). In addition, participants with higher baseline Hcy concentrations had persistently higher systolic blood pressure levels across the entire study treatment period. Similarly, baseline Hcy concentrations were inversely associated with diastolic blood pressure reduction during the short-term enalapril alone treatment. However, the inverse association between baseline Hcy and diastolic blood pressure reduction was attenuated and became insignificant after the long-term enalapril-based treatment period.
Conclusions—
Elevated Hcy concentrations significantly decreased the antihypertensive effect of the short-term and long-term enalapril-based antihypertensive treatment in previously untreated hypertensive patients.
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Affiliation(s)
- Xianhui Qin
- From the Renal Division, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Guangzhou, China (X.Q., Y.L., X.X., M.L., J.N., B.W., F.F.H.); Department of Cardiology, Peking University People’s Hospital, Beijing, China (N.S.); Centers for Metabolic Disease Research, Temple University School of Medicine, PA (H.W.); Department of Cardiology, Peking University First Hospital, Beijing, China (Y.Z., J.L., Y.H
| | - Youbao Li
- From the Renal Division, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Guangzhou, China (X.Q., Y.L., X.X., M.L., J.N., B.W., F.F.H.); Department of Cardiology, Peking University People’s Hospital, Beijing, China (N.S.); Centers for Metabolic Disease Research, Temple University School of Medicine, PA (H.W.); Department of Cardiology, Peking University First Hospital, Beijing, China (Y.Z., J.L., Y.H
| | - Ningling Sun
- From the Renal Division, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Guangzhou, China (X.Q., Y.L., X.X., M.L., J.N., B.W., F.F.H.); Department of Cardiology, Peking University People’s Hospital, Beijing, China (N.S.); Centers for Metabolic Disease Research, Temple University School of Medicine, PA (H.W.); Department of Cardiology, Peking University First Hospital, Beijing, China (Y.Z., J.L., Y.H
| | - Hong Wang
- From the Renal Division, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Guangzhou, China (X.Q., Y.L., X.X., M.L., J.N., B.W., F.F.H.); Department of Cardiology, Peking University People’s Hospital, Beijing, China (N.S.); Centers for Metabolic Disease Research, Temple University School of Medicine, PA (H.W.); Department of Cardiology, Peking University First Hospital, Beijing, China (Y.Z., J.L., Y.H
| | - Yan Zhang
- From the Renal Division, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Guangzhou, China (X.Q., Y.L., X.X., M.L., J.N., B.W., F.F.H.); Department of Cardiology, Peking University People’s Hospital, Beijing, China (N.S.); Centers for Metabolic Disease Research, Temple University School of Medicine, PA (H.W.); Department of Cardiology, Peking University First Hospital, Beijing, China (Y.Z., J.L., Y.H
| | - Jiguang Wang
- From the Renal Division, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Guangzhou, China (X.Q., Y.L., X.X., M.L., J.N., B.W., F.F.H.); Department of Cardiology, Peking University People’s Hospital, Beijing, China (N.S.); Centers for Metabolic Disease Research, Temple University School of Medicine, PA (H.W.); Department of Cardiology, Peking University First Hospital, Beijing, China (Y.Z., J.L., Y.H
| | - Jianping Li
- From the Renal Division, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Guangzhou, China (X.Q., Y.L., X.X., M.L., J.N., B.W., F.F.H.); Department of Cardiology, Peking University People’s Hospital, Beijing, China (N.S.); Centers for Metabolic Disease Research, Temple University School of Medicine, PA (H.W.); Department of Cardiology, Peking University First Hospital, Beijing, China (Y.Z., J.L., Y.H
| | - Xin Xu
- From the Renal Division, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Guangzhou, China (X.Q., Y.L., X.X., M.L., J.N., B.W., F.F.H.); Department of Cardiology, Peking University People’s Hospital, Beijing, China (N.S.); Centers for Metabolic Disease Research, Temple University School of Medicine, PA (H.W.); Department of Cardiology, Peking University First Hospital, Beijing, China (Y.Z., J.L., Y.H
| | - Min Liang
- From the Renal Division, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Guangzhou, China (X.Q., Y.L., X.X., M.L., J.N., B.W., F.F.H.); Department of Cardiology, Peking University People’s Hospital, Beijing, China (N.S.); Centers for Metabolic Disease Research, Temple University School of Medicine, PA (H.W.); Department of Cardiology, Peking University First Hospital, Beijing, China (Y.Z., J.L., Y.H
| | - Jing Nie
- From the Renal Division, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Guangzhou, China (X.Q., Y.L., X.X., M.L., J.N., B.W., F.F.H.); Department of Cardiology, Peking University People’s Hospital, Beijing, China (N.S.); Centers for Metabolic Disease Research, Temple University School of Medicine, PA (H.W.); Department of Cardiology, Peking University First Hospital, Beijing, China (Y.Z., J.L., Y.H
| | - Binyan Wang
- From the Renal Division, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Guangzhou, China (X.Q., Y.L., X.X., M.L., J.N., B.W., F.F.H.); Department of Cardiology, Peking University People’s Hospital, Beijing, China (N.S.); Centers for Metabolic Disease Research, Temple University School of Medicine, PA (H.W.); Department of Cardiology, Peking University First Hospital, Beijing, China (Y.Z., J.L., Y.H
| | - Xiaoshu Cheng
- From the Renal Division, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Guangzhou, China (X.Q., Y.L., X.X., M.L., J.N., B.W., F.F.H.); Department of Cardiology, Peking University People’s Hospital, Beijing, China (N.S.); Centers for Metabolic Disease Research, Temple University School of Medicine, PA (H.W.); Department of Cardiology, Peking University First Hospital, Beijing, China (Y.Z., J.L., Y.H
| | - Nanfang Li
- From the Renal Division, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Guangzhou, China (X.Q., Y.L., X.X., M.L., J.N., B.W., F.F.H.); Department of Cardiology, Peking University People’s Hospital, Beijing, China (N.S.); Centers for Metabolic Disease Research, Temple University School of Medicine, PA (H.W.); Department of Cardiology, Peking University First Hospital, Beijing, China (Y.Z., J.L., Y.H
| | - Yingxian Sun
- From the Renal Division, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Guangzhou, China (X.Q., Y.L., X.X., M.L., J.N., B.W., F.F.H.); Department of Cardiology, Peking University People’s Hospital, Beijing, China (N.S.); Centers for Metabolic Disease Research, Temple University School of Medicine, PA (H.W.); Department of Cardiology, Peking University First Hospital, Beijing, China (Y.Z., J.L., Y.H
| | - Lianyou Zhao
- From the Renal Division, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Guangzhou, China (X.Q., Y.L., X.X., M.L., J.N., B.W., F.F.H.); Department of Cardiology, Peking University People’s Hospital, Beijing, China (N.S.); Centers for Metabolic Disease Research, Temple University School of Medicine, PA (H.W.); Department of Cardiology, Peking University First Hospital, Beijing, China (Y.Z., J.L., Y.H
| | - Xiaobin Wang
- From the Renal Division, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Guangzhou, China (X.Q., Y.L., X.X., M.L., J.N., B.W., F.F.H.); Department of Cardiology, Peking University People’s Hospital, Beijing, China (N.S.); Centers for Metabolic Disease Research, Temple University School of Medicine, PA (H.W.); Department of Cardiology, Peking University First Hospital, Beijing, China (Y.Z., J.L., Y.H
| | - Fan Fan Hou
- From the Renal Division, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Guangzhou, China (X.Q., Y.L., X.X., M.L., J.N., B.W., F.F.H.); Department of Cardiology, Peking University People’s Hospital, Beijing, China (N.S.); Centers for Metabolic Disease Research, Temple University School of Medicine, PA (H.W.); Department of Cardiology, Peking University First Hospital, Beijing, China (Y.Z., J.L., Y.H
| | - Yong Huo
- From the Renal Division, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Guangzhou, China (X.Q., Y.L., X.X., M.L., J.N., B.W., F.F.H.); Department of Cardiology, Peking University People’s Hospital, Beijing, China (N.S.); Centers for Metabolic Disease Research, Temple University School of Medicine, PA (H.W.); Department of Cardiology, Peking University First Hospital, Beijing, China (Y.Z., J.L., Y.H
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