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Plasma homocysteine, aortic stiffness, and renal function in hypertensive patients
L A Bortolotto1, M E Safar, E Billaud
1Department of Internal Medicine and Inserm U 337, Broussais Hospital, APHP, Paris, France.
Insights
High homocysteine levels are linked to arterial stiffness in hypertensive patients. Evaluating aortic distensibility and homocysteine aids cardiovascular risk assessment.
Area of Science:
- Cardiovascular Medicine
- Clinical Chemistry
Background:
- Hyperhomocysteinemia is linked to vascular structure changes and clinical events.
- Hypertension is a major risk factor for cardiovascular disease.
Purpose of the Study:
- To assess the relationship between plasma homocysteine, large artery structure and function, and clinical vascular disease in hypertensive patients.
- To determine if homocysteine levels correlate with arterial stiffness and cardiovascular disease presence.
Main Methods:
- Investigated 236 hypertensive patients.
- Measured carotid-femoral pulse wave velocity for arterial stiffness.
- Determined total plasma homocysteine using fluorometric high-performance liquid chromatography.
- Defined cardiovascular disease by clinical events (coronary, cerebrovascular, peripheral vascular disease).
Main Results:
- Pulse wave velocity positively correlated with homocysteine, independent of other factors (P=0.016).
- Higher homocysteine, creatinine clearance, and pulse wave velocity observed with increased atherosclerosis extent.
- Elevated plasma homocysteine, creatinine clearance, and pulse wave velocity in patients with clinical vascular disease.
Conclusions:
- Plasma homocysteine strongly and independently correlates with arterial stiffness (aortic pulse wave velocity) in hypertensive patients.
- Elevated homocysteine and arterial stiffness are associated with clinical vascular disease.
- Aortic distensibility and homocysteine evaluation can improve cardiovascular risk assessment in hypertensive populations.
Abstract:
Hyperhomocysteinemia has been associated with both vascular structure alterations and vascular clinical end points. To assess the relation between plasma homocysteine, structure and function of large arteries, and the presence of clinical vascular disease, we investigated a population of 236 hypertensive patients. We estimated arterial stiffness by measuring the carotid-femoral pulse wave velocity. Total plasma homocysteine was determined by fluorometric high-performance liquid chromatography. The presence of cardiovascular disease was defined on the basis of clinical events, including coronary heart disease, cerebrovascular disease, and peripheral vascular disease. In this population, pulse wave velocity was positively correlated with homocysteine, even after adjustments for age, mean blood pressure, extent of atherosclerosis, and creatinine clearance (P=0.016). Analysis of variance showed statistically significant differences between the mean values of homocysteine, creatinine clearance, and pulse wave velocity according to the extent of atherosclerosis, with an increase in these 3 parameters concomitant with an increase in the number of vascular sites involved with atherosclerosis. In conclusion, in hypertensive patients the levels of homocysteine are strongly and independently correlated to arterial stiffness measured by aortic pulse wave velocity. Plasma homocysteine, creatinine clearance, and aortic pulse wave velocity are higher in patients presenting with clinical vascular disease. These results suggest that the evaluation of aortic distensibility and homocysteine levels can help in cardiovascular risk assessment in hypertensive populations.