Relationship between homocysteine and hypertension: New data add to the debate

Abstract

Over the past 5 decades, as well as presently, the morbidity and mortality attributable to hypertension continues to be a major public health issue both at the local and global levels. Despite individual and population-based efforts to address the traditional and well-known modifiable risk factors that contribute to cardiovascular disease, including hypertension, such as reducing dietary sodium intake, weight reduction, increasing physical activity, and smoking cessation, the disease burden attributable to hypertension and its corresponding target organ damage is on the rise. This increase is associated with considerable individual, family, societal, and economic implications.Of the multiplicity of established risk factors associated with the development of hypertension and its complications (such as heart disease, stroke, chronic kidney disease, accelerated atherosclerosis, and premature death), hyperhomocysteinemia has arguably been one of the most elusive of the proposed risk factors to convincingly link to hypertension. Multiple clinical and epidemiological studies investigating the relationship of increased homocysteine levels to hypertension have come to contrasting conclusions. As such, the debate as to the causal link between hyperhomocysteinemia and hypertension continues. trial, demonstrated an increased prevalence of hypertension in persons with higher compared with lower homocysteine levels. 2,3 In the case of NHANES III, which provides some of the most convincing evidence for the association between hyperhomocysteinemia and hypertension, a 5-μmol/L increase in homocysteine levels (or 1 SD above the mean), was associated with a 0.7-and 0.5-mm Hg increase in systolic blood and diastolic BPs, respectively, in men and an increase of 1.2-and 0.7-mm Hg increase in systolic and diastolic BPs, respectively, in women.Additional support for the association between hyperhomocysteinemia and an elevation in BP includes evidence that reducing homocysteine levels by dietary B vitamin supplementation resulted in a reduction of BP. Thus, the observation of an increased prevalence of

Homocysteine and small vessel stroke: A mendelian randomization analysis

“…Smokers have higher tHcy levels and lower folate, vitamin B 6 , and vitamin B 12 levels compared to never smokers . Furthermore, raised tHcy levels may cause an increase in blood pressure mediated by damage to vascular smooth muscle and endothelial cells, which, in turn, could lead to a loss of arterial vasodilation and vascular integrity . Blood pressure may thus be in the causal pathway linking elevated tHcy levels to SVS risk.…”

Hyperhomocysteinemia and Cardiovascular Disease: Is the Adenosinergic System the Missing Link?

“…HHCy is a condition in which the plasma concentration of HCy is elevated, which occurs as a result of an imbalance between its biosynthesis and catabolism [17]. The definition of HHCy is controversial, but it is generally defined as plasma HCy ≥ 10 µmol/L [18][19][20]. However, a slight increase (10-15 µmol/L) in plasma HCy level is associated with morbi-mortality [21], and a higher cut-off (≥15 µmol/L) was also considered to designate HHCy [22,23].…”

Value of plasma homocysteine to predict stroke, cardiovascular diseases, and new-onset hypertension

“…Therefore, the definition of hyperhomocysteinemia (Hhcy) is controversial, but it is generally defined as plasma Hcy ≥15 μmol/L, [ 8 , 9 ] but it also has been known to be defined as plasma Hcy ≥10 μmol/L. [ 10 – 12 ] There is a large amount of epidemiological data demonstrating that elevated plasma Hcy is an independent risk factor for CVDs, [ 13 – 15 ] even when the plasma Hcy levels are only slightly increased (10–15 μmol/L). [ 16 ] Nevertheless, there are only a few long-term follow-up cohort studies available and there are currently no cohort studies that assessed the influence of Hhcy on cardiovascular events in patients with or without hypertension.…”