Research On Hcy Levels And Risk Factors Of Different Complications Caused By H-type Hypertension

Background:Essential hypertension, if accompanied by elevated serum homocysteine, is called H-type hypertension. When the level of serum homocysteine stands at or aboeve10umol/l, it is known as hyperhomocystinemia (HHcy). For long, it has been a consensus that hypertension is the most threatening factor for cardio-cerebrovascular diseases. In recent years, a growing number of reports have proved that HHcy is another independent risk factor, and there are synergies between the two when the diseases occur. Current studies have found some possible mechanisms leading to cardio-cerebrovascular diseases by elevated level of serum homocysteine:1. endothelial toxic effects,2. cell proliferation of smooth muscle,3. thrombogenic effects,4. metabolic disturbance of fat, carbohydrate and protein. These may cause atherosclerosis, damaging human’s arterial system, resulting in visceral complications including heart, brain, kidney, etc. Though there are high incidences of H-type hypertension in China, the treatment rate is low, while the combined damage to the heart, brain and kidney more severe. Consequently, it is a focus in our current work to study the risk factors to H-type hypertension, to understand the features of different complications of H-type hypertension, to prevent H-type hypertension effectively, and to take comprehensive intervention against multiple risk factors. This thesis, collecting various case histories of H-type hypertensive patients with different complications, makes a research into the respective risk factors for each, and takes a preliminary probe into the differences between the risk factors. It is to provide some reference for the prevention and treatment of H-type hypertension in the clinical work.Objective:1. To preliminarily explain the discrepancy and relationship between varied Hcy levels of complications of H-type hypertension.2. To take initial steps in expounding the difference between varied risk factors to kinds of complications of H-type hypertensionMethods:253cases of H-type hypertensive patients were collected. They were divided into groups according to their inspection results, e.g. group of Coronary Heart Disease(CHD), group of Cerebral Infarction(CI) and group of Proteinuria. Meanwhile,30cases of normal people were selected as contrast. The general information and biochemical tests of all selected people, analysed by Software SPSS15.0, then were under analysis with Logistic repression for different groups on Hcy levels, biochemical markers and associated risk factors of H-type hypertension.Results:1.The group of CI, CHD, and Proteinuria have higher Hcy、TC、LDL、 GLu、 Cr、CRP levels than the contrasting group,(39.85±11.20μmol/1VS23.30±7.60umol/l、15.72±7.08μmol/l、6.35±2.10μmol/l, P<0.05), TC in the group of CI (5.46±0.96VS4.65±0.75、4.32±0.82, P<0.05)、LDL-C (4.11±0.87mmol/L VS4.07±0.67、2.24±0.82, P<0.05、GLU (6.75±2.96mmol/L VS5.91±3.085.04±2.16, P<0.05、Cr (5.79±0.75mmol/L VS4.32±0.96、4.21±0.74, P<0.05). CRP (10.20±3.5μmol/L VS5.13±1.65、2.24±0.82, P<0.05) are higher the group of Coronary Heart Disease(CHD), group of Cerebral Infarction(CI) and group of Proteinuria.2. A multivariate analysis of the CHD group shows that the major risk factors to coronary heart disease are:Hey, LDL-C, GLU, CRP (OR are0.79,70.39,2.97respectively, P<0.05). The major risk factors of infarction are LDL-C、Cr、CRP、 Hey (OR are0.05,7.90,1.93,0.79respectively, P<0.05), The major risk factors of Proteinuria are GLU and Hey (OR are4.93,0.85,P<0.05).Conclusions:1. H-type hypertension with coronary heart disease and that with cerebral infarction basically have the same risk factors. LDL-C, low HDL-C, CRP, GLU, Hey, etc are important predictors of cardiovascular diseases. Significantly high Hey levels are easy to trigger cerebral infarction2. For H-type hypertension with proteinuria, the risk factors are blood glucose and Hey. The control of blood glucose may reduce the incidence of Hypertensive nephropathy.