The Relationship Between Level Of Plasma Homocysteine And Left Ventricular Hypertrophy In Hypertensives

Background:To investigate the correlation between homocysteine(Hcy)levels and left ventricular hypertrophy in hypertensives.Methods:636 subjects were selected from outpatients and inpatient of the First Affiliated Hospital of Fujian Medical University from January 2016 to 2018 March.According to the levels of blood pressure and homocysteine,subjects were divided into normal control group(n=159),high homocysteine group(n=101),hypertension group(n=158),high homocysteine and hypertension group(n=218).Medical history,medication history,personal history and family history of all subjects enrolled were recorded.Blood pressure,height,weight,and body mass index(BMI)were calculated.The fasting venous blood of patients were collected early in the morning and tested for biochemical indicators such as cholesterol,liver function factors and renal function factors.The levels of Plasma Hcy were determined by HPLC-tandem mass spectrometry.Left ventricular morphology and cardiac functions were measured by echocardiography.Cardiac ultrasound parameters,Hcy,blood pressure,BMI,glomerular filtration rate(GFR)were comparied among groups.A multivariate analysis of variance was used to investigate the association of high blood pressure and high Hcy levels with left ventricular hypertrophy.Linear regression was used to explore the major factors that contribute to left ventricular hypertrophy.Results:1.Compared with Hyper homocysteinemia and Hypertension(HHcy+HT)group,the level of GFR,cystatin-C,HDL-C,EF,LVMI,LVM,IVST,LVPWT,LVVD were significantly higher in Hypertension(HT)group(P<0.05).There was no significant difference in blood pressure,TCHO,TG,LDL-C,e,e1,/e,and E/A between two groups(P<0.05).There was no significant difference between the normal control group and the pure Hey group.2.Multivariate analysis of variance showed that higher levels of blood pressure and Hcy were have a promote impact on the increase of LVMI and LVM as well as the decrease of el,E/A and EF%.3.Spearman correlation analysis results showed that age,BMI,Hcy,SBP,uric acid were positively correlated with LVMI((r=0.240?0.201?0.192?0.337?0.131,P<0.05)),while the levels of low-density lipoprotein cholesterol,glomerular filtration rate and LVMI were negatively correlated(r =-0.136,-0.152,P <0.05).There was no significant correlation between triglyceride,smoking,drinking,gender and LVMI(P>0.05).Multiple linear regression analysis showed that Hcy,a Age?BMI?SBP?LDL-C were independent risk factors for the predict factors of left ventricular hypertrophy after adjusting for confounding factors.4.In the subgroups,multiple linear regression analysis suggested that SBP and BMI were independent risk factors of left ventricular hypertrophy in subjects of young and middle-aged group(n=358).Whereas,Hcy had no influence on LVH.After a stratification by blood pressure in young and middle-aged subjects,Hcy and BMI were risk factors for left ventricular hypertrophy in hypertensive patients(n=182).In elderly subjects,Hcy,SBP,and BMI were independent risk factors for the prediction of left ventricular hypertrophy after adjusting for confounding factors.After stratified by blood pressure,Hcy level was the only risk factor for left ventricular hypertrophy(P <0.05),Whereas,BMI was the independent risk factor in subjects with normal blood pressure.and the difference was statistically significant(P<0.05).Elderly subjects also had a stratification in BMI,results showed that Hcy and systolic blood pressure were independent risk factors for left ventricular hypertrophy.Systolic blood pressure was still an independent risk factor of left ventricular hypertrophy in non-overweight subjects(n=143).Conclusions:1.The leves of Hcy and blood pressure have a synergistic effect on left ventricular hypertrophy and decreased diastolic function of the left ventricle.2.Age,systolic blood pressure,BMI,and Hcy were important influencing factors of left ventricular hypertrophy.3.The plasma Hcy levels in the young and middle-aged hypertensives and the elderly population(especially in the elderly overweight population)is an independent risk factor for left ventricular hypertrophy.