High homocysteine levels are independently related to isolated systolic hypertension in older adults
Sutton-Tyrrell, K.; Bostom, A.; Selhub, J.; Zeigler-Johnson, C.
Circulation 96(6): 1745-1749
1997
ISSN/ISBN: 0009-7322 PMID: 9323056 Document Number: 473475
Background: The association between homocysteine and isolated systolic hypertension in older adults was evaluated using a case-control design, and the relationship between homocysteine and clinical or subclinical atherosclerosis was explored. Methods and Results: Cases were 179 adults gtoreq 60 years with a systolic blood pressure of gtoreq 160 mm Hg and diastolic blood pressure lt 90 mm Hg. One hundred seventy-one control subjects had the same criteria except systolic blood pressures were lt 160 mm Hg. All had normal creatinine levels. Homocysteine levels were performed on fasting blood samples that had been stored at -70 degree C. Atherosclerosis was defined as either a history of clinical disease, an internal carotid stenosis of gtoreq 40% by duplex scan, or an ankle/arm pressure ratio of lt 0.9. The median homocysteine value was 11.5 mu-mol/L for cases and 9.9 for control subjects (P lt .001). After control for potential confounders, homocysteine remained significantly associated with systolic hypertension (P=.019). For the hypertensive group, there was no apparent association between level of homocysteine and prevalence of atherosclerosis. However, among the normotensive group, the prevalence of atherosclerosis went from 22% in the lowest quintile of homocysteine values to 53% in the fifth quintile, with an odds ratio of 4.1 (fifth quintile in comparison to the first, P lt .05). After adjustment for age, sex, systolic blood pressure, cholesterol, and smoking, this odds ratio increased to 6.4 (P lt .01). Conclusions: Elevated levels of homocysteine may be related to the cause of isolated systolic hypertension in some individuals. In normotensive older adults, homocysteine appears to be an independent risk factor for atherosclerosis.