Plasma homocysteine, aortic stiffness, and renal function in hypertensive patients

Hyperhomocysteinemia has been associated with both vascular structure alter ations and vascular clinical end points. To assess the relation between pla sma homocysteine, structure and function of large arteries, and the presenc e of clinical vascular disease, we investigated a population of 236 hyperte nsive patients. We estimated arterial stiffness by measuring the carotid-fe moral pulse wave velocity. Total plasma homocysteine was determined by fluo rometric high-performance liquid chromatography. The presence of cardiovasc ular disease was defined on the basis of clinical events, including coronar y heart disease, cerebrovascular disease, and peripheral vascular disease. In this population, pulse wave velocity was positively correlated with homo cysteine, even after adjustments for age, mean blood pressure, extent of at herosclerosis, and creatinine clearance (P=0.016). Analysis of variance sho wed statistically significant differences between the mean values of homocy steine, creatinine clearance, and pulse wave velocity according to the exte nt of atherosclerosis, with an increase in these 3 parameters concomitant w ith an increase in the number of vascular sites involved with atheroscleros is. In conclusion, in hypertensive patients the levels of homocysteine are strongly and independently correlated to arterial stiffness measured by aor tic pulse wave velocity. Plasma homocysteine, creatinine clearance, and aor tic pulse wave velocity are higher in patients presenting with clinical vas cular disease. These results suggest that the evaluation of aortic distensi bility and homocysteine levels can help in cardiovascular risk assessment i n hypertensive populations.