H型高血压:同型半胱氨酸水平升高与高血压发生及控制的研究进展

H-type hypertension: research progress on elevated homocysteine and the occurrence and control of hypertension

H型高血压是指伴有血同型半胱氨酸(homocysteine,Hcy)水平升高(≥10μmol/L)的高血压。高水平的H型高血压(高血压人群中患病率约为75%)是我国高血压人群的主要特征之一。现有研究表明,Hcy水平升高与高血压之间关联密切,作用机制明确;高血压患者Hcy水平与血压水平呈连续、线性正相关;同时,Hcy水平与降压药物的短期、中期及长期降压疗效呈连续、线性负相关:与Hcy水平<10μmol/L比较,Hcy水平为10~15μmol/L及≥15μmol/L的患者不同治疗周期收缩压下降幅度和血压达标率均显著下降;而由叶酸干预或饮食导致Hcy水平下降,可改善收缩压的控制。因而,血Hcy水平升高(≥10μmol/L)在高血压的发生、发展中具有重要作用,高血压患者基线Hcy水平是影响降压药物效果的重要因素和干预靶点,H型高血压的筛检和规范干预是提高我国高血压控制水平的重要策略。现有循证证据支持下列结论 :对于高血压患者,当Hcy水平≥10μmol/L时,即应开始进行联合干预。

It was estimated that about 75% of the Chinese hypertensive adults had elevated homocysteine concentrations （ ≥ 10 μmol/L）. Subjects with concomitant hypertension and elevated homocysteine were defined as having H-type hypertension. There was a positive association between homocysteine concentration and systolic blood pressure （SBP） or diastolic blood pressure （DBP） levels. Furthermore, higher homocysteine concentrations, even that of a moderate increase （10 ~ 15 μmol/L）, are significantly associated with decreased antihypertensive response to short- or long-term enalapril-based antihypertensive treatments in previously untreated hypertensive patients. After the 3-week treatment period with enalapril alone, the SBP lowering effect was significantly reduced by 1.39 （95%CI： 0.40 ~ 2.37） and 3.25 （95%CI： 1.98 ~ 4.52） mmHg in those with baseline Hcy concentrations of 10-15 and ≥ 15 μmol/L, respectively （P for trend 〈 0.001） as compared to those with Hcy 〈 10 μmol/L. Similar results were observed after a 15-week or 4.5-year antihypertensive treatment period. However, there was a positive relationship between homocysteine reduction and SBP reduction. These results show that homocysteine concentration may possibly be a powerful predictor for the benefit of antihypertensive therapy and a critical therapeutic target. Our findings raised the possibility that by better understanding and lowering the adverse effect of elevated homocysteine on the antihypertensive therapy, we may be better able to improve BP control, which has remained to be a big challenge in clinical and community settings. The above results suggest that patients with H-typed hypertension may particularly benefit from homocysteine-lowering therapy along with anti-hypertension therapy.