Elevated homocysteine concentrations decrease the antihypertensive effect of angiotensin-converting enzyme inhibitors in hypertensive patients

Xianhui Qin, Youbao Li, Ningling Sun, Hong Wang, Yan Zhang, Jiguang Wang, Jianping Li, Xin Xu, Min Liang, Jing Nie, Binyan Wang, Xiaoshu Cheng, Nanfang Li, Yingxian Sun, Lianyou Zhao, Xiaobin Wang, Fan Fan Hou, Yong Huo

Research output: Contribution to journalArticle

Abstract

Objective - We aimed to examine whether baseline homocysteine (Hcy) concentrations affect antihypertensive responses to enalapril treatment among previously untreated hypertensive patients (n=10 783) in the CSPPT (China Stroke Primary Prevention Trial). Approach and Results - After a 3-week run-in treatment with a daily dose of 10 mg enalapril, eligible hypertensive patients were randomly assigned to a double-blind daily treatment of a tablet of either enalapril (10 mg) and folic acid (0.8 mg) or enalapril (10 mg) alone for a median of 4.5 years. After the 3-week treatment period with enalapril alone, the systolic blood pressure-lowering effect was significantly reduced by 1.39 (95% confidence interval 0.40-2.37) and 3.25 (95% confidence interval 1.98-4.52) mm Hg, respectively, in those with baseline Hcy concentrations of 10 to 15 and ≥15 μmol/L (P for trend <0.001) as compared with those with Hcy concentration of <10 μmol/L. Similar results were observed after a 15-week treatment period with enalapril alone. After a median 4.5-year enalapril-based antihypertensive treatment period, compared with those with Hcy concentration of <10 μmol/L, the systolic blood pressure-lowering effect was still significantly reduced by 0.77 (95% confidence interval 0.01-1.53) and 1.70 (95% confidence interval 0.72-2.68) mm Hg, respectively, in those with Hcy concentrations of 10 to 15 and ≥15 μmol/L (P for trend <0.001). In addition, participants with higher baseline Hcy concentrations had persistently higher systolic blood pressure levels across the entire study treatment period. Similarly, baseline Hcy concentrations were inversely associated with diastolic blood pressure reduction during the short-term enalapril alone treatment. However, the inverse association between baseline Hcy and diastolic blood pressure reduction was attenuated and became insignificant after the long-term enalapril-based treatment period. Conclusions - Elevated Hcy concentrations significantly decreased the antihypertensive effect of the short-term and long-term enalapril-based antihypertensive treatment in previously untreated hypertensive patients.

Original languageEnglish (US)
Pages (from-to)166-172
Number of pages7
JournalArteriosclerosis, Thrombosis, and Vascular Biology
Volume37
Issue number1
DOIs
StatePublished - Jan 1 2017

Keywords

  • antihypertensive responses
  • enalapril-based antihypertensive treatment
  • folic acid therapy
  • homocysteine concentrations
  • hypertension

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Fingerprint Dive into the research topics of 'Elevated homocysteine concentrations decrease the antihypertensive effect of angiotensin-converting enzyme inhibitors in hypertensive patients'. Together they form a unique fingerprint.

  • Cite this

    Qin, X., Li, Y., Sun, N., Wang, H., Zhang, Y., Wang, J., Li, J., Xu, X., Liang, M., Nie, J., Wang, B., Cheng, X., Li, N., Sun, Y., Zhao, L., Wang, X., Hou, F. F., & Huo, Y. (2017). Elevated homocysteine concentrations decrease the antihypertensive effect of angiotensin-converting enzyme inhibitors in hypertensive patients. Arteriosclerosis, Thrombosis, and Vascular Biology, 37(1), 166-172. https://doi.org/10.1161/ATVBAHA.116.308515