(Circulation. 1997;96:1745-1749.)
© 1997 American Heart Association, Inc.
Articles |
High Homocysteine Levels Are Independently Related to Isolated Systolic Hypertension in Older Adults
From the Department of Epidemiology (K.S.-T., C.Z.-J.), Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pa; and the Vitamin Bioavailability Laboratory (A.B., J.S.), Jean Mayer United States Department of Agriculture Human Nutrition Research Center on Aging, Tufts New England Medical Center, Boston, Mass.
Correspondence to Kim Sutton-Tyrrell, DrPH, Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto St, Pittsburgh, PA 15261. E-mail Tyrrell{at}edc1.gsph.pitt.edu
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 
60 years with a
systolic blood pressure of 160 mm Hg and
diastolic blood pressure <90 mm Hg. One hundred
seventy-one control subjects had the same criteria except
systolic blood pressures were <160 mm Hg. All had normal
creatinine levels. Homocysteine levels were performed on
fasting blood samples that had been stored at -70°C.
Atherosclerosis was defined as either a history of
clinical disease, an internal carotid stenosis of 40% by
duplex scan, or an ankle/arm pressure ratio of <0.9. The median
homocysteine value was 11.5 µmol/L for cases and 9.9 for control
subjects (P<.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<.05). After adjustment for age, sex, systolic
blood pressure, cholesterol, and smoking, this odds ratio
increased to 6.4 (P<.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.
Key Words: aging • atherosclerosis • elasticity • hypertension • peripheral vascular disease
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