H-type of arterial hypertension: connection with atherosclerosis of carotid arteries

The aim – determination of the relationship between arterial hypertension (AH) and hyperhomocysteinemia (H-Hcy) with the presence of atherosclerotic plaques in the carotid arteries.Materials and methods. Our research was carried out within the framework of the study HIPSTER in Ukraine. The study included 40 patients with I and II degrees of hypertension (average office systolic (SBP) / diastolic (DBP) BP – 155.88/92.60±1.63/1.43 mm Hg). The average age of the patients was 55.85±2.09 years. Patients with homocystein level ≥ 10 μmol/L were defined as patients with H-Hcy (H-type AH). The stiffness of blood vessels was determined by PWV. Patients were examined at the beginning, after 6 months of treatment. Determination of the presence of atherosclerosis of the carotid arteries was detected at the beginning and after 12 months.Results and discussion. We found that office blood pressure in patients with H-type hypertension at the beginning and after 6 months of treatment was higher compared to patients without hypertension (156.45±1.04 mm Hg vs. 152.55±1.41 mm Hg at the beginning (p<0.05) and 130.65±0.96 mm Hg versus 126.97±1.08 mm Hg after 6 months (p<0,05)). Patients with H-type AH compared to patients without H-Hcy had a more insulin resistance (HOMA index 4.27±0.18 vs. 3.20±0.24 units, p<0.05). Atherosclerotic plaques in carotid arteries were found in 56.7 % (n=17) of patients with H-type hypertension and in 40.0 % (n=4) of patients with hypertension without H-Hcy (p<0.05 between groups). Patients with H-type AH had a higher prevalence of carotid atherosclerosis – atherosclerotic plaque area measured by NASCET was 43.4 % vs. 26.7 %, p<0.05, and was greater than in patients with AH without H-Hcy. 3 patients (10.0 %) with H-type AH developed new atherosclerotic plaques after 12 months, and no patients from the AH group without H-Hcy. After regression analysis, homocysteine ​ was associated with PWV regardless of the reduction of blood pressure on the therapy, as well as with the level of LDL cholesterol and the presence of atherosclerotic plaques in the carotid arteries. Homocysteine ​​was associated with PWVel after treatment (β=0.307, р=0.001), LDL cholesterol level before treatment (β=–1.501, р=0.017), and the presence of atherosclerotic of plaques in carotid arteries after treatment (β=5.236, р=0.031).Conclusions. H-type of arterial hypertension was associated with the presence of atherosclerotic plaques of the carotid arteries.