| BackgroundA large of epidemiological investigation and clinical study find that plasma homocysteine (Homocysteine, Hey) levels and cardiovascular disease are closely linked, high homocysteine is an important independent risk factor of cardiovascular disease. Studies have shown that plasma Hey is significantly higher in hypertension population than normal population, plasma Hey levels have the synergistic effect of hypertension. Higher homocysteine will increase the damage of hypertension on blood vessels, thus prone to heart, brain, kidney. Thus, while decrease blood pressure in hypertensive patients, observed the changes in plasma Hey levels is of significance. Because of Folate involving in metabolism of Hey and effectively reducing the concentration of Hey have direct protective effects of vascular endothelial cells methylenetetrahydrofolate reductase (5,10-Methylenetetrahydrofolate reductase vascular endothelial cells MTHFR enzyme) is, a key enzyme of in folate metabolism and Hey, MTHFRC677T mutations lead to decreased activity, MTHFR (CT) activity is MTHFR (CC) 65%, and MTHFR (TT) is MTHFR CC only 30%, folate levels of MTHFRTT genotype decreases, Plasma Hey increases. Overseas studies have shown that folic acid reducies Hcy,in MTHFRTT genotype groups significantly reducing the risk of stroke better than MTHFRCC, CT genotype. High plasma homocysteine (Hey) levels and methylenetetrahydrofolate reductase (MTHFR) gene C677T polymorphism are important factors of cardiovascular disease, reducing cardiovascular events by folic acid reducing Hey has become a hot issue in cardiovascular research field, but the relationships of folic acid, MTHFR gene polymorphism and Hey little researches and conclusions different betwwen domestic and foreign.ObjectiveTo investigate the influence of MTHFR gene polymorphism in lowering plasma Hey on combination of enalapril with folic acid in patients with essential hypertension.Methods422 of patients essential hypertension people were randomly selected in An Qing area of An Hui, using the polymerase chain reaction-restriction fragment length polymorphism analysised genotyping of MTHFR, which were CC 74 of patients,CT 230 of patients, TT 118 of patients, according to MTHFR C677T genotype 1:1:1 randomly selected TT 76 of patients, CT 83 of patients, CC 74 of patients,intotle233 patients Group 1 receiving enalapril 10 mg, once daily,a period of 8 weeks;Group 2 receiving enalapril plus folic acid at the ratio of 10/0.4 mg or 10/0.8 mg, once daily, a period of 8 weeks. The changes in plasma Hcy were observed and analyzed by MTHFR genotypes (TT vs CC/CT).ResultsIn Group 1, the percentages of plasma Hey reduction were-15% for TT subjects and 2% for CC/CT subjects after 8week treatment (P=0.017). In Group 2, the percentages of plasma Hcy reduction were 21% for TT subjects and 9% for CC/CT subjects after 8week treatment (P=0.002). The OR value of baseline Hcy≥10μmol/L at TT vs CC/CT genotype in Group 2 was 2.7(P=0.005), and 2.2(P=0.043) after 8 week treatment. In a Logistic analysis for the variable Hcy (8week to baseline), theβvalue was -2.8(P<0.001) for TT subjects in Group 2, theβvalue was 2.4 for TT subjects in Group 1, after adjusting for age, sex, and body mass index. ConclusionA combination of folic acid and enalapril can effectively decrease the level of plasma Hcy in hypertensives, with the most benefitions in those with MTHFR genotype TT, who are fit for an individualized medical regimen. |
