| Background:Hypertension is one of the most common diseases all over the world,which usually be known as the main risk factor of the "Cardiovascular Continuum".Besides,hypertension also plays an important role in the target organ damage,and effective controls of blood pressure can ameliorate the target organ damage as well as the related mortality.Kidney damages caused by hypertension are relatively common in clinical practice.However,it should be noted that although hypertension plays an important role in kidney injury,which often clusters with other cardiovascular(CV)risk factors,such as the elevated levels of homocysteine(HCY).The previous studies have shown that hypertensive patients with the increase of HCY levels can exacerbate the damage of kidney.But there are some disputes about the optimal HCY levels in clinical practices.For example,the 2010 Chinese guidelines for the management of hypertension recommended HCY target of<10 umol/L.However,currently the best available evidence for HCY in cardiovascular disease(CVD)prevention justifies the level of HCY to<15 umol/L.Referring to the Guidelines,should a classification by HCY levels be urgent to stratify the severity of related diseases and guide treatments?And fewer advances have been made in the clinical evaluations and assessments of HCY-mediated organ damages in patients with hypertension.Objective:1.To elucidate the role of HCY in renal function changes.2.To determine the different risks of the renal damage in various subgroups.Methods:1.SubjectsPatients were screened through the medical records database in Shandong provincial Qianfoshan Hospital from January 2015 to April 2019.By establishing the included and excluded criteria,the eligible people were screened and a retrospective study was constructed.In this retrospective,observational study,data were compiled for all patients presenting with hypertensive patients undergoing hospitalizations at least 2 times.2.Date CollectionBasic data(including gender,age,grades of hypertension,and antihypertensive medications usage,etc.);Biochemical data[(mainly including estimated glomerular filtration rate,eGFR),HCY,triglycerides,high-density lipoprotein cholesterol and low-density lipoprotein cholesterol,etc.].3.Definition of endpoint eventA sequential decrease in eGFR was defined as endpoint events.4.Statistical analysisAll data were statistically analyzed using SPSS 24.0 version,and P<0.05 was considered statistically significant.Independent sample t-tests were used to analyze the continuous variable data of normal distribution.And χ2 tests were used for comparison between the classified data groups.Logistic regression analysis and Cox proportional risk models were used to analyze the effects of HCY levels on the renal damage,and the results were expressed as hazard ratio(HR)and 95%confidence interval(95%CI).Result:1.A total of 7240 patients were eligible.There were 3604 patients with HCY≥ 15 umol/L and 3636 patients in the group with HCY<15 umol/L.Overall,1,145 patients had a hypertension grade 1[15.8%],2,455 hypertension grade 2[33.9%],and 3,640 hypertension grade 3[50.27%].2.Logistic regression analysis showed that the elevated HCY levels can increase the risk of renal function decline in patients with hypertension(P=0.000,HR=1.347,95%CI[1.224,1.482]).3.The incidence of outcome were significantly higher in patients who had HCY levels at 10 umol/L ≤ HCY<15 umol/L(48.1%),15 umol/L ≤HCY<20 umol/L(52.0%),and HCY≥20 umol/L(53.7%)compared with those HCY<10 umol/L group(43.9%).By contrast to patients who had HCY<10 umol/L,the risks of outcome event were higher in hypertensive patients who had 10 umol/L≤ HCY<15 umol/L(HR=1.195,95%CI[1.048,1.364];p<0.05),15 umol/L≤HCY<20 umol/L(HR=1.400,95%CI[1.227,1.597];p<0.05),and relatively HCY≥20 umol/L(HR=1.475,95%CI[1.305,1.667];p<0.05).4.Cox regression analysis showed that the risk of renal damage in the HCY≥ 15 umol/L group increased by 9.7%in contrast with the HCY<15 umol/L group.After adjusted of confounders,the elevated HCY levels was associated with the increased incidence of outcome event {adjusted hazard ratio(aHR)=1.112,95%CI,[1.039,1.190],P=0.002}.Conclusions and significance:1.The elevated HCY level can increased renal damage in hypertensive patients.2.Patients with hypertension and elevated HCY levels had a substantially increased risk of the renal damage. |
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