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Circulating homocysteine levels in sustained and white coat hypertension

Journal of Human Hypertension volume 17, pages 165–170 (2003)Cite this article

Abstract

Although white coat hypertension has been widely studied in the last years, its risk profile is not yet completely clear. The aim of this study was to evaluate circulating homocysteine levels, an emerging cardiovascular risk factor, in subjects with white coat and sustained hypertension. We selected 31 sustained hypertensive subjects, 31 white coat hypertensive subjects and 31 normotensive subjects matched for age, gender, body mass index and occupation. Women were also matched for menopausal status. Subjects with smoking habit, dyslipidaemia and diabetes mellitus were excluded from the study. White coat hypertension was defined as clinical hypertension and daytime ambulatory blood pressure <135/85 mmHg. Blood samples were drawn after a fasting period of 12 h for routine laboratory tests and homocysteine determination. Homocysteine levels were evaluated by fluorescence polarization immunoassay. Creatinine, glucose, cholesterol and triglycerides were not different among the groups. White coat hypertensive subjects had significantly lower homocysteine levels than sustained hypertensive patients (8.2±2.0 vs 12.6±3.9 μmol/l, P=0.0003). No significant difference was observed between white coat hypertensive and normotensive subjects regarding this parameter (8.2±2.0 vs 7.6±1.9 μmol/l, P=0.9). In conclusion, our data show that middle-aged white coat hypertensive subjects without other cardiovascular risk factors have lower circulating homocysteine levels than sustained hypertensive patients suggesting that they are at lower cardiovascular risk.

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References

  1. Pickering TG et al. How common is white-coat hypertension? JAMA 1988; 259: 225–228.

    Article  CAS  PubMed  Google Scholar 

  2. Pierdomenico SD et al. White-coat hypertension in patients with newly diagnosed hypertension: evaluation of prevalence by ambulatory monitoring and impact on cost of health care. Eur Heart J 1995; 16: 692–697.

    Article  CAS  PubMed  Google Scholar 

  3. White WB, Schulman P, MacCabe EJ, Dey HM . Average daily blood pressure, not office blood pressure, determines cardiac function in patients with hypertension. JAMA 1989; 261: 873–877.

    Article  CAS  PubMed  Google Scholar 

  4. Hoegholm A et al. Left ventricular mass and geometry in patients with established hypertension and white coat hypertension. Am J Hypertens 1993; 6: 282–286.

    Article  CAS  PubMed  Google Scholar 

  5. Gosse P, Promax H, Durandet P, Clementy J . ‘White coat’ hypertension. No harm for the heart. Hypertension 1993; 22: 766–770.

    Article  CAS  PubMed  Google Scholar 

  6. Hoegholm A et al. Microalbuminuria in 411 untreated individuals with established hypertension, white coat hypertension, and normotension. Hypertension 1994; 24: 101–105.

    Article  CAS  PubMed  Google Scholar 

  7. Cavallini MC et al. Is white coat hypertension associated with arterial disease or left ventricular hypertrophy? Hypertension 1995; 26: 413–419.

    Article  CAS  PubMed  Google Scholar 

  8. Pierdomenico SD et al. Target organ status and serum lipids in patients with white coat hypertension. Hypertension 1995; 26: 801–807.

    Article  CAS  PubMed  Google Scholar 

  9. Pickering TG . Clinic measurement of blood pressure and white coat hypertension. In: Pickering TG (ed). Ambulatory Monitoring and Blood Pressure Variability. Science Press: London, 1991, pp 7.1–7.14.

    Google Scholar 

  10. Marchesi E et al. Metabolic risk factors in white coat hypertensives. J Hum Hypertens 1994; 8: 475–479.

    CAS  PubMed  Google Scholar 

  11. Pierdomenico SD et al. Low-density lipoprotein oxidation and vitamins E and C in sustained and white-coat hypertension. Hypertension 1998; 31: 621–626.

    Article  CAS  PubMed  Google Scholar 

  12. Martinez MA et al. Frequency and determinants of white coat hypertension in mild to moderate hypertension: a primary care-based study. Am J Hypertens 1999; 12: 251–259.

    Article  CAS  PubMed  Google Scholar 

  13. Pierdomenico SD et al. Twenty-four-hour autonomic nervous function in sustained and ‘white coat’ hypertension. Am Heart J 2000; 140: 672–677.

    Article  CAS  PubMed  Google Scholar 

  14. Pierdomenico SD et al. Clinic and ambulatory heart rate in sustained and white-coat hypertension. Blood Press Monit 2001; 6: 239–244.

    Article  CAS  PubMed  Google Scholar 

  15. Verdecchia P et al. Ambulatory blood pressure. An independent predictor of prognosis in essential hypertension. Hypertension 1994; 24: 793–801.

    Article  CAS  PubMed  Google Scholar 

  16. Khattar RS, Senior R, Lahiri A . Cardiovascular outcome in white-coat versus sustained mild hypertension: a 10-year follow-up study. Circulation 1998; 98: 1892–1897.

    Article  CAS  PubMed  Google Scholar 

  17. Fagard RH et al. Response to antihypertensive therapy in older patients with sustained and nonsustained systolic hypertension. Circulation 2000; 102: 1139–1144.

    Article  CAS  PubMed  Google Scholar 

  18. Julius S et al. ‘White coat’ versus ‘sustained’ borderline hypertension in Tecumseh, Michigan. Hypertension 1990; 16: 617–623.

    Article  CAS  PubMed  Google Scholar 

  19. Cardillo C, De Felice F, Campia U, Folli G . Psychophysiological reactivity and cardiac end-organ changes in white coat hypertension. Hypertension 1993; 21: 836–844.

    Article  CAS  PubMed  Google Scholar 

  20. Kuwajima I, Suzuki Y, Fujisawa A, Kuramoto K . Is white coat hypertension innocent? Structure and function of the heart in the elderly. Hypertension 1993; 22: 826–831.

    Article  CAS  PubMed  Google Scholar 

  21. Weber MA, Neutel JM, Smith DHG, Graettinger WF . Diagnosis of mild hypertension by ambulatory blood pressure monitoring. Circulation 1994; 90: 2291–2298.

    Article  CAS  PubMed  Google Scholar 

  22. Glen SK et al. White-coat hypertension as a cause of cardiovascular dysfunction. Lancet 1996; 348: 654–657.

    Article  CAS  PubMed  Google Scholar 

  23. Soma J et al. Left ventricular systolic and diastolic function assessed with two-dimensional and Doppler echocardiography in ‘white coat’ hypertension. J Am Coll Cardiol 1996; 28: 190–196.

    Article  CAS  PubMed  Google Scholar 

  24. Ferrara LA et al. Isolated office hypertension and end-organ damage. J Hypertens 1997; 15: 979–985.

    Article  CAS  PubMed  Google Scholar 

  25. Palatini P et al. Target-organ damage in stage 1 hypertensive subjects with white coat and sustained hypertension: results from the HARVEST study. Hypertension 1998; 31: 57–63.

    Article  CAS  PubMed  Google Scholar 

  26. Zakopoulos N et al. Isolated clinic hypertension is not an innocent phenomenon: effect on the carotid artery structure. Am J Hypertens 1999; 12: 245–250.

    Article  CAS  PubMed  Google Scholar 

  27. McGill Jr HC et al. Effects of serum lipoproteins and smoking on atherosclerosis in young men and women. The PDAY Research Group. Pathobiological determinants of atherosclerosis in youth. Arterioscler Thromb Vasc Biol 1997; 17: 95–106.

    Article  PubMed  Google Scholar 

  28. Wilson PW et al. Prediction of coronary heart disease using risk factor categories. Circulation 1998; 97: 1837–1847.

    Article  CAS  Google Scholar 

  29. Malinow MF et al. Carotid artery intimal-medial wall thickening and plasma homocyst(e)ine in asymptomatic adults. The Atherosclerosis Risk in Communities Study. Circulation 1993; 87: 1107–1113.

    Article  CAS  PubMed  Google Scholar 

  30. Selhub J et al. Association between plasma homocysteine concentrations and extracranial carotid-artery stenosis. N Engl J Med 1995; 332: 286–291.

    Article  CAS  PubMed  Google Scholar 

  31. Perry IJ et al. Prospective study of serum total homocysteine concentration and risk of stroke in middle-aged British men. Lancet 1995; 346: 1395–1398.

    Article  CAS  PubMed  Google Scholar 

  32. Giles WH et al. Total homocyst(e)ine concentration and the likelihood of nonfatal stroke. Results from the Third National Health and Nutrition Examination Survey, 1988–1994. Stroke 1998; 29: 2473–2477.

    Article  CAS  PubMed  Google Scholar 

  33. Matsui T et al. Elevated plasma homocysteine levels and risk of silent brain infarction in elderly people. Stroke 2001; 32: 1116–1119.

    Article  CAS  PubMed  Google Scholar 

  34. Stampfer MJ et al. A prospective study of plasma homocyst(e)ine and risk of myocardial infarction in US physicians. JAMA 1992; 268: 877–881.

    Article  CAS  PubMed  Google Scholar 

  35. Robinson K et al. Hyperhomocysteinemia and low pyridoxal phosphate. Common and independent reversible risk factors for coronary artery disease. Circulation 1995; 92: 2825–2830.

    Article  CAS  PubMed  Google Scholar 

  36. Boushey CJ, Beresford SAA, Omenn GS, Motulsky AG . A quantitative assessment of plasma homocysteine as a risk factor for vascular disease. Probable benefits of increasing folic acid intakes. JAMA 1995; 274: 1049–1057.

    Article  CAS  Google Scholar 

  37. Graham IM et al. Plasma homocysteine as a risk factor for vascular disease. The European Concerted Action Project. JAMA 1997; 277: 1775–1781.

    Article  CAS  PubMed  Google Scholar 

  38. Nygard O et al. Plasma homocysteine levels and mortality in patients with coronary artery disease. N Engl J Med 1997; 337: 230–236.

    Article  CAS  PubMed  Google Scholar 

  39. Wald NJ et al. Homocysteine and ischemic heart disease. Results of a prospective study with implications regarding prevention. Arch Intern Med 1998; 158: 862–867.

    Article  CAS  PubMed  Google Scholar 

  40. Eikelboom JW et al. Homocyst(e)ine and cardiovascular disease: a critical review of the epidemiologic evidence. Ann Intern Med 1999; 131: 363–375.

    Article  CAS  PubMed  Google Scholar 

  41. Ridker PM et al. Homocysteine and risk of cardiovascular disease among postmenopausal women. JAMA 1999; 281: 1817–1821.

    Article  CAS  PubMed  Google Scholar 

  42. Nappo F et al. Impairment of endothelial functions by acute hyperhomocysteinemia and reversal by antioxidant vitamins. JAMA 1999; 281: 2113–2118.

    Article  CAS  PubMed  Google Scholar 

  43. Virdis A et al. Mechanisms responsible for endothelial dysfunction induced by fasting hyperhomocysteinemia in normotensive subjects and patients with essential hypertension. J Am Coll Cardiol 2001; 38: 1106–1115.

    Article  CAS  PubMed  Google Scholar 

  44. Nygard O et al. Total plasma homocysteine and cardiovascular risk profile. The Hordaland Homocysteine Study. JAMA 1995; 274: 1526–1533.

    Article  CAS  PubMed  Google Scholar 

  45. Malinow MR et al. Role of blood pressure, uric acid, and hemorheological parameters on plasma homocyst(e)ine concentration. Atherosclerosis 1995; 114: 175–183.

    Article  CAS  PubMed  Google Scholar 

  46. Sheu WHH, Lee WJ, Chen YT . Plasma homocysteine concentrations and insulin sensitivity in hypertensive subjects. Am J Hypertens 2000; 13: 14–20.

    Article  CAS  PubMed  Google Scholar 

  47. Pickering TG . Recommendations for the use of home (self) and ambulatory blood pressure monitoring. Am J Hypertens 1996; 9: 1–11.

    Article  CAS  Google Scholar 

  48. Shipchandler MT, Moore EG . Rapid, fully automated measurement of plasma homocyst(e)ine with the Abbott Imx Analyzer. Clin Chem 1995; 41: 991–995.

    CAS  PubMed  Google Scholar 

  49. Altman DG . Practical Statistics for Medical Research. Chapman & Hall: London; 1992. pp 179–276.

  50. Lip GYH et al. A pilot study of homocyst(e)ine levels in essential hypertension : relationship to von Wille-brand factor, an index of endothelial damage. Am J Hypertens 2001; 14: 627–631.

    Article  CAS  PubMed  Google Scholar 

  51. Tsioufis C et al. Relationships between new risk factors and circadian blood pressure variation in untreated subjects with essential hypertension. Am J Hypertens 2002; 15: 600–604.

    Article  CAS  PubMed  Google Scholar 

  52. Pierdomenico SD et al. Endothelial function in sustained and white coat hypertension. Am J Hypertens 2002; 15: 946–952.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Dipartimento di Medicina e Scienze dell'Invecchiamento, Centro per lo Studio dell'Ipertensione Arteriosa, delle Dislipidemie e dell'Arteriosclerosi, University ‘Gabriele d'Annuzio,’, Chieti, Italy

    S D Pierdomenico, A Bucci, D Lapenna, F Cuccurullo & A Mezzetti

  2. Dipartimento di Oncologia e Neuroscienze, Laboratorio di Patologia Clinica II, University ‘Gabriele d'Annuzio’, Chieti, Italy

    F M Lattanzio & L Talone

Authors
  1. S D Pierdomenico
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  2. A Bucci
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  3. D Lapenna
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  4. F M Lattanzio
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  5. L Talone
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  6. F Cuccurullo
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  7. A Mezzetti
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Correspondence to S D Pierdomenico.

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Pierdomenico, S., Bucci, A., Lapenna, D. et al. Circulating homocysteine levels in sustained and white coat hypertension. J Hum Hypertens 17, 165–170 (2003). https://doi.org/10.1038/sj.jhh.1001524

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  • DOI: https://doi.org/10.1038/sj.jhh.1001524

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