vitamin-b-12 and Hypertension

Nearly all of the annual 287,000 global maternal deaths are preventable. Hypertensive disorders of pregnancy (HDP) are among the major causes. A novel fixed-dose combination pill or polypill to prevent cardiovascular disease is a promising strategy for prevention of HDP. The aim of this study was to identify eligible candidates for a polypill for the prevention of HDP. A comprehensive review of systematic reviews on drug and dietary interventions to prevent HDP was conducted. Interventions were evaluated based on efficacy, dose, route of administration, and side effects. Fourteen interventions were assessed. Low-dose aspirin and calcium were identified as candidates for a polypill, with risk reduction estimations for pregnancy-induced hypertension and preeclampsia ranging between 10 and 62 %, depending on patient population characteristics including a priori risk, and gestation age at start of intervention. Their effect may be augmented through the addition of vitamin D, vitamin B12, and folic acid. The effect and optimal composition needs to be evaluated in future trials. Given the persistent burden of maternal and perinatal mortality associated with HDP, prevention of these disorders is key-especially in low-resource settings. The polypill approach with a combination of aspirin, calcium, vitamin D, vitamin B12, and folic acid is a promising strategy to improve maternal and perinatal health outcomes.

Topics: Antihypertensive Agents; Aspirin; Calcium, Dietary; Drug Therapy, Combination; Female; Humans; Hypertension; Pregnancy; Pregnancy Complications, Cardiovascular; Treatment Outcome; Vitamin B 12; Vitamin B Complex; Vitamin D; Vitamins

Nutritional factors such as magnesium, folic acid, vitamins B12 and B6, L-arginine, and polyunsaturated fatty acids (PUFAs) appear to be significantly beneficial for patients with coronary artery disease (CAD), and in the prevention and arresting the progression of HF and cardiac arrhythmias. Additionally, ingestion of adequate amounts of protein and maintaining normal concentrations of plasma albumin seem to be essential for these patients. These nutrients closely interact with the metabolism of L-arginine-nitric oxide (NO) system, essential fatty acids, and eicosanoids such that beneficial products such as NO, prostaglandin E1, prostacyclin, prostaglandin I3, lipoxins, resolvins, and protectins are generated and synthesis of proinflammatory cytokines is suppressed that results in platelet anti-aggregation, vasodilation, angiogenesis, and prevention of CAD, cardiac arrhythmias, and stabilization of HF. This implies that individuals at high risk for CAD, cardiac arrhythmias, and HF and those who have these diseases need to be screened for plasma levels of magnesium, folic acid, vitamins B12 and B6, L-arginine, NO, various PUFAs, lipoxin A4, resolvins, protectins, asymmetrical dimethylarginine (an endogenous inhibitor of NO), albumin, and various eicosanoids and cytokines and correct their abnormalities to restore normal physiology.

Topics: Alprostadil; Anti-Inflammatory Agents; Arginine; CD59 Antigens; Coronary Artery Disease; Diabetes Mellitus, Type 2; Epoprostenol; Fatty Acids, Essential; Fatty Acids, Unsaturated; Female; Folic Acid; Heart Failure; Humans; Hypertension; Lipoxins; Magnesium; Male; Middle Aged; Nitric Oxide; Nutritional Status; Serum Albumin; Vasodilation; Vitamin B 12; Vitamin B 6

Homocysteine (Hcy) is an endogenous, non-structural protein, a sulfur-containing amino acid emerging on the pathway of methionine and cysteine, actively involved in numerous biochemical reactions. Total concentration of homocysteine in plasma of healthy humans is low and its level is between 5.0 and 15.0 mmol/l, assessed with the use of HPLC, or 5.0-12.0 mmol/l, using immunoassay methods. Higher concentration of this amino acid in blood is called hyperhomocysteinemia. Hyperhomocysteinemia is significantly correlated with cardiovascular disease and its complications: heart attacks and strokes. It is believed that hyperhomocysteinemia damages endothelial cells, reduces the flexibility of vessels, and adversely affects the process of hemostasis. In addition, hyperhomocysteinemia enhances the adverse effects of risk factors such as hypertension, smoking, and impaired glucose, lipid and lipoprotein metabolism, as well as promoting the development of inflammation. The concentration of homocysteine can be effectively lowered by supplementation with folic acid and vitamins B12 and B6. However, intervention studies conducted in the past decade did not confirm the clinical benefit of vitamin therapy lowering the level of homocysteine in blood of patients with cardiovascular disease. Moreover, there is not clear evidence from genetic studies that the presence of the gene for MTFHR polymorphism 677C>T, which is one of the most common causes of hyperhomocysteinemia, is also associated with the development of cardiovascular disease. These results led the researchers to discuss the role of homocysteine in the development and treatment of cardiovascular disease as well as the need for further research on this issue.

Topics: Cardiovascular Diseases; Causality; Comorbidity; Folic Acid; Homocysteine; Humans; Hyperhomocysteinemia; Hypertension; Myocardial Infarction; Risk Factors; Vitamin B 12

The authors examine the available clinical and experimental data supporting the view that homocysteine, an alternative risk factor of cardiovascular disease, may play a role in the pathogenesis of essential hypertension. The mechanism of this disease has not been elucidated, but it may be related to impairment of vascular endothelial and smooth muscle cell function. Therefore, the occurrence of endothelial dysfunction could contribute to alterations of the endothelium-dependent vasomotor regulation. Elevated homocysteinemia diminishes the vasodilation by nitric oxide, increases oxidative stress, stimulates the proliferation of vascular smooth muscle cells, and alters the elastic properties of the vascular wall. Thus, homocysteine contributes to elevate the blood pressure. Also it is known that elevated plasma levels of homocysteine could lead to oxidant injury to the endothelium. The correction of elevated homocysteinemia by administration of vitamins B12 and B6 plus folic acid, could be a useful adjuvant therapy of hypertension. However, further controlled randomized trials are necessary to establish the efficacy and tolerability of these potentially therapeutic agents.

Topics: Antioxidants; Endothelium, Vascular; Folic Acid; Homocysteine; Humans; Hyperhomocysteinemia; Hypertension; Muscle, Smooth, Vascular; Nitric Oxide; Vitamin B 12

Topics: Abscess; Acute Disease; Antiviral Agents; Child; Ear Diseases; Electromyography; Facial Paralysis; Humans; Hypertension; Leukemia; Magnetic Resonance Imaging; Neoplasms; Neurophysiology; Radionuclide Imaging; Steroids; Virus Diseases; Vitamin B 12

Evidence of a positive association between mild hyperhomocysteinemia and arterial vascular disease has been accumulating in the last decade. Mild hyperhomocysteinemia acts as an independent vascular risk factor with equal strength as hypercholesterolemia and smoking. If jointly present with hypertension and smoking, its effect seems synergistic. This could make the outcome of homocysteine-lowering intervention beneficial, particularly in cases with concomitance of conventional vascular risk factors. So far, however, data on the clinical outcome of homocysteine-lowering treatment with a simple, safe, and cheap vitamin regimen are lacking. Trials investigating a beneficial clinical effect of homocysteine-lowering treatment using folic acid in a dose ranging from 0.2 to 5 mg daily, alone or in combination with vitamin B12 with or without vitamin B6 versus placebo, are ongoing. Furthermore, exploration of the unifying mechanism by which increased homocysteine levels may lead to both arterial and venous occlusions is warranted. These lines of investigations have to provide the ultimate proof of causality of hyperhomocysteinemia in vascular disease in the near future.

Topics: Arteriosclerosis; Case-Control Studies; Clinical Trials as Topic; Comorbidity; Coronary Disease; Folic Acid; Genetic Predisposition to Disease; Humans; Hyperhomocysteinemia; Hypertension; Meta-Analysis as Topic; Multicenter Studies as Topic; Oxidative Stress; Pyridoxine; Risk Factors; Smoking; Vitamin B 12

Topics: Age Factors; Animals; Blood Coagulation; Cerebrovascular Disorders; Chemical and Drug Induced Liver Injury; Contraceptives, Oral; Contraceptives, Oral, Hormonal; Coronary Disease; Folic Acid; Humans; Hypertension; Metabolism; Myocardial Infarction; Neoplasms; Progestins; Skin; Smoking; Teratogens; Thromboembolism; Time Factors; Vitamin B 12

Topics: Adolescent; Adult; Age Factors; Child; Child, Preschool; Deglutition Disorders; Female; Ganglioneuroma; Horner Syndrome; Humans; Hypertension; Infant; Infant, Newborn; Lung Diseases; Lung Neoplasms; Male; Mediastinal Neoplasms; Mediastinum; Meningocele; Middle Aged; Neoplasm Regression, Spontaneous; Neoplasms, Nerve Tissue; Neurilemmoma; Neuroblastoma; Neurofibroma; Neurofibromatosis 1; Neurologic Manifestations; Osteoarthropathy, Secondary Hypertrophic; Pain; Paraganglioma, Extra-Adrenal; Pheochromocytoma; Sex Factors; Vitamin B 12

Chronic Prostatitis/Chronic Pelvic Pain Syndrome (CP/CPPS) is reported in the literature ranging from 1 to 14.2%. The aim of the present study was to assess the impact on patient's quality of life and symptoms of Flower pollen extract in association with vitamins (Deprox 500®) in comparison with Serenoa repens 320 mg (Permixon 320 mg® by Pierre Fabre) in patients with CP/CPPS.. All consecutive patients, with a diagnosis of CP/CPPS, referred to our center from January to August 2016, were screened to be enrolled in this single-center, randomized, controlled trial. The main outcome measure was the evaluation of IPSS/NIHCPSI (International Prostatic Symptom Score/NIH-Chronic Prostatitis Symptom Index) score variation and the assessment of the quality of life and symptoms at the end of the therapy. The second outcome measure was the evaluation of the comorbidity role in the CP/CPPS therapy. 63 patients were analyzed; patients were randomized into two groups: 29 patients were treated with Deprox 500® 2 tablets/day for 6 weeks and 34 patients with Serenoa repens 320 mg, 1 tablet/day for 6 weeks.. The mean score variation for IPSS was -12.7 ± 4.3 in the Deprox 500® group and -7.8 ± 4.7 in the Serenoa repens group (p=0.0005) while for NIH-CPSI was -17.3±3.1 in the Deprox 500® group and -13.6±4.8 in the Serenoa repens group (p=0.0016). By accounting only the symptoms part of NIH-CPSI questionnaire, the mean score variation reported was -11.5±2.5 in the Deprox 500® group and -9.02±4.0 in the Serenoa repens group (p=0.009321). Furthermore, analyzing the comorbidity subgroups, in patients with hypertension, the mean IPSS score variation was -14.3±3.2 in the Deprox 500® group and - 9.02±4.0 in the Serenoa repens group.. In conclusion, in patients with CP/CPPS, Deprox 500® improves IPSS and NIH-CPSI scores up to 74.5% and 84.5% respectively. Furthermore, in patients with hypertension, the antioxidant effect of Deprox 500® reduces the mean IPSS score of 82.7%.

Topics: Adult; Aged; Disease Progression; Drug Combinations; Folic Acid; Humans; Hypertension; Male; Middle Aged; Plant Extracts; Prostatitis; Quality of Life; Riboflavin; Serenoa; Surveys and Questionnaires; Thiamine; Treatment Outcome; Vitamin B 12; Vitamin B 6; Young Adult

To analyze the effect of mecobalamin on the early-functional outcomes of patients with ischemic stroke and H-type hypertension.. From October of 2014 to October of 2016, 224 cases of ischemic stroke and H-type hypertension were selected. The patients were randomly divided into treatment control groups, with 112 patients in each group. The control group was treated with the conventional therapy. The observation group was treated with 500 µg of mecobalamin three times a day in addition to the conventional therapy. We compared serum homocysteine (Hcy), hs-CRP levels, carotid plaques, and NIHSS scores between the two groups on the 2nd day and at 4 weeks, 8 weeks, 3 months, and 6 months.. After 4 weeks, 8 weeks, 3 months and 6 months, the difference of serum Hcy level between the two groups was statistically significant (t = 4.049, 3.896, 6.052, 6.159, respectively. All P <0.05). After the treatment, at 4 weeks, 8 weeks, 3 months and 6 months, the levels of hs-CRP in the treatment group were significantly lower than those in the control group (t = 37.249, 28.376, 26.454, 20.522, respectively. All P <0.01). After 3 months and 6 months, the carotid artery plaques were significantly reduced in the treatment group compared to those in the control group (t = 2.309 and 2.434. All P <0.05). After 3 months and 6 months, the NIHSS score was significantly higher in the treatment group compared to those in the control group (t = 2.455 and 2.193. All P <0.05).. Mecobalamin can reduce the level of plasma homocysteine, then lead to reductions of levels of plasma inflammatory factors and volume of carotid artery plaques, resulting in more significant functional recovery.

Topics: Aged; Aged, 80 and over; Brain Ischemia; Female; Homocysteine; Humans; Hypertension; Male; Middle Aged; Prognosis; Stroke; Treatment Outcome; Vitamin B 12

To investigate the impact of adding folic acid, vitamin B(12) and probucol to standard antihypertensive medication on plasma homocysteine (Hcy) and asymmetric dimethylarginine (ADMA), serum NO and eNOS of essential hypertensive patients.. A total of 120 patients with hypertension were randomly divided to three groups (n = 40 each): group 1 (standard medication), group 2 (adding folic acid 5 mg/day and vitamin B(12) 500 µg twice daily) and group 3 (adding folic acid 5 mg/day and vitamin B(12) 500 µg twice daily and probucol 500 mg twice daily). Plasma Hcy and ADMA, serum NO and eNOS levels were observed at baseline, 2 and 12 weeks after various therapy.. In group 1, concentrations of plasma Hcy [(23.06 ± 14.15) µmol/L, (23.67 ± 12.31) µmol/L, (23.25 ± 11.64) µmol/L], ADMA [(0.21 ± 0.12) µmol/L, (0.23 ± 0.13) µmol/L, (0.21 ± 0.09) µmol/L] and serum NO [(64.14 ± 15.07) µmol/L, (65.29 ± 15.04) µmol/L, (65.32 ± 13.58) µmol/L], eNOS [(20.02 ± 4.50) µg/L, (20.79 ± 4.03) µg/L, (19.82 ± 5.70) µg/L] remained unchanged during the 12 weeks therapy (all P > 0.05). In group 2, concentrations of plasma Hcy [(12.54 ± 6.49) µmol/L] and ADMA[(0.18 ± 0.07) µmol/L] were significantly decreased after the treatment of 12 weeks than the treatment baseline value [(21.51 ± 7.82) µmol/L, (0.20 ± 0.12) µmol/L] and 2 weeks value[(19.38 ± 8.14) µmol/L, (0.21 ± 0.12) µmol/L], however the concentrations of serum NO and eNOS showed contrary results of the Hcy and ADMA's. (all P < 0.05). In group 3, similar changes occurred at 2 weeks after therapy (P < 0.05 2 weeks vs. baseline and 12 weeks vs. 2 weeks). Plasma ADMA level was positively correlated with Hcy at baseline (r = 0.546, P < 0.05).. Supplementation of folic acid, VitB(12) and/or probucol helps to improve endothelial function and reduce plasma Hcy and ADMA levels in patients with hypertension.

Topics: Aged; Antihypertensive Agents; Arginine; Female; Folic Acid; Homocysteine; Humans; Hypertension; Male; Middle Aged; Nitric Oxide; Nitric Oxide Synthase Type III; Plasma; Probucol; Vitamin B 12; Vitamin B Complex; Vitamins

No data are currently available on the prevalence and control of cardiovascular (CV) risk factors in secondary prevention depending on the cardiac or cerebral localization of the ischemic disease. We investigated the prevalence and control of modifiable CV risk factors, as well as the determinants of CV risk factors' control and adequate treatment in a secondary prevention cohort, the SU-FOL-OM3 study cohort, to determine the role of the localization of the ischemic disease including events.. A total of 2491 patients were included in the study. The prevalence of all modifiable risk factors was high in both coronary heart disease and cerebrovascular disease (CVD) groups. Control of all risk factors and the presence of antiplatelet medication were noted in 29.6% of patients with coronary heart disease and 11% of patients with CVD. The cardiac localization of the including event was independently associated with the control of each of the risk factors studied (hypertension, low-density lipoprotein-cholesterol, smoking) and to the control of all risk factors present and prescription of antiplatelet therapy with an odds ratio (95% confidence interval) of 2.72 (1.97-3.75).. There is a need to improve the control of CV risk factors in secondary prevention patients. This is particularly crucial for patients with CVD.

Topics: Aged; Anticholesteremic Agents; Antihypertensive Agents; Biomarkers; Brain Ischemia; Chi-Square Distribution; Cholesterol, LDL; Cohort Studies; Diabetes Mellitus; Dietary Supplements; Double-Blind Method; Fatty Acids, Omega-3; Female; Folic Acid; France; Humans; Hypercholesterolemia; Hypertension; Hypoglycemic Agents; Logistic Models; Male; Middle Aged; Myocardial Ischemia; Odds Ratio; Platelet Aggregation Inhibitors; Risk Assessment; Risk Factors; Secondary Prevention; Smoking Cessation; Treatment Outcome; Vitamin B 12; Vitamin B 6

To compare the effect of candesartan or amlodipine on concentrations of cellular markers of oxidative stress, plasma homocysteine and vitamins in hypertensive patients.. Forty-nine middle-aged patients with untreated stage I-II essential hypertension were recruited in a randomized double-blind double-dummy study to receive a daily dose either of 8 mg candesartan (n = 25) or 5 mg amlodipine (n = 24) for 16 weeks. Blood pressure, reduced glutathione (GSH) and oxidized glutathione (GSSG), glutathione redox ratio (GSSG : GSH) in red blood cells, plasma homocysteine, vitamin B12 and folic acid status were measured at baseline, at week 2 and at week 16. The same parameters were measured in 32 healthy age- and sex-matched controls. An increase in homocysteine of at least 2 micromol/l was considered significant.. Hypertensive patients had significantly greater oxidative stress and homocysteine concentrations than controls. In addition to a significant decrease in blood pressure, in both treatment groups GSSG decreased (P < 0.03), GSSG : GSH had a tendency to decrease (P = 0.054), but homocysteine did not change. An increase in homocysteine concentration of at least 2 micromol/l was found in 12 patients (five in the candesartan group, seven in the amlodipine group), with a significant decrease in folic acid concentration and no changes in cellular oxidative stress. In patients with no increase in homocysteine concentration, both GSSG (P < 0.02) and GSSG : GSH (P = 0.051) decreased. GSH and vitamin B12 did not change in any of the groups studied.. Untreated hypertension is associated with disturbed glutathione redox status and increased plasma homocysteine concentrations. Both candesartan and amlodipine had favourable effects on cellular oxidative stress, but the oxidative stress status did not decrease in patients with adverse changes in homocysteine.

Topics: Amlodipine; Antihypertensive Agents; Benzimidazoles; Biphenyl Compounds; Blood Pressure; Female; Folic Acid; Glutathione; Glutathione Disulfide; Homocysteine; Humans; Hypertension; Male; Middle Aged; Oxidation-Reduction; Oxidative Stress; Tetrazoles; Vitamin B 12

Thiazides and angiotensin-converting enzyme (ACE) inhibitors are first-choice drugs for lowering elevated blood pressure and hence risk of cardiovascular disease. Homocysteine (tHcy) is another and independent cardiovascular risk factor and has been reported to be elevated in patients on antihypertensive therapy. As these studies reported only associations, a preliminary, randomized, prospective treatment study was performed in 40 hypertensive patients. We investigated the major determinants of tHcy concentrations after treatment with hydrochlorothiazide (HCT) or captopril: vitamins B6, B12, folic acid, and creatinine and cystatin C as parameters of renal function. A total of 21 Patients were treated with HCT and 19 with captopril, for, respectively, 31 and 29 days. HCT, but not captopril, raised tHcy by 16% (P =.003) and also creatinine and cystatin C (P =.025 and P =.004, respectively). This tHcy increase may offset the desired cardioprotection conferred by lowering the blood pressure.

Topics: Aged; Angiotensin-Converting Enzyme Inhibitors; Antihypertensive Agents; Captopril; Cardiovascular Diseases; Creatinine; Cystatin C; Cystatins; Female; Folic Acid; Homocysteine; Humans; Hydrochlorothiazide; Hypertension; Male; Middle Aged; Prospective Studies; Risk Factors; Vitamin B 12; Vitamin B 6

To examine the relationship between abnormal homocysteine metabolism and essential hypertension in a Chinese population, a community-based case-control study was conducted.. 127 essential hypertensive patients aged 35 to 75 were randomly selected from a community. Another 170 control subjects with blood pressure < 140/90 mmHg were selected from the same community. Serum homocysteine was determined using HPLC. Folate and vitamin B(12) were measured by radioimmunoassay. MTHFR genotypes were identified by PCR and restriction fragment length polymorphism analysis with Hinf I digestion.. After adjusting for age and sex, the mean homocysteine level was 10.56 micromol/L for hypertensive patients and 10.34 micromol/L for controls (F = 0.234, P = 0.63). No association between either SBP or DBP and Hcy concentration was found in subjects without anti-hypertensive medications. The prevalence of homozygousity for thermolabile MTHFR variant for this population was 13.1%, and the mutant allele frequency was 38.7%. There was no significant difference on genotype distributions and the mutant allele frequency for the two studied groups. However, the concentrations of folate and B(12) for the hypertensive subjects were generally higher than the controls.. The present study did not discover that the elevation of Hcy levels or MTHFR mutation were independent risk factors for essential hypertension. The higher folate and B(12) in the hypertensive subjects might contribute to a lower risk.

Topics: Adult; Aged; Case-Control Studies; China; Female; Folic Acid; Gene Frequency; Genotype; Homocysteine; Humans; Hypertension; Male; Methylenetetrahydrofolate Reductase (NADPH2); Middle Aged; Point Mutation; Polymorphism, Restriction Fragment Length; Risk Factors; Vitamin B 12

The effects of chronic diuretic use on serum homocysteine and its metabolic cofactors vitamin B6, vitamin B12, and red blood cell (RBC) folate have not been well studied.. Blood samples from 17 hypertensive patients receiving long-term diuretic therapy and 17 hypertensive patients not taking diuretics were analyzed for serum homocysteine, vitamin B6, vitamin B12, and RBC folate.. The mean serum homocysteine concentration for patients taking diuretics (17.87 +/- 1.72 micromol/L) was significantly higher than the mean serum homocysteine concentration for patients not taking diuretics (10.31 +/- 0.99 micromol/L). The mean RBC folate concentration for patients taking diuretics (281.01 +/- 17.56 ng/mL) was significantly lower than the mean RBC folate concentration for patients not taking diuretics (430.85 +/- 28.58 ng/mL). Serum vitamin B6 and vitamin B12 concentrations were not significantly different between the two groups.. Chronic diuretic use is associated with a significant increase in serum homocysteine concentration, a significant decrease in RBC folate concentration, and no significant change in concentrations of vitamins B6 and B12.

Topics: Diuretics; Female; Folic Acid; Homocysteine; Humans; Hypertension; Linear Models; Male; Middle Aged; Prospective Studies; Pyridoxine; Statistics, Nonparametric; Time Factors; Vitamin B 12

Elevated blood homocysteine is a risk factor for cardiovascular disease. A 5-micromol/L increase is associated with an approximately 70% increase in relative risk of cardiovascular disease in adults. For patients with established risk factors, this risk is likely even greater.. Effects of increased dietary folate and recommended intakes of vitamins B-12 and B-6 on serum total homocysteine (tHcy) were assessed in individuals at high risk of cardiovascular disease.. This trial was conducted at 10 medical research centers in the United States and Canada and included 491 adults with hypertension, dyslipidemia, type 2 diabetes, or a combination thereof. Participants were randomly assigned to follow a prepared meal plan (PMP; n = 244) or a self-selected diet (SSD; n = 247) for 10 wk, which were matched for macronutrient content. The PMP was fortified to provide >/=100% of the recommended dietary allowances for 23 micronutrients, including folate.. Mean folate intakes at 10 wk were 601 +/- 143 microgram/d with the PMP and 270 +/- 107 microgram/d with the SSD. With the PMP, serum tHcy concentrations fell from 10.8 +/- 5.8 to 9.3 +/- 4.9 micromol/L (P < 0.0001) between weeks 0 and 10 and the change was associated with increased intakes of folate, vitamin B-12, and vitamin B-6 and with increased serum and red blood cell folate and serum vitamin B-12 concentrations. tHcy concentrations did not change significantly with the SSD.. The PMP resulted in increased intakes and serum concentrations of folate and vitamin B-12. These changes were associated with reduced serum tHcy concentrations in persons at high risk of cardiovascular disease.

Topics: Adult; Aged; Analysis of Variance; Cardiovascular Diseases; Diabetes Mellitus, Type 2; Diet; Female; Folic Acid; Food, Fortified; Homocysteine; Humans; Hyperlipidemias; Hypertension; Male; Middle Aged; Pyridoxine; Risk Factors; Vitamin B 12

Our study aims to evaluate the associations between the serum cobalamin (vitamin B12) and related biomarkers with mortality in hypertensive adults. Data on serum cobalamin from the National Health and Nutrition Examination Survey (NHANES) 1999-2006 and 2011-2014 were included. Mortality status was linked to National Death Index mortality data through 31 December, 2019. Cox regression and restricted cubic spline (RCS) analyses were used to determine the hazard ratios (HRs) and 95% CIs for mortality risk. A total of 9934 hypertensive adults were included in the analysis (mean age, 58.1 ± 17.5 years; 4899 [49.3%] men). At 11.0 years of mean follow-up, 935 cardiovascular deaths and 3096 all-cause deaths were identified. Compared to the third quartiles, the first and fourth quartiles of serum cobalamin were associated with risk of cardiovascular mortality, with multivariable-adjusted HRs of 1.26 (1.05-1.53) and 1.40 (1.17-1.68). Similar results were observed in the relationship between serum cobalamin and all-cause mortality. These results were supported by the RCS analysis. The inflection points for the nonlinear associations of serum cobalamin with cardiovascular and all-cause mortality were 649.9 pg/mL and 577.2 pg/mL, respectively. In addition, compared with the second quartile of circulating methylmalonic acid (MMA, a cobalamin-deficiency marker), this association with the fourth quartile was evident for an increased rate of cardiovascular and all-cause mortality, with 111% (HR = 2.11, 1.71-2.61) and 73% (HR = 1.73, 1.55-1.93) increase. Findings suggest that both lower and higher serum cobalamin concentrations were associated with a higher risk of cardiovascular and all-cause mortality in hypertensive adults. This study was a prospective cohort study that included serum cobalamin data from 9934 hypertensive adults from the NHANES from 1999-2006 and 20011-2014. Findings suggested that both lower and higher serum cobalamin concentrations were associated with a higher risk of cardiovascular and all-cause mortality in hypertensive adults.

Topics: Adult; Aged; Cardiovascular Diseases; Female; Follow-Up Studies; Humans; Hypertension; Male; Middle Aged; Nutrition Surveys; Prospective Studies; Vitamin B 12

We hypothesized that the prevalence of hypertension is related to B-vitamin intake in the general population, but it has not been sufficiently studied. This study aimed to investigate the intakes of dietary folate, vitamin B

Topics: Adolescent; Adult; Female; Folic Acid; Humans; Hypertension; Male; Middle Aged; Nutrition Surveys; Prevalence; Pyridoxine; Vitamin B 12; Vitamin B 6; Vitamin B Complex

Hyperhomocysteinemia (HHcy) and hypertension are associated with cardiovascular events. However, effects of Hcy-lowing interventions on cardiovascular outcome were conflicting. Serum folate level was proposed to be a possible determinant of efficacy of extra folate supplementation on cardiovascular outcome. The aims of the present study were to describe representative information on the levels of serum homocysteine and folate in hypertensive patients, and to explore the major determinants of HHcy.. 11,007 participants with hypertension were analyzed in this cross-sectional study. Blood pressure and serum levels of biochemical indicators were measured. Multivariate logistic regression model was used to assess the associated factors of HHcy.. Geometric mean of serum total homocysteine was 14.1 (95% CI: 13.9, 14.4) μmol/L and prevalence of HHcy was 36.1 (95% CI: 34.0, 38.1) % in hypertensive patients. HHcy was strongly associated with factors including male sex, older age, elevated serum creatinine (SCr), lower serum folate and vitamin B12, and uncontrolled blood pressure in hypertensive patients. Elevated SCr attributed to HHcy with the etiologic fraction of 0.29. The change of the odds ratio of HHcy associated with folate was significantly higher in patients with elevated SCr compared with that of patients with normal SCr.. The results suggested the protection of female sex and higher levels of folate and vitamin B12 from HHcy and attribution of older age and elevated SCr to HHcy. Restoring renal function deserved attention for hypertensive patients to benefit from Hcy-lowing measures.

Topics: Cross-Sectional Studies; Female; Folic Acid; Homocysteine; Humans; Hyperhomocysteinemia; Hypertension; Male; Prevalence; Risk Factors; Vitamin B 12

Topics: Aged; Aged, 80 and over; Antibodies, Anticardiolipin; Blood Coagulation; Blood Platelets; Cerebral Infarction; Clinical Laboratory Techniques; Creatine Kinase; Diabetes Complications; Diabetes Mellitus; Female; Folic Acid; Homocysteine; Humans; Hypertension; Immunity; L-Lactate Dehydrogenase; Lipids; Male; Middle Aged; Thyroid Hormones; Vitamin B 12

Primary aldosteronism is one of the most frequent causes of secondary arterial hypertension, and whether primary aldosteronism is associated with masked hypertension is unknown.. We describe a 64-year-old man with a history of hypothyroidism, recurring hypokalaemia, and normal home and office blood pressure values. Ambulatory blood pressure monitoring revealed masked hypertension with strikingly high systolic blood pressure variability and typical hypertension-mediated organ damage.. The patient required gradual escalation of antihypertensive medication to four drugs. During the diagnostic process we identified primary aldosteronism, cobalamin deficiency, severe obstructive sleep apnoea, and low baroreflex sensitivity (1.63 ms/mmHg). Following unilateral adrenalectomy, cobalamin supplementation and continuous positive airway pressure, we observed a spectacular improvement in the patient's blood pressure control, baroreflex sensitivity (4.82 ms/mmHg) and quality of life.. We report an unusual case of both masked arterial hypertension and primary aldosteronism. Elevated blood pressure values were masked in home and office measurements by coexisting hypotension which resulted most probably from deteriorated baroreflex sensitivity. Baroreflex sensitivity increased following treatment, including unilateral adrenalectomy. Hypertension can be masked by coexisting baroreceptor dysfunction which may derive from structural but also functional reversible changes.

Topics: Blood Pressure; Blood Pressure Monitoring, Ambulatory; Humans; Hyperaldosteronism; Hypertension; Male; Masked Hypertension; Middle Aged; Quality of Life; Vitamin B 12

Milk consumption in the Indonesian elderly population is among the lowest in the world, and two-thirds of the population are lactose intolerant. This might have an impact on energy and nutrient intakes. However, data on the prevalence of nutrient intake inadequacies in dairy users versus non-dairy users, as well as population characteristics, are lacking. Therefore we obtained data comparing nutritional inadequacies and characteristics of Indonesian older adults consuming or refraining from dairy products.. A cross-sectional study was conducted in 2021 as a part of the INA LACTASE study, involving 194 community-dwelling older adults in the outpatient geriatric clinic at Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia. We collected data on demographic and clinical characteristics as part of a routinely performed comprehensive geriatric assessment. A structured questionnaire was developed to categorize participants as dairy-or non-dairy users based on habitual dairy intake. Food records were collected to assess nutrient intakes. The prevalence of inadequacies of energy, macronutrients, and a selection of micronutrients (calcium, vitamin D, and vitamin B12) was calculated by comparing the reported mean intakes to the recommended dietary intakes of the Indonesian population (Indonesian RDA). Prevalence ratios were calculated to measure the association between dairy product consumption and the prevalence of nutrient inadequacies.. We recruited 194 eligible participants. This study found that dairy users had a higher proportion of women, a higher monthly income, but a lower proportion of hypertension, diabetes mellitus, and dyslipidaemia in older adults consuming dairy products. We observed wide variability in energy and nutrient intakes, as well as a high prevalence of inadequacies for all dietary intake parameters, particularly micronutrients. Dairy users had a lower prevalence of micronutrient inadequacies than non-dairy users. The prevalence of vitamin D inadequacies in dairy users versus non-dairy users was 91.6% vs. 99.3% in men and 71.9% vs. 98.0% in women, respectively. Inadequate vitamin B12 intake was found in 60.6% of dairy users vs. 89.4% of non-dairy users in men and 65.5% vs.. 68.4% of women, respectively. The most pronounced difference was found in the prevalence of calcium intake inadequacies in dairy users vs. non-dairy users, which was 64.8% vs. 99.5% in men and 89.9% vs. 99.8% in women. We found statistically significant differences in the prevalence of calcium, vitamin D, and vitamin B inadequacies between dairy and non-dairy users.. This study identified that dairy users had a higher monthly income and had a lower proportion of hypertension, diabetes mellitus, and dyslipidemia. In addition, we discovered a high prevalence of nutrient intakes inadequacies in Indonesian older adults, particularly among non-dairy users. Micronutrient inadequacies are major sources of concern, with statistically significant difference in calcium, vitamin D, and vitamin B12 prevalence of inadequacies.

Topics: Aged; Calcium; Cross-Sectional Studies; Dairy Products; Diet; Energy Intake; Female; Humans; Hypertension; Indonesia; Male; Micronutrients; Vitamin B 12; Vitamin D

Hyperhomocysteinemia (HHcy) is a common complication in Chinese hypertensive patients and associated with methylenetetrahydrofolate reductase (MTHFR) C677T polymorphism, folate, and vitamin B12 (Vit B12) status. This study evaluated the associations of MTHFR C677T polymorphism, folate, and Vit B12 with H-type hypertension.. 887 eligible patients with essential hypertension were included. Patients were divided into two groups according to the Hcy level, the H-type hypertension group and the normal hypertension group. Related risk factors such as MTHFR polymorphism, folate and Vit B12 status were analyzed in the two groups. Age, gender, SBP, DBP, MTHFR C677T genotype, folate and Vit B12 differed significantly between H-type hypertension and normal hypertension groups (P < 0.05). MTHFR 677TT variant, gender, folate, and Vit B12 were independent risk factors for the occurrence of H-type hypertension. The risk for TT carriers was 8 times higher than that of CC and CT carriers [OR (95% CI) 8.248 (5.274-12.899)]. Male patients had almost fivefold higher odds than female patients [OR (95% CI) 4.923 (2.741-8.842)]. Folate level of patients with H-type hypertension decreased with the C to T substitution of MTFHR C677T gene (P < 0.05), while Vit B12 level was not associated with the gene (P > 0.05).. MTHFR 677TT variant, gender, folate, and Vit B12 were risk factors for the occurrence of H-type hypertension. Folate but not Vit B12 was associated with MTFHR C677T polymorphism in patients with H-type hypertension. Accordingly, the above factors may be considered in the prevention and treatment of hypertension.

Topics: Antihypertensive Agents; Female; Folic Acid; Genotype; Homocysteine; Humans; Hypertension; Male; Methylenetetrahydrofolate Reductase (NADPH2); Vitamin B 12

Topics: Abdominal Pain; Adult; Anemia; Blood Group Incompatibility; Bradycardia; Emergency Service, Hospital; Erythrocyte Transfusion; Fatigue; Female; Fluid Therapy; Headache; Humans; Hypertension; Iron; Nausea; Patient Readmission; Transfusion Reaction; Vitamin B 12; Vitamin B 12 Deficiency; Vitamin B Complex

There are few studies examining the association between homocysteine (Hcy) level and the risk of hypertension with consideration for folate and vitamin B

Topics: Aged; Blood Pressure; Cross-Sectional Studies; Diet; Female; Folic Acid; Homocysteine; Humans; Hypertension; Male; Middle Aged; Multivariate Analysis; Odds Ratio; Prevalence; Preventive Medicine; Risk; Surveys and Questionnaires; Vitamin B 12

Hypertension (HT) is one of the risk factors associated with atherosclerosis. Midkine (MK) plays a role as a growth factor in various biologic and pathologic events. In some reports, MK expression has been shown to be linked with vascular smooth muscle proliferation and neo-angiogenesis in atherosclerotic vessels. The aim was to research relationship of MK serum levels with some atherosclerotic risk factors in hypertensive patients.. This study examined 60 patients with essential HT and 30 healthy controls. Serum biochemistry, including lipid profile, MK, Vitamin B. MK levels of the HT patients were significantly higher than the control group (24.8 ± 6.8 ng/mL vs. 18.39 ± 5.6 ng/mL, respectively, P < 0.01). Lipid profile parameters such as total cholesterol, triglyceride, low-density lipoprotein (LDL) were also significantly higher in HT patients (P < 0.021, P < 0.01, and P < 0.01, respectively). Zinc levels were 179.13 ± 34.06 μg/dL and 172.55 ± 45.47μg/dL in the HT and control group, respectively. Serum MK levels were positively correlated with diastolic (r = 0.288, P < 0.05) and systolic blood pressures (r = 0.390, P < 0.002), and also with serum total cholesterol (r = 0.406, P < 0.002) and LDL cholesterol (r = 0.318, P < 0.015) levels. Furthermore MK was also negatively correlated with zinc and Vitamin B. This study has demonstrated an important association between increased serum MK levels and risk factors of atherosclerosis such as HT, increased total and LDL cholesterol.

Topics: Adult; Atherosclerosis; Blood Pressure; C-Reactive Protein; Case-Control Studies; Cholesterol, LDL; Copper; Female; Humans; Hypertension; Intercellular Signaling Peptides and Proteins; Lipids; Male; Middle Aged; Midkine; Risk Factors; Vitamin B 12; Zinc

In western populations, a higher level of dietary B vitamins intake has been associated with a lower risk of hypertension. However, data in Chinese is limited, whose B vitamins consumption is low and rates of hypertension are high.. To investigate whether the three B vitamins are associated with hypertension in rural Chinese.. Cross-sectional survey among 2241 rural Chinese aged 18-80 years was conducted in northwestern China in 2010. Blood pressure was measured by trained medical staff and dietary nutrients were assessed with a semiquantitative food frequency questionnaire.. 592 cases of hypertension were newly diagnosed. The deficiency proportions were 20.5% for vitamin B-6, 43.9% for folate and 98.5% for B-12. For females, participants in the highest quartile of B-6 intake had a significantly lower risk of hypertension (OR = 0.69; 95% CI: 0.50-0.93; p for trend <0.05). For males, the multivariable OR for the same comparison was 0.75 (95% CI: 0.56-0.99, p for trend >0.05). No significant associations were observed between B-12, folate intake and hypertension. For females, the highest quartile of both folate and B-6 intake was associated with a reduced risk of hypertension (OR = 0.53; 95% CI: 0.29-0.89), compared with in the middle quartile of both vitamins.. Higher intake of vitamin B-6 is independently associated with lower risk of hypertension in Chinese rural adults. Among females with high folate intake, the association between B-6 and hypertension was strongest. Additional studies are warrant to establish the causal inference.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Asian People; Blood Pressure; China; Cross-Sectional Studies; Diet; Female; Folic Acid; Humans; Hypertension; Male; Middle Aged; Risk; Rural Population; Vitamin B 12; Vitamin B 6; Vitamin B Complex; Young Adult

Gastric bypass has been thought to be associated with a risk of gastric cancer, particularly in Asia. Sleeve gastrectomy with duodenojejunal end-to-side anastomosis (SG-DJESA) was suggested to be a better-designed procedure to avoid this risk, and it also has other advantages.. We aimed to evaluate the clinical efficacy and feasibility of SG-DJESA in the treatment of nonobese patients with type 2 diabetes (T2D).. University Hospital, China.. We present prospective data from 7 consecutive T2D patients with gastric precancerosis who underwent SG-DJESA from December 15, 2011 to June 8, 2013. The group had a mean body mass index of 27.7 kg/m. Along with a decrease in antidiabetic medication requirements, body mass index, fasting plasma glucose, 2-hour postprandial plasma glucose, and glycated hemoglobin decreased significantly at each postoperative time point, compared with the preoperative baseline (P<.05, respectively). Four patients (4/7, 57.1%) achieved a complete remission of T2D at 12 months and maintained remission at the 4-year follow-up time; 1 patient (1/7, 14.3%) achieved a partial remission at 6 months but had recurrence at 12 months postoperatively; and the other 2 patients (2/7, 28.6%) achieved improvement during the follow-up time. There were no deaths during the follow-up period. One patient had a postoperative anastomotic bleed and recovered under conservative treatment. Another patient had iron deficiency anemia 8 weeks after surgery and recovered after taking an oral iron supplement for 1 month. No other serious perioperative complications or postoperative malnutrition occurred.. SG-DJESA is an effective and safe procedure for nonobese patients with T2D and could be recommended as a treatment option for T2D patients with gastric precancerosis. A larger sample size may be required for better evaluation.

Topics: Adolescent; Adult; Aged; Anastomosis, Surgical; Bariatric Surgery; Blood Glucose; China; Diabetes Mellitus, Type 2; Duodenum; Fasting; Feasibility Studies; Female; Folic Acid; Gastrectomy; Hemoglobins; Humans; Hypertension; Jejunum; Laparoscopy; Lipid Metabolism; Male; Middle Aged; Obesity; Postoperative Complications; Prospective Studies; Transferrin; Vitamin B 12; Young Adult

Vitamin B12 deficiency could be associated with cardiovascular autonomic neuropathy (CAN) in diabetes patients. We aim to investigate the association between serum levels of vitamin B12 and CAN in type 2 diabetes patients.. 469 ambulatory type 2 diabetes patients (mean diabetes duration 10.0years (IQR 5.0;17.0), mean age 59.0years (SD 11.6), 63% men, mean B12 289.0pmol/l (IQR 217;390)) were screened for CAN using three cardiovascular reflex tests, five minute resting heart rate (5min RHR) and heart rate variability indices.. Serum levels of vitamin B12 were significantly lower in patients treated with metformin and/or proton pump inhibitors (PPIs) compared with patients not treated (p<0.001). A 25pmol/l higher level of vitamin B12 was associated with an odds ratio of the CAN diagnosis of 0.94 (95% CI 0.88; 1.00, p=0.034), an increase in E/I-ratio of 0.21% (95% CI 0.01; 0.43, p=0.038), and a decrease in 5min RHR of 0.25 beats per minute (95% CI -0.47; -0.03, p=0.025).. Vitamin B12 may be inversely associated with CAN in patients with type 2 diabetes. Confirmatory studies investigating a causal role of vitamin B12 for the development of diabetic CAN are warranted.

Topics: Antihypertensive Agents; Autonomic Nervous System Diseases; Cardiovascular Diseases; Cohort Studies; Cross-Sectional Studies; Denmark; Diabetes Mellitus, Type 2; Diabetic Angiopathies; Diabetic Cardiomyopathies; Diabetic Neuropathies; Female; Heart Rate; Humans; Hypertension; Hypoglycemic Agents; Male; Mass Screening; Metformin; Middle Aged; Prevalence; Proton Pump Inhibitors; Risk Factors; Vitamin B 12; Vitamin B 12 Deficiency

Elevated serum homocysteine has been shown to be a risk factor for hypertension, cardiovascular disease (CVD), and type-2 diabetes mellitus (T2DM).We characterized the relationships between the serum levels of homocysteine, folic acid, and vitamins D2, D3, and B12 in patients with T2DM, CVD, and hypertension in Shanghai, China. The levels of these serum biochemical markers were determined for 9311 Chinese patients (mean age: 79.50 ± 13.26 years) with T2DM (N = 839), hypertension (N = 490), or CVD (N = 7925). The demographic and serum biochemical data were compared using an analysis of variance. We performed stratified analyses using Pearson linear regression to investigate correlations between the different variables in the T2DM, CVD, and hypertension groups and in patients aged < 50, 50 to 64, 65 to 80, and ≥80 years. A subgroup analysis was also performed to identify correlations between the serum biochemical markers. Stratified chi-squared analyses were performed based on the levels of folic acid and total vitamin D.In all 3 patient groups, elevated levels of vitamin D2 and homocysteine were observed, whereas the levels of folic acid and vitamins D3 and B12 were lower than the reference range for each serum marker (P < 0.05 for all). The linear regression and stratified analyses showed that the highest levels of folic acid and vitamins D2 and D3 correlated with the lowest level of homocysteine in T2DM, CVD, and hypertension patients (P < 0.05 for all), whereas the highest level of vitamin B12 correlated with a lowest level of homocysteine in CVD patients only (P < 0.05).Our results indicate that the contributions of both vitamin D2 and vitamin D3 should be considered in investigations of the effects of vitamin D supplements in T2DM, CVD, and hypertension patients. Our findings warrant future studies of the benefits of vitamin D and folic acid supplements for reducing the risk of T2DM, CVD, and hypertension in elderly Chinese people, as well as the benefits of vitamin B12 supplements for reducing the risk of CVD alone.

Topics: Aged; Aged, 80 and over; Asian People; Cardiovascular Diseases; Diabetes Mellitus, Type 2; Dietary Supplements; Female; Folic Acid; Homocysteine; Humans; Hypertension; Male; Vitamin B 12; Vitamin D

Regular intake of vitamin C/ascorbate reduces blood pressure (BP) in hypertensives. High-dose intravenous vitamin C (IVC) achieves higher plasma levels; however, there is a paucity of research on acute BP effects. Our study is the first to investigate the effect of high-dose IVC, with or without concomitant i.v. nutrients, on BP during i.v.. A cohort of adult patients scheduled to receive IVC treatment for infection, cancer or fatigue, as prescribed by their treating doctor, participated at a Melbourne clinic, Australia. Ambulatory BP was assessed every 10 min over 90 min during i.v.. Patients received 15-100 g of IVC alone or in addition to i.v. vitamin B, glutathione, magnesium or zinc. BP change over time adjusted for baseline BP, IVC dosage, i.v. treatment and BMI was analysed.. A total of 77 mostly normotensive patients participated, with a third receiving IVC alone (42±20 g), and two-thirds also received other i.v. nutrients. IVC alone (>30 g) reduced the mean BP up to 8-9 mmHg in prehypertensive patients. In contrast, concomitant intravenous vitamin B12 (IVB12) significantly increased the mean BP by 11-13 mmHg. Comparison of BP change during IVC versus IVC+IVB12 indicated a highly significant difference [systolic blood pressure: mean difference (SD)=16.6 (17.8) mmHg, P<0.001; diastolic blood pressure: mean difference (SD)=12.5 (16.7) mmHg, P=0.003].. Our study suggests an acute BP-reducing effect of high-dose IVC, particularly with dosages above 30 g, and in patients with prehypertension and normal BMI. Furthermore, our study indicated a marked and clinically relevant hypertensive effect of IVB12, suggesting routine BP monitoring during i.v. therapy in clinical practice.

Topics: Administration, Intravenous; Adult; Aged; Ascorbic Acid; Blood Pressure; Female; Glutathione; Humans; Hypertension; Magnesium; Male; Middle Aged; Vitamin B 12; Zinc

To analyse the relationship between serum folate (SF), vitamin B12 and impaired cognitive function in the Chilean elderly.. We analysed the relationships between impaired cognitive function and age, SF (µg/l) and vitamin B12 (pg/ml) with Student's t test, as well as between impaired cognitive function and gender, educational level, residence area, diabetes and hypertension with the χ 2 test. Multiple logistic regressions with interactions were estimated to assess the impact of SF on impaired cognitive function according to these methods.. Chile.. Older adults (>65 years, n 1051), drawn from representative households of a national prevalence study, assessed using the Modified Mini Mental Status Examination (MMMSE). Individuals with altered MMMSE scores (≤13 points) were sequentially assessed using the Pfeffer Functional Activities Questionnaire (PFAQ).. Multivariate models using the MMMSE demonstrated an increased risk of impaired cognitive function for seniors who had hypertension, diabetes and higher vitamin B12 levels. SF and its square (SF2) were statistically significant, indicating that this predictor of impaired cognitive function displays a U-shaped distribution. The interaction between SF and vitamin B12 was not statistically significant. Models using the MMMSE plus PFAQ suggested that urban residence decreased the risk of impaired cognitive function, whereas male gender, older age, vitamin B12 levels and hypertension increased this risk. The variables SF and SF2 and the SF × vitamin B12 interaction were statistically significant (P<0.05). The risk of impaired cognitive function depended on different combinations of SF and vitamin B12 levels. When SF was low, a one-unit increase in SF (1 µg/l) diminished the risk. When SF was elevated, a further increase in SF raised the risk, especially at low vitamin B12 levels.. The relationship between folate, vitamin B12 and impaired cognitive function warrants further study.

Topics: Activities of Daily Living; Age Factors; Aged; Chile; Cognition; Cognition Disorders; Cross-Sectional Studies; Female; Folic Acid; Folic Acid Deficiency; Geriatric Assessment; Humans; Hypertension; Male; Nutrition Assessment; Nutritional Status; Sex Factors; Surveys and Questionnaires; Urban Population; Vitamin B 12; Vitamin B 12 Deficiency; Vitamin B Complex

Topics: Adult; Anemia, Megaloblastic; Delayed Diagnosis; Diabetes Mellitus, Type 2; Diagnosis, Differential; Female; Gout; Humans; Hypertension; Lichen Planus; Melanosis; Nail Diseases; Remission Induction; Vitamin B 12; Vitamin B 12 Deficiency

Hyper-homocysteinemia (HHcy) is associated with microalbuminuria and glomerular injury in general and diabetic populations. However, HHcy's role in hypertensive patients was not studied. We investigated whether HHcy is an independent risk factor for renal function decline and development of chronic kidney disease (CKD) in hypertensive men and women. This was a community-based prospective cohort study of 2,387 hypertensive adults without CKD at baseline, with a mean follow-up of 4.4 years. Baseline and follow-up levels of plasma Hcy, folate, vitamin B12, blood pressure and other pertinent covariables were obtained. CKD was defined as an estimated glomerular filtration rate (eGFR) <60 ml/min/per 1.73 m(2) and an eGFR decline rate >1 ml/min/per 1.73 m(2)/year. There was a graded association between Hcy tertiles and eGFR decline. Subjects in the 3(rd) tertile of Hcy levels had an accelerated rate of eGFR decline and an increased risk of incident CKD, as compared with those in the 1st tertile, after adjusting for age, gender, baseline diabetes, SBP, BMI, smoking, dyslipidemia, eGFR, folate and vitamin B12 levels. In conclusion, in this prospective cohort of Chinese hypertensive adults, elevated baseline plasma Hcy can serve as an independent biomarker to predict renal function decline and incident CKD.

Topics: Aged; Blood Pressure; Cohort Studies; Demography; Female; Folic Acid; Follow-Up Studies; Glomerular Filtration Rate; Homocysteine; Humans; Hyperhomocysteinemia; Hypertension; Kidney; Male; Middle Aged; Prospective Studies; Renal Insufficiency, Chronic; Risk Factors; Vitamin B 12

Meta-analyses have suggested an effect of MTHFR C677T genotype (rs1801133), a proxy for blood total homocysteine, on cardiovascular disease (CVD) in populations with low population dietary folate. The aim was to examine the association and effect modification by serum folate and vitamin B12 levels between MTHFR and CVD-related outcomes in a general population with no mandatory folic acid fortification policy.. The study population included 13,748 adults retrieved from pooling of four population-based studies conducted in Denmark. MTHFR genotype, serum folate (measured in approximately 9,356 individuals), and serum vitamin B12 (9,215 individuals), hypertension, and dyslipidemia were measured at baseline, and participants were followed for a mean of 10.5-11.7 years in central registries for diagnoses of stroke (623 incidents), ischaemic heart disease (IHD) (835 incidents), and all-cause mortality (1,272 incidents).. The MTHFR genotype (TT vs. CC/CT) was not associated with hypertension [OR (95% CI) 1.09 (0.95-1.25)], dyslipidemia [OR (95% CI) 0.97 (0.84-1.11)], stroke [HR (95% CI) 0.92 (0.69-1.23)], and all-cause mortality [HR (95% CI) 0.94 (0.77-1.14)], either overall, or in participants with low serum folate or B12 status (P values for interactions 0.15-0.94). Individuals with the MTHFR TT genotype had a higher risk of IHD (HR (95% CI) 1.38 (1.11-1.71)), but this association was not modified by folate status (P value for interaction 0.45).. Our results do not support a causal relationship between homocysteine and CVD. However, we cannot exclude a direct causal effect of MTHFR C677T genotype on IHD.

Topics: Adolescent; Adult; Aged; Cardiovascular Diseases; Cholesterol, HDL; Cholesterol, LDL; Cohort Studies; Denmark; Dyslipidemias; Female; Folic Acid; Follow-Up Studies; Genotype; Genotyping Techniques; Homocysteine; Humans; Hypertension; Male; Methylenetetrahydrofolate Reductase (NADPH2); Middle Aged; Polymorphism, Genetic; Risk Factors; Stroke; Triglycerides; Vitamin B 12; Young Adult

Hypertension is considered to be among the most important risk factors for cardiovascular and cerebrovascular diseases. In recent years, several investigators have reported that high plasma levels of total homocysteine (t-hcy) has a key role in the development of hypertension, and the deficiency of B complex vitamins could increase the risk of hypertension. The purpose of this study was to investigate the relationship between plasma homocysteine, folate and vitamin B12 in hypertensive patients.. In 116 patients with hypertension and 81 healthy subjects, total plasma homocysteine, vitamin B12 and folate levels were measured.. Homocysteine was significantly higher in patients than in control subjects (22.9±3.5 versus 9.0±2.3 μmol/L respectively, p<0.001); the folate plasma concentrations in hypertensive patients were significantly lower than in control subjects (6.7±5.0 ng/ml and 9.0±4.4 ng/ml respectively, p<0.05). Moreover, no differences in vitamin B12 plasma levels were observed when comparing the levels of hypertensive patients and those of the controls (440±223 pg/ml vs 491±185 pg/ml respectively, p>0.05). Our results confirmed that, as previously observed, elevated t-hcy levels and low folate levels, but not vitamin B12 levels, are significantly associated with hypertension.

Topics: Female; Folic Acid; Humans; Hyperhomocysteinemia; Hypertension; Male; Middle Aged; Reference Standards; Vitamin B 12

Suboptimal maternal dietary intake during pregnancy might lead to fetal cardiovascular adaptations and higher blood pressure in the offspring. The aim of the present study was to investigate the associations of maternal first-trimester dietary intake with blood pressure in children at the age of 6 years. We assessed first-trimester maternal daily dietary intake by a FFQ and measured folate, homocysteine and vitamin B₁₂ concentrations in the blood, in a population-based prospective cohort study among 2863 mothers and children. Childhood systolic and diastolic blood pressure was measured using a validated automatic sphygmomanometer. First-trimester maternal daily intake of energy, fat, protein and carbohydrate was not associated with childhood blood pressure. Furthermore, maternal intake of micronutrients was not associated with childhood blood pressure. Also, higher maternal vitamin B₁₂ concentrations were associated with a higher diastolic blood pressure (0·31 mmHg per standard deviation increase in vitamin B₁₂ (95% CI 0·06, 0·56)). After taking into account multiple testing, none of the associations was statistically significant. Maternal first-trimester folate and homocysteine concentrations were not associated with childhood blood pressure. The results from the present study suggest that maternal Fe intake and vitamin B₁₂ concentrations during the first trimester of pregnancy might affect childhood blood pressure, although the effect estimates were small and were not significant after correction for multiple testing. Further studies are needed to replicate these findings, to elucidate the underlying mechanisms and to assess whether these differences in blood pressure persist in later life.

Topics: Blood Pressure; Child; Cohort Studies; Diet; Dietary Supplements; Female; Folic Acid; Homocysteine; Humans; Hypertension; Male; Maternal Nutritional Physiological Phenomena; Micronutrients; Netherlands; Pregnancy; Pregnancy Trimester, First; Prospective Studies; Vitamin B 12

This report highlights a rare presentation of vitamin B(12) deficiency (concurrent psychotic disorder, seizures and hypertension). A 16-year-old girl presented with nervousness that had been persisting for 2 weeks. She had stopped eating and there was decreased self-care and she could not walk and sleep. Two days prior to admission, generalized tonic-clonic convulsions were noted. On physical examination, vital signs were normal, except for hypertension (150/100 mm Hg). She did not respond to conversation; she could not answer the questions. Mood was depressive and hallucinations were noted. Laboratory analyses were normal, except for a low vitamin B(12) level (<150 pg mL(-1)). The patient was not given any treatment of hypertension, psychosis or seizures, except vitamin B(12) injections. After that, she showed improvement within 1 week. In the 7 days of hospitalization, the arterial blood pressure returned to normal, psychotic symptoms were resolved, the visual hallucinations and the depressive mood subsided, and she could eat and speak clearly. No hypertension or convulsions have been detected on the control examinations, and she has now been followed-up without any symptoms or findings. In conclusion, with this report we emphasized that psychosis, seizures and hypertension can be a rare manifestation of vitamin B(12) deficiency, which is reversible with therapy and serum vitamin B(12) level should be checked in patients who do not have an obvious cause for psychosis, seizures or hypertension.

Topics: Adolescent; Female; Humans; Hypertension; Psychotic Disorders; Seizures; Treatment Outcome; Vitamin B 12; Vitamin B 12 Deficiency

Laboratory studies suggest that folate intake may decrease blood pressure (BP) through increasing nitric oxide synthesis in endothelial cells and/or reducing plasma homocysteine concentrations. However, human studies, particularly longitudinal data, are limited.. Our objective was to investigate whether dietary folate intake is associated with the 20-y incidence of hypertension.. We prospectively followed 4400 men and women (African Americans and whites aged 18-30 y) without hypertension at baseline (1985) in the Coronary Artery Risk Development in Young Adults study 6 times, in 1987, 1990, 1992, 1995, 2000, and 2005. Diet was assessed by dietary-history questionnaire at baseline and in 1992 and 2005. Incident hypertension was defined as the first occurrence at any follow-up examination of systolic BP ≥ 140 mm Hg, diastolic BP ≥ 90 mm Hg, or use of antihypertensive medication.. A total of 989 incident cases were identified during the 20-y follow-up. After adjustment for potential confounders, participants in the highest quintile of total folate intake had a significantly lower incidence of hypertension (HR: 0.48; 95% CI: 0.38, 0.62; P-trend < 0.01) than did those in the lowest quintile. The multivariable HRs for the same comparison were 0.33 (95% CI: 0.22, 0.51; P-trend < 0.01) in whites and 0.54 (95% CI: 0.40, 0.75; P-trend < 0.01) in African Americans (P-interaction = 0.047). The inverse associations were confirmed in a subset of the cohort (n = 1445) with serum folate measured at baseline and in 1992 and 2000.. Higher folate intake in young adulthood was longitudinally associated with a lower incidence of hypertension later in life. This inverse association was more pronounced in whites. Additional studies are warranted to establish the causal inference.

Topics: Adolescent; Adult; Black or African American; Blood Pressure; Diet; Female; Folic Acid; Follow-Up Studies; Homocysteine; Humans; Hypertension; Incidence; Interviews as Topic; Longitudinal Studies; Male; Proportional Hazards Models; Prospective Studies; Regression Analysis; Risk Factors; Surveys and Questionnaires; Vitamin B 12; Vitamin B 6; White People; Young Adult

Maternal nutrition is an important determinant of one-carbon metabolism that lies at the heart of intrauterine epigenetic programming. Exchange of nutrients and other vital molecules between the mother and fetus takes place across the placenta and hence may play direct role in fetal programming. Pre-eclampsia (PE) originates in the placenta and altered maternal nutrition may influence epigenetic patterns in the placenta, thereby affecting birth outcome. In the present study, we investigated the global DNA methylation levels in placentas of pre-eclampsia women (i.e., women delivering at term and those delivering preterm) and studied their associations with maternal blood pressure and birth outcome. Increased homocysteine and global DNA methylation levels were seen in the pre-eclampsia group (term and preterm PE) when compared with the normotensive group (p < 0.05). A positive association between global DNA methylation and systolic (p < 0.01) and diastolic (p < 0.05) blood pressure was seen in the term pre-eclampsia group, whereas there was no association with birth outcome. The study for the first time provides evidence for altered global DNA methylation patterns in pre-eclampsia placentas and its association with blood pressure. It is possible that increased homocysteine levels may be related to increased methylation in pre-eclampsia.

Topics: Blood Pressure; DNA Methylation; Female; Folic Acid; Homocysteine; Humans; Hypertension; Infant, Newborn; Mothers; Placenta; Pre-Eclampsia; Pregnancy; Premature Birth; Term Birth; Vitamin B 12

Elevated plasma homocysteine concentrations have been associated with both cognitive impairment and dementia. However, it is unclear whether some cognitive domains are more affected than others, or if this relationship is independent of B12 and folate levels, which can also affect cognition. We examined the relationship between plasma homocysteine and cognitive decline in an older hypertensive population.. 182 older people (mean age 80 years) with hypertension and without dementia, were studied at one center participating in the Study on COgnition and Prognosis in the Elderly (SCOPE). Annual cognitive assessments were performed using a computerized assessment battery and executive function tests, over a 3-5 year period (mean 44 months). Individual rates of decline on five cognitive domains were calculated for each patient. End of study plasma homocysteine, folate and B12 concentrations were measured. The relationship between homocysteine levels and cognitive decline was studied using multivariate regression models, and by comparing high versus low homocysteine quartile groups.. Higher homocysteine showed an independent association with greater cognitive decline in three domains: speed of cognition (β = -27.33, p = 0.001), episodic memory (β = -1.25, p = 0.02) and executive function (β = -0.05, p = 0.04). The association with executive function was no longer significant after inclusion of folate in the regression model (β = -0.032, p = 0.22). Change in working memory and attention were not associated with plasma homocysteine, folate or B12. High homocysteine was associated with greater decline with a Cohen's d effect size of approximately 0.7 compared to low homocysteine.. In a population of older hypertensive patients, higher plasma homocysteine was associated with cognitive decline.

Topics: Aged; Aged, 80 and over; Aging; Biomarkers; Cognition; Cognition Disorders; Executive Function; Female; Folic Acid; Follow-Up Studies; Homocysteine; Humans; Hypertension; Male; Neuropsychological Tests; Risk Factors; Vitamin B 12

Vitamin status and role in end stage renal disease (ESRD) is controversial. This study was aimed at assessing vitamin A, E, B12, and folic acid status in Tunisian ESRD patients and testing their predictive value for overall mortality and cardiovascular events (CVE).. We examined plasma vitamin A, E, B12, and folic acid in 115 ESRD patients and looked for any correlation with all-cause mortality and CVE after a six year follow-up. Vitamin A and E were determined by HPLC and vitamin B12 and folic acid were determined by enzyme immunoassay.. At enrolment, plasma vitamin A was higher in patients than controls, while plasma vitamin B12 was higher in HD patients. No significant differences were observed for plasma vitamin E and folic acid concentrations between patients and controls. Folic acid and vitamin B12 levels were higher in supplemented patients. During the follow-up period, 17 patients were lost, 15 died, and 36 presented a CVE. Survival analysis showed that mortality and/or CVE trend to be lower for high folic acid levels (Log Rank = 0.098). Cox's regression analysis showed that high levels of folic acid are inversely related to all-cause mortality and/or CVE [Hazard ratio (95% confidence interval), 0.255 (0.08 - 0.740); p = 0.012].. Plasma vitamins A, E, B12, and folic acid concentrations are usually normal in Tunisian ESRD patients. High folic acid levels are associated with fewer CVE and better survival. However, as uremia could be associated with functional vitamin deficiency, maintaining high plasma vitamin levels by adequate nutrition and tolerable supplementation would be beneficial in ESRD patients.

Topics: Adolescent; Adult; Aged; Cardiovascular Diseases; Cause of Death; Comorbidity; Female; Folic Acid; Humans; Hypertension; Kidney Failure, Chronic; Male; Middle Aged; Prognosis; Proportional Hazards Models; Smoking; Tunisia; Vitamin A; Vitamin B 12; Vitamin E; Young Adult

The aim of this retrospective study of patients with tongue pain who showed no improvement after initial treatment and examination was to find out if their lack of response correlated with serum concentrations of zinc, vitamin B12, folic acid, and copper, and if it was associated with coexisting systemic diseases. We studied 311 patients for whom we had data about serum concentrations of these elements, and recorded whether they had any systemic diseases and were taking medicines regularly. One patient (0.3%) had a copper concentration outside the reference range; 2 patients (0.6%) had folic acid concentrations outside the reference range. The corresponding number for vitamin B12 was 5 (2%), and for zinc 30 (10%). The systemic diseases with the highest rates were: hyperlipidaemia (n=53, 17%), gastritis or gastric ulcer (n=51, 16%), angina pectoris (n=39, 13%), diabetes mellitus (n=31, 10%), thyroid disease (n=31, 10%), mild mental disorder (n=27, 9%), hypertension (n=18, 6%), cerebral infarction (n=17, 6%), leiomyoma (n=15, 5%) and anaemia (n=15, 5%). Roughly 10% of the patients were deficient in zinc. This study suggested that the serum concentration of zinc was most important to the patients with tongue pain. Many patients had more than one systemic condition, and all were taking various drugs.

Topics: Adult; Aged; Aged, 80 and over; Anemia; Angina Pectoris; Cerebral Infarction; Copper; Diabetes Complications; Female; Folic Acid; Gastritis; Glossalgia; Humans; Hyperlipidemias; Hypertension; Leiomyoma; Male; Middle Aged; Retrospective Studies; Thyroid Diseases; Vitamin B 12; Young Adult; Zinc

We sought to evaluate the magnetic resonance (MR) angiography (MRA) findings in patients with ischemic stroke (IS) from North India and correlate the changes with various conventional and nonconventional risk factors.. The study took place at a tertiary care teaching hospital. The patients with IS were clinically evaluated including body mass index, dietary habits, and family history of stroke. MR imaging, MRA, and testing for blood sugar, lipid profile, B12, folic acid, and homocysteine were carried out. The MRA abnormalities were considered significant if stenosis was 50% or greater and these were categorized into extracranial (EC), intracranial (IC), or combined lesions. The location of infarct on MR imaging was also noted.. There were 151 patients whose median age was 60 (22-85) years. The EC MRA was abnormal in 56.3% and the IC MRA in 63.3% of patients, the internal carotid artery being the most common site. Corresponding infarct was present in 64.7% and noncorresponding in 45.3% of patients. The MRA abnormality positively correlated with hypertension and diabetes, and negatively with alcohol consumption. The EC MRA abnormality was more common in upper caste Hindus and Muslims and in the city dwellers.. In North Indian patients with IS, the frequency of EC and IC MRA abnormality lies between Whites and the Orientals.

Topics: Adult; Aged; Aged, 80 and over; Alcohol Drinking; Biomarkers; Blood Glucose; Body Mass Index; Brain Ischemia; Carotid Artery, External; Carotid Artery, Internal; Diabetes Mellitus; Feeding Behavior; Female; Folic Acid; Homocysteine; Humans; Hypertension; India; Lipids; Magnetic Resonance Angiography; Male; Middle Aged; Racial Groups; Risk Factors; Socioeconomic Factors; Stroke; Vitamin B 12; Young Adult

Non-arteritic anterior ischemic optic neuropathy (NAION) is a multifactorial disease that is caused by an infarction of the vessels that supply the optic nerve head. This study aims at evaluating the role of traditional and emerging cardiovascular risk factors on the development of NAION.. A total of 85 newly diagnosed NAION patients and 107 age- and gender-matched healthy controls were studied. All participants underwent blood testing for homocysteine and lipoprotein(a). Plasma levels of vitamin B6 and B12, and folic acid were also determined. Plasma values of all these parameters were evaluated as continuous variables, by a logarithmic transformation. In addition, traditional cardiovascular risk factors were considered.. With univariate analysis, higher values of homocysteine and Lp(a) (OR 4.24, 95% CI 2.01-8.94, p < 0.0001; OR 1.32, 95% CI 1.04-1.67, p = 0.03, respectively) and lower values of vitamin B6 (OR 0.44, 95% CI 0.25-0.76, p = 0.003) were significantly associated with NAION. At multivariate analysis, adjusted for age, gender, smoking habit, hypertension, dyslipidemia, diabetes, sleep apnea, and thrombophilic risk factors, the higher homocysteine and Lp(a) values (OR 5.74, 95% CI 2.41-13.67, p = 0.0001; OR 1.27, 95% CI 1.01-1.63, p = 0.04) and lower vitamin B6 values (OR 0.42, 95% CI 0.23-0.77, p = 0.005) maintained their significant relationship with NAION.. This study demonstrated that elevated plasma homocysteine and lipoprotein(a) levels, as well as low vitamin B6 levels, may increase the risk of developing NAION. A screening for these thrombophilic markers could be useful in subjects experiencing NAION.

Topics: Adult; Aged; Aged, 80 and over; Cardiovascular Diseases; Case-Control Studies; Dyslipidemias; Enzyme-Linked Immunosorbent Assay; Female; Folic Acid; Homocysteine; Humans; Hypertension; Lipoprotein(a); Male; Middle Aged; Optic Neuropathy, Ischemic; Risk Factors; Thrombophilia; Vitamin B 12; Vitamin B 6

Hyperhomocysteinemia (HH) is an emerging risk factor for ischemic stroke but its role in outcome is controversial. We compare the risk factors, nature of stroke and outcome of patients with and without hyperhomocysteinemia.. CT proven ischemic stroke patients were included. The conventional risk factors such as diabetes, hypertension, hyperlipidemia, obesity, smoking, and family history of stroke were recorded. Dietary history was noted. Fasting serum homocysteine (Hcy), B12 and folic acid were estimated after 1 month of stroke. Severity of stroke was assessed by Canadian Neurological Scale (CNS) and outcome at 3 months by Barthel Index (BI) score into good (BI > or = 12) and poor (BI < 12). Serum Hcy, B12 and folic acid were also estimated in 200 normal healthy volunteers.. There were 198 patients with ischemic stroke whose median age was 56 years and 36 were females. In the study group, 41.4% patients were vegetarian, 55.1% hypertensive, 24.7% diabetic, 30.8% smoker, 61.1% sedentary and 28.8% obese. 23.2% had past history of stroke and 21.7% had stroke in their first degree relative. Serum cholesterol was elevated in 11.7% and LDL in 10.8% patients. Serum Hcy was elevated in 60.6% and serum B12 low in 25.7% and folic acid in 42.1%. Hcy levels correlated with serum B12 and LDL. Patients with hyperhomocysteinemia had significantly better outcome at 3 months. Hcy levels in stroke patients did not significantly differ from controls.. Hyperhomocysteinemia is found in 60.6% stroke patients, which is related to low serum B12 level. Patients with hyperhomocysteinemia had a better 3-month outcome.

Topics: Adult; Aged; Brain Ischemia; Comorbidity; Diabetes Mellitus; Diet, Vegetarian; Female; Folic Acid; Homocysteine; Humans; Hyperhomocysteinemia; Hyperlipidemias; Hypertension; India; Male; Middle Aged; Obesity; Risk Factors; Severity of Illness Index; Smoking; Stroke; Tomography, X-Ray Computed; Vitamin B 12

Essential hypertension (EH) and cardiovascular disease are common, multifactorial disorders likely to be influenced by multiple genes of modest effect. The C677T methylenetetrahydrofolate reductase (MTHFR) gene polymorphism is related to MTHFR enzyme activity and to plasma homocysteine (Hcy) concentration. This study was designed to investigate an association of this polymorphism with coronary artery disease (CAD), EH, and healthy subjects.. In this study, we measured serum folate, serum vitamin B12, and plasma homocysteine and determined the MTHFR C677T genotype of 78 patients with essential hypertension, 100 patients with coronary artery disease, and 100 healthy subjects. MTHFR genotypes were assessed by real-time polymerase chain reaction.. CC, CT, and TT genotype frequencies were 52, 44.0, and 4.0% in patients with CAD, respectively. In patients with essential hypertension, the CC, CT, and TT genotype frequencies were 46.2, 41.0, and 12.8%, respectively. In control subjects, the CC, CT, and TT genotype frequencies were 72.0, 26.0, and 2.0%, respectively. The C allele was significantly more frequent in controls compared with patients with EH (p<0.05), and CC genotypes were more frequent in controls compared to patients with EH and CAD. Homocysteine level was higher in TT genotypes in CAD patients compared with CC and CT genotypes (p<0.01). MTHFR gene polymorphism is an independent risk factor for EH but not for CAD.. The TT genotype of the 677C/T MTHFR polymorphism is associated with EH and CAD. In addition, TT genotypes had higher plasma Hcy levels in CAD patients compared with CC and CT genotypes. MTHFR gene polymorphism is an independent risk factor for EH but not for CAD.

Topics: Aged; Coronary Artery Disease; Female; Folic Acid; Gene Frequency; Genotype; Homocysteine; Humans; Hyperhomocysteinemia; Hypertension; Male; Methylenetetrahydrofolate Reductase (NADPH2); Middle Aged; Polymorphism, Genetic; Risk Factors; Turkey; Vitamin B 12

The nephrotic syndrome is associated with heightened risk for arterial and venous thrombosis. Multiple derangements of hemostasis and acquired risk factors such as hyperlipidemia and hypertension contribute to this risk. The prevalence in the nephrotic syndrome of high circulating levels of homocysteine and of low levels of the B vitamins that are involved in its metabolism, which may play a role in thrombosis, is not well defined.. In 84 patients with nephrotic syndrome and 84 sex- and age-matched controls, hemostasis variables and the circulating levels of total homocysteine (tHcy), vitamin B(6), B(12) and folates were measured.. tHcy levels were higher, vitamin B(6) and vitamin B(12) levels were lower in nephrotic patients than in controls. The association of low vitamin B(6) levels with the nephrotic syndrome was independent of any other alteration associated with the disease. Eighty-two percent of patients with the nephrotic syndrome had vitamin B(6) levels falling in the lowest quartile of the normal distribution. Antithrombin deficiency, factor V Leiden, antiphospholipid antibodies, hypertension, dyslipidemia, were more frequent in patients with the nephrotic syndrome than in controls.. Patients with the nephrotic syndrome have multiple risk factors for thrombosis. We report that they frequently have low circulating levels of vitamin B(6), which associate with a heightened risk for venous and arterial thrombosis.

Topics: Adult; Antibodies, Antiphospholipid; Antithrombins; Factor V; Female; Folic Acid; Homocysteine; Humans; Hyperlipidemias; Hypertension; Male; Middle Aged; Nephrotic Syndrome; Risk; Risk Factors; Vitamin B 12; Vitamin B 6; Vitamin B Complex

To investigate the effect of clonidine, moxonidine, folic acid, and mecobalamin on arterial baroreflex (ABR) function in stroke-prone spontaneously hypertensive rats (SHR-SP) and the possible mechanisms involved.. Eighty-one SHR-SP were divided into 7 groups. Four groups were designated for the intragastric (ig) administration of clonidine (1.0 and 10.0 microg/kg), moxonidine (0.1 and 1.0 mg/kg), folic acid (1.0 mg/kg), and mecobalamin (1.0 mg/kg). Three groups were for the intracerebroventricular (icv) injection of clonidine (4 microg/4 microL), moxonidine (5 microg/4 microL), and mecobalamin (20 microg/4 microL). Blood pressure (BP) was recorded in the conscious state for 30 min and baroreflex sensitivity (BRS) was determined respectively before and after drug administration.. Clonidine and moxonidine significantly decreased BP, prolonged the heart period (HP), and increased BRS when administered as either ig or icv injections. Both BP and HP were unchanged by ig folic acid or mecobalamin injection. However, BRS was significantly increased by both.. Clonidine, moxonidine, folic acid, and mecobalamin improved impaired ABR function in SHR-SP. The central mechanism was involved in this effect of either clonidine or moxonidine. Mecobalamin improved ABR function through the peripheral mechanism.

Topics: Animals; Antihypertensive Agents; Baroreflex; Blood Pressure; Clonidine; Female; Folic Acid; Hematinics; Hypertension; Imidazoles; Random Allocation; Rats; Rats, Inbred SHR; Vitamin B 12

Elevated plasma homocysteine is widely seen as an independent risk factor of cardiovascular disease in adults. In order to investigate the role of homocysteine in a paediatric population at risk for early atheroclerosis, we studied plasma homocysteine in obese schoolchildren and non-obese peers. Plasma homocysteine, serum vitamin B12 and serum folic acid were determined in 41 obese and 27 control subjects and related to carotid intima-media thickness and flow-mediated dilatation measured on high-resolution ultrasonography. Homocysteine, vitamin B12 and folic acid were all significantly elevated in obese children. In girls, plasma homocysteine correlated significantly with body mass index (r=0.56, p=0.002), increased ICA intima-media thickness (r=0.39, p=0.035) and flow-mediated dilatation (r=-0.40, p=0.031). In boys, none of these associations reached significance (all p>0.234). No independent association of homocysteine with IMT and FMD was seen after adjustment for BMI.. Plasma homocysteine is elevated in obese schoolchildren with hypertension and dyslipidaemia, particularly in girls. This may indicate a high-risk constellation, so that plasma homocysteine should be monitored in these children.

Topics: Atherosclerosis; Body Mass Index; Brachial Artery; Carotid Artery, Internal; Case-Control Studies; Child; Dyslipidemias; Female; Folic Acid; Homocysteine; Humans; Hypertension; Male; Obesity; Regional Blood Flow; Tunica Intima; Tunica Media; Ultrasonography; Vitamin B 12

Homocysteine is known as an independent risk factor of atherosclerosis. The aim of this study was assessment of serum homocysteine concentrations in obese children and evaluation of possible relationship between homocysteine and risk factors of atherosclerosis. 498 children with simple obesity were included into our study. There was a significant correlation between serum homocysteine levels and both traditional and new risk factors of atherosclerosis. The issues confirm a necessity of evaluation serum homocysteine levels of obese children in estimation of cardiovascular disease risk.

Topics: Adolescent; Atherosclerosis; Biomarkers; Body Mass Index; Child; Comorbidity; Female; Folic Acid; Genetic Predisposition to Disease; Homocysteine; Humans; Hypertension; Male; Obesity; Obesity, Morbid; Poland; Risk Factors; Statistics, Nonparametric; Vitamin B 12

cblC disease is a cause of hemolytic uremic syndrome (HUS), which has been primarily described in neonates and infants with severe renal and neurological lesions.. Two sisters aged 6 and 8.5 years presented with a latent hemolytic process characterized by undetectable or low plasma haptoglobin, respectively, associated with renal failure and gross proteinuria. Renal biopsies performed in both patients found typical findings of thrombotic microangiopathy suggesting the diagnosis of HUS. Both patients were free of neurologic signs.. Biochemical investigations found a cobalamin processing deficiency of the cblC type. Search for additional factors susceptible to worsen endothelial damage revealed homozygosity 677C--> T mutation in the methylenetetrahydrofolate reductase gene as well as heterozygosity for a 3254T--> C mutation in factor H in the patient with the most severe clinical presentation. Long-term subcutaneous administration of hydroxocobalamin in combination with oral betaine and folic acid resulted in clinical and biological improvement in both patients.. cblC disease may be a cause of chronic HUS with delayed onset in childhood. Superimposed mutation of factor H gene might influence clinical severity.

Topics: Anemia; Betaine; Child; Combined Modality Therapy; Complement Factor H; Drug Therapy, Combination; Endothelium, Vascular; Female; Folic Acid; Genetic Predisposition to Disease; Genotype; Haptoglobins; Hemolytic-Uremic Syndrome; Humans; Hydroxocobalamin; Hypertension; Kidney; Methylenetetrahydrofolate Reductase (NADPH2); Mutation, Missense; Nephrotic Syndrome; Plasma Exchange; Point Mutation; Proteinuria; Proto-Oncogene Proteins; Proto-Oncogene Proteins c-cbl; Renal Dialysis; Vitamin B 12

Hyperhomocysteinemia is one of the newly recognised risk factors of coronary artery disease (CAD). The role of hyperhomocysteinemia in the development of atherosclerosis has been controversial.. To assess homocysteine (Hcy) plasma concentration in patients with CAD and to correlate Hcy level with some cardiovascular risk factors.. The study group consisted of 150 males aged <55 years (mean age 49.5+/-5.7 years) with stable CAD. Lipid and carbohydrate profiles as well as Hcy, folic acid and vitamin B(12) serum concentration were assessed, and correlated with such cardiovascular risk factors as cigarette smoking, hypertension, obesity and a history of myocardial infarction.. Mean Hcy plasma concentration was 11.81+/-3.75 micro mol/L. In patients with Hcy >11.21 micro mol/L (median value) a lower level of folic acid and vitamin B12 as well as reduced ejection fraction and glomerular filtration rate were found when compared to patients with Hcy level <11.21 micro mol/L. In addition, creatinine concentration, mean patient's age, proportion of patients who smoked cigarettes and the number of affected coronary arteries were significantly higher in patients with an increased level of Hcy. The Hcy plasma concentration positively correlated with the progression of hypertension, creatinine level and the number of coronary vessels with stenosis. A significant negative correlation between Hcy and folic acid as well as vitamin B12 concentrations was documented. In patients with a three-vessel CAD, Hcy concentration was 12.46+/-3.85 micro mol/L and was significantly higher (p<0.03) compared with patients with a less advanced CAD. In the group of patients with diabetes the mean Hcy concentration increased with the number of affected coronary vessels (p<0.02) and reached the highest values in patients with a three-vessel CAD (15.38+/-7.28 micro mol/L).. There is a significant relationship between homocysteine plasma concentration and the incidence as well as progression of CAD. This association is particularly evident in patients with diabetes.

Topics: Adult; Blood Glucose; Coronary Artery Disease; Disease Progression; Folic Acid; Homocysteine; Humans; Hypertension; Lipids; Male; Middle Aged; Myocardial Infarction; Obesity; Research Design; Risk Factors; Smoking; Vitamin B 12

While the incidence of infectious diseases has been on the decline in developing countries, the toll of cardiovascular diseases, including stroke and myocardial infarction, has been increasing. The impression of physicians in certain regions of the western Sahel, including the state of Gombe in northeastern Nigeria, is that macrovascular disease in the indigenous population is on the rise. This study was, therefore, undertaken to compare well-established risk factors for cardiovascular disease in a group of 53 men (n=34) and women (n=19) in the town of Gombe who had suffered a stroke or heart attack with the corresponding parameters in 48 age- and gender-matched healthy adults living in the same environment. The parameters of cardiovascular diseases considered were: overweight and obesity, blood pressure, lipid profiles, and homocysteine. While the male and female patients who had suffered stroke (n=48) or heart attack (n=5) were borderline hypertensive, their mean body mass index values were not different from the corresponding values of their control groups. Although the serum homocysteine levels of the patients and controls were not significantly different, 85% of the stroke patients had serum homocysteine levels greater than 10 microM. These high homocysteine levels could not be accounted for by sub-optimal folate or vitamin B 12 status. The serum levels of HDL-cholesterol and triglyceride were not significantly different between the male and female patients and their respective controls. However, the males, but not the females, with macrovascular disease had significantly higher levels of total cholesterol (161 vs 137 mg/dL, p=0.04) and LDL-cholesterol (91 vs 70 mg/dL, p=0.02). In addition, both female and male stroke/myocardial infarction patients exhibited an elevated LDL-cholesterol/HDL-cholesterol ratio. These results indicate that blood pressure and the LDL-cholesterol/HDL-cholesterol ratio are associated with stroke and myocardial infarction in adults in northern Nigeria, thereby creating potential opportunities for possible public-health interventions.

Topics: Case-Control Studies; Cholesterol, HDL; Cholesterol, LDL; Female; Folic Acid; Homocysteine; Humans; Hypertension; Lipids; Male; Middle Aged; Myocardial Infarction; Nigeria; Risk Factors; Stroke; Triglycerides; Vitamin B 12

An association of plasma homocysteine concentration ([Hcy]) with cardiovascular events has been described, but the role of [Hcy] in the early phase of cardiovascular disease is uncertain. The purpose of this study was to determine whether [Hcy] is related to blood pressure (BP) or other risk factors in African Americans, a population at high risk for cardiovascular disease.. This cross-sectional study was conducted on a sample of premenopausal African American women (N = 119) and men (N = 56), 30 to 40 years of age. Each subject was classified as normotensive or hypertensive. Fasting blood samples were obtained for serum lipids, insulin, glucose, Hcy, folate, and B-12, followed by an oral glucose tolerance test.. Mean [Hcy] was higher in hypertensives compared to normotensives, but the difference was statistically significant only in women (10.5 +/- 5.3 v 8.2 +/- 2.3; P <.01). In women, the simple correlation analysis revealed a statistically significant relationship of [Hcy] with systolic BP (r = 0.22, P =.02) and diastolic BP (r = 0.240, P =.01). However, after adjusting for age and body mass index (BMI), the correlations were attenuated and no longer significant. There was a significant inverse relationship of [Hcy] with plasma folate (r = -0.35, P <.001) and B-12 (r = -0.29, P <.01) in women.. Although the simple correlation coefficient suggests a significant relationship of [Hcy] with BP in women, this relationship was no longer statistically significant after adjustment for age and BMI. The significant inverse relationship of plasma folate and B-12 with [Hcy] suggest that diet factors may affect the crude [Hcy]-BP relationship identified in this sample.

Topics: Adult; Age Factors; Biomarkers; Black or African American; Blood Glucose; Blood Pressure; Body Mass Index; Cross-Sectional Studies; Diastole; Female; Folic Acid; Homocysteine; Humans; Hypertension; Insulin; Male; Risk Factors; Sex Factors; Smoking; Statistics as Topic; Systole; Triglycerides; Vitamin B 12

The aim of this study was to study the relationship between plasma homocysteine (Hcy), folic acid, vitamin B12 and early coronary artery disease (early-CAD) and high coronary risk factors. The plasma Hcy levels of 58 cases with early-CAD and 31 subjects without CAD were measured using high-performance liquid chromatography (HPLC) with fluorescence detection. Plasma folic acid and Vitamin B12 levels were measured with radioassay method. The plasma Hcy level was significantly higher in the early-CAD patients than in the controls [(13.7 +/- 5.1) micromol/L vs (10.3 +/- 5.7) micromol/L]. The plasma folic acid and Vitamin B12 levels were significantly lower in the early-CAD patients than in the controls. The plasma Hcy level was higher in patients with more than 3 risk factors of CAD than in patients with 1 or 2 risk factors and in the controls [(17.3 +/- 5.1) micromol/ L vs (12.9 +/- 4.8) micromol/L, (7.8 +/- 2.5) micromol/L]. Other than gender, all classical coronary risk factors were related to the elevated Hcy level. Hcy levels were elevated in patients with early-CAD and with high risk factors. Hyperhomocysteinemia plays an important role in the pathogenesis of CAD.

Topics: Adult; Aged; Coronary Stenosis; Diabetes Complications; Folic Acid; Homocysteine; Humans; Hypercholesterolemia; Hypertension; Male; Middle Aged; Risk Factors; Smoking; Vitamin B 12

Homocysteine generates oxygen radicals (superoxide anion and hydrogen peroxide) that are known to produce vasoconstriction. Hypertension is a common problem in individuals with diabetes mellitus. It is possible that hypertension in diabetic patients may be due to increased levels of plasma homocysteine. We investigated the plasma levels of homocysteine, factors involved in homocysteine metabolism (serum folic acid and vitamin B12) and lipid peroxidation product in the serum of diabetic patients with hypertension.. The studies were conducted in three groups: 1) healthy controls, and diabetic patients who were 2) normotensive and 3) hypertensive. Plasma homocysteine, serum malondialdehyde (a lipid peroxidation product), vitamin B12, and folic acid were measured in these patients. Plasma homocysteine and serum malondialdehyde levels were elevated in diabetic patients compared to the control group. Plasma levels of homocysteine and serum levels of malondialdehyde were higher in the hypertensive diabetic patients than in those who were normotensive. Levels of serum folate were lower in hypertensive diabetic patients compared to the normotensive group. Levels of serum vitamin B12 were similar in both the normotensive and hypertensive diabetic patients.. Levels of plasma homocysteine and serum malondialdehyde are elevated in hypertensive diabetic patients. Hyperhomocysteinemia may be involved in the induction and sustaining of hypertension in diabetic patients.

Topics: Adult; Aged; Aged, 80 and over; Biomarkers; Blood Glucose; Blood Pressure; Diabetes Mellitus; Diastole; Female; Folic Acid; Homocysteine; Humans; Hypertension; Lipid Peroxidation; Male; Malondialdehyde; Middle Aged; Systole; Vitamin B 12

To investigate the relationship between pregnancy induced hypertension syndrome (PIH) and homocysteine, folic acid and vitamin B(12).. There were 59 cases of PIH (group A) and 60 cases of normal late pregnancy were enrolled (group B). The serum homocysteine level was detected with fluorescence polarization immunoassay (FPIA), serum folic acid and vitamin B(12) levels were detected with microparticle enzyme immunoassay (MEIA).. There was significant difference (P < 0.05) of serum homocysteine levels between group A [(13.1 +/- 3.7) micromol/L] and group B [(10.4 +/- 3.9) micromol/L]. Although, the level of folic acid and vitamin B(12) in group A were lower than those of group B, there was no statistical differences between the two groups (P > 0.05).. It was concluded that the disorder of homocysteine metabolism may play an important role in the pathogenesis of PIH, and no direct evidence to prove that folic acid and vitamin B(12) were related with PIH.

Topics: Adult; Female; Folic Acid; Homocysteine; Humans; Hypertension; Pregnancy; Pregnancy Complications, Cardiovascular; Vitamin B 12

Although insulin resistance and elevated plasma homocysteine are associated with hypertension in adults, the role of these conditions in the initial phase of hypertension is largely unknown. We examined whether insulin resistance and disturbed homocysteine metabolism are present in young adults at the early stages of essential hypertension.. We measured physical characteristics, plasma levels of insulin, lipids, total homocysteine, and vitamins in 164 patients with essential juvenile hypertension (median age, 19 years; 92% males) and in 173 controls (median age, 18 years; 66% males). Furthermore, we analyzed the prevalence of six polymorphisms in four genes of the methionine cycle.. Patients with hypertension and controls differed significantly (P <.05) in body mass index, levels of insulin, high-density lipoprotein-cholesterol, fasting and post-load plasma homocysteine, and folates. Systolic blood pressure was correlated with homocysteine levels and inversely correlated with plasma folates. Logistic regression showed that fasting homocysteine, vitamin B(12), and low-density lipoprotein-cholesterol were associated with a significantly increased risk of juvenile hypertension. In contrast, the birth length, polymorphism c.2756 A-->G in the MTR gene and plasma folate were associated with a significantly decreased risk of juvenile hypertension.. Our study showed that essential hypertension in adolescents is associated with lower folate and higher homocysteine levels, and with signs of insulin resistance. These data suggest that hypertension in young individuals may be a part of early manifestation of insulin resistance syndrome, and that disturbed folate and homocysteine metabolism may play a role in the early stages of hypertension.

Topics: 5-Methyltetrahydrofolate-Homocysteine S-Methyltransferase; Adolescent; Adult; Cystathionine beta-Synthase; Female; Ferredoxin-NADP Reductase; Folic Acid; Genetic Predisposition to Disease; Homocysteine; Humans; Hypertension; Insulin Resistance; Male; Methylenetetrahydrofolate Reductase (NADPH2); Oxidoreductases Acting on CH-NH Group Donors; Polymorphism, Genetic; Prevalence; Risk Factors; Vitamin B 12; Vitamin B 6

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Antihypertensive Agents; Arteriosclerosis; Cardiovascular Diseases; Chlamydia Infections; Controlled Clinical Trials as Topic; Diabetes Mellitus, Type 2; Double-Blind Method; Female; Folic Acid; Humans; Hypercholesterolemia; Hyperhomocysteinemia; Hypertension; Hypolipidemic Agents; Infections; Male; Middle Aged; Multicenter Studies as Topic; Obesity; Randomized Controlled Trials as Topic; Risk Factors; Vitamin B 12; Vitamin B Complex

Established determinants of fasting total homocysteine (tHcy) concentration include folate and vitamin B-12 status, serum creatinine concentration, and renal function.. Our objective was to examine the relation between known and suspected determinants of fasting plasma tHcy in a population-based cohort.. We examined the relations between fasting plasma tHcy concentrations and nutritional and other health factors in 1960 men and women, aged 28-82 y, from the fifth examination cycle of the Framingham Offspring Study between 1991 and 1994, before the implementation of folic acid fortification.. Geometric mean tHcy was 11% higher in men than in women and 23% higher in persons aged > or = 65 y than in persons aged < 45 y (P < 0.001). tHcy was associated with plasma folate, vitamin B-12, and pyridoxal phosphate (P for trend < 0.001). Dietary folate, vitamin B-6, and riboflavin were associated with tHcy among non-supplement users (P for trend < 0.01). The tHcy concentrations of persons who used vitamin B supplements were 18% lower than those of persons who did not (P < 0.001). tHcy was positively associated with alcohol intake (P for trend = 0.004), caffeine intake (P for trend < 0.001), serum creatinine (P for trend < 0.001), number of cigarettes smoked (P for trend < 0.001), and antihypertensive medication use (P < 0.001).. Our study confirmed, in a population-based setting, the importance of the known determinants of fasting tHcy and suggested that other dietary and lifestyle factors, including vitamin B-6, riboflavin, alcohol, and caffeine intakes as well as smoking and hypertension, influence circulating tHcy concentrations.

Topics: Adult; Age Factors; Aged; Aged, 80 and over; Alcohol Drinking; Caffeine; Cohort Studies; Creatinine; Dietary Supplements; Fasting; Female; Folic Acid; Homocysteine; Humans; Hypertension; Kidney; Male; Middle Aged; Nutritional Status; Pyridoxal Phosphate; Pyridoxine; Riboflavin; Sex Factors; Smoking; Vitamin B 12

Few studies examining the association between total homocyst(e)ine and coronary heart disease have included blacks or Hispanics.. Data from the third National Health and Nutrition Examination Survey (3173 patients), a nationally representative survey of US adults, were used to examine the relation between total homocyst(e)ine and an electrocardiogram or a physician's diagnosis of acute myocardial infarction (259 patients) among whites, blacks, and Mexican Americans >/=40 years old.. Vitamin B(12) and serum folate concentrations were significantly lower among persons with a total homocyst(e)ine concentration >/=15 micromol/L than among those with a total homocyst(e)ine concentration /=15 micromol/L were also older and more likely to be hypertensive, have a higher cholesterol concentration, and smoke. Compared with persons with a total homocyst(e)ine concentration /=15 micromol/L had an odds ratio (OR) for myocardial infarction of 1.8 (95% confidence interval [CI], 1.2-2.9) after adjustment for cardiovascular disease risk factors. Similar associations were noted among whites (OR 1.8, 95% CI, 1.1-3.1) and blacks (OR 1.9, 95% CI, 0.8-4.2); a more modest association was noted among Mexican Americans (OR 1.2, 95% CI, 0.3-5.0). The association between total homocyst(e)ine and myocardial infarction was also more pronounced in persons without hypertension or diabetes.. Almost a 2-fold increased likelihood of myocardial infarction among persons with a total homocyst(e)ine concentration >/=15 micromol/L was noted in this nationally representative survey. The magnitude of the association did not differ by race or ethnicity.

Topics: Age Distribution; Black People; Cholesterol; Comorbidity; Diabetes Mellitus; Educational Status; Female; Folic Acid; Homocysteine; Homocystine; Humans; Hypertension; Male; Mexico; Middle Aged; Multivariate Analysis; Myocardial Infarction; Nutrition Surveys; Odds Ratio; Prevalence; Risk Assessment; Sex Distribution; Smoking; United States; Vitamin B 12; White People

To examine erythropoiesis in renal transplant pregnancies.. Retrospective cohort study of 30 renal transplant cases and 30 age, smoking and parity-matched healthy controls with normal index pregnancy. Retrospective chart review and assay of frozen antenatal serum (for serum erythropoietin concentration [serum EPO]), transferrin receptor protein [TfR], ferritin, folate and B12) were performed. The linear regression equation for normal pregnancy controls was used to calculate predicted [serum EPO] and the observed/predicted (O/P) log [serum EPO] was plotted. The relationship between [serum EPO] and haemoglobin (Hb) among transplant cases was considered to be different from that among controls if the slope of the O/P log [serum EPO] versus Hb regression was significantly different from zero.. The transplant (14 cadaveric) to conception interval was (median [range]) 33.5 [4, 189] months. Immunosuppressants were azathioprine (n = 25), cyclosporine (n = 22) and/or prednisone (n = 25). Cases were more often primiparous (20 vs. 7 [controls]; p = 0.01), had pre-existent hypertension (20 vs. 0 [controls]; p < 0.001), developed new/increased hypertension or pre-eclampsia (28 vs. 0 [controls]; p < 0.001) and an antenatal rise in creatinine (14 vs. 2 [controls]; p < 0.001). In early pregnancy, cases had similar EPO (15.2 [2.6, 84.6] vs. 15.7 [6.4, 41.0] [controls] U/L) but lower Hb (101 [65, 129] vs. 116 [106, 150] g/L; p < 0.001). Twenty-two (73%) cases had Hb < 100 g/L (vs. 4 [controls]; p < 0.0001); Hb was comparable at 6 wk postpartum. With advancing gestational age (GA), Hb remained stable and serum EPO increased in both groups. The slope of the O/P log [serum EPO] versus Hb for transplant cases was significantly different from zero within both the 17-28 wk (slope +/- SEM: 0.010 +/- 0.002; p < 0.0001) and the 29-42 wk GA categories (0.006 +/- 0.003; p = 0.02). Cases showed smaller rises in serum TfR (change 481 [- 1471, 2780]) vs. 1119 [- 698, 4195] [controls] ng/mL; p = 0.005).. Anaemia frequently complicates renal transplant pregnancies, in which serum EPO is inappropriately low and the rate of erythropoiesis blunted.

Topics: Adult; Anemia; Case-Control Studies; Cohort Studies; Creatinine; Erythropoiesis; Erythropoietin; Female; Ferritins; Folic Acid; Gestational Age; Hemoglobins; Humans; Hypertension; Immunosuppressive Agents; Kidney Transplantation; Linear Models; Parity; Pre-Eclampsia; Pregnancy; Pregnancy Complications, Cardiovascular; Pregnancy Complications, Hematologic; Receptors, Transferrin; Retrospective Studies; Time Factors; Vitamin B 12

Elevated plasma total homocysteine (tHcy) levels, either measured in the fasting state or after oral methionine loading, are associated with an increased risk of atherothrombotic disease. Fasting and post-methionine hyperhomocysteinemia (HHC) overlap to a limited extent; both can occur as familial traits. We investigated determinants of fasting, postmethionine and delta (ie, post-methionine minus fasting levels) tHcy levels in 510 subjects of 192 HHC-prone families including 161 patients with clinical vascular disease and 349 without vascular disease. We focused on tHcy levels in relation to levels of vitamin B12, B6 and folate and the methylenetetrahydrofolate reductase (MTHFR) C677T mutation. Multivariate linear analyses adjusted for the presence of vascular disease showed that fasting tHcy was significantly related to folate and vitamin B12, and the presence of the MTHFR TT genotype and the T allele, and to age, smoking habits, and serum levels of creatinine. Both post-methionine and delta tHcy levels were related to serum folate levels, and the presence of the MTHFR TT genotype and the T allele, and to postmenopausal status, and body mass index. An interaction was found between MTHFR TT genotype and serum folate levels for both fasting and post-methionine tHcy, ie, for a given decrease in serum folate, homocysteine levels increased more in subjects with the TT genotype than in those with the CC genotype. Fasting, post-methionine and delta tHcy were higher in patients with vascular disease than in their healthy siblings, but these levels were less dependent on serum folate levels (P<0.05), whereas the effect of MTHFR genotype was stronger (P=0.01). This study found evidence that post-methionine and delta tHcy levels are not only influenced by factors affecting homocysteine transsulfuration but also by factors that affect remethylation. The explained variances of fasting, post-methionine and delta tHcy were 49%, 62%, and 78%, respectively. We also found evidence, in patients with premature vascular disease but not in their healthy siblings, for a factor that increases tHcy levels but weakens the normal inverse relation between folate and tHcy and amplifies the effect of the MTHFR genotype.

Topics: Adult; Age Factors; Amino Acid Substitution; Arteriosclerosis; Body Mass Index; Comorbidity; Fasting; Female; Folic Acid; Genetic Predisposition to Disease; Genotype; Homocysteine; Humans; Hyperhomocysteinemia; Hypertension; Lipids; Male; Menopause; Methionine; Methylenetetrahydrofolate Reductase (NADPH2); Middle Aged; Oxidoreductases Acting on CH-NH Group Donors; Polymorphism, Genetic; Pyridoxine; Smoking; Vitamin B 12

The atherogenicity of homocyst(e)ine--H(e) --emerged from many studies showing an association between moderately elevated levels and vascular occlusive disease. The aim of this study was to evaluate whether high homocyst(e)ine levels were associated with carotid atherosclerosis. Carotid atherosclerosis was defined as an intimal media thickness of internal and carotid bifurcation of at least 2 mm on the near and far walls as determined by B-mode ultrasonography. The study population included 91 patients: group 1 (61% males, mean age 64+/-10 years, 57% with history of hypertension) with ultrasound evidence of carotid atherosclerosis and 100 with normal carotid walls--group 2 (36% males, mean age 52+/-15 years, 27% with history of hypertension). Homocyst(e)ine levels (mol/L) were determined by high-performance liquid chromatography with a fluorescent detector. Body mass index, dyslipidemia, smoking, diabetes, serum creatinine, plasma folic acid and vitamin B12 were not significantly different in the two groups. Homocyst(e)ine levels (micromol/L) were significantly higher in patients with carotid ather osclerosis than in those with normal arteries (11.7+/-6.5 micromol/L, 95% CI 10.4-13.1 vs 8.07+/-4.4 micromol/L, 95% CI 7.2-8.9, p<0.0001). By multiple regression analysis H(e) levels were positively correlated with male gender (p<0.02), age (p<0.001), and negatively with folic acid (p<0.0001). By logistic regression the independent predictors of carotid atherosclerosis were male gender (OR 2.65), hypertension (OR 2.55), age (x10 years, OR 2.15) and H(e) levels (x1 micromol/L, OR 1.11). This study confirmed homocyst(e)ine is associated with carotid atherosclerosis. Consequently the authors recommend H(e) levels be screened in all patients at risk for atherosclerosis.

Topics: Age Factors; Body Mass Index; Carotid Artery Diseases; Carotid Artery, Common; Carotid Artery, Internal; Chromatography, High Pressure Liquid; Creatinine; Diabetes Complications; Female; Fluorescence; Folic Acid; Homocysteine; Humans; Hyperhomocysteinemia; Hyperlipidemias; Hypertension; Logistic Models; Male; Middle Aged; Regression Analysis; Risk Factors; Sex Factors; Smoking; Tunica Intima; Tunica Media; Ultrasonography; Vitamin B 12

In order to see whether conventional low-dose folic acid supplement along with vitamin B6 and B12 reduces hyperhomocysteinemia in patients with ESRD, we compared the levels of homocysteine, vitamin B6, B12 and folic acid among 3 groups of patients: 44 ESRD patients on hemodialysis with replacement of folic acid, vitamin B6, and B12 (dialysis group); 27 chronic renal failure patients without vitamin replacement (predialysis group); and 17 hypertensive patients without vitamin replacement (control group). Mean plasma total homocysteine concentration was higher in the dialysis (15.5 +/- 6.6 micromol/l) and the predialysis groups (15.7 +/- 4.2 micromol/l) than in the control group (6.2 +/- 1.5 micromol/l) (p < 0.001). However, there was no difference in homocysteine concentrations between the dialysis and predialysis groups. In the control and predialysis groups, the homocysteine concentration showed a reverse correlation with the concentrations of folic acid (r = 0.584, p = 0. 014 for the control group; r = 0.431, p = 0.247 for the predialysis group) and vitamin B12 (r = 0.485, p = 0.049 for the control group; r = -0.562, p = 0.023 for the predialysis group) but not with vitamin B6. In conclusion, plasma folic acid concentrations were 3-4 times higher in the dialysis than in the predialysis group. But these levels of folic acid are not enough to reduce hyperhomocysteinemia in ESRD.

Topics: Adult; Female; Folic Acid; Homocysteine; Humans; Hypertension; Kidney Failure, Chronic; Male; Middle Aged; Pyridoxine; Renal Dialysis; Vitamin B 12

Limited data are available on the determinants of homocysteinemia or the association between plasma homocysteine (Hcy) levels and prevalent cardiovascular disease (CVD) in maintenance dialysis patients. We assessed etiology of renal failure, residual renal function and dialysis adequacy-related variables, and vitamin status, as determinants of fasting total plasma homocysteine (Hcy) in 75 maintenance dialysis patients. We also assessed the potential interactive effect on plasma Hcy of folate status and a common mutation (ala to val; homozygous val-val frequency approximately 10%) in methylenetetrahydrofolate reductase (MTHFR), a folate-dependent enzyme crucial for the remethylation of homocysteine (Hcy) to methionine. Lastly, we evaluated whether the Hcy levels differed amongst these patients in the presence or absence of prevalent CVD, after adjustment for the traditional CVD risk factors. Fasting total plasma Hcy, folate, pyridoxal 5'-phosphate (PLP; active B6), B12, creatinine, glucose, total and HDL cholesterol levels, and presence of the ala to val MTHFR mutation were determined, and clinical CVD and CVD risk factor prevalence were ascertained. General linear modelling/analysis of covariance revealed: (1) folate status and serum creatinine were the only significant independent predictors of fasting Hcy; (2) there was a significant interaction between presence of the val mutation and folate status, i.e., among patients with plasma folate below the median (< 29.2 ng/ml), geometric mean Hcy levels were 33% greater (29.0 vs. 21.8 microM, P = 0.012) in the pooled homozygotes (val-val) and heterozygotes (ala-val) for the ala to val mutation, vs. normals (ala-ala); (3) there was no association between prevalent CVD and plasma Hcy. Given potentially intractable survivorship effects, prospective cohort studies will be required to clarify the relationship between plasma Hcy or any putative CVD risk factor, and incident CVD in dialysis patients. If a positive association between plasma Hcy and incident CVD can be established in maintenance dialysis patients, the current data provide a rationale for additional folic acid supplementation in this patient population.

Topics: Adult; Aged; Amino Acid Sequence; Cardiovascular Diseases; Cholesterol, HDL; Comorbidity; Creatinine; DNA Mutational Analysis; Female; Folic Acid; Glucose Intolerance; Homocysteine; Humans; Hypertension; Kidney Failure, Chronic; Male; Methylenetetrahydrofolate Reductase (NADPH2); Middle Aged; Oxidoreductases Acting on CH-NH Group Donors; Peritoneal Dialysis; Polymorphism, Restriction Fragment Length; Prevalence; Renal Dialysis; Risk Factors; Smoking; Vitamin B 12

Serum vitamin B12, folic acid and haematological data from 147 elderly people (55 males and 92 females) who visited the special clinic for the elderly at Rajvithi Hospital, Bangkok between July and November 1989 were investigated. The individuals studied came from a health-conscious group of the middle socio-economic class in Bangkok. All of them were fairly well except for minor ailments and typical diseases of elderly people such as hypertension, mild to moderate degree coronary heart diseases and non-insulin dependent diabetes mellitus. There was a statistically significant difference in haemoglobin concentrations between males and females. According to the standard haemoglobin cut-off point values of 13 g/dl for males and 12 g/dl for females, anaemia was detected in 22 (15%) of the 147 subjects. The percentage of folic acid deficiency was found to be 20.6 per cent (30 of the 147 cases). Vitamin B12 insufficiency was found in only 6.9 per cent (10 of the 147 cases). No statistically significant correlation between haemoglobin, folic acid and vitamin B12 was found. However, when the data were grouped according to different intervals of increasing haemoglobin concentrations, for females there was a tendency for serum vitamin B12 to decrease, and serum folic acid to increase in both males and females. The results of this study suggest that folate deficiency may play a role in the occurrence of anaemia in elderly people, and therefore, dietary counselling and supplementation of folic acid are recommended.

Topics: Aged; Blood Cell Count; Cardiovascular Diseases; Developing Countries; Diabetes Mellitus, Type 2; Erythrocyte Indices; Female; Folic Acid; Folic Acid Deficiency; Hematocrit; Hemoglobinometry; Humans; Hypertension; Male; Middle Aged; Thailand; Vitamin B 12; Vitamin B 12 Deficiency

Myocardial capillary exchange capacity was investigated by stereologic and functional techniques in parallel during pressure-overload cardiac hypertrophy and after long-term antihypertensive therapy with the vasodilator felodipine. In 26-week-old female spontaneously hypertensive rats (SHR) blood pressure increased by 25% and left ventricular weight (LVW/BW) increased by 18% compared to Wistar-Kyoto rats (WKY). Myocardial capillary surface and volume densities normalized for organ weight were similar in both ventricles for both strains. Moreover, capillary surface density was higher sub-epicardially (EPI) than in the subendocardium (ENDO) in the left ventricle of SHR. Thirteen weeks of felodipine-therapy (SHR-Felo) normalized blood pressure without affecting LVW/BW although a transition from concentric to eccentric hypertrophy is known to occur. Myocardial capillary surface and volume densities and the left ventricular ENDO-EPI-gradient in surface density were similar to untreated SHR. However, felodipine-treatment increased right ventricular weight and capillary volume density. Functional capillary exchange was estimated in terms of permeability surface area products (PS) for Cr-EDTA and vitamin B12 and normalized for organ weight. PSCr-EDTA, PSB12 and the ratio PSCr-EDTA/PSB12 (an index of capillary permeability) were similar in SHR and WKY. Furthermore, the relation between functional and stereological indices of exchange capacity was investigated in a multiple linear regression analysis. However, no significant correlation between PS and neither capillary surface nor volume density was found. In conclusion, myocardial capillary exchange capacity was well adapted to the pressure overload cardiac hypertrophy present in female SHR. Despite induction of right ventricular hypertrophy, felodipine-treatment did not affect capillary exchange capacity. Furthermore, when functional and stereologic estimates were performed in parallel, the importance of dynamic factors for myocardial capillary exchange capacity (e.g. heterogeneity) was illustrated.

Topics: Animals; Capillaries; Colorimetry; Coronary Circulation; Edetic Acid; Female; Hypertension; Myocardium; Permeability; Rats; Rats, Inbred SHR; Rats, Inbred WKY; Tissue Fixation; Vascular Resistance; Vitamin B 12

A total of 1280 80-year-old men were invited to a medical examination to study common risk indicators for cardiovascular disease (CVD) in the elderly. From the pool of 811 responders (63.3%), all 122 individuals who fulfilled our inclusion criteria were assigned to one of four groups: (1) no CVD, non-smokers; (2) no CVD, smokers; (3) CVD, smokers; (4) CVD, non-smokers. A telephone interview with 75 non-responders suggested that this group contained more institutionalized subjects, but otherwise did not differ from the group of participants. Subjects with CVD had higher levels of plasma cholesterol and LDL cholesterol than those without CVD, whereas plasma HDL cholesterol and plasma triglyceride concentrations did not differ between the groups; thus the LDL/HDL ratio was higher in the CVD group. Lipoprotein concentrations did not differ between smokers and non-smokers. However, the mean cholesterol levels were low (5.19 +/- 1.01 mmol l-1), suggesting selective mortality. No differences between the groups were found with regard to Lp(a). The mean blood pressure for the whole group was 149/79 mmHg, and there were no differences between subgroups. Our study suggests that mechanisms such as selective mortality modify the risk factor pattern in the elderly. In 80-year-old individuals, elevated LDL cholesterol levels can still be identified as a risk indicator for CVD, whereas there does not appear to be any association between CVD or low HDL levels or elevated blood pressure in this age group.

Topics: Aged; Aged, 80 and over; Alkaline Phosphatase; Cardiovascular Diseases; Cholesterol; Creatinine; Cross-Sectional Studies; Glycated Hemoglobin; Humans; Hypertension; Lipoproteins; Male; Myocardial Infarction; Prevalence; Risk Factors; Smoking; Sweden; Vitamin B 12

Topics: Adult; Contraceptives, Oral; England; Family Practice; Female; Humans; Hypertension; Medical Audit; Medical Records; Psychotropic Drugs; Referral and Consultation; Vitamin B 12

Investigations on the vitamin pattern of diabetic neuropathy: thiamine, riboflavin, pyridoxine, cobalamin and tocopherol. The contents of the vitamins mentioned above have been measured in the blood of 119 patients (53 diabetic neuropathies, 66 diabetics without neuropathy). The incidence of neuropathy shows a strong correlation with the duration of the diabetic state, but not with sex, nor with concomitant diseases such as adipositas, hypertension, heart and circulatory diseases, except retinopathia diabetica. Most of the diabetics in our study are well supplied with vitamins B1, B2, and E; B6 and B12 are occasionally low, but there is no statistically relevant difference between diabetic controls and neuropathies. Adipose patients have neither a markedly different vitamin content nor a different calory uptake from non-adipose patients. A general trend towards reduced total calory uptake is seen in old age, men (lower protein intake) and women (lower carbohydrate intake) obviously differing somewhat in their habits. The influence of therapy on the vitamin pattern is not clear cut, except for patients under diet and biguanide-therapy showing a higher proportion of low or subnormal B12 values. The increased frequency of neuropathies in patients treated with sulfonyl-urea approaches only the limits of significance and needs further investigations.

Topics: Diabetes Complications; Diabetes Mellitus; Diabetic Neuropathies; Diabetic Retinopathy; Female; Humans; Hypertension; Male; Middle Aged; Obesity; Pyridoxine; Riboflavin; Sex Factors; Thiamine; Vitamin B 12; Vitamin E

Topics: Adult; Anemia, Hypochromic; Child; Cholelithiasis; Coronary Disease; Diabetes Mellitus; Diet Therapy; Diet, Diabetic; Diet, Reducing; Female; Humans; Hypertension; Male; Middle Aged; Obesity; Osteoporosis; Peptic Ulcer; Pregnancy; Ureteral Calculi; Urinary Bladder Calculi; Vitamin B 12; Vitamin B 6 Deficiency

Topics: Adolescent; Adrenocorticotropic Hormone; Adult; Aged; Anti-Bacterial Agents; Arteriosclerosis; Basilar Artery; Cerebrovascular Disorders; Chronic Disease; Deoxyribonucleases; Diabetic Neuropathies; Diuretics; Facial Nerve; Facial Paralysis; Female; Herpes Zoster; Humans; Hypertension; Ischemia; Male; Middle Aged; Physical Therapy Modalities; Prednisolone; Recurrence; Tonsillitis; Vertebral Artery; Vitamin B 12

Topics: Anemia; Antihypertensive Agents; Humans; Hypertension; Iron; Vitamin B 12

Topics: Adult; Age Factors; Aged; Analgesics; Carbamazepine; Ethanol; Female; Follow-Up Studies; Humans; Hypertension; Male; Middle Aged; Minnesota; Multiple Sclerosis; Neoplasms; Phenytoin; Sex Factors; Trigeminal Neuralgia; Vitamin B 12

In pregnancy the level of serum vitamin B(12) is lower in women who smoke than in non-smokers. This finding occurs independently of social class, parity, or level of haemoglobin. In addition, the mean serum B(12) level tends to be less in women who are anaemic and is less in those women who have smaller babies. These findings may be an effect of the cyanide content of tobacco smoke, since cyanide may be detoxified by a mechanism which depletes the stores of vitamin B(12) in the body.

Topics: Anemia; Biotransformation; Birth Weight; Cyanides; Female; Gestational Age; Humans; Hypertension; Parity; Pre-Eclampsia; Pregnancy; Pregnancy Complications, Hematologic; Smoking; Social Class; Vitamin B 12

Topics: Adult; Aged; Arteriosclerosis; Biliary Tract Diseases; Carbohydrate Metabolism; Coronary Disease; Diabetes Mellitus; Diabetic Nephropathies; Female; Humans; Hypertension; Male; Middle Aged; Nucleotides; Obesity; Pyridoxine; Taurine; Vitamin B 12

Topics: Adult; Blood Coagulation; Female; Folic Acid; Humans; Hypertension; Lipid Metabolism; Male; Middle Aged; Proteins; Vitamin B 12

Topics: Blood Circulation Time; Blood Pressure; Cardiac Output; Female; Folic Acid; Humans; Hypertension; Male; Middle Aged; Myocardial Infarction; Orotic Acid; Time Factors; Vascular Resistance; Vitamin B 12

Topics: Adult; Aged; Arteriosclerosis; Cerebrovascular Disorders; Dementia; Female; Hemiplegia; Humans; Hypertension; Male; Middle Aged; Nucleotides; Pyridoxine; Taurine; Vitamin B 12

Topics: Body Weight; Carbohydrate Metabolism; Colon; Diarrhea; Digestive System Surgical Procedures; Electrolytes; Female; Humans; Hypertension; Ileum; Jejunum; Lipid Metabolism; Liver Diseases; Malabsorption Syndromes; Male; Methods; Obesity; Postoperative Complications; Preoperative Care; Proteins; Prothrombin; Stomach; Vitamin B 12

Topics: Adult; Aged; Cobalt Isotopes; Diuresis; Diuretics; Female; Glomerular Filtration Rate; Humans; Hypertension; Hypertension, Renal; Iodine Isotopes; Iodohippuric Acid; Kidney Function Tests; Male; Mannitol; Middle Aged; Pyelonephritis; Renal Artery Obstruction; Urea; Vasopressins; Vitamin B 12

Topics: Adenine Nucleotides; Aged; Arteriosclerosis; Female; Hepatitis; Humans; Hypertension; Joint Diseases; Male; Spinal Diseases; Thiamine Pyrophosphate; Vitamin B 12

Topics: Animals; Blood Pressure; Folic Acid; Hypertension; Injections, Intramuscular; Methods; Nucleic Acids; Orotic Acid; Rats; Sodium Chloride; Vitamin B 12

Topics: Adult; Aged; Arteriosclerosis; Female; Humans; Hypertension; Male; Middle Aged; Vitamin B 12

Topics: Adolescent; Adult; Aged; Blood; Cerebrovascular Disorders; Cobalt Isotopes; Coronary Disease; Female; Glomerular Filtration Rate; Humans; Hypercholesterolemia; Hypertension; Male; Middle Aged; Pre-Eclampsia; Pregnancy; Statistics as Topic; Uric Acid; Vitamin B 12

Topics: Adolescent; Adult; Aged; Arteriosclerosis; Blood; Cholecystitis; Cobalt Isotopes; Colitis, Ulcerative; Creatine; Female; Glomerular Filtration Rate; Glomerulonephritis; Goiter; Humans; Hypertension; Inulin; Male; Middle Aged; Nephrocalcinosis; Pyelonephritis; Scleroderma, Systemic; Urine; Vitamin B 12

Topics: Aged; Arteriosclerosis; Female; Humans; Hypertension; Male; Middle Aged; Niacinamide; Reserpine; Rutin; Vitamin B 12

Topics: Adenine Nucleotides; Adult; Aged; Coronary Disease; Female; Heart Diseases; Humans; Hypertension; Male; Middle Aged; Myocarditis; Thiamine Pyrophosphate; Vitamin B 12

Topics: Cobalt Isotopes; Creatine; Creatinine; Diagnosis; Glomerular Filtration Rate; Gout; Humans; Hypertension; Hypertension, Renal; Injections, Intravenous; Inulin; Kidney; Kidney Diseases; Kidney Function Tests; Uric Acid; Urine; Vitamin B 12; Vitamins

Topics: Atropine; Bradykinin; Caffeine; Chlorpromazine; Dibucaine; Ergot Alkaloids; Humans; Hypertension; Lysergic Acid Diethylamide; Morphine; Oxytocin; Peptides; Phenoxybenzamine; Reserpine; Tripelennamine; Vasopressins; Vitamin B 12

The serum vitamin B(12) level was abnormally high in 14 out of 32 cases of renal failure. This was probably due to impaired excretion of the vitamin, but the results of measurements of the rate of excretion of radioactive vitamin B(12) did not provide unequivocal evidence on this point; other possible explanations are discussed. Renal failure must be added to the causes of high serum B(12) levels.

Topics: Arteriosclerosis; Glomerulonephritis; Humans; Hypertension; Hypertension, Malignant; Kidney; Kidney Diseases; Nephritis; Nephrocalcinosis; Polycystic Kidney Diseases; Pyelonephritis; Renal Insufficiency; Vitamin B 12

Topics: Corrinoids; Edema; Female; Humans; Hypertension; Pregnancy; Vitamin B 12; Vitamin B Complex; Vitamins

The hypotensive action of veratrum viride given intravenously was studied in 24 patients, 22 of them hypertensive and 2 normotensive. Vasodepression of considerable but variable degree was obtained in all patients. Maximum hypotension occurred 8 to 15 minutes after injection and relative hypotension usually lasted at least two hours. In four patients subnormal hypotension occurred but there were no clinical manifestations of shock. The blood pressure rose promptly when pressor drugs were administered.A dose of 0.3 to 0.5 mg. brought about a satisfactory decrease in blood pressure. The degree of decrease was affected by the speed of administration and in a few patients by idiosyncratic sensitivity to the drug. Veratrum has an extravagal action on the pulse rate, and in that and other respects resembles digitalis. Veratrum should be given with caution to digitalized patients. Atropine reduced but did not abolish the hypotensive effect of veratrum, and was more effective when given before veratrum. This indicates that the parasympathomimetic action of veratrum is important in the mechanism of blood pressure reduction.

Topics: Blood Pressure; Cardiovascular System; Heart Rate; Hematinics; Hypertension; Hypotension; Injections, Intravenous; Parasympathomimetics; Pharmaceutical Preparations; Plant Extracts; Vasoconstrictor Agents; Veratrum; Veratrum Alkaloids; Vitamin B 12

Topics: Anemia; Anemia, Pernicious; Blood Pressure; Dietetics; Humans; Hypertension; Nutritional Sciences; Potassium; Vitamin B 12

Topics: Anemia; Anemia, Pernicious; Antacids; Anti-Bacterial Agents; Arthritis; Arthritis, Rheumatoid; Blood Pressure; Cortisone; Dibenzylchlorethamine; Dicumarol; Epilepsy; Ergot Alkaloids; Heart Failure; Heparin; Histamine Antagonists; Humans; Hyaluronoglucosaminidase; Hydantoins; Hypersensitivity; Hypertension; Hyperthyroidism; Imidazoles; Iodine; Iodine Isotopes; Kidney; Meperidine; Mephenesin; Methadone; Motion Sickness; Norepinephrine; Organomercury Compounds; Peptic Ulcer; Tetraethylammonium; Therapeutics; Thiouracil; Thrombosis; Veratrum; Vitamin B 12