title: Effect of folic acid intervention on ALT concentration in hypertensives without known hepatic disease: a randomized, double-blind, controlled trial.
abstract: OBJECTIVE
  Increasing evidence suggests that altered methionine/folate metabolism may contribute to the development of hepatic injury. We addressed the question of whether folic acid (FA) supplementation can affect serum alanine aminotransferase (ALT) level in hypertensive Chinese adults.
  
  
  METHODS
  A total of 480 participants with mild or moderate essential hypertension and without known hepatic disease were randomly assigned to three treatment groups: (1) enalapril only (10 mg, control group); (2) enalapril-FA tablet (10 mg enalapril combined with 0.4 mg of FA, low FA group); and (3) enalapril-FA tablet (10 mg enalapril combined with 0.8 mg of FA, high FA group), once daily for 8 weeks.
  
  
  RESULTS
  This report included 455 participants in the final analysis according to the principle of intention to treat. We found a significant reduction in ALT level in the high FA group (median (25th percentile, 75th percentile), -0.6 (-6.9, 2.0)IU/l, P=0.0008). Compared with the control group, the high FA group showed a significantly greater ALT-lowering response in men (median ALT ratio (ALT at week 8 to ALT at baseline; 25th percentile, 75th percentile): 0.93 (0.67, 1.06) vs 1.00 (0.91, 1.21), P=0.032), and in participants with elevated ALT (ALT>40 IU/l) at baseline. There was no difference in ALT lowering between the control and the low FA group.
  
  
  CONCLUSIONS
  Compared with treatment using 10 mg of enalapril alone, a daily dose of 10 mg enalapril combined with 0.8 mg of FA showed a beneficial effect on serum ALT level, particularly in men and in participants with elevated (>40 IU/l) ALT.
authors.affiliation: Institute of Biomedicine, Anhui Medical University, Hefei, China.
authors.forename: X
authors.initials: X
authors.lastname: Qin
authors.forename: J
authors.initials: J
authors.lastname: Li
authors.forename: Y
authors.initials: Y
authors.lastname: Cui
authors.forename: Z
authors.initials: Z
authors.lastname: Liu
authors.forename: Z
authors.initials: Z
authors.lastname: Zhao
authors.forename: J
authors.initials: J
authors.lastname: Ge
authors.forename: D
authors.initials: D
authors.lastname: Guan
authors.forename: J
authors.initials: J
authors.lastname: Hu
authors.forename: Y
authors.initials: Y
authors.lastname: Wang
authors.forename: F
authors.initials: F
authors.lastname: Zhang
authors.forename: X
authors.initials: X
authors.lastname: Xu
authors.forename: X
authors.initials: X
authors.lastname: Wang
authors.forename: X
authors.initials: X
authors.lastname: Xu
authors.forename: Y
authors.initials: Y
authors.lastname: Huo
mesh_terms: D000368:Aged; D000410:Alanine Transaminase / Q000097:blood*; D000959:Antihypertensive Agents / Q000494:pharmacology*; D019587:Dietary Supplements; D004311:Double-Blind Method; D004656:Enalapril / Q000494:pharmacology* / Q000627:therapeutic use; D005260:Female; D005492:Folic Acid / Q000494:pharmacology* / Q000627:therapeutic use; D006801:Humans; D006973:Hypertension / Q000097:blood* / Q000188:drug therapy; D008107:Liver Diseases / Q000097:blood*; D008297:Male; D008875:Middle Aged; D012737:Sex Factors; D014803:Vitamin B Complex / Q000494:pharmacology* / Q000627:therapeutic use
chemical_list: D000959:Antihypertensive Agents; D014803:Vitamin B Complex; D004656:Enalapril; D005492:Folic Acid; D000410:Alanine Transaminase