title: [Prethrombotic status and long-time thromboembolic events in primary hypertensive patients with or without elevated homocysteine level].
abstract: OBJECTIVE
  To evaluate the association between homocysteine level and prethrombotic status and long-term thromboembolic events in patients with primary hypertension.
  
  
  METHODS
  Results between 110 hypertensive patients with elevated homocysteine (HCY) level were compared with 110 hypertensive patients with normal HCY level which were enrolled from October 2003 to November 2009. Fibrinogen (FIB), viscosity, thrombomodulin (TM), granule membrane protein (GMP-140), prethrombin F1+2 fragment (F1+2), D-dimer fragment (D-Dimer) and antithrombin III (AT-III) were measured and correlated to HCY and prethrombotic state. The endpoints of the study were arterial and venous thromboembolic events. The variables linked with arterial and venous thromboembolic events were included in Cox proportional hazard models. The event-free survival was illustrated with Kaplan-Meier survival curves and compared by the Log-rank test.
  
  
  RESULTS
  The patients were followed up for 8-122 months (median follow-up time was 85 months). Compared with hypertensive patients with normal HCY, the plasma level of TM ((4.8±1.2) µg/L vs. (4.5±1.0) µg/L, P = 0.045), GMP-140 ((18.8±3.2) µg/L vs. (17.1±4.3) µg/L, P = 0.001), F1+2 ((1.2±0.4) nmol/L vs. (1.0±0.6) nmol/L, P = 0.004) were significantly higher while the plasma level of AT-III ((95.3±10.4) % vs. (98.6±10.6)%, P = 0.021) was significantly lower in hypertensive patients with elevated HCY level. FIB, viscosity of plasma and D-dimer were similar between the two groups. Multiple regression analyses indicated that HCY level was negatively correlated with AT-III (β = -0.199, P = 0.011) and positively correlated with age (β = 0.217, P = 0.04), female gender (β = 5.667, P = 0.001) and TM (β = 2.341, P = 0.003). Cox multivariate analysis revealed that age and HCY level were independent prognostic risk factors of thromboembolic events (OR 1.046, 95% CI 1.013-1.082, OR 1.052, 95% CI 1.027-1.078, respectively) (all P < 0.05). Kaplan-Meier curves showed that there was a significant difference in the event-free survival between the two groups (Log-rank test, P = 0.027).
  
  
  CONCLUSIONS
  Compared with normal HCY hypertensive patients, the levels of plasma prothrombin activators such as TM, GMP-140 and F1+2 were significant increased and anti-thrombin factor such as AT-III was significant decreased in hypertensive patients with elevated HCY. Old age and high HCY level were independent prognostic risk factors of thromboembolic events. The event-free survival in hypertensive patients with elevated HCY is lower than in hypertensive patients with normal HCY level.
authors.affiliation: Department of Cardiology, Baoshan Branch of Huashan Hospital, Fudan University, Shanghai 200431, China.
authors.forename: Zepu
authors.initials: Z
authors.lastname: Li
authors.forename: Liping
authors.initials: L
authors.lastname: Tang
authors.forename: Bing
authors.initials: B
authors.lastname: Xu
authors.forename: Lu
authors.initials: L
authors.lastname: Yuan
authors.forename: Yunqing
authors.initials: Y
authors.lastname: Liu
authors.forename: Rong
authors.initials: R
authors.lastname: Jiang
authors.forename: Qinhua
authors.initials: Q
authors.lastname: Zhao
authors.forename: Baogui
authors.initials: B
authors.lastname: Sun
authors.forename: Zhicheng
authors.initials: Z
authors.lastname: Jing
authors.affiliation: Email: lixiaohui@medmail.com.cn.
authors.forename: Xiaohui
authors.initials: X
authors.lastname: Li
mesh_terms: D016022:Case-Control Studies; D000075222:Essential Hypertension; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products; D006710:Homocysteine / Q000097:blood*; D006801:Humans; D006973:Hypertension / Q000150:complications*; D053208:Kaplan-Meier Estimate; D019007:P-Selectin; D011379:Prognosis; D016016:Proportional Hazards Models; D012044:Regression Analysis; D012307:Risk Factors; D013923:Thromboembolism / Q000150:complications*
chemical_list: D005338:Fibrin Fibrinogen Degradation Products; D019007:P-Selectin; C036309:fibrin fragment D; D006710:Homocysteine