Regarding these issues, I have written several articles before. 
Cardiac risk factors for hypertension patients
Increased levels of homocysteine (Hcy) in the blood are cardiovascular risk factors and can aggravate arteriosclerosis. This has long been said . For patients with hypertension, hypertension itself is a cardiovascular risk factor. If high homocysteine is added, the cardiovascular risk will be even higher. Therefore, many countries regard elevated blood homocysteine as a cardiovascular risk factor for patients with hypertension, and the standards in the early years were strict. In the 2010 edition of the Chinese Hypertension Prevention and Treatment Guidelines, the standard for hyperhomocysteinemia is ≥10μmol/L, and is stricter than the normal standard of 15μmol/L for normal people at that time. At that time, Europe and the United States were also this standard.
This standard for hyperhomocysteinemia was revised in the 2018 edition of the " China Hypertension Prevention and Treatment Guidelines ", and changed to ≥15μmol/L .
Hypertensive patients with hypertensive combined with stroke , and folic acid supplementation to prevent stroke, this is how it has come step by step.
- Study on the prevention of stroke supplementation with folic acid in patients with hypertension is caused by the high incidence of stroke in patients with hypertension in my country.
stroke is the first cause of death from cardiovascular disease in my country , and it is growing every year, with an annual increase of up to 8.7%. Studies have found that most patients with hypertension in the West suffer from myocardial infarction, and most patients with hypertension in my country suffer from stroke . Two studies on elderly hypertension found that the ratios of stroke and myocardial infarction in my country were 13 and 6.6 respectively, while 5 in Japan and 2 in Europe and the United States.
One of the risk factors for stroke is high homocysteine. The following investigation found that is commonly seen in patients with hypertension in my country, with high homocysteine and low folic acid. Data shows that 75% to 80% of patients with hypertension in my country have hypertension combined with hyperhomocysteinemia.
This reminds doctors that high incidence of stroke in Chinese patients with hypertension is related to people with hyperhomocysteinemia .
Because the English initial letters of homocysteine and hyperhomocysteinemia are both "H", some experts have proposed the concept of "H-type hypertension". However, this is not formally classified into one type of in the typing of hypertension.
- Why are there many people with hypertensive patients in my country who have high homocysteinemia?
This is related to folate deficiency and abnormal folate metabolic enzymes in Chinese people .
In our body, the metabolism of homocysteine requires the participation of folic acid and some enzymes. One of the key enzymes is called "methylenetetrahydrofolate reductase ", which is also an enzyme related to folic acid metabolism. If is folic acid deficiency or there is a problem with this enzyme, it will affect the metabolism of homocysteine, and the homocysteine level in the blood will increase .
However, the genes of the enzyme study were found that A considerable number of people in my country's hypertensive population had different genotypes , which belongs to the "TT type" (I won't go into details about it). People with this "TT" type gene have significantly reduced the activity of tetrahydrofolate reductase and are prone to folic acid deficiency. People with this genotype account for 25% of the hypertensive population in my country, while people with other races account for only 10% to 12%.
Due to the cooking and eating habits of Chinese residents, their folic acid intake is relatively low, and coupled with the defects of this enzyme gene, most people with hypertension in my country have hypertension and high homocysteinemia, and the incidence of stroke is high. Study on
- supplementation with folic acid to prevent stroke .
For patients with hypertension, since folic acid deficiency and elevated blood homocysteine increase the risk of stroke, can folic acid be supplemented to reduce homocysteine and reduce stroke? Is there any useful and side effects to supplement folic acid? Because folic acid can also promote tumor growth, we also need to look at the efficacy and safety issues.
So, there was a clinical study on for hypertension and hyperhomocysteinemia supplemented with folic acid to prevent stroke .
The drug used in the initial research was enalapric folic acid tablets, "Yiye leaf". Here, enalapril is an antihypertensive drug, 10 mg per tablet and 0.8 mg of folic acid per tablet. It is up to 2 tablets per day. If the antihypertensive drug is not met, you can add other antihypertensive drugs. According to the research results, can further reduce the risk of first stroke by 21% compared with compared with alone, and the safety of is also good.
Use antihypertensive drugs and folic acid together to facilitate the use of medication and reduce missed doses. I once asked why enalapril is chosen, and the answer is that enalapril and folic acid are better combined.
Patients with hypertensive blood pressure do not have to take erine leaf
Because not all hypertensive patients take enalapril , so clinicians have done a lot of research. has achieved good results for hypertensive patients with hypertensive who have hypertensive hypertensive treatment with low doses of folic acid, and has achieved good results with low doses of erine leaf 6, so it is not necessary to take erine leaf 6.
The original study on the prevention of stroke by reducing blood pressure and supplementing folic acid was provided by the manufacturer. Experts are very cautious about for such research results. Therefore, the guideline for preventing and treating hypertension in (2018) suggests that for patients with hypertension and elevated homocysteine, a small dose of folic acid " can be added if necessary.
If folic acid alone is not effective in clinical practice, you can also add some B vitamins.
Main references:
1. China's Guide to Prevention and Treatment of Hypertension (Revised Edition in 2018). China Medical Technology Press, 2018.12
2. Expert consensus on diagnosis and treatment of H-type hypertension [J]. Li Jianping, Lu Xinzheng, Huo Yong, et al., Chinese Journal of Hypertension. 2016, 24(02)
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