One of the risk factors for cardiovascular disease to be evaluated in patients with hypertension is an elevated blood homocysteine, which is medically called "hyperhomocysteinemia".
This hyperhomocysteinemia is closely related to the occurrence and development of arteriosclerosis and hypertension, which will increase the occurrence of cardiovascular and cerebrovascular diseases, especially stroke. Therefore, high blood pressure was found, and this item should be investigated. According to the guidelines for the prevention and treatment of hypertension in China, blood homocysteine should be ≤ 15 μmol/L. If it is exceeded, it is hyperhomocysteinemia. For such patients, it is recommended to make lifestyle changes and supplement with small doses of folic acid (for patients with high blood pressure, why should the blood be tested for "homocysteine"?). ）。
However, some people can't lower their folate even after taking it, and 46-year-old Xiao Zhao is like this.
Xiao Zhao was found to have high blood pressure of 170/130mmHg when he measured his blood pressure before tooth extraction in February this year. At that time, the tooth could not be extracted, so I went to the cardiology department for blood pressure lowering treatment.
When I went to the cardiology department to measure my blood pressure, it was 180/110mmHg, and after I found high blood pressure, Xiao Zhao's daily test was also 140-150/110mmHg, and the diagnosis of hypertension was not running. So, I took blood pressure medication. At the first visit for examination, the doctor checked Xiao Zhao's blood biochemistry and found that the blood lipids were high, and the blood homocysteine was high, 44.9μomol/L, so he added hypolipid-lowering statins and low-dose folic acid on the basis of antihypertensive drugs.
In general, high levels of homocysteine in the blood indicate a possible lack of folic acid in the body. Because in the metabolism of an amino acid, "methionine", folic acid is needed in the body. If folic acid is deficient, the metabolic process of methionine is not completed to the end, and the metabolic intermediate product homocysteine is elevated. Some eating habits and cooking methods in the mainland, and some people are deficient in folic acid due to genetic problems.
Studies have found that high blood pressure is associated with an increase in homocysteine, which is associated with an increase in stroke. This type of hypertension with elevated blood homocysteine was once called "H-type hypertension", but there is still some controversy in the industry. In terms of treatment, it is to add a small dose of folic acid, and studies have found that folic acid supplementation can reduce the initial stroke in this part of patients.
How much to supplement? Small dose, according to the consensus of mainland experts, the general population is 0.4mg~1mg per day. In the study of folic acid supplementation with hypertension with hyperhomocysteinemia, the dosage of folic acid is 0.8mg~1.6mg per day, and 0.8mg per day is recommended. It has also been found that supplementing with folic acid >2 mg and ≤2 mg per day can reduce the risk of stroke (all these years, about high blood pressure and high homocysteine, stroke, folic acid supplementation).
Because the folic acid in the hospital is 5mg 1 tablet, the doctor asked Xiao Zhao to take half a tablet of folic acid every day, 2.5mg.
One month later, Xiao Zhao rechecked his blood lipids, and by the way, he rechecked the homocysteine, and the results did not decrease but increased, reaching 60μomol/L.
Why?
This is because folic acid deficiency can lead to hyperhomocysteinemia, but the increase in homocysteine is not only a cause of folate deficiency, according to medical terms, this indicator belongs to "non-specific", not specific to folic acid deficiency, and there are many factors that can affect blood homocysteine levels, such as metabolic enzyme gene variations, B vitamins such as vitamin B2, B6, B12 deficiency, renal insufficiency, etc., which may affect the relevant metabolism in the body, resulting in an increase in homocysteine. In the metabolism of methionine, vitamins B6 and B12 are involved.
So, the doctor gave Xiao Zhao vitamins B6 and B12.
Three months later, Xiao Zhao had another laboratory examination. This time, the blood homocysteine dropped to 18.9 μomol/L, which is close to normal.
So, what should I do if I have high blood pressure and high blood homocysteine, and I can't lower it by eating folic acid alone? Vitamin B6 and B12 can be added. The study found that there was a clear synergistic effect between these two drugs and folic acid when combined.
It should be noted that although folic acid supplementation combined with B vitamins can reduce homocysteine levels, the cardiovascular benefits are still being studied. Do not overdose on folic acid, as there is a safety issue with the use of folic acid. In addition, because folic acid is also required for tumor growth, patients with malignant tumors are generally not suitable for taking folic acid.
(Original, all rights reserved, may not be reproduced without my authorization!) ）
Department of Cardiovascular Medicine, Hou Xiaoping
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