Homocystein a iniciální stadium kardiovaskulárního onemocnění (Metabolické aspekty juvenilní hypertenze - výsledky výzkumného projektu)

Homocysteine and Initial Stage of Cardiovascular Disease (Metabolic Aspects of Juvenile Hypertension - Results of Research Project)

Primary hypertension is one of the main risk factors of cardiovascular disease (CVD) in adult age. Fundamental subjects for investigations of CVD and atherosclerosis in the adult population during the last decade are metabolic aspects and molecular genetic studies. Consistent with this trend it was the objective of the submitted study to test the hypothesis of the existence of selected metabolic deviations in adolescent and young adult patients with the initial stage of primary hypertension. For investigation parameters of insulin, lipid and homocysteine (Hcy) metabolism were selected in 97 probands with a fluctuating or permanently elevated blood pressure (BP) as compared with 105 normotonics. Partial results confirmed, already previously defined hyperinsulinaemia in hypertonic subjects and statistically significant differences of some fractions of the lipid spectrum (lipid index, HDL cholesterol). Basal and stimulated Hcy levels as part of the methionine test were in hypertonic subjects higher than in normotonic ones. Although plasma values of enzymatic cofactors of Hcy metabolism (folate, vitamin B6 and B12) reach lower mean values in hypertensive subjects than in normotonics, the statistical significance of differences in only partial.In summary the metabolic profile of juvenile hypertension can be described as proatherogenic. Preliminary results indicate that the etiopathogenesis of CVD in the stage of asymptomatic primary hypertension in adolescents is associated with hyperinsulinaemia, dyslipidaemia, and probably also hyperhomocysteinaemia (HHcy). Confirmation of these conclusions calls for extension of the number of probands and their longitudinal follow-up.

Key words:
juvenile hypertension, homocysteine, insulin, lipids