Effect of Antihypertensive Drugs on Homocysteine level among Hypertensive Patients

 

Rahul Rawat1, Yogesh Joshi2*

1Pharm.D. (PB) Intern, Department of Pharmaceutical Science, Shri Guru Ram Rai Institute of Technology and Science, Dehradun-248001, Uttarakhand, India

2Assistant Professor, Department of Pharmaceutical Science, Shri Guru Ram Rai University, Dehradun-248001, Uttarakhand, India

*Corresponding Author E-mail: yogeshjoshi1583@rediffmail.com

 

ABSTRACT:

The present study was a prospective, cross-sectional, and observational study carried out for a period of six months to evaluate the effect of antihypertensive drugs on homocysteine level among hypertensive patients. A total of 70 patients were included in the study from inpatient department of medicine to assess the effect of antihypertensive drugs on their homocysteine level. Demographic Analysis revealed that out of 70 patients, 51% were males and 49% were females while maximum number of patients (28.57%) was found in age group of 51-60 years. Patients taking telmisartan were categorized as group A containing 40 patients and patients taking amlodipine were categorized as group B containing 30 patients. Homocysteine level was initially taken before starting the antihypertensive drug treatment and finally taken after one or two weeks of follow-up visit. Result showed that homocysteine level decreases with telmisartan use and patients treated with amlodipine showed an increase in homocysteine level. The present study was concluded that homocysteine level decreases but not significantly after treatment with telmisartan whereas homocysteine level increases significantly after treatment with amlodipine.

 

KEYWORDS: Hypertension, homocysteine, antihypertensive drug, telmisartan, amlodipine.

 

 


 

 

INTRODUCTION:

Hypertension is most important risk factor for developing cardiovascular diseases worldwide1. Homocysteine (Hcy) is a product formed in-between the biogenesis of amino acids named methionine and cysteine. It is an amino acid formed through the demethylation of dietary methionine.

 

Methionine converted to the homocysteine and homocysteine further converted to the cysteine by the help of enzyme cystathionine-β-synthase, vitamin B6 as cofactor and vitamin B12 as a coenzyme. The increased level of homocysteine in the plasma called Hyperhomocysteinemia. In worldwide, the most common cause behind the hyperhomocysteinemia is single nucleotide polymorphisms of 5, 10-methylene tetrahydrofolate which has been related with mild (13-24µM) and moderate (25-60µM) hyperhomocysteinemia and also caused by inadequacy of cystathionine-β-synthase enzyme. Some other causes of hyperhomocysteinemia were shortage of methionine synthase, nutritional deficiencies like folate, vitamin B6 and vitamin B12, methionine-rich protein diet. Homocysteine concentration varies according to the age, diet and genes. Factor which are associated with hyperhomocysteinemia includes smoking, coffee consumptions, hypertension, lipid profile and elevated level of serum creatinine2-5.

 

Relation between Homocysteine and Drugs6-11:

A study shows that drug changes the plasma total homcysteine concentrations. Some drugs elevated the homocysteine concentration while some drugs decrease the homocysteine concentration in plasma. Some drugs affect the renal function and metabolism of vitamins like B6, B9 and B12 influencing the total homocysteine concentration in plasma. One of the studies shows a relation between hyperhomocysteinemia, dyslipidaemia and diabetics.

 

METHODOLOGY:

This was a prospective, cross-sectional, and observational study carried out in the inpatient department of medicine at Shri Mahant Indiresh Hospital, Dehradun, Uttarakhand for a period of six months. Patient’s data was collected from the patient case record, medication history and laboratory data. Hypertensive patients of either gender and above 18 years of age were included in the study. Study was conducted after the approval from the institutional ethical committee.

 

RESULTS AND DISCUSSION:

A total of 70 patients were included in the study from inpatient department of medicine to assess the effect of antihypertensive drugs on their homocysteine level.

 

Demographic Analysis:

In this study, out of 70 patients, distribution of patients according to gender and age were tabulated in Table 1. Gender wise distribution of patients showed that 36 (51%) were males and 34 (49%) were females (Figure 1). Age wise distribution of patients were categorized between class groups of 20-30, 31-40, 41-50, 51-60, 61-70, 71-80, 81-90 years. Maximum number of patients (28.57%) was found in age group of 51-60 years while minimum number of patients (1.42%) was found in age group of 81-90 years as shown in Figure 2.

 

 

 

 

Table 1: Demographic analysis of patients

Disribution variables

No. of patients (%)(n=70)

Gender

Male

Female

 

36 (51.00)

34 (49.00)

Age (Years)

20-30

31-40

41-50

51-60

61-70

71-80

81-90

 

08 (11.59)

10 (14.28)

15 (12.42)

20 (28.57)

10 (14.28)

06 (8.57)

01 (1.42)

 

 

 

 

Figure 1: Gender wise distribution of patients

 

 

 

 

Figure 2: Age wise distribution of patients

 

Effect of Antihypertensive drugs on serum Homocystenine level:

Patients taking telmisartan were categorized as group A and patients taking amlodipine were categorized as group B. Homocysteine level was initially taken before starting the antihypertensive drug treatment and finally taken after one or two weeks of follow-up visit.  Data of initial as well as final homocysteine level of hypertensive patients were tabulated group wise in Table 2.

 

Table 2: Homocysteine level of hypertensive patients

Homocysteine level

(umol/l)

No. of patients (%)

Initial

Final

Group A (n=40)

4-8

07 (17.50)

06 (15.00)

8-12

02 (5.00)

05 (12.50)

12-16

08 (20.00)

10 (25.00)

>16

23 (57.50)

19 (47.50)

Group B (n=30)

4-8

03 (10.00)

01 (3.33)

8-12

07 (23.33)

07 (23.33)

12-16

10 (33.33)

11 (36.67)

>16

10 (33.33)

11 (36.67)

 

From Figure 3, initial homocysteine level of hypertensive patients (Group A) showed that out of 40 patients, homocysteine level (8-12 umol/l) were shown by minimum number (5%) of patients while homocysteine level (>16 umol/l) were shown by maximum number (57.5%) of patients. From Figure 4, final homocysteine level of hypertensive patients after temisartan use (Group A) showed that out of 40 patients, homocysteine level (8-12 umol/l) were shown by minimum number (12.5%) of patients while homocysteine level (>16 umol/l) were shown by maximum number (47.5%) of patients. Above result shows that homocysteine level decreases but not significantly after treatment with telmisartan. The data of patients taken in above result were also prescribed with vitamin supplements, which also play an important role in controlling homocysteine level. Elevated level of homocysteine induces oxidative stress to endothelium and decreases nitric oxide production. Nitric oxide and AMP-activated protein kinase (AMPk) play an important role in the protection of vascular endothelium from oxidative stress and telmisartan significantly increases nitric oxide and AMPk phosphroylation level8, 11.

 

 

Figure 3: Initial homocysteine level of hypertensive patients (Group A)

 

Figure 4: Homocysteine level after telmisartan (Group A)

 

From Figure 5, initial homocysteine level of hypertensive patients (Group B) showed that out of 30 patients, homocysteine level (4-8 umol/l) were shown by minimum number (10%) of patients while homocysteine level (both 12-16umol/l and >16 umol/l) were shown by maximum number (33%) of patients. From Figure 6, final homocysteine level of hypertensive patients after amlodipine use (Group B) showed that out of 30 patients, homocysteine level (4-8 umol/l) were shown by minimum number (3.33%) of patients while homocysteine level (both 12-16umol/l and >16 umol/l) were shown by maximum number (36.67%) of patients. The patients treated with amlodipine shows the significant increase in plasma serum homocysteine level which was comparable with a study in which serum homocysteine level increase in patients treated with amlodipine but these changes were not related to antihypertensive efficacy of drug5.

 

 

Figure 5: Initial homocysteine level of hypertensive patients (Group B)

 

 

Figure 6: Homocysteine level after amlodipine (Group B)

 

CONCLUSION:

The present study was concluded that telmisartan decreases the homocysteine level whereas the level of homocysteine increases in patients treated with amlodipine but such outcomes were not related to antihypertensive efficacy of amlodipine which act by improving vascular function for reducing hypertension induced by elevated homocysteine level.

 

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Received on 16.08.2018                Modified on 20.09.2018

Accepted on 11.10.2018            © A&V Publications All right reserved

Asian J. Res. Pharm. Sci. 2018; 8(4): 219-222.

DOI: 10.5958/2231-5659.2018.00037.1