Coronary flow velocity reserve is impaired in hypertensive patients with hyperhomocysteinemia.

Hyperhomocysteinemia (HHcy) is an independent risk factor for coronary artery disease. Chronic HHcy induces coronary endothelial injury, and homocysteine (Hcy) inhibits insulin sensitivity by inducing endoplasmic reticulum stress in adipose tissue. However, the combined effects of chronic HHcy and hypertension on coronary artery endothelial function have still remained unclear. Fifty-one patients with essential hypertension (HT) were recruited, and were divided into nHT group (without HHcy) and H-type HT group (with HHcy). Forty healthy subjects were enrolled as controls. We assessed coronary artery endothelial function by coronary flow velocity reserve (CFVR). Hcy levels were significantly higher (15.60±6.58 vs 13.08±4.13 μmol l(-1), P<0.05), whereas CFVR values were significantly lower in the HT patients than in the control group (2.88±0.70 vs 3.23±0.54, P<0.05). Hcy levels were negatively correlated with CFVR value (r=-0.578, P<0.01, 95% confidence interval -0.085 to -0.046). The homeostasis model assessment-insulin resistance values were significantly higher (3.92±2.16 vs 2.72±1.50, P<0.05) , whereas CFVR values were significantly lower in H-type HT group than in nHT group (2.31±0.31 vs 3.25±0.62, P<0.01). Coronary artery endothelial function may be impaired in essential hypertensive patients with HHcy, and insulin resistance induced by HHcy may contribute to this damage.