H-type hypertension is a risk factor for chronic kidney disease: a case-control study

H-type hypertension is a risk factor for chronic kidney disease: a case-control study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article H-type hypertension is a risk factor for chronic kidney disease: a case-control study Tianyao Long, Liuyangyi Zheng, Zihao Ding, Tong Yu, Xiuqin Hong This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3992934/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background : Previous studies have examined the relationship between hypertension or homocysteine and chronic kidney disease (CKD). However, the relationship between H-type hypertension and CKD remains uncertain. The aim of this study was to investigate the relationship between H-type hypertension and CKD and to provide a scientific basis for the prevention and treatment of CKD; Methods : This case-control study included 514 study subjects, 257 in each of the case and control groups. The diagnostic criteria for CKD were structural or functional abnormalities of the kidneys for ≥ 3 months, which may or may not be accompanied by a decrease in eGRF, and which may be manifested by abnormalities of pathology or indicators of renal injury (including blood urine and composition or imaging tests). All patients were categorized into normal, Hcy (Hcy ≥10 μmol/L), hypertensive, and H-type hypertension groups according to their Hcy levels and whether they had hypertension.Univariate analysis and multivariate logistic regression models were used to assess the association between H-type hypertension and CKD, and subgroup analyses were performed for potential confounders; Results : The differences between the CKD group and the control group in terms of age, education, exercise, BMI, TG, HDL, UA, Scr, BUN and hs-CRP were statistically significant (p < 0.05).Logistic regression modeling showed that after correcting for confounders, we found that the H-type hypertension group had the highest risk of CKD (OR=4.453; 95% CI: 2.075-9.560; P<0.001). There was no interaction of H-type hypertension with age, education level, physical activity, or TG on the development of CKD(P＞0.05); Conclusions : The coexistence of Hcy and hypertension increases the risk of developing CKD, and H-type hypertension is a risk factor for CKD. homocysteine hypertension H-type hypertension chronic kidney disease case-control study Figures Figure 1 1. Introduction Chronic kidney disease (CKD) is a chronic progressive disease characterized by structural dysfunction of the kidneys or a decrease in glomerular filtration rate (GFR) that is difficult to cure( 1 , 2 ).CKD is a global public health problem. The incidence of CKD is on the rise worldwide, with a global prevalence of 13.4%, and can cause 1.2 million deaths and 28 million years of life lost each year( 3 , 4 ).In China, the prevalence of CKD is 10.8%, and the number of people suffering from the disease is as high as 132 million, ranking first in the world( 5 ).H-type hypertension is essential hypertension with elevated homocysteine (Hcy ≥ 10 umol/L)( 6 ).There is a close causal relationship between hypertension and the occurrence and development of chronic kidney disease, and hypertension is one of the risk factors for chronic kidney disease( 7 , 8 ).Studies have shown that hypertension is closely related to the decline of renal function in patients with CKD( 9 ).At the same time, hypertension is one of the most common serious complications of CKD, and the prevalence of hypertension increases as renal function declines( 10 ).Therefore, the treatment of hypertension is very important for CKD patients. Since 70% of Hcy in the body is excreted through the kidneys, renal function is closely related to Hcy.Hcy has been found to be associated with progressive deterioration of renal function and cardiovascular complications in patients with CKD, and 80–90% of patients with end-stage renal disease have significantly higher concentrations of Hcy in their blood( 11 , 12 ).More than 70% of hypertensive patients in China have elevated plasma homocysteine levels( 13 ).These findings suggest that H-type hypertension may imply double damage to the kidneys. In order to understand the relationship between H-type hypertension and CKD, this case-control study explored the relationship to provide a scientific basis for the prevention and treatment of CKD. 2. Materials and Methods 2.1 Study population Using a case-control study, the study population was selected from 257 inpatients diagnosed with CKD in the Department of Nephrology of Hunan Provincial People's Hospital from December 2021 to December 2022 as a case group, and 257 patients not diagnosed with CKD from other departments as a control group. Inclusion criteria: (1) complete clinical information; (2) able to complete the entire survey independently; (3) voluntary participation in this survey and cooperation in completing the questionnaire and physical examination. Exclusion criteria: (1) female population during pregnancy or lactation; (2) patients with recent use of drugs that may affect blood pressure and Hcy levels; (3) patients with secondary hypertension caused by pheochromocytoma, sleep apnea syndrome, etc.; (4) patients with a clear history of renal disease, such as diabetic nephropathy, gouty nephropathy, lupus nephritis, etc.; and (5) patients with combined organ failure, hepatic cirrhosis at the stage of decompensated stage, and renal insufficiency. This study was reviewed and approved by the Medical Ethics Committee of Hunan Normal University (No. 034/2017), and all subjects signed an informed consent form before participating in this study. 2.2 Data collection A self-administered questionnaire was used to conduct a "face-to-face" survey of all respondents. The survey included information on general demographic characteristics (age, sex, education, marital status), lifestyle habits (exercise, smoking, alcohol consumption), and past medical history (history of hypertension, history of taking antihypertensive drugs). Physical examination (including height, weight, heart rate and waist circumference). Laboratory tests include homocysteine (Hcy); total cholesterol (TC), triglyceride (TG), high density lipoprotein (HDL), low density lipoprotein (LDL), alanine aminotransferase (ALT), blood creatinine (CRE), and blood glucose. Low density lipoprotein cholesterol (LDL), alanine aminotransferase (ALT), creatinine (Scr), blood urea nitrogen (BUN), ultra-sensitive C-reactive protein (UCRP), and blood glucose (BG). ), hypersensitive C-reactive protein (hs-CRP). Education level was categorized into four groups: elementary school and below, middle school, high school, and college and above. Marital status was categorized as single and married. Patients were judged to be exercising regularly based on the number of times they exercised in a week: 0 was no exercise, 1-3 was irregular exercise, and >3 was regular exercise. We defined current smoking as continuous or cumulative smoking of one or more cigarettes per day; current alcohol consumption was defined as at least 2 drinks per week. 2.3 Definition of H-type hypertension Patients with essential hypertension whose plasma Hcy concentration exceeded 10 μmol/L were classified as H-type hypertension. All patients were categorized into a normal group, a simple hypertension group, a simple Hcy group (Hcy ≥10 μmol/L), and an H-hypertension group according to their Hcy levels and whether they had hypertension. 2.4 Definition of CKD The diagnostic criteria for CKD were the presence of structural or functional abnormalities in the kidneys for ≥3 months, which may or may not be accompanied by a decrease in eGRF, and which may be manifested by abnormalities in pathology or markers of renal injury (including blood-urine and compositional or imaging tests). 2.5 Statistical methods Data were statistically analyzed using SPSS 26.0, categorical variables were expressed as numbers and percentages (%), and the χ 2 test was used to compare differences between groups. Continuous variables are expressed as M (P 25 , P 75 ), and nonparametric comparisons of between-group differences were used. Multivariate logistic regression models were used to examine the association between H-type subgroups and CKD risk. We constructed 3 models: model 1 was unadjusted; in model 2, we adjusted for age, educational background, exercise, and BMI. model 3: TG, HDL, UA, Scr, BUN, and CRP were added to model 2. Subgroup analyses were performed and the interaction between H-type hypertension and related influencing factors on the development of CKD was further analyzed. Differences were statistically significant at P < 0.05. 3. Results 3.1 Basic information In this case-control study the control group of 257 cases had a median age of 63.00 years and an interquartile range of (47.00,68.00) years. The case group of 257 cases had a median age of 65.00 years and an interquartile range of (50.00,71.00) years. According to the presence or absence of CKD, Table 1 shows the baseline characteristics of the study population. It was found that the difference between the H-hypertension subgroups was statistically significant, and the prevalence of CKD was highest in the H-hypertension group (p < 0.05).Low education, insufficient physical activity, and obesity were risk factors for CKD compared to the control group. In addition, eGFR was significantly lower and TG, UA, Scr, BUN, and hs-CRP levels were significantly higher in CKD patients (P < 0.05).Table 1. 3.2 Correlation between H-type hypertension and CKD Model 1 was built with the presence of H-type hypertension as the dependent variable (assignment: CKD = 1, control = 0) and H-type hypertension as the independent variable, and the results showed that the risk of CKD in the H-type hypertension group was significantly higher than that in both the Hcy and the hypertension groups (OR = 12.632,95% CI: 7.162-22.297; P < 0.001), and in a logistic regression model adjusting for some confounding factors ( educational background, exercise, BMI, TG, HDL, UA, Scr, BUN, hs-CRP) in a logistic regression model (Model 3), H-type hypertension could still increase the risk of CKD (OR = 4.453, 95% CI: 2.075-9.560; P < 0.001). Table 2. 3.3 Subgroup analysis In order to more clearly define the relationship between H-type hypertension and the risk of developing CKD, further subgroup analyses of age, education level, exercise status and TG were performed, and the interactions between H-type hypertension and related influencing factors on the development of CKD were analyzed. The results showed that there was no interaction between H-type hypertension and age, education level, exercise status and TG on the development of CKD (P > 0.05). Figure 1. 4. Discussion This case-control study examined the relationship between H-type hypertension and CKD. Logistic regression revealed that the risk of CKD was associated with H-type hypertension, which was more closely associated with CKD. After adjusting for possible confounders, we obtained the same results. In all subgroups, the risk of CKD was higher in the H-type hypertension group than in the Hcy and hypertension groups. CKD greatly reduces the quality of life of patients and imposes a heavy financial and psychological burden on patients and their families( 14 ).There is a strong Association between CKD and hypertension and Hcy( 15 ).The presence of decreased renal function in hypertensive patients may lead to incurable CKD( 16 ).Hcy is a sulfur-containing amino acid, an intermediate product in the metabolism of methionine, one of the essential amino acids.And the kidney, as the main site of Hcy metabolism, plays an important role in the process of Hcy metabolism.Epidemiologic investigations have shown that increased levels of Hcy in the body play a key role in the development of CKD and are one of the major risk factors for the development of CKD( 17 ).Some studies have found that Hcy can be used as an independent biomarker to predict the decline of renal function and the development of CKD( 18 ).Liu et al.( 19 )who retrospectively analyzed 7240 hypertensive patients, found that patients with hyperhomocysteinemia had a higher rate of long-term decline in renal function compared to non-homocysteinemic patients( 20 ).The results of the present study similarly found that Hcy levels were significantly higher in CKD patients than in non-CKD patients .The effect of Hcy on the prevalence of CKD and eGFR in Chinese patients with H-type hypertension was also found in a cross-sectional study of 12,873 Chinese adults with H-type hypertension between the ages of 27 and 75 years( 21 ).Therefore, high attention should be paid to the development of H-type hypertension in the management of CKD. Current experimental studies have found that Hcy can promote the development and progression of CKD by inducing oxidative stress, inflammatory response, hypomethylation and other pathways( 22 ).Some studies have even found that renal vascular changes such as decreased vascular density, decreased blood flow and increased smooth muscle cell proliferation associated with Hcy are one of the causes of impaired renal function( 19 ).Oxidative stress can also damage kidney cells affecting glomerular filtration rate and promoting the fibrotic process in the kidney( 23 ).It is possible that the mechanism of CKD due to H-hypertension is because Hcy can affect glomerulosclerosis and interstitial fibrosis leading to progressive decline in CKD function( 24 ).Meanwhile, the increase of Hcy can attenuate the vasodilatory effect of NO, induce oxidative stress( 25 ),and stimulate the proliferation of vascular smooth muscle cells ( 26 ), which alters the elasticity of the vascular wall, increases vascular resistance, and ultimately leads to an increase in blood pressure( 27 ).Both Hcy and hypertension can cause severe kidney damage( 28 ).This suggests that both blood pressure changes and Hcy levels should be paid attention to in the early prevention of CKD, and that the dangers of H-type hypertension should be fully recognized in order to avoid more serious damage and poorer prognosis for CKD patients. However, this study still has some limitations. Firstly, this study is a retrospective case-control study with weak causal argumentation to prove the causal relationship between H-type hypertension and CKD. This study also has some recall bias, which will have some influence on the results. Second, the subjects of this study were all from Hunan Provincial People's Hospital, and there was a certain selection bias; the results of this study can only represent the situation of patients in this hospital, and the conclusions obtained cannot be extrapolated to the whole population. Finally, this study did not adjust for other relevant confounding factors such as relevant disease history and diet that may have an impact on the results. 5. Conclusions Our findings suggest that H-type hypertension is associated with chronic kidney disease.The risk of morbidity in the H-type hypertension group was higher than that in the Hcy and hypertension groups.Therefore, high attention should be paid to the development of H-type hypertension in the prevention and treatment of CKD. Declarations Availability of Data and Materials The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Author Contributions TL: research design, data analysis, and manuscript writing. LZ: data collection and research design. ZD: data collection and comments. TY: data collection and investigation. All authors contributed to the article and approved the submitted version. XH: funding acquisition, conceptualization, and writing—review and editing. Ethics Approval and Consent to Participate The studies involving human participants were reviewed and approved by the Medical Ethics Committee of Hunan Normal University (No. 034/2017). The patients/participants provided their written informed consent to participate in this study.Written informed consent was obtained from the individual(s) for the publication of any potentially identifiable images or data included in this article. Acknowledgment We thank all those who participated in this study and Hunan Provincial People's Hospital for their support. Funding This study was funded by the National Natural Science Foundation of China (8177120863), Hunan Provincial Science and Technology Department (2020JJ4047), and Changsha Science and Technology Bureau (kq1801096). The funders had no role in the study design, data collection,and analysis, decision to publish, or preparation of the manuscript. Consent for publication Not applicable. Competing interests The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. References Strazzella A, Ossoli A, Calabresi L. High-Density Lipoproteins and the Kidney. Cells. 2021;10(4). Parrish AR. Advances in Chronic Kidney Disease. International journal of molecular sciences. 2016;17(8). Lunyera J, Mohottige D, Von Isenburg M, Jeuland M, Patel UD, Stanifer JW. CKD of Uncertain Etiology: A Systematic Review. Clinical journal of the American Society of Nephrology : CJASN. 2016;11(3):379-85. Hill NR, Fatoba ST, Oke JL, Hirst JA, O'Callaghan CA, Lasserson DS, et al. Global Prevalence of Chronic Kidney Disease - A Systematic Review and Meta-Analysis. PloS one. 2016;11(7):e0158765. Global, regional, and national burden of chronic kidney disease, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet (London, England). 2020;395(10225):709-33. Huo Y, Li J, Qin X, Huang Y, Wang X, Gottesman RF, et al. Efficacy of folic acid therapy in primary prevention of stroke among adults with hypertension in China: the CSPPT randomized clinical trial. Jama. 2015;313(13):1325-35. Gonzalez Suarez ML, Kattah A, Grande JP, Garovic V. Renal Disorders in Pregnancy: Core Curriculum 2019. American journal of kidney diseases : the official journal of the National Kidney Foundation. 2019;73(1):119-30. Gandhi NV, Murad DN, Nguyen DT, Graviss EA, Ibrahim HN. Hypertension and renal outcomes in normotensive kidney donors with multiple renal arteries. Transplant international : official journal of the European Society for Organ Transplantation. 2021;34(11):2382-93. Hamrahian SM, Falkner B. Hypertension in Chronic Kidney Disease. Advances in experimental medicine and biology. 2017;956:307-25. Cheung AK, Rahman M, Reboussin DM, Craven TE, Greene T, Kimmel PL, et al. Effects of Intensive BP Control in CKD. Journal of the American Society of Nephrology : JASN. 2017;28(9):2812-23. Ye Z, Zhang Q, Li Y, Wang C, Zhang J, Ma X, et al. High Prevalence of Hyperhomocysteinemia and Its Association with Target Organ Damage in Chinese Patients with Chronic Kidney Disease. Nutrients. 2016;8(10). Abene EE, Gimba ZM, Edah JO, Akinbuwa BA, Uchendu DG, Onyenuche C, et al. Blood pressure control and kidney damage in hypertension: Results of a three-center cross-sectional study in North Central Nigeria. Nigerian journal of clinical practice. 2020;23(11):1590-7. Liang Z, Fan FF, Zhang Y, Qin XH, Li JP, Huo Y. [Rate and characteristics of H-type hypertension in Chinese hypertensive population and comparison with American population]. Beijing da xue xue bao Yi xue ban = Journal of Peking University Health sciences. 2022;54(5):1028-37. Webster AC, Nagler EV, Morton RL, Masson P. Chronic Kidney Disease. Lancet (London, England). 2017;389(10075):1238-52. Cianciolo G, De Pascalis A, Di Lullo L, Ronco C, Zannini C, La Manna G. Folic Acid and Homocysteine in Chronic Kidney Disease and Cardiovascular Disease Progression: Which Comes First? Cardiorenal medicine. 2017;7(4):255-66. Muntner P, Anderson A, Charleston J, Chen Z, Ford V, Makos G, et al. Hypertension awareness, treatment, and control in adults with CKD: results from the Chronic Renal Insufficiency Cohort (CRIC) Study. American journal of kidney diseases : the official journal of the National Kidney Foundation. 2010;55(3):441-51. Kim J, Kim H, Roh H, Kwon Y. Causes of hyperhomocysteinemia and its pathological significance. Archives of pharmacal research. 2018;41(4):372-83. Zhang Y, Wang L, Zhou X, Geng J, Li X. The immunomodulatory mechanism of brain injury induced by hyperhomocysteinemia in spontaneously hypertensive rats. Journal of cellular biochemistry. 2019;120(6):9421-9. Cohen E, Margalit I, Shochat T, Goldberg E, Krause I. The relationship between the concentration of plasma homocysteine and chronic kidney disease: a cross sectional study of a large cohort. Journal of nephrology. 2019;32(5):783-9. Liu C, Lin L, Xu R. Elevated homocysteine and differential risks of the renal function decline in hypertensive patients. Clinical and experimental hypertension (New York, NY : 1993). 2020;42(6):565-70. Shi Y, Ding C, Hu L, Li M, Huang X, Zhou W, et al. Saturation Effects of Plasma Homocysteine on Chronic Kidney Disease in Chinese Adults With H-type Hypertension: A Cross-sectional Study. Journal of renal nutrition : the official journal of the Council on Renal Nutrition of the National Kidney Foundation. 2021;31(5):459-66. Zdrojewski Ł, Zdrojewski T, Rutkowski M, Bandosz P, Król E, Wyrzykowski B, et al. Prevalence of chronic kidney disease in a representative sample of the Polish population: results of the NATPOL 2011 survey. Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association. 2016;31(3):433-9. Daenen K, Andries A, Mekahli D, Van Schepdael A, Jouret F, Bammens B. Oxidative stress in chronic kidney disease. Pediatric nephrology (Berlin, Germany). 2019;34(6):975-91. Kubo M, Kiyohara Y, Kato I, Tanizaki Y, Katafuchi R, Hirakata H, et al. Risk factors for renal glomerular and vascular changes in an autopsy-based population survey: the Hisayama study. Kidney international. 2003;63(4):1508-15. Vyssoulis G, Karpanou E, Kyvelou SM, Adamopoulos D, Gialernios T, Gymnopoulou E, et al. Associations between plasma homocysteine levels, aortic stiffness and wave reflection in patients with arterial hypertension, isolated office hypertension and normotensive controls. Journal of human hypertension. 2010;24(3):183-9. Haynes WG. Hyperhomocysteinemia, vascular function and atherosclerosis: effects of vitamins. Cardiovascular drugs and therapy. 2002;16(5):391-9. Ye Z, Wang C, Zhang Q, Li Y, Zhang J, Ma X, et al. Prevalence of Homocysteine-Related Hypertension in Patients With Chronic Kidney Disease. Journal of clinical hypertension (Greenwich, Conn). 2017;19(2):151-60. An J, Kurella Tamura M, Odden MC, Ni L, Thomas IC, Montez-Rath ME, et al. Prevalence of Apparent Treatment-Resistant Hypertension in Chronic Kidney Disease in Two Large US Health Care Systems. Clinical journal of the American Society of Nephrology : CJASN. 2022;17(10):1457-66. Tables Table 1.Baseline characteristics of study participants according to CKD status Characteristics Total Control group CKDgroup χ²/Z P -value Genders,n(%) 0.238 0.626 Female 367(71.40) 76(29.57) 71(27.63) Male 147(28.60) 181(70.43) 186(72.37) Education background,n(%) 14.730 0.002 Primary school and below 182(35.41) 86(33.46) 96(37.35) Junior school 136(26.46) 55(21.40) 81(31.52) Senior school 142(27.63) 79(30.74) 63(24.51) College and above 54(10.51) 37(14.40) 17(6.61) Marital status,n(%) 0.485 0.486 Single 90(17.51) 42(16.34) 48(18.68) Married 424(82.49) 215(83.66) 209(81.32) Exercise,n(%) 16.178 <0.001 No exercise 230(44.75) 105(40.86) 125(48.64) Irregular exercise 159(30.93) 70(27.24) 89(34.63) Regular exercise 125(24.32) 82(31.91) 43(16.73) Smoking history,n(%) 0.036 0.850 Never smokes 166(32.30) 82(31.91) 84(32.68) Current or former smokers 348(67.70) 175(68.09) 173(67.32) Drinking history,n(%) 0.406 0.524 No 114(22.18) 60(23.35) 54(21.01) Yes 400(77.82) 197(76.65) 203(78.99) BMI,n(%) 8.171 0.043 <18.5 kg/m2 32(6.23) 17(6.61) 15(5.83) 18.5–23.9 kg/m2 277(53.89) 129(50.19) 148(57.59) 24.0-28.0kg/m2 167(32.49) 84(32.68) 83(32.30) ≥28.0 kg/m2 38(7.39) 27(10.50) 11(4.28) H-type hypertension 94.22 <0.001 Normal group 129(25.10) 110(42.80) 19(7.39) Hypertension group 119(23.15) 56(21.79) 63(24.51) Hcy group 56(10.89) 25(9.27) 31(12.06) H-type hypertension group 210(40.86) 66(25.68) 144(56.03) age(year) 63.00(48.75,69.25) 63.00(47.00,68.00) 65.00(50.00,71.00) -2.576 0.010 TG(mmol/L) 1.60(1.08,2.25) 1.50(0.99,2.06) 1.71(1.21,2.35) -2.878 0.004 TC(mmol/L) 4.61(3.89,5.25) 4.61(3.94,5.32) 4.60(3.82,5.22) -1.26 0.208 LDL(mmol/L) 2.63(2.08,3.23) 2.63(2.17,3.27) 2.63(1.98,3.18) -1.093 0.274 HDL(mmol/L) 1.21(1.03,1.40) 1.27(1.08,1.44) 1.16(0.99,1.36) -3.391 0.001 ALT(U/L) 18.00(13.00,26.13) 17.00(12.00,27.50) 19.00(13.68,25.99) -1.708 0.088 UA(μmol/L) 314.00(261.00,390.00) 302.00(270.95,350.00) 358.00(154.00,431.45) -2.375 0.018 Scr(μmol/L) 69.00(49.68,95.00) 64.50(54.00,78.00) 86.00(10.93,107.15) -2.160 0.031 BUN(mmol/L) 5.89(4.46,8.46) 4.98(3.98,6.16) 8.03(5.46,29.57) -11.355 <0.001 eGFR(mL/min) 61.90(33.10,91.28) 89.50(77.50,106.55) 33.80(2.54,50.80) -18.886 hs-CRP(mg/L) 1.88(1.32,2.47) 1.63(1.09,2.15) 1.99(1.51,3.00) -6.553 <0.001 Table 2.Association between H-type hypertension and CKD in different models H-type hypertension Model 1 Model 2 Model3 0R(95%CI) P-value 0R(95%CI) P-value 0R(95%CI) P-value Normal group Reference Reference Reference Hypertension group 6.513(3.555,11.934) <0.001 7.858(4.179,14.777) <0.001 3.217(1.418,7.299) 0.005 Hcy group 7.179(3.503,14.711) <0.001 8.000(3.797,16.854) <0.001 3.680(1.403,9.651) 0.008 H-type hypertension group 12.632(7.162,22.279) <0.001 14.567(7.970,26.624) <0.001 4.453(2.075,9.560) <0.001 Model 1: we did not adjust any confounding factors. Model 2: we adjusted age, education background,exercise,BMI Model 3: we adjusted for model 2 plus TG,HDL,UA,Sc r,BUN,hs-CRP Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3992934","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":276454734,"identity":"f706c43a-757d-4204-817e-afaa027ea29c","order_by":0,"name":"Tianyao Long","email":"","orcid":"","institution":"Hunan Normal University","correspondingAuthor":false,"prefix":"","firstName":"Tianyao","middleName":"","lastName":"Long","suffix":""},{"id":276454735,"identity":"3566519d-c5e1-48ee-ab32-fd93df059edc","order_by":1,"name":"Liuyangyi Zheng","email":"","orcid":"","institution":"Hunan Normal University","correspondingAuthor":false,"prefix":"","firstName":"Liuyangyi","middleName":"","lastName":"Zheng","suffix":""},{"id":276454736,"identity":"592e03a1-b3b4-4104-aec9-7413220462af","order_by":2,"name":"Zihao Ding","email":"","orcid":"","institution":"Hunan Normal University","correspondingAuthor":false,"prefix":"","firstName":"Zihao","middleName":"","lastName":"Ding","suffix":""},{"id":276454737,"identity":"ed36260a-5d57-4416-b5bd-96d150acdf4b","order_by":3,"name":"Tong Yu","email":"","orcid":"","institution":"Hunan Normal University","correspondingAuthor":false,"prefix":"","firstName":"Tong","middleName":"","lastName":"Yu","suffix":""},{"id":276454738,"identity":"55edb9e7-90ac-4b69-8fb2-bd1ef08d120e","order_by":4,"name":"Xiuqin Hong","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABEklEQVRIiWNgGAWjYDACZiBOYDgAJBnbP3yosElAEieohfkY44wzaURogQCQFrY0Zt62w4S1GBznMbzxcMcdOXP+NWYPeM6czzO43XtMgqHCOrGB/ewBbFokm3mMLRLPPDO2nPHG3ECi4naxwZ1zaRIMZ9ITG3jyErBp4WfmMZNIbDucuOHGGQMJgzO3gYwcMwlGoEiDBI8BNi1sKFoS285BtfzDrQVhy/m2NImDbQegWhpwa5FsZiu2AGoxNrjBfNiw4Uxy4swbOcYWCcfSjdt4crBqMTh/eOPNn22H5QzOH2x8/KfCLrHvRo7hjQ811rL97GewagEBCQiJHDwgNhsu9XAt/AfwKBkFo2AUjIIRDQC7VWqCsW+VMQAAAABJRU5ErkJggg==","orcid":"","institution":"The First Affiliated Hospital of Hunan Normal University","correspondingAuthor":true,"prefix":"","firstName":"Xiuqin","middleName":"","lastName":"Hong","suffix":""}],"badges":[],"createdAt":"2024-02-27 05:29:49","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3992934/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3992934/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":52101873,"identity":"bfa34bca-8939-4d6c-83e5-a45b7e01b984","added_by":"auto","created_at":"2024-03-06 19:14:30","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":139026,"visible":true,"origin":"","legend":"\u003cp\u003eSubgroup analysis of the association between H-type hypertension and CKD. Adjusted for age, education, exercise, BMI, TG, HDL, UA, Scr, BUN and hs-CRP.\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-3992934/v1/8d0cb0e970078dcb0e2c3334.png"},{"id":58182742,"identity":"7ac59257-7027-4650-af1e-ec765b7f83cc","added_by":"auto","created_at":"2024-06-12 06:38:21","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":648623,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3992934/v1/d43c96ac-7e4b-454f-8053-e42109d62d49.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"H-type hypertension is a risk factor for chronic kidney disease: a case-control study","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eChronic kidney disease (CKD) is a chronic progressive disease characterized by structural dysfunction of the kidneys or a decrease in glomerular filtration rate (GFR) that is difficult to cure(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e).CKD is a global public health problem. The incidence of CKD is on the rise worldwide, with a global prevalence of 13.4%, and can cause 1.2\u0026nbsp;million deaths and 28\u0026nbsp;million years of life lost each year(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).In China, the prevalence of CKD is 10.8%, and the number of people suffering from the disease is as high as 132\u0026nbsp;million, ranking first in the world(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).H-type hypertension is essential hypertension with elevated homocysteine (Hcy\u0026thinsp;\u0026ge;\u0026thinsp;10 umol/L)(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).There is a close causal relationship between hypertension and the occurrence and development of chronic kidney disease, and hypertension is one of the risk factors for chronic kidney disease(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).Studies have shown that hypertension is closely related to the decline of renal function in patients with CKD(\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e).At the same time, hypertension is one of the most common serious complications of CKD, and the prevalence of hypertension increases as renal function declines(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).Therefore, the treatment of hypertension is very important for CKD patients. Since 70% of Hcy in the body is excreted through the kidneys, renal function is closely related to Hcy.Hcy has been found to be associated with progressive deterioration of renal function and cardiovascular complications in patients with CKD, and 80\u0026ndash;90% of patients with end-stage renal disease have significantly higher concentrations of Hcy in their blood(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e).More than 70% of hypertensive patients in China have elevated plasma homocysteine levels(\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e).These findings suggest that H-type hypertension may imply double damage to the kidneys. In order to understand the relationship between H-type hypertension and CKD, this case-control study explored the relationship to provide a scientific basis for the prevention and treatment of CKD.\u003c/p\u003e"},{"header":"2. Materials and Methods","content":"\u003cp\u003e\u003cstrong\u003e2.1 Study population\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eUsing a case-control study, the study population was selected from 257 inpatients diagnosed with CKD in the Department of Nephrology of Hunan Provincial People\u0026apos;s Hospital from December 2021 to December 2022 as a case group, and 257 patients not diagnosed with CKD from other departments as a control group. Inclusion criteria: (1) complete clinical information; (2) able to complete the entire survey independently; (3) voluntary participation in this survey and cooperation in completing the questionnaire and physical examination. Exclusion criteria: (1) female population during pregnancy or lactation; (2) patients with recent use of drugs that may affect blood pressure and Hcy levels; (3) patients with secondary hypertension caused by pheochromocytoma, sleep apnea syndrome, etc.; (4) patients with a clear history of renal disease, such as diabetic nephropathy, gouty nephropathy, lupus nephritis, etc.; and (5) patients with combined organ failure, hepatic cirrhosis at the stage of decompensated stage, and renal insufficiency. This study was reviewed and approved by the Medical Ethics Committee of Hunan Normal University (No. 034/2017), and all subjects signed an informed consent form before participating in this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.2 Data collection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA self-administered questionnaire was used to conduct a \u0026quot;face-to-face\u0026quot; survey of all respondents. The survey included information on general demographic characteristics (age, sex, education, marital status), lifestyle habits (exercise, smoking, alcohol consumption), and past medical history (history of hypertension, history of taking antihypertensive drugs). Physical examination (including height, weight, heart rate and waist circumference). Laboratory tests include homocysteine (Hcy); total cholesterol (TC), triglyceride (TG), high density lipoprotein (HDL), low density lipoprotein (LDL), alanine aminotransferase (ALT), blood creatinine (CRE), and blood glucose. Low density lipoprotein cholesterol (LDL), alanine aminotransferase (ALT), creatinine (Scr), blood urea nitrogen (BUN), ultra-sensitive C-reactive protein (UCRP), and blood glucose (BG). ), hypersensitive C-reactive protein (hs-CRP).\u003c/p\u003e\n\u003cp\u003eEducation level was categorized into four groups: elementary school and below, middle school, high school, and college and above. Marital status was categorized as single and married. Patients were judged to be exercising regularly based on the number of times they exercised in a week: 0 was no exercise, 1-3 was irregular exercise, and \u0026gt;3 was regular exercise. We defined current smoking as continuous or cumulative smoking of one or more cigarettes per day; current alcohol consumption was defined as at least 2 drinks per week.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.3 Definition of H-type hypertension\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePatients with essential hypertension whose plasma Hcy concentration exceeded 10 \u0026mu;mol/L were classified as H-type hypertension. All patients were categorized into a normal group, a simple hypertension group, a simple Hcy group (Hcy \u0026ge;10 \u0026mu;mol/L), and an H-hypertension group according to their Hcy levels and whether they had hypertension.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.4 Definition of CKD\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe diagnostic criteria for CKD were the presence of structural or functional abnormalities in the kidneys for \u0026ge;3 months, which may or may not be accompanied by a decrease in eGRF, and which may be manifested by abnormalities in pathology or markers of renal injury (including blood-urine and compositional or imaging tests).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.5 Statistical methods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData were statistically analyzed using SPSS 26.0, categorical variables were expressed as numbers and percentages (%), and the \u0026chi;\u003csup\u003e2\u003c/sup\u003e test was used to compare differences between groups. Continuous variables are expressed as M (P\u003csub\u003e25\u003c/sub\u003e , P\u003csub\u003e75\u003c/sub\u003e), and nonparametric comparisons of between-group differences were used. Multivariate logistic regression models were used to examine the association between H-type subgroups and CKD risk. We constructed 3 models: model 1 was unadjusted; in model 2, we adjusted for age, educational background, exercise, and BMI. model 3: TG, HDL, UA, Scr, BUN, and CRP were added to model 2. Subgroup analyses were performed and the interaction between H-type hypertension and related influencing factors on the development of CKD was further analyzed. Differences were statistically significant at P \u0026lt; 0.05.\u003c/p\u003e"},{"header":"3. Results","content":"\u003cp\u003e\u003cstrong\u003e3.1 Basic information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn this case-control study the control group of 257 cases had a median age of 63.00 years and an interquartile range of (47.00,68.00) years. The case group of 257 cases had a median age of 65.00 years and an interquartile range of (50.00,71.00) years. According to the presence or absence of CKD, Table 1 shows the baseline characteristics of the study population. It was found that the difference between the H-hypertension subgroups was statistically significant, and the prevalence of CKD was highest in the H-hypertension group (p \u0026lt; 0.05).Low education, insufficient physical activity, and obesity were risk factors for CKD compared to the control group. In addition, eGFR was significantly lower and TG, UA, Scr, BUN, and hs-CRP levels were significantly higher in CKD patients (P \u0026lt; 0.05).Table 1.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.2 Correlation between H-type hypertension and CKD\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eModel 1 was built with the presence of H-type hypertension as the dependent variable (assignment: CKD = 1, control = 0) and H-type hypertension as the independent variable, and the results showed that the risk of CKD in the H-type hypertension group was significantly higher than that in both the Hcy and the hypertension groups (OR = 12.632,95% CI: 7.162-22.297; P \u0026lt; 0.001), and in a logistic regression model adjusting for some confounding factors ( educational background, exercise, BMI, TG, HDL, UA, Scr, BUN, hs-CRP) in a logistic regression model (Model 3), H-type hypertension could still increase the risk of CKD (OR = 4.453, 95% CI: 2.075-9.560; P \u0026lt; 0.001). Table 2.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.3 Subgroup analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn order to more clearly define the relationship between H-type hypertension and the risk of developing CKD, further subgroup analyses of age, education level, exercise status and TG were performed, and the interactions between H-type hypertension and related influencing factors on the development of CKD were analyzed. The results showed that there was no interaction between H-type hypertension and age, education level, exercise status and TG on the development of CKD (P \u0026gt; 0.05). Figure 1.\u003c/p\u003e"},{"header":"4. Discussion","content":"\u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eThis case-control study examined the relationship between H-type hypertension and CKD. Logistic regression revealed that the risk of CKD was associated with H-type hypertension, which was more closely associated with CKD. After adjusting for possible confounders, we obtained the same results. In all subgroups, the risk of CKD was higher in the H-type hypertension group than in the Hcy and hypertension groups.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eCKD greatly reduces the quality of life of patients and imposes a heavy financial and psychological burden on patients and their families(\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e).There is a strong Association between CKD and hypertension and Hcy(\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e).The presence of decreased renal function in hypertensive patients may lead to incurable CKD(\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e).Hcy is a sulfur-containing amino acid, an intermediate product in the metabolism of methionine, one of the essential amino acids.And the kidney, as the main site of Hcy metabolism, plays an important role in the process of Hcy metabolism.Epidemiologic investigations have shown that increased levels of Hcy in the body play a key role in the development of CKD and are one of the major risk factors for the development of CKD(\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e).Some studies have found that Hcy can be used as an independent biomarker to predict the decline of renal function and the development of CKD(\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e).Liu et al.(\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e)who retrospectively analyzed 7240 hypertensive patients, found that patients with hyperhomocysteinemia had a higher rate of long-term decline in renal function compared to non-homocysteinemic patients(\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e).The results of the present study similarly found that Hcy levels were significantly higher in CKD patients than in non-CKD patients .The effect of Hcy on the prevalence of CKD and eGFR in Chinese patients with H-type hypertension was also found in a cross-sectional study of 12,873 Chinese adults with H-type hypertension between the ages of 27 and 75 years(\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e).Therefore, high attention should be paid to the development of H-type hypertension in the management of CKD.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eCurrent experimental studies have found that Hcy can promote the development and progression of CKD by inducing oxidative stress, inflammatory response, hypomethylation and other pathways(\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e).Some studies have even found that renal vascular changes such as decreased vascular density, decreased blood flow and increased smooth muscle cell proliferation associated with Hcy are one of the causes of impaired renal function(\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e).Oxidative stress can also damage kidney cells affecting glomerular filtration rate and promoting the fibrotic process in the kidney(\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e).It is possible that the mechanism of CKD due to H-hypertension is because Hcy can affect glomerulosclerosis and interstitial fibrosis leading to progressive decline in CKD function(\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e).Meanwhile, the increase of Hcy can attenuate the vasodilatory effect of NO, induce oxidative stress(\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e),and stimulate the proliferation of vascular smooth muscle cells (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e), which alters the elasticity of the vascular wall, increases vascular resistance, and ultimately leads to an increase in blood pressure(\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e).Both Hcy and hypertension can cause severe kidney damage(\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e).This suggests that both blood pressure changes and Hcy levels should be paid attention to in the early prevention of CKD, and that the dangers of H-type hypertension should be fully recognized in order to avoid more serious damage and poorer prognosis for CKD patients.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eHowever, this study still has some limitations. Firstly, this study is a retrospective case-control study with weak causal argumentation to prove the causal relationship between H-type hypertension and CKD. This study also has some recall bias, which will have some influence on the results. Second, the subjects of this study were all from Hunan Provincial People's Hospital, and there was a certain selection bias; the results of this study can only represent the situation of patients in this hospital, and the conclusions obtained cannot be extrapolated to the whole population. Finally, this study did not adjust for other relevant confounding factors such as relevant disease history and diet that may have an impact on the results.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e"},{"header":"5. Conclusions","content":"\u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eOur findings suggest that H-type hypertension is associated with chronic kidney disease.The risk of morbidity in the H-type hypertension group was higher than that in the Hcy and hypertension groups.Therefore, high attention should be paid to the development of H-type hypertension in the prevention and treatment of CKD.\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eAvailability of Data and Materials\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003eAuthor Contributions\u003c/p\u003e\n\u003cp\u003eTL: research design, data analysis, and manuscript writing. LZ: data collection and research design. ZD: data collection and comments. TY: data collection and investigation. All authors contributed to the article and approved the submitted version. XH: funding acquisition, conceptualization, and writing\u0026mdash;review and editing.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eEthics Approval and Consent to Participate\u003c/p\u003e\n\u003cp\u003eThe studies involving human participants were reviewed and approved by the Medical Ethics Committee of Hunan Normal University (No. 034/2017). The patients/participants provided their written informed consent to participate in this study.Written informed consent was obtained from the individual(s) for the publication of any potentially identifiable images or data included in this article.\u003c/p\u003e\n\u003cp\u003eAcknowledgment\u003c/p\u003e\n\u003cp\u003eWe thank all those who participated in this study and Hunan Provincial People\u0026apos;s Hospital for their support.\u003c/p\u003e\n\u003cp\u003eFunding\u003c/p\u003e\n\u003cp\u003eThis study was funded by the National Natural Science Foundation of China (8177120863), Hunan Provincial Science and Technology Department (2020JJ4047), and Changsha Science and Technology Bureau (kq1801096). The funders had no role in the study design, data collection,and analysis, decision to publish, or preparation of the manuscript.\u003c/p\u003e\n\u003cp\u003eConsent for publication\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003eCompeting interests\u003c/p\u003e\n\u003cp\u003eThe authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eStrazzella A, Ossoli A, Calabresi L. High-Density Lipoproteins and the Kidney. Cells. 2021;10(4).\u003c/li\u003e\n\u003cli\u003eParrish AR. Advances in Chronic Kidney Disease. International journal of molecular sciences. 2016;17(8).\u003c/li\u003e\n\u003cli\u003eLunyera J, Mohottige D, Von Isenburg M, Jeuland M, Patel UD, Stanifer JW. CKD of Uncertain Etiology: A Systematic Review. Clinical journal of the American Society of Nephrology : CJASN. 2016;11(3):379-85.\u003c/li\u003e\n\u003cli\u003eHill NR, Fatoba ST, Oke JL, Hirst JA, O\u0026apos;Callaghan CA, Lasserson DS, et al. Global Prevalence of Chronic Kidney Disease - A Systematic Review and Meta-Analysis. PloS one. 2016;11(7):e0158765.\u003c/li\u003e\n\u003cli\u003eGlobal, regional, and national burden of chronic kidney disease, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet (London, England). 2020;395(10225):709-33.\u003c/li\u003e\n\u003cli\u003eHuo Y, Li J, Qin X, Huang Y, Wang X, Gottesman RF, et al. Efficacy of folic acid therapy in primary prevention of stroke among adults with hypertension in China: the CSPPT randomized clinical trial. Jama. 2015;313(13):1325-35.\u003c/li\u003e\n\u003cli\u003eGonzalez Suarez ML, Kattah A, Grande JP, Garovic V. Renal Disorders in Pregnancy: Core Curriculum 2019. American journal of kidney diseases : the official journal of the National Kidney Foundation. 2019;73(1):119-30.\u003c/li\u003e\n\u003cli\u003eGandhi NV, Murad DN, Nguyen DT, Graviss EA, Ibrahim HN. Hypertension and renal outcomes in normotensive kidney donors with multiple renal arteries. Transplant international : official journal of the European Society for Organ Transplantation. 2021;34(11):2382-93.\u003c/li\u003e\n\u003cli\u003eHamrahian SM, Falkner B. Hypertension in Chronic Kidney Disease. Advances in experimental medicine and biology. 2017;956:307-25.\u003c/li\u003e\n\u003cli\u003eCheung AK, Rahman M, Reboussin DM, Craven TE, Greene T, Kimmel PL, et al. Effects of Intensive BP Control in CKD. Journal of the American Society of Nephrology : JASN. 2017;28(9):2812-23.\u003c/li\u003e\n\u003cli\u003eYe Z, Zhang Q, Li Y, Wang C, Zhang J, Ma X, et al. High Prevalence of Hyperhomocysteinemia and Its Association with Target Organ Damage in Chinese Patients with Chronic Kidney Disease. Nutrients. 2016;8(10).\u003c/li\u003e\n\u003cli\u003eAbene EE, Gimba ZM, Edah JO, Akinbuwa BA, Uchendu DG, Onyenuche C, et al. Blood pressure control and kidney damage in hypertension: Results of a three-center cross-sectional study in North Central Nigeria. Nigerian journal of clinical practice. 2020;23(11):1590-7.\u003c/li\u003e\n\u003cli\u003eLiang Z, Fan FF, Zhang Y, Qin XH, Li JP, Huo Y. [Rate and characteristics of H-type hypertension in Chinese hypertensive population and comparison with American population]. Beijing da xue xue bao Yi xue ban = Journal of Peking University Health sciences. 2022;54(5):1028-37.\u003c/li\u003e\n\u003cli\u003eWebster AC, Nagler EV, Morton RL, Masson P. Chronic Kidney Disease. Lancet (London, England). 2017;389(10075):1238-52.\u003c/li\u003e\n\u003cli\u003eCianciolo G, De Pascalis A, Di Lullo L, Ronco C, Zannini C, La Manna G. Folic Acid and Homocysteine in Chronic Kidney Disease and Cardiovascular Disease Progression: Which Comes First? Cardiorenal medicine. 2017;7(4):255-66.\u003c/li\u003e\n\u003cli\u003eMuntner P, Anderson A, Charleston J, Chen Z, Ford V, Makos G, et al. Hypertension awareness, treatment, and control in adults with CKD: results from the Chronic Renal Insufficiency Cohort (CRIC) Study. American journal of kidney diseases : the official journal of the National Kidney Foundation. 2010;55(3):441-51.\u003c/li\u003e\n\u003cli\u003eKim J, Kim H, Roh H, Kwon Y. Causes of hyperhomocysteinemia and its pathological significance. Archives of pharmacal research. 2018;41(4):372-83.\u003c/li\u003e\n\u003cli\u003eZhang Y, Wang L, Zhou X, Geng J, Li X. The immunomodulatory mechanism of brain injury induced by hyperhomocysteinemia in spontaneously hypertensive rats. Journal of cellular biochemistry. 2019;120(6):9421-9.\u003c/li\u003e\n\u003cli\u003eCohen E, Margalit I, Shochat T, Goldberg E, Krause I. The relationship between the concentration of plasma homocysteine and chronic kidney disease: a cross sectional study of a large cohort. Journal of nephrology. 2019;32(5):783-9.\u003c/li\u003e\n\u003cli\u003eLiu C, Lin L, Xu R. Elevated homocysteine and differential risks of the renal function decline in hypertensive patients. Clinical and experimental hypertension (New York, NY : 1993). 2020;42(6):565-70.\u003c/li\u003e\n\u003cli\u003eShi Y, Ding C, Hu L, Li M, Huang X, Zhou W, et al. Saturation Effects of Plasma Homocysteine on Chronic Kidney Disease in Chinese Adults With H-type Hypertension: A Cross-sectional Study. Journal of renal nutrition : the official journal of the Council on Renal Nutrition of the National Kidney Foundation. 2021;31(5):459-66.\u003c/li\u003e\n\u003cli\u003eZdrojewski Ł, Zdrojewski T, Rutkowski M, Bandosz P, Kr\u0026oacute;l E, Wyrzykowski B, et al. Prevalence of chronic kidney disease in a representative sample of the Polish population: results of the NATPOL 2011 survey. Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association. 2016;31(3):433-9.\u003c/li\u003e\n\u003cli\u003eDaenen K, Andries A, Mekahli D, Van Schepdael A, Jouret F, Bammens B. Oxidative stress in chronic kidney disease. Pediatric nephrology (Berlin, Germany). 2019;34(6):975-91.\u003c/li\u003e\n\u003cli\u003eKubo M, Kiyohara Y, Kato I, Tanizaki Y, Katafuchi R, Hirakata H, et al. Risk factors for renal glomerular and vascular changes in an autopsy-based population survey: the Hisayama study. Kidney international. 2003;63(4):1508-15.\u003c/li\u003e\n\u003cli\u003eVyssoulis G, Karpanou E, Kyvelou SM, Adamopoulos D, Gialernios T, Gymnopoulou E, et al. Associations between plasma homocysteine levels, aortic stiffness and wave reflection in patients with arterial hypertension, isolated office hypertension and normotensive controls. Journal of human hypertension. 2010;24(3):183-9.\u003c/li\u003e\n\u003cli\u003eHaynes WG. Hyperhomocysteinemia, vascular function and atherosclerosis: effects of vitamins. Cardiovascular drugs and therapy. 2002;16(5):391-9.\u003c/li\u003e\n\u003cli\u003eYe Z, Wang C, Zhang Q, Li Y, Zhang J, Ma X, et al. Prevalence of Homocysteine-Related Hypertension in Patients With Chronic Kidney Disease. Journal of clinical hypertension (Greenwich, Conn). 2017;19(2):151-60.\u003c/li\u003e\n\u003cli\u003eAn J, Kurella Tamura M, Odden MC, Ni L, Thomas IC, Montez-Rath ME, et al. Prevalence of Apparent Treatment-Resistant Hypertension in Chronic Kidney Disease in Two Large US Health Care Systems. Clinical journal of the American Society of Nephrology : CJASN. 2022;17(10):1457-66.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cdiv align=\"\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"left\" width=\"101%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"6\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 1.Baseline characteristics of study participants according to CKD status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.958333333333332%\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e\u003cstrong\u003eControl group\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e\u003cstrong\u003eCKDgroup\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026chi;\u0026sup2;/Z\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003eP\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.958333333333332%\"\u003e\n \u003cp\u003eGenders,n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\"\u003e\n \u003cp\u003e0.238\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\"\u003e\n \u003cp\u003e0.626\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.958333333333332%\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e367(71.40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e76(29.57)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e71(27.63)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.958333333333332%\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e147(28.60)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e181(70.43)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e186(72.37)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.958333333333332%\"\u003e\n \u003cp\u003eEducation background,n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\"\u003e\n \u003cp\u003e14.730\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.958333333333332%\"\u003e\n \u003cp\u003ePrimary school and below\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e182(35.41)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e86(33.46)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e96(37.35)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.958333333333332%\"\u003e\n \u003cp\u003eJunior school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e136(26.46)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e55(21.40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e81(31.52)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.958333333333332%\"\u003e\n \u003cp\u003eSenior school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e142(27.63)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e79(30.74)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e63(24.51)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.958333333333332%\"\u003e\n \u003cp\u003eCollege and above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e54(10.51)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e37(14.40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e17(6.61)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.958333333333332%\"\u003e\n \u003cp\u003eMarital status,n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\"\u003e\n \u003cp\u003e0.485\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\"\u003e\n \u003cp\u003e0.486\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.958333333333332%\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e90(17.51)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e42(16.34)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e48(18.68)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.958333333333332%\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e424(82.49)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e215(83.66)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e209(81.32)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.958333333333332%\"\u003e\n \u003cp\u003eExercise,n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\"\u003e\n \u003cp\u003e16.178\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.958333333333332%\"\u003e\n \u003cp\u003eNo exercise\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e230(44.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e105(40.86)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e125(48.64)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.958333333333332%\"\u003e\n \u003cp\u003eIrregular exercise\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e159(30.93)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e70(27.24)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e89(34.63)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.958333333333332%\"\u003e\n \u003cp\u003eRegular exercise\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e125(24.32)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e82(31.91)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e43(16.73)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.958333333333332%\"\u003e\n \u003cp\u003eSmoking history,n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\"\u003e\n \u003cp\u003e0.036\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\"\u003e\n \u003cp\u003e0.850\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.958333333333332%\"\u003e\n \u003cp\u003eNever smokes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e166(32.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e82(31.91)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e84(32.68)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.958333333333332%\"\u003e\n \u003cp\u003eCurrent or former smokers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e348(67.70)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e175(68.09)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e173(67.32)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.958333333333332%\"\u003e\n \u003cp\u003eDrinking history,n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\"\u003e\n \u003cp\u003e0.406\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\"\u003e\n \u003cp\u003e0.524\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.958333333333332%\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e114(22.18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e60(23.35)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e54(21.01)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.958333333333332%\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e400(77.82)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e197(76.65)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e203(78.99)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.958333333333332%\"\u003e\n \u003cp\u003eBMI,n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\"\u003e\n \u003cp\u003e8.171\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\"\u003e\n \u003cp\u003e0.043\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.958333333333332%\"\u003e\n \u003cp\u003e\u0026lt;18.5 kg/m2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e32(6.23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e17(6.61)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e15(5.83)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.958333333333332%\"\u003e\n \u003cp\u003e18.5\u0026ndash;23.9 kg/m2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e277(53.89)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e129(50.19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e148(57.59)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.958333333333332%\"\u003e\n \u003cp\u003e24.0-28.0kg/m2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e167(32.49)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e84(32.68)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e83(32.30)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.958333333333332%\"\u003e\n \u003cp\u003e\u0026ge;28.0 kg/m2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e38(7.39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e27(10.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e11(4.28)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.958333333333332%\"\u003e\n \u003cp\u003eH-type hypertension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\"\u003e\n \u003cp\u003e94.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.958333333333332%\"\u003e\n \u003cp\u003eNormal group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e129(25.10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e110(42.80)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e19(7.39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.958333333333332%\"\u003e\n \u003cp\u003eHypertension group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e119(23.15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e56(21.79)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e63(24.51)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.958333333333332%\"\u003e\n \u003cp\u003eHcy group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e56(10.89)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e25(9.27)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e31(12.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.958333333333332%\"\u003e\n \u003cp\u003eH-type hypertension group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e210(40.86)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e66(25.68)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e144(56.03)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.958333333333332%\"\u003e\n \u003cp\u003eage(year)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e63.00(48.75,69.25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e63.00(47.00,68.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e65.00(50.00,71.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\"\u003e\n \u003cp\u003e-2.576\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\"\u003e\n \u003cp\u003e0.010\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.958333333333332%\"\u003e\n \u003cp\u003eTG(mmol/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e1.60(1.08,2.25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e1.50(0.99,2.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e1.71(1.21,2.35)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\"\u003e\n \u003cp\u003e-2.878\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\"\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.958333333333332%\"\u003e\n \u003cp\u003eTC(mmol/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e4.61(3.89,5.25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e4.61(3.94,5.32)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e4.60(3.82,5.22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\"\u003e\n \u003cp\u003e-1.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\"\u003e\n \u003cp\u003e0.208\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.958333333333332%\"\u003e\n \u003cp\u003eLDL(mmol/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e2.63(2.08,3.23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e2.63(2.17,3.27)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e2.63(1.98,3.18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\"\u003e\n \u003cp\u003e-1.093\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\"\u003e\n \u003cp\u003e0.274\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.958333333333332%\"\u003e\n \u003cp\u003eHDL(mmol/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e1.21(1.03,1.40)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e1.27(1.08,1.44)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e1.16(0.99,1.36)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\"\u003e\n \u003cp\u003e-3.391\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.958333333333332%\"\u003e\n \u003cp\u003eALT(U/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e18.00(13.00,26.13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e17.00(12.00,27.50)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e19.00(13.68,25.99)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\"\u003e\n \u003cp\u003e-1.708\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\"\u003e\n \u003cp\u003e0.088\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.958333333333332%\"\u003e\n \u003cp\u003eUA(\u0026mu;mol/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e314.00(261.00,390.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e302.00(270.95,350.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e358.00(154.00,431.45)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\"\u003e\n \u003cp\u003e-2.375\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\"\u003e\n \u003cp\u003e0.018\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.958333333333332%\"\u003e\n \u003cp\u003eScr(\u0026mu;mol/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e69.00(49.68,95.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e64.50(54.00,78.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e86.00(10.93,107.15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\"\u003e\n \u003cp\u003e-2.160\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\"\u003e\n \u003cp\u003e0.031\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.958333333333332%\"\u003e\n \u003cp\u003eBUN(mmol/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e5.89(4.46,8.46)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e4.98(3.98,6.16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e8.03(5.46,29.57)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\"\u003e\n \u003cp\u003e-11.355\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.958333333333332%\"\u003e\n \u003cp\u003eeGFR(mL/min)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e61.90(33.10,91.28)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e89.50(77.50,106.55)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e33.80(2.54,50.80)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\"\u003e\n \u003cp\u003e-18.886\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.958333333333332%\"\u003e\n \u003cp\u003ehs-CRP(mg/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e1.88(1.32,2.47)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e1.63(1.09,2.15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.791666666666668%\"\u003e\n \u003cp\u003e1.99(1.51,3.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\"\u003e\n \u003cp\u003e-6.553\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.333333333333334%\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"\" width=\"113%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"7\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 2.Association between H-type hypertension and CKD in different models\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.448979591836736%\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eH-type hypertension\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.53061224489796%\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eModel 1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"26.53061224489796%\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eModel 2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.489795918367346%\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eModel3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.68421052631579%\"\u003e\n \u003cp\u003e\u003cstrong\u003e0R(95%CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.526315789473685%\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.68421052631579%\"\u003e\n \u003cp\u003e\u003cstrong\u003e0R(95%CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.526315789473685%\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.05263157894737%\"\u003e\n \u003cp\u003e\u003cstrong\u003e0R(95%CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.526315789473685%\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.448979591836736%\"\u003e\n \u003cp\u003eNormal group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.367346938775512%\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.16326530612245%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.367346938775512%\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.16326530612245%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003eReference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.16326530612245%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.448979591836736%\"\u003e\n \u003cp\u003eHypertension group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.367346938775512%\"\u003e\n \u003cp\u003e6.513(3.555,11.934)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.16326530612245%\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.367346938775512%\"\u003e\n \u003cp\u003e7.858(4.179,14.777)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.16326530612245%\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003e3.217(1.418,7.299)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.16326530612245%\"\u003e\n \u003cp\u003e0.005\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.448979591836736%\"\u003e\n \u003cp\u003eHcy group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.367346938775512%\"\u003e\n \u003cp\u003e7.179(3.503,14.711)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.16326530612245%\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.367346938775512%\"\u003e\n \u003cp\u003e8.000(3.797,16.854)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.16326530612245%\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003e3.680(1.403,9.651)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.16326530612245%\"\u003e\n \u003cp\u003e0.008\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"22.448979591836736%\"\u003e\n \u003cp\u003eH-type hypertension group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.367346938775512%\"\u003e\n \u003cp\u003e12.632(7.162,22.279)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.16326530612245%\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.367346938775512%\"\u003e\n \u003cp\u003e14.567(7.970,26.624)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.16326530612245%\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.3265306122449%\"\u003e\n \u003cp\u003e4.453(2.075,9.560)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.16326530612245%\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"7\"\u003e\n \u003cp\u003eModel 1: we did not adjust any confounding factors.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"7\"\u003e\n \u003cp\u003eModel 2: we adjusted age, education background,exercise,BMI\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" colspan=\"7\"\u003e\n \u003cp\u003eModel 3: we adjusted for model 2 plus TG,HDL,UA,Sc r,BUN,hs-CRP\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"homocysteine, hypertension,H-type hypertension, chronic kidney disease,case-control study","lastPublishedDoi":"10.21203/rs.3.rs-3992934/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3992934/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e: Previous studies have examined the relationship between hypertension or homocysteine and chronic kidney disease (CKD). However, the relationship between H-type hypertension and CKD remains uncertain. The aim of this study was to investigate the relationship between H-type hypertension and CKD and to provide a scientific basis for the prevention and treatment of CKD;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: This case-control study included 514 study subjects, 257 in each of the case and control groups. The diagnostic criteria for CKD were structural or functional abnormalities of the kidneys for ≥ 3 months, which may or may not be accompanied by a decrease in eGRF, and which may be manifested by abnormalities of pathology or indicators of renal injury (including blood urine and composition or imaging tests). All patients were categorized into normal, Hcy (Hcy ≥10 μmol/L), hypertensive, and H-type hypertension groups according to their Hcy levels and whether they had hypertension.Univariate analysis and multivariate logistic regression models were used to assess the association between H-type hypertension and CKD, and subgroup analyses were performed for potential confounders;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: The differences between the CKD group and the control group in terms of age, education, exercise, BMI, TG, HDL, UA, Scr, BUN and hs-CRP were statistically significant (p \u0026lt; 0.05).Logistic regression modeling showed that after correcting for confounders, we found that the H-type hypertension group had the highest risk of CKD (OR=4.453; 95% CI: 2.075-9.560; P\u0026lt;0.001). There was no interaction of H-type hypertension with age, education level, physical activity, or TG on the development of CKD(P＞0.05);\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e: The coexistence of Hcy and hypertension increases the risk of developing CKD, and H-type hypertension is a risk factor for CKD.\u003c/p\u003e","manuscriptTitle":"H-type hypertension is a risk factor for chronic kidney disease: a case-control study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-03-06 19:14:25","doi":"10.21203/rs.3.rs-3992934/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"8f929e88-68c4-4af0-a2c1-05849ae1f9ae","owner":[],"postedDate":"March 6th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-06-12T06:30:14+00:00","versionOfRecord":[],"versionCreatedAt":"2024-03-06 19:14:25","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3992934","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3992934","identity":"rs-3992934","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}