EXPRESS: Research on ambulatory blood pressure characteristics and lifestyle intervention strategies in hypertensive patients based on homocysteine levels

This prospective cohort study aimed to investigate the differences in blood pressure control among hypertensive patients with varying homocysteine (Hcy) levels following lifestyle intervention. Three hundred hypertensive patients were enrolled and categorized into a high Hcy group (Hcy ≥ 15 μmol/L, 150 cases) and a normal Hcy group (Hcy < 15 μmol/L, 150 cases) according to plasma Hcy levels following national clinical guidelines. All participants underwent 24-hour ambulatory blood pressure monitoring (ABPM) and received a standardized 3-month lifestyle intervention, including dietary and exercise guidance. Post-intervention ABPM was subsequently conducted. Outcomes included changes in 24-hour systolic and diastolic blood pressure (SBP/DBP), blood pressure attainment rate (with the blood pressure control criterion defined as an average SBP < 140 mmHg and DBP < 90 mmHg over 24 hours post-intervention), incidence of adverse events, and adherence. Post-intervention, the high Hcy group exhibited higher 24-hour SBP (142.45 ± 9.39 mmHg) and DBP (91.59 ± 3.05 mmHg) compared to the normal Hcy group (SBP: 139.26 ± 8.35 mmHg, DBP: 88.83 ± 3.14 mmHg) (P = 0.002 and P < 0.001, respectively). The blood pressure attainment rate was also higher in the normal Hcy group (37.33% vs. 19.33%, P < 0.05). No significant differences were observed between the two groups in the incidence of adverse reactions within three months or in adherence rates after three months (both P > 0.05). Lifestyle intervention can effectively improve blood pressure control in hypertensive patients, with more favorable blood pressure response observed in those with normal Hcy levels.