Association between plasma homocysteine and hypertension: Results from a cross‐sectional and longitudinal analysis in Beijing’s adult population from 2012 to 2017

Plasma homocysteine (Hcy) levels are associated with elevated blood pressure. However, the causal association between Hcy levels and the risk of hypertension remains ambiguous. Taking the study design effect into consideration, this study aimed to investigate this issue through a cross-sectional and longitudinal analysis. Data were obtained from the Beijing Health Management Cohort study, which conducted routine health check-ups from 2012 to 2017. Multivariate logistic regression was used for the cross-sectional analysis, and a quadratic inference function approach was performed for the longitudinal analysis. A total of 30 376 subjects (mean age = 50.0 years) were included in the cross-sectional analysis, and a subgroup of 3913 subjects without hypertension at baseline was included in the longitudinal analysis. After adjusting for potential confounders, the risk of hypertension increased with Hcy levels in the cross-sectional analysis using the traditional definition of hypertension (OR = 1.262, 95% CI: 1.155-1.378, Q2 vs Q1; OR = 1.458, 95% CI: 1.335-1.593, Q3 vs Q1; OR = 1.520, 95% CI: 1.388-1.664, Q4 vs Q1) and the 2017 hypertension definition (OR = 1.159, 95% CI: 1.067-1.259, Q2 vs Q1; OR = 1.328, 95% CI: 1.221-1.445, Q3 vs Q1; OR = 1.328, 95% CI: 1.217-1.449, Q4 vs Q1). The longitudinal analysis showed that hypertension risk increased in the third quartile of Hcy (OR = 1.268, 95% CI: 1.030-1.560, Q3 vs Q1). Elevated total plasma Hcy may be used as a predictive biomarker for hypertension. Attention should be paid to gender-specific mechanisms when issuing precise precautions.