Carnagarin R, Nolde JM, Ward NC, et al. - Researchers investigated, in a real-world clinical setting, if homocysteine levels were related to hypertension mediated organ damage (HMOD) and could guide treatment choices in hypertension. Participants were 145 hypertensive patients, with an average age of 56 ± 17 years. In regression analysis, homocysteine showed a significant association with the following: PWV, albumin-creatinine ratio, 24 h urinary protein excretion, and estimated glomerular filtration rate; this association remained following adjustment for potential confounders such as age, sex, 24 h BP, inflammation, smoking, diabetes mellitus, and dyslipidemia. Homocysteine was identified to be significantly linked with increased aldosterone level, and with attenuation of angiotensin converting enzyme inhibitors mediated systolic BP lowering and regression of HMOD vs angiotensin receptor blockers in higher physiological ranges of homocysteine. Overall, findings demonstrated an association between homocysteine and hypertension mediated vascular damage. Also, results showed that homocysteine could potentially help in guiding first-line antihypertensive therapy.