Ethical committee approval has been obtained from Ethics committee of Faculty of Medicine, Alexandria University~Agreement from all participants should be taken in this clinical study by assigning an informed consent~Adult end stage renal disease patients maintained on hemodialysis three times a week for at least 3 months with resistant hypertension will be recruited from hemodialysis unit in Alexandria University Hospitals~Patients will be screened for resistant hypertension as determined by the mean of mid-week pre-dialysis BP > 140/90 mm Hg, post-dialysis BP > 130/80 mm Hg over a period of one month.~A blood sample will be collected for homocysteine measurement at baseline~Patients will be randomized using simple randomization technique via computer based program to take one tablet daily containing L-methylfolate and methylcobalamine or no treatment.~Patients will be followed over a period of 3 months after which blood pressure measurement and blood sampling would be repeated and compared to baseline values~As a measurement of the prognosis of elevated homocysteine, we should follow the development of myocardial infarction, stroke and cardiovascular events for 3 months~The appropriate statistical tests will be held according to the study design and parameters to evaluate the significance of the results~Results, conclusion, discussion and recommendations will be given
The aim of the study is to evaluate the efficacy of L-methylfolate in combination with methylcobalamine in reducing homocysteine blood levels in hypertensive end-stage renal disease patients on regular hemodialysis and its association with blood pressure control in treatment of resistant hypertension