Cihan AYDIN, Seref ALPSOY, Mesut ENGİN, Şenol YAVUZ

Is there a difference between normotensive and hypertensive patients in terms of blood parameters and cardiovascular diseases?

Objectives: It has been stated in various studies that there is a difference in some blood parameters between hypertensive and normotensive patients for a long time. Mean platelet volume (MPV), and red blood cell distribution width (RDW), have been studied in hypertensive patient groups in many studies. Hypertension is a classic risk factor for ischemic stroke and myocardial ischemia, as known. In our study, we examined whether there was a difference between hypertensive patient groups and normotensive patients in terms of blood parameters such as MPV and RDW, and the incidence of stroke and myocardial infarction. Methods: Blood samples and twenty-four-hour ambulatory blood pressure monitoring (ABPM) results of 552 patients admitted to our outpatient clinic with a pre-diagnosis of hypertension were retrospectively analyzed. According to ABPM results, we divided the study participants into four groups; dippers, non-dippers, extreme dippers, and normotansives. Complete blood count and biochemical test results were found in the database of our hospital for all patients and differences between groups were investigated. Results: One hundred seventy three normotensives (Group 1) (mean age, 47.4 ± 15.4 years), 210 non-dippers (Group 2) (mean age, 53.8 ± 15.8 years), 67 extreme dippers (Group 3) (mean age, 49.1 ± 15.9 years) and 102 dippers (Group 4) (mean age, 52.2 ± 12.5 years). Daytime mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) and night-time mean SBP and DBP were significantly different in groups (Group 1: 117 [90-193] mmHg and 71 [55-87] mmHg; Group 2: 137 [107-188] mmHg and 83 [107-188] mmHg; Group 3: 143 [115-193] mmHg and 88 [56-122] mmHg; and Group 4: 140.5 [116-173] mmHg and 76 [55-124] mmHg), p < 0.001; respectively. MPV and RDW levels were different in all four groups (p < 0.001). We found a significant difference in the rates of stroke and coronary artery disease between the four groups (p = 0.018 and p = 0.002, respectively). In the ROC curve analysis MPV had sensitivity of %77. 8 and specificity of 78. 1% for stroke when the cut-off value MPV was 9.25 (Area under curve: 0.808, 95% confidence interval: 0.726-0.889, p < 0.001). Conclusions: In our study, MPV and RDW levels and the rates of stroke and cardiovascular disease were significantly higher in non-dipper patients compared to other groups.

Keywords:

Hypertension, platelet, inflammation, complications,

PDF

___

1. Özünal ZG, Tahirbegolli İA, Baykal M, Ateş B, Tahirbegolli B, Kılıç Y, et al. The drug adherence and lifestyle factors that contribute to blood pressure control among hypertensive patients. Eur Res J 2019;5:853-60.
2. Gu JW, Liu JH, Xiao HN, Yang YF, Dong WJ, Zhang QB, et al. Relationship between plasma levels of 25-hydroxyvitamin D and arterial stiffness in elderly Chinese with non-dipper hypertension: an observational study. Medicine (Baltimore). 2020;99:e19200.
3. Kario K, Pickering TG, Umeda Y, Hoshide S, Hoshide Y, Morinari M, et al. Morning surge in blood pressure as a predictor of silent and clinical cerebrovascular disease in elderly hypertensives: a prospective study. Circulation 2003;107:1401-6.
4. Allen LA, Felker GM, Mehra MR, Chiong JR, Dunlap SH, Ghali JK, et al. Validation and potential mechanisms of red cell distribution width as a prognostic marker in heart failure. J Cardiac Fail 2010;16:230-8.
5. Hampole CV, Mehrotra AK, Thenappan T, Gomberg‑Maitland M, Shah SJ. Usefulness of red cell distribution width as a prognostic marker in pulmonary hypertension. Am J Cardiol 2009;104:868-72.
6. Felker GM, Allen LA, Pocock SJ, Shaw LK, McMurray JJ, Pfeffer MA, et al. Red cell distribution width as a novel prognostic marker in heart failure: data from the CHARM program and the duke databank. J Am Coll Cardiol 2007;50:40-7.
7. Bath P, Algert C, Chapman N, Neal B. Association of mean platelet volume with risk of stroke among 3134 individuals with a history of CVD. Stroke 2004;35:622-6.
8. Akgül E, Engin M, Özyazıcıoğlu AF. Effects of mean platelet volume and platelet counts on peripheral biodegradable stent restenosis. J Surg Med. 2019;3:663-5.
9. Erdolu B, Engin M. The effect of mean platelet volume-to-lymphocyte ratio on symptom onset in patients with carotid artery stenosis. Turk J Vasc Surg 2021;30:7-12.
10. Bofosa T, Miangindula B, Kusuayi G, Kiana N, Nkiama C. Effect of an adapted physical activity program on the morphological and physiological profile of hypertensive patients of University Clinics of Kinshasa. Eur Res J 2019;5:618-22.
11. Sega R, Facchetti R, Bombelli M, Cesana G, Corrao G, Grassi G, et al. Prognostic value of ambulatory and home blood pressures compared with office blood pressure in the general population: follow-up results from the Pressioni Arteriose Monitorate e Loro Associazioni (PAMELA) study. Circulation 2005;111:1777-83.
12. Fagard RH, Thijs L, Staessen JA, Clement DL, De Buyzere ML, De Bacquer DA. Night-day blood pressure ratio and dipping pattern as predictors of death and cardiovascular events in hypertension. J Hum Hypertens 2009;23:645-53.
13. Tonelli M, Sacks F, Arnold M, Moye L, Davis B, Pfeffer M. for the Cholesterol and Recurrent Events (CARE) Trial Investigators. Relation between red blood cell distribution width and cardiovascular event rate in people with coronary disease. Circulation 2008;117:163-8.
14. Tosu AR, Demir S, Selcuk M, Kaya Y, Akyol A, Ozdemir M, et al. Comparison of inflammatory markers in non-dipper hypertension vs. dipper hypertension and normotensive individuals: uric acid, C-reactive protein, and red blood cell distribution width readings. Postepy Kardiol Interwencyjnej 2014;10:98-103.
15. Seo SG, Lee MY, Park SH, Han JM, Lee KB, Kim H, et al. The association between red cell distribution width and incident hypertension in Korean adults. Hypertens Res 2020;43:55-61.
16. Villmann JM, Burkhardt R, Teren A, Villmann T, Thiery J, Drogies T. Atherosclerosis, myocardial infarction and primary hemostasis: impact of platelets, von Willebrand factor and soluble glycoprotein VI. Thromb Res 2019;180:98-104.
17. Korniluk A, Koper-Lenkiewicz OM, Kamińska J, Kemona H, Dymicka-Piekarska V. Mean platelet volume (MPV): new perspectives for an old marker in the course and prognosis of inflammatory conditions. Mediators Inflamm 2019;2019:9213074.
18. Lewington S, Clarke R, Qizilbash N, Peto R, Collins R. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet 2002;360:1903-13.
19. Vasunta RL, Kesaniemi YA, Ylitalo A, Ukkola O. Nondipping pattern and carotid atherosclerosis in a middle-aged population: OPERA study. Am J Hypertens 2012;25:60-6.
20. Cuspidi C, Tadic M, Sala C, Gherbesi E, Grassi G, Mancia G. Extreme dipping: is the cardiovascular risk increased? An unsolved issue. J Hypertens 2019;37:1917-26.
21. Ohkubo T, Imai Y, Tsuji I, Watanabe N, Minami N, Kato J, et al. Relation between the nocturnal decline in blood pressure and mortality. Am J Hypertens 1997; 10:1201-7.
22. Cuspidi C, Tadic M, Sala C, Carugo S, Mancia G, Grassi G. Reverse dipping and subclinical cardiac organ damage: a meta-analysis of echocardiographic studies. J Hypertens 2021;39:1505-12.