CARDIOVASCULAR JOURNAL OF AFRICA • Volume 33, No 6, November/December 2022 AFRICA 317 The relationship between gender and systemic immune– inflammation index in patients with new-onset essential hypertension Emine Altuntas, Sükrü Cetın, Songül Usalp Abstract Aim: The systemic immune–inflammation index (SII) has been reported to have a prognostic ability in various cardiovascular diseases and tumours. In this study, we aimed to investigate whether there was an association between SII and gender and age in newly diagnosed, treatment-naïve, hypertensive patients. Methods: A total of 153 participants, of whom 93 were men and 60 were women, were included in this retrospective study. Retrospective evaluation of the patients was performed using electronic medical records. The SII was calculated according to the following formula at admission: SII = platelet × neutrophil/lymphocyte counts Results: The SII was significantly higher in women compared to men (546.31 vs 385, respectively, p = 0.003) and was positively correlated with age. The receiver operating characteristic curve shows the SII cut-off value predicting new-onset essential hypertension with a sensitivity of 67.6% and a specificity of 67.2% in women. Conclusion: According to these results, using the SII in cardiovascular diseases may be recommended to increase survival rate in hypertensive women. Keywords: systemic immune–inflammation index, newly diagnosed hypertension, gender, age, inflammation Submitted 16/2/22, accepted 30/5/22 Published online 22/7/22 Cardiovasc J Afr 2022; 317–321 www.cvja.co.za DOI: 10.5830/CVJA-2022-030 The global prevalence of hypertension is estimated to be 1.13 billionpeople.1 In addition, the general prevalence of hypertension in adults is around 30 to 45%, with the global age-standardised prevalence in men and women being 24 and 20%, respectively.1,2 Moreover, hypertension is responsible for nearly 10 million deaths and more than 200 million disabilities and premature deaths. Despite advances in diagnosis and treatment, disability attributable to hypertension has increased by 40% since 1990.3 Hypertension has an independent and continuous relationship with the incidence of several cardiovascular events such as haemorrhagic stroke, ischaemic stroke, myocardial infarction, sudden death, heart failure, peripheral artery disease, end-stage renal disease and atrial fibrillation 4,5 The systemic immune–inflammation index (SII) has been reported to have a prognostic ability in various cardiovascular diseases and tumours. It is based on platelet, neutrophil and lymphocyte counts.6,7 Inflammation leads to the development of hypertension and consequently end-organ damage.8 An association between hypertension and inflammatory markers such as white blood cells, C-reactive protein and interleukin-6 (IL-6) level has been shown in several studies.9,10 Before the onset of hypertension, the neutrophil count increases,11 and it is also associated with the incidence of hypertension.12,13 Platelets are activated by several agonists in hypertensive patients, and a positive linear relationship has been shown between blood pressure and platelet aggregation.14 The activated T cells cause a release of reactive oxygen species and vasoactive cytokines. Consequently, blood pressure is affected.15 The role of inflammation in the pathogenesis of hypertension is a known issue; however, to the best of our knowledge, the link between hypertension and gender has not been studied in patients with newly diagnosed hypertension. In this study, we aimed to investigate whether there was an association between SII and gender and age in newly diagnosed, treatment-naïve, hypertensive patients. Methods A total of 153 participants, of whom 93 were men and 60 were women, were included in this retrospective study. Blood pressure (BP) was measured according to the 2018 European Society of Cardiology/European Society of Hypertension clinical practice guidelines for the management of arterial hypertension.16 BP measurements were taken two or more times on separate days following at least 10 minutes of rest at the cardiology out-patient clinic. Patients with high clinical BP [mean systolic blood pressure (SBP) ≥ 140 mmHg and/or mean diastolic blood pressure (DBP) ≥ 90 mmHg] were subjected to laboratory and ambulatory blood pressure monitoring (ABPM). Hypertension was defined in both clinical and ABPM assessments. Hypertension was defined as an office SBP of ≥ 135 mmHg, a DBP of ≥ 85 mmHg and ≥ 130/80 mmHg over 24 hours, ≥ 135/85 mmHg for the daytime average and ≥ 120/70 mmHg for the night-time average (all equivalent to office BP ≥ 140/90 mmHg).16 Retrospective evaluation of the patients was performed using electronic medical records. Newly diagnosed essential hypertensive patients were included in the study. Patients receiving antihypertensive treatment were excluded from the study. We also excluded patients ≤ 18 years old, with white-coat hypertension, a history of coronary artery disease, atrial fibrillation, diabetes Department of Cardiology, Sancaktepe Sehit Prof Dr Ilhan Varank Education and Research Hospital, Istanbul, Turkey Emine Altuntas, MD, emine_altuntas@hotmail.com Sükrü Cetın, MD Songül Usalp, MD
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