CARDIOVASCULAR JOURNAL OF AFRICA • Volume 33, No 6, November/December 2022 318 AFRICA mellitus, secondary hypertension, pregnancy, malignancies, acute or chronic inflammatory or autoimmune disease, acute or chronic infectious disease, heart failure with reduced ejection fraction, moderate/severe valve stenosis or insufficiency, chronic liver and kidney disease [Cockcroft–Gault glomerular filtration rate (GFR) < 60 ml/min/1.73 m2], cancer or end-organ damage. The local ethics committee approved the current study. The research was carried out in compliance with the Declaration of Helsinki. All patients with high clinical BP had a 24-hour ABPM (Schiller MT-300 BP, Baar, Switzerland) that assessed and recorded BP and pulse rate at 15-minute intervals during the day and at 30-minute intervals at night. On the ABPM, patients with mean 24-hour SBP ≥ 130 mmHg and/or DBP ≥ 80 mmHg or mean daytime SBP ≥ 135 mmHg and/or DBP ≥ 85 mmHg were classified as hypertensive. Fasting blood samples were obtained from the peripheral veins. Fasting glucose level, cholesterol panel and renal function tests were measured by Cobas 6000 Roche. Complete blood count parameters were measured by an auto-haematology analyser (BC6800 Mindray Medical Electronics Co, Shenzhen, China). The SII index was calculated according to the following formula at admission: SII = platelet counts × neutrophil counts _______________ lymphocyte counts. 17 Platelet–lymphocyte ratio (PLR) and neutrophil–lymphocyte ratio (NLR) were calculated according to the following formulae: PLR = platelet counts/lymphocyte counts NLR = neutrophil counts/lymphocyte counts. Heart chamber diameters, valvular pathology, systolic pulmonary artery pressure and ejection fraction (measured using the modified Simpson method) were obtained from the apical and parasternal axes with a 2.5-MHz transducer and echocardiography machine (Vivid 5; GE Healthcare, Inc, Chicago, IL, USA). Statistical analysis IBM SPSS Statistics for Windows, version 18.0 (IBM Corp, Armonk, NY, USA) was used to perform the statistical analysis. The Kruskal–Wallis test was used to assess the normality of distribution of the variables. Quantitative variables with a normal distribution are specified as the mean ± standard deviation and non-normally distributed variables are specified as median (interquartile range, IQR). Categorical variables are shown as numbers and percentages. The non-normally distributed variables were assessed with the Mann–Whitney U-test, while normally distributed variables were assessed with an independent samples Student’s t-test. Spearman correlation analysis was used for each group separately to examine the relationships between total cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglycerides, fasting glucose, creatinine and SII. Receiver operating characteristic (ROC) curve analysis was performed and the Youden index was calculated separately to determine the SII threshold to predict for hypertensive women. Results Among baseline characteristics, serum creatinine (p < 0.001) and haemoglobin levels (p < 0.001) were significantly higher in the men. However, HDL-C and platelet counts were higher in the women (p = 0.006; p < 0.001, respectively). Baseline characteristics of the study population are summed up in Table 1. Table 2 shows the comparison of ABPM results and inflammatory markers. PLR [110.98 (IQR 45.42) vs 94.77 (IQR 37.65), respectively, p < 0.001] and SII [546.31 (IQR 190.61) vs 385 (IQR 204.01), respectively, p = 0.003] were significantly higher in women, whereas 24-hour DBP, daytime DBP and night-time DBP were lower (p < 0.001, p < 0.001 and p = 0.021, respectively). Correlation analysis was performed between SII and lipid parameters, and inflammatory and metabolic markers in women andmen. In the hypertensive women, SII was positively correlated with age (r = 0.385, p = 0.003). Results of the correlation analysis in the women are shown in Tables 3, 4. ROC analysis was performed to determine the optimal threshold for SII to predict the occurrence of new-onset essential hypertension in women. The ROC curve shows the SII cut-off Table. 1. Comparison of demographic and laboratory parameters between the groups Parameters Whole population (n = 153) Women (n = 60) Men (n = 93) p-value Age (years) 46.74 ± 8.4 45.71 ± 8.10 46.72 ± 9.54 0.502 BMI (kg/m2) 29.68 ± 4.22 30.77 ± 5.52 29.17 ± 3.36 0.182 Glucose (mg/dl) (mmol/l) 96.1 ± 11.26 96.76 ± 10.46 97.85 ± 11.82 0.601 Serum creatinine (mg/dl) 0.82 ± 0.21 0.67 ± 0.16 0.92 ± 0.17 < 0.001 Total cholesterol (mg/dl) (mmol/l) 195.3 ± 38.37 (5.06 ± 0.99) 191.61 ± 42.66 (4.96 ± 1.10) 205.93 ± 47.93 (5.35 ± 1.24) 0.132 LDL-C (mg/dl) (mmol/l) 118.67 ± 31.61 (3.07 ± 0.82) 112.4 ± 32.87 (2.91 ± 0.85) 122.71 ± 30.39 (3.18 ± 0.79) 0.135 HDL-C (mg/dl) (mmol/l) 45.75 ± 10.64 (1.18 ± 0.28) 48.26 ± 12.57 (1.25 ± 0.33) 42.08 ± 9.41 (1.09 ± 0.24) 0.006 Triglycerides (mg/dl) (mmol/l) 162.86 (107–219.5)** [1.84 (1.21–2.48)] 180.49 ± 151.10 (2.04 ± 1.71) 218.78 ± 161.52 (2.47 ± 1.83) 0.240 Haemoglobin (g/dl) 14.52 ± 1.46 13.3 (12.45–14.35)** 15.25 (14.75–16.05)** < 0.001* White blood cell count (×103 cells/µl) 8258 ± 2042 8250 (6765–8575)** 8350 (7350–10500)** 0.314* Neutrophil count (×103 cells/µl) 4871 ± 1571 4920 (3802–6037)** 4760 (4045–6645)** 0.842* Lymphocyte count (×103 cells/µl) 2593 ± 839 2508 ± 786.81 2641 ± 858.25 0.357 Platelet count (×103 cells/µl) 206.86 ± 61.33 286.82 ± 62.02 243.14 ± 54,47 < 0.001 BMI: body mass index; LDL-C: low-density lipoprotein cholesterol; HDL-C: high-density lipoprotein cholesterol. *Mann–Whitney U-test; **interquartile range.
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