CARDIOVASCULAR JOURNAL OF AFRICA • Volume 33, No 6, November/December 2022 AFRICA 319 value predicting new-onset essential hypertension, with a sensitivity of 67.6% and a specificity of 67.2% in women (area under the curve = 0.714, p < 0.001, 95% CI: 0.611–0.818; SII = 488.21) (Fig. 1). Discussion This study has shown that SII was higher in newly diagnosed, treatment-naïve, hypertensive women than in men. The SII value was significantly positively correlated with age in women. To our knowledge, this study is the first in the literature that has investigated the relationship between SII and gender in newly diagnosed, treatment-naïve, hypertensive patients. Chronic inflammation has a very important place in the development of many diseases, such as malignancy, metabolic diseases and cardiovascular diseases. Determination of the active role of inflammation in the development of hypertension has enabled research to focus on this area. Until now, inflammatory parameters such as white blood count, NLR, C-reactive protein and some interleukins have been reported to be associated with the severity of arterial hypertension.18,19 Seo et al. for the first time described SII as a prognostic marker in congestive heart failure.20 Thereafter, Yang et al. reported that SII had better risk prediction than traditional risk factors regarding death, congestive heart failure and major adverse cardiovascular events in patients with coronary artery disease.21 Saylık et al. aimed to investigate whether there was an association between SII and the exaggerated morning blood pressure surge in newly diagnosed, treatment-naïve, hypertensive patients. They observed that SII was higher in patients with exaggerated morning blood pressure surges and was independently associated with the surges.22 In another study, the relationship between systemic inflammatory indicators and subclinical changes related to atherosclerosis within the arterial wall in hypertensive patients was investigated. The study consisted of 215 consecutive patients who were followed previously with essential hypertension. Increased carotid intima–media thickness (CIMT) was detected Table. 2. Comparison of ambulatory blood pressure monitoring results and inflammatory markers between the groups Parameters Whole population (n = 153) Women (n = 60) Men (n = 93) p-value SII 473.6 (335.55–627.18)** 546.31 (452.32–626.78)** 385 (329.75–634) ** 0.003* NLR 1.83 (1.43–2.26) 1.83 (1.59–2.26)** 1.7 (1.44–2.46)** 0.341* PLR 144 (83.72–124.32) 110.98 (86.99–139.19)** 94.77 (80.14–114.74)** < 0.001* Clinic SBP (mmHg) 147.15 (138–150.5)** 145 (134,78–151.86)** 149 (142.3–153.75)** 0.077* Clinic DBP (mmHg) 98.78 ± 9.23 97.50 ± 8.18 99.31 ± 9.35 0.062 24-h SBP (mmHg) 144 (138–150.5)** 141.5 (136–140.5)** 145 (141.5–152)** 0.134* 24-h DBP (mmHg) 95.54 ± 8.45 91.98 ± 7.67 97.07 ± 8.25 < 0.001 Daytime SBP (mmHg) 146 (140–154)** 144 (139.75–152.25)** 149 (144.5–154)** 0.069* Daytime DBP (mmHg) 97.72 ± 9.32 93.56 ± 8.18 99.59 ± 9.35 < 0.001 Night-time SBP (mmHg) 137.54 ± 9.32 137.1 ± 13.46 137.60 ± 15.05 0.834 Night-time DBP (mmHg) 88.38 ± 11.24 85.5 ± 10.13 89.74 ± 11.49 0.021 LVEF (%) 60.90 ± 3.36 60.74 ± 3.96 61.01 ± 2.96 0.654 LVMI (g/m2) 100 (87–114)** 100 (83.75–110.5)** 101 (87–112)** 0.603* SII: systemic immune–inflammation index; NLR: neutrophil-to-lymphocyte ratio; PLR: platelet-to-lymphocyte ratio; SBP: systolic blood pressure; DBP: diastolic blood pressure; LVEF: left ventricular ejection fraction; LVMI: left ventricular mass index. *Mann–Whitney U-test, **interquartile range. Table. 4 Correlation analysis between SII and age, fasting glucose and lipid parameters in men Parameters p-value Rho Age 0.620 0.055 Fasting glucose 0.486 0.081 Total cholesterol 0.236 0.150 Low-density lipoprotein cholesterol 0.835 0.029 High-density lipoprotein cholesterol 0.060 –0.206 Triglycerides 0.801 0.032 SII: systemic immune–inflammation index. Table. 3. Correlation analysis between SII and age, fasting glucose and lipid parameters in women Parameters p-value Rho Age 0.003 0.385* Fasting glucose 0.600 –0.077 Total cholesterol 0.525 –0.106 Low-density lipoprotein cholesterol 0.255 –0.198 High-density lipoprotein cholesterol 0.907 0.020 Triglycerides 0.663 0.073 SII: systemic immune–inflammation index. 100 – Specificity (%) 0.0 0.2 0.4 0.6 0.8 1.0 Sensitivity (%) 1.0 0.8 0.6 0.4 0.2 0.0 Fig. 1. Receiver operating characteristic curve to determine the optimal threshold for SII to predict new-onset, essential hypertension in women (AUC: 0.714; p = 0.000; 95% CI: 0.611–0.818; 67.6% sensitivity, 67.2% specificity; SII = 488.21).
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