CARDIOVASCULAR JOURNAL OF AFRICA • Volume 33, No 6, November/December 2022 320 AFRICA in 55 (25.6%) hypertensive patients. It was reported that the patients with increased CIMT were older and had higher neutrophil counts (p < 0.001), NLR (p < 0.001) and SII (p < 0.001).17 Moreover, they found that SII (odds ratio, OR: 3.906; p < 0.001) was an independent predictor of increased CIMT in multivariable logistic regression analysis. In our study, we concluded that SII was higher in newly diagnosed, treatmentnaïve, hypertensive women than in men. Women have higher circulating inflammatory cytokines and expression of pro-inflammatory genes, including C-reactive protein. Gender-based differences in myocardial gene expression revealed that many of the differentially expressed genes are involved in inflammation and cardiac remodelling.23 Furthermore, Tatsukawa et al. observed that increased neutrophil count was significantly related to incidence of hypertension in Japanese women.13 In our study, SII was higher in women with newly diagnosed hypertension than in men. Traditional cardiovascular risk factors are useful for predicting incident events in the younger population, however, their predictive value decreases with age.24 It is possible that the absence of inflammatory markers from these models decreases their predictive accuracy in older age groups. It suggests that a more substantial role of low-grade inflammation has cardiovascular disease pathogenesis in older adults than in younger adults. In observational studies of older adults, inflammatory markers are consistently and independently associated with cardiovascular disease.25 The age-associated decline in steroid hormone levels may also contribute to the elevation of pro-inflammatory markers. In vitro studies suggest that IL-6 gene transcription is repressed by oestrogen and androgen,26,27 and that these hormones inhibit the secretion of IL-6.28 In our study, it was found there was a positive correlation between SII and age in newly diagnosed, hypertensive women. The increased propensity of platelets to aggregation was determined in hypertensive patients. This situation is induced by adenosine diphosphate, and the presence of different morphological forms, especially the pseudopod formation of platelets, suggests activation of these blood cells.29 L-arginine uptake and platelet nitric oxide generation are impaired in hypertensive patients.30 In a study, it was demonstrated that platelet activation increased more in non-dipping hypertensive patients than in dipping hypertensive patients.31 Saylık et al. observed in their study that platelet counts and PLR were significantly higher in exaggerated morning blood pressure surges.22 In our study, platelet counts and PLR were significantly higher in newly diagnosed, hypertensive women. There are some limitations of this study. The first was that the study included only newly diagnosed and treatment-naïve hypertensive patients. Therefore, the effect of treatment could not be evaluated. Furthermore, our study cannot be generalised to all hypertensive patients because patients on antihypertensive medication were excluded from the study. The study was retrospective and the number of patients was small. Complete information about smoking status could not be obtained from the anamnesis of the patients. Conclusion This study showed that SII levels were higher in newly diagnosed, untreated, hypertensive women than in men. SII was correlated with age in this population. Inflammation is responsible for most of the unexpected complications of arterial hypertension. In addition, it can be concluded that complications related to hypertension may increase with increasing age in women due to inflammation. From these results, we recommend the use of the SII in cardiovascular diseases to increase survival in hypertensive women. References 1. Zhou B, Bentham J, Di Cesare M, Bixby H, Danaei G, Cowanet MJ, et al. 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