The relationship between red cell distribution width and resistant hypertension

Abstract

Aim: Erythrocyte distribution width (RDW) is known to be associated with cardiovascular diseases. Patients with resistant hypertension (RHT) have a higher risk of cardiovascular events. In this study, we aimed to evaluate the relationship between RDW and resistant hy-pertension. Material and Methods: A total of 157 patients, 69 (43%) of them being resistant hyperten-sion, who had 24-hour ambulatory blood pressure measurement (ABPM) were included in this study. RDW and other laboratory parameters were measured after ABPM. Results: The average age in the study population was 57 ± 11, and 77% (121) of the patients were female. Patients were divided into two groups as controlled and RHT. The RDW was significantly higher in the RHT group (14.8±1.4) compared to the CHT group (14.1±1.2); (p=0,02). RDW by multivariable logistic regression analysis (odds ratio [OR]: 1.684, 95% confidence Interval [CI]: 1.250-2.201 p <0.001), diabetes mellitus (OR: 3.459, 95% CI: 1.095-10.930 p = 0.035) and Body Mass Index (BMI) (OR: 1.085, 95% CI: 1.013-1.163 p = 0.02) was found to be an independent predictor of RHT. In the ROC analysis performed of RDW in predicting RHT, the optimal predictive value for RDW was % 14.65 with 62.5% sensitivity and 65.2% specificity. RDW's Area Under Curve (AUC) value was 0.63 (95%CI: 0.551-0.726). Conclusion: RDW, which was found to be associated with high mortality in cardiovascular diseases, was significantly higher in the RHT patient group compared to the CHT patient group, and RDW was found to be an independent predictor of resistant hypertension.

Keywords

• Red Blood Cell Width, Hypertension, Resistant Hypertension, Controlled Hypertension, Ambulatory Blood Pressure Measurement

Kırmızı hücre dağılım genişliği ile dirençli hipertansiyon arasındaki ilişki

Abstract

Amaç: Eritrosit dağılım genişliğinin (RDW) kardiyovasküler hastalıklarla ilişkili olduğu bilinmektedir. Dirençli hipertansiyonu (DHT) olan hastalarda kardiyovasküler olay riski daha yüksektir. Bu çalışmada RDW ile dirençli hipertansiyon arasındaki ilişkiyi değerlendirmeyi amaçladık. Gereç ve Yöntemler: Bu çalışmaya 24 saatlik ambulatuar kan basıncı ölçümü (AKBÖ) yapılan 69 (%43) dirençli hipertansiyon olmak üzere toplam 157 hasta dahil edildi. AKBÖ'den sonra RDW ve diğer laboratuvar parametreleri ölçüldü. Bulgular: Çalışma popülasyonundaki ortalama yaş 57 ± 11 idi ve hastaların %77'si (121) kadındı. Hastalar kontrollü HT (KHT) ve DHT olarak iki gruba ayrıldı. RDW, KHT grubuna (14.1±1.2) kıyasla DHT grubunda (14.8±1.4) anlamlı olarak daha yüksekti; (p=0,002). Çok değişkenli lojistik regresyon analizi ile RDW (olasılık oranı [OR]: 1.684, %95 Güven Aralığı [GA]: 1.250-2.201 p <0.001), diabetes mellitus (OR: 3.459, %95 GA: 1.095-10.930 p = 0.035) ve Vücut Kitle İndeksi (VKI) (OR: 1.085, %95 GA: 1.013-1.163 p = 0.02), RHT'nin bağımsız bir belirleyicisi olarak bulundu. RDW'nin RHT'yi öngörmede yaptığımız ROC analizinde, RDW için optimal prediktif değer %62,5 duyarlılık ve %65,2 özgüllük ile %14.65 idi. RDW'nin Eğri Altındaki Alan (AUC) değeri 0,63 (%95CI: 0,551-0,726) idi. Sonuç: Kardiyovasküler hastalıklarda yüksek mortalite ile ilişkili bulunan RDW, DHT hasta grubunda KHT hasta grubuna göre anlamlı olarak daha yüksek bulundu ve RDW dirençli hipertansiyonun bağımsız bir öngördürücüsü olarak bulundu.

Keywords

• Kırmızı Kan Hücresi Genişliği
• Hipertansiyon
• Dirençli Hipertansiyon
• Kontrollü Hiper-tansiyon
• Ayaktan Kan Basıncı Ölçümü

References

1. 1- Williams B, Mancia G, Spiering W et al. 2018 Practice guidelines for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension. Blood Pressure 2018; 27: 314-40.
2. 2- Carey RM, Calhoun DA, Bakris GL et al. Resistant Hypertension: Detection, Evaluation, and Management: A Scientific Statement From the American Heart Association. Hyper-tension 2018; 72: 53-90.
3. 3- Daugherty SL, Powers JD, Magid DJ et al. Incidence and Prognosis of Resistant Hyper-tension in Hypertensive Patients. Circulation 2012; 125: 1635-42.
4. 4- Calhoun DA, Jones D, Textor S et al. Resistant Hypertension: Diagnosis, Evaluation, and Treatment. Hypertension 2008; 51: 1403-19.
5. 5- Hiremath S, Sapir-Pichhadze R, Nakhla M et al. Hypertension Canada's 2020 Evidence Review and Guidelines for the Management of Resistant Hypertension. Can J Cardiol 2020; 36: 625-34.
6. 6- Bessman JD, Gilmer PR, Jr., Gardner FH: Improved classification of anemias by MCV and RDW. Am J ClinPathol 1983; 80: 322-6.
7. 7- Pierce CN, Larson DF. Inflammatory cytokine inhibition of erythropoiesis in patient simp-lanted with a mechanical circulatory assist device. Perfusion 2005; 20: 83-90.
8. 8- Kato H, Ishida J, Imagawa S et al. Enhanced erythropoiesis mediated by activation of the renin‐angiotensin system via angiotensin II type 1a receptor. FASEB j 2005; 19: 2023-5.

9. 9- Biaggioni I, Robertson D, Krantz S et al. The anemia of primary autonomic failure and its reversal with recombinant erythropoietin. Ann Intern Med 1994; 121: 181-6.
10. 10- Tanindi A, Topal FE, Topal F, Celik B. Red cell distribution width in patients with prehypertension and hypertension. Blood Press 2012; 21: 177-81.
11. 11- Daugherty SL, Powers JD, Magid DJ et al. Incidence and prognosis of resistant hyperten-sion in hypertensive patients. Circulation 2012; 125: 1635-42.
12. 12- Tsioufis C, Kasiakogias A, Kordalis A et al. Dynamic resistant hypertension patterns as predictors of cardiovascular morbidity: a 4-year prospective study. J Hypertens 2014; 32: 415-22.
13. 13- Pierdomenico SD, Lapenna D, Bucci A et al. Cardiovascular outcome in treated hyperten-sive patients with responder, masked, false resistant, and true resistant hypertension. Am J Hypertens 2005; 18: 1422-8.
14. 14- Salles GF, Cardoso CR, Muxfeldt ES. Prognostic influence of office and ambulatory blood pressures in resistant hypertension. Arch Intern Med 2008; 168: 2340-6.
15. 15- Muxfeldt ES, Cardoso CR, Salles GF. Prognostic value of nocturnal blood pressure reduc-tion in resistant hypertension. Arch Intern Med 2009; 169: 874-80.
16. 16- Akın H, Bilge Ö, Yavuz B, Özkan S, Işık F. The relationship between mean platelet volu-me and resistant hypertension. Clin Exp Hypertens 2022; 3: 1-5.
17. 17- Lippi G, Targher G, Montagnana M, Salvagno GL, Zoppini G, Guidi GC. Relation between red blood cell distribution width and inflammatory biomarkers in a large cohort of unselected outpatients. Arch Pathol Lab Med 2009; 133: 628-32.
18. 18- Lappé JM, Horne BD, Shah SH et al. Red cell distribution width, C-reactive protein, the complete blood count, and mortality in patients with coronary disease and a normal com-parison population. Clin Chim Acta 2011; 412: 2094-9.
19. 19- Fukuta H, Ohte N, Mukai S et al. Elevated plasma levels of B-type natriuretic Peptide but not C-reactive protein are associated with higher red cell distribution width in patients with coronary artery disease. Int Heart 2009; 50: 301-12.
20. 20- Isik T, Uyarel H, Tanboga IH et al. Relation of red cell distribution width with the presen-ce, severity, and complexity of coronary artery disease. Coron Artery Dis 2012; 23: 51-6.
21. 21- Felker GM, Allen LA, Pocock SJ 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.
22. 22- Uyarel H, Ergelen M, Cicek G et al. Red cell distribution width as a novel prognostic marker in patients undergoing primary angioplasty for acute myocardial infarction. Coron Artery Dis 2011; 22: 138-44.
23. 23- Dabbah S, Hammerman H, Markiewicz W, Aronson D. Relation between red cell distribu-tion width and clinical outcomes after acute myocardial infarction. Am J Cardiol 2010; 105: 312-7.
24. 24- Ye Z, Smith C, Kullo IJ. Usefulness of red cell distribution width to predict mortality in patients with peripheral artery disease. Am J Cardiol 2011; 107: 1241-5.
25. 25- Weiss G, Goodnough LT. Anemia of chronic disease. N Engl J Med 2005; 352: 1011-23.
26. 26- Tonelli M, Sacks F, Arnold M, Moye L, Davis B, Pfeffer M. Relation Between Red Blood Cell Distribution Width and Cardiovascular Event Rate in People With Coronary Disease. Circulation. 2008; 117: 163-8.
27. 27- Ozcan F, Turak O, Durak A et al. Redcell distribution width and inflammation in patients with non-dipper hypertension. Blood Press 2013; 22: 80-5.