hsCRP in pre-hypertension and hypertension: a prospective study in Southern Asian region
Keywords:Hypertension, Pre-hypertension, hsCRP, Systolic blood pressure, Diastolic blood pressure
Background:Hypertension is turned into a leading cause of non-communicable disease associated mortality and morbidity in both developing as well as developed world. Hypertension is reported to be the fourth contributor to premature death in developed countries and the seventh in developing countries. In the regard of early diagnosis and better prognosis, the concept of pre-hypertension, defined as a systolic blood pressure of 120-139 mmHg and/or a diastolic blood pressure of 80-89 mmHg was introduced as the new guideline for the management of blood pressure by the seventh report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure (JNC-7). Among various other factors inflammation may be a causative factor for development of Hypertension But the association is not very clear. Accordingly, we have designed our study to find any association of hsCRP with pre-hypertension and hypertension so that early prevention and control can help to avoid or delay the grave outcome and complications of hypertension.
Methods:A total of 37 hypertensives, 30 pre-hypertensives and 31 age and sex matched healthy control subjects were selected for the study, with consent. Two BP readings were taken five minutes apart, on both arms, with a mercury sphygmomanometer. The estimation of serum hsCRP was done on XL-600 automatic analyzer with the kit (Erba Mannheim) based on the measurement of antigen-antibody reaction by the end-point method.
Results:There is significant difference in systemic and diastolic blood pressure and hsCRP in between group study. In pre-hypertensive group hsCRP is correlated with diastolic blood pressure.
Conclusion:Our results suggest a correlation exists between hsCRP and hypertension more significantly with pre-hypertension. So estimation of serum hsCRP can be a good diagnostic as well as prognostic marker in diagnosing pre-hypertensives and prevent the occurance of hypertension and cardio vascular disorders thereby.
He J, Whelton PK. Epidemiology and prevention of hypertension. Med Clin North Am. 1997;81:1077-97.
Whelton PK. Epidemiology of hypertension. Lancet. 1994;344:101-6.
Takale LR, More UK, Sontakke AN, Tilak MA. Serum total and free calcium in hypertension. Indian J Basic Appl Med Res. 2013 Jun;2(7):716-20.
Lewington S, Clarke R, Qizilbash N, Peto R, Collins R. Epidemiology of hypertension. Suppl JAPI. 2013 Feb;61:12-3.
Devi P, Rao M, Sigamani A, Faruqui A, Jose M, Gupta R, et al. Prevalence, risk factors and awareness of hypertension in India: a systematic review. J Hum Hypertens. 2013 May;27:281-7.
Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, et al. JNC 7: Complete Report. Seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure. Hypertension. 2003;42:1206-52.
A. K. Gupta, M. McGlone, F. L. Greenway, W. D. Johnson. Prehypertension in disease-free adults: a marker for an adverse cardiometabolic risk profile. Hypertens Res. 2010;33(9):905-10.
Wu SL, Zhang ZQ, Song SB, Yao TC, Li Y, Wang JL, et al. Prevalence of prehypertension and associated cardiovascular risk: two years follow up results. Zhonghua Xin Xue Guan Bing Za Zhi. 2010 May;38(5):415-9.
S. A. Isezuo, A. A. Sabir, A. E. Ohwovorilole, O. A. Fasanmade. Prevalence, associated factors and relationship between prehypertension and hypertension: a study of two ethnic African populations in Northern Nigeria. J Hum Hypertens. 2011;25:224-30.
Cordero A, Laclaustra M, Le´on M, Grima A, Casasnovas JA, Luengo E, et al. Prehypertension is associated with insulin resistance state and not with an initial renal function impairment: a metabolic syndrome in active subjects in Spain (MESYAS) registry substudy. Am J Hypertens. 2006;19(2):189-96.
LI Jian-jun. Inflammation in hypertension: primary evidence. Chin Med J. 2006;119:1215-21.
Pauleto P, Rattazzi M. Inflammation and Hypertension: the search for a link. Nephrol Dial Transplant. 2006;21:850-3.
Hirschfield GM, Pepys MB. C-reactive protein and cardiovascular disease: new insights from an old molecule. Q J Med. 2003;96:793-807.
Di Napoli M, Schwaninger M, Cappelli R, Ceccarelli E, Di Gianfilippo G, Donati C, et al. Evaluation of C-reactive protein measurement for assessing the risk and prognosis in ischemic stroke; a statement for health care professionals from the crp pooling project members. Stroke. 2005;36:1316-29.
Black S, Kushner I, Samols D. C-reactive protein. J Biol Chem. 2004;279:48487-90.
Boos CJ, Lip GYH. Elevated high-sensitivity C-reactive protein, large arterial stiffness and atherosclerosis: a relationship between inflammation and hypertension? J Human Hypertens. 2005;19:511-3.
Bautista LE, Lopez- Jaramillo, Vera LM, Casas JP, Otero AP, Guaracao AI. Is C-Reactive Protein an independent risk factor for essential hypertension? J Hypertens. 2001;19(5):857-61.
Mendall MA, Patel P, Ballam L, Strachan D, Northfield TC. C-reactive protein and its relation to cardiovascular risk factors: a population based cross sectional study. BMJ. 1996;312:1061-5.
Dawri S, Padwal MK, Melinkeri R. Evaluation of high sensitivity C-reactive protein and serum lipid profile in prehypertension and essential hypertension. NJIRM. 2014 Jan-Feb;5(1):1-5.
Ryu SY, Lee YS, Park J, Kang MG, Kim KS. Relations of plasma high-sensitivity C-reactive protein to various cardiovascular risk factors. J Korean Med Sci. 2005;20:379-83.
M. Shafi Dar, A. A. Pandith, A. S. Sameer, M. Sultan, A. Yousuf, S. Mudassar. hs-CRP: a potential marker for hypertension in Kashmiri population. Indian J Clin Biochem. 2010;25(2):208-12.
National High Blood Pressure Education Program. National Institutes of Health National Heart, Lung, and Blood Institute. Complete Report. The seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure, 2004 Available at: http://www.nhlbi. Accessed 23 September 2009.
Marcy EM, Hayes TE, Tracy RP. Variability in measurement of C-reactive protein in healthy subjects: implication reference interval and epidemiological applications. Clin Chem. 1997;43:52-8.
Rohde LE, Hennekens CH, Ridker PM. Survey of C-reactive protein and cardiovascular risk factors in apparently healthy men. Am J Cardiol. 1999;84:1018-22.
Sesso HD, Bruing JE, Rifai N, Blake GJ, Gaziano JM, Ridker PM. C-reactive protein and the risk of developing hypertension. JAMA. 2003;290:2945-51.
Bermudez EA, Rifai N, Buring J, Manson JE, Ridker PM. Interrelationships among circulating interleukin-6, C-reactive protein, and traditional cardiovascular risk factors in women. Arterioscler Thromb Vasc Biol. 2002;22:1668-73.
Devaraj S, Xu DY, Jialal I. C-reactive protein increases plasminogen activator inhibitor-1 expression and activity in human aortic endothelial cells; implications for the metabolic syndrome and atherothrombosis. Circulation. 2003;107:398-404.
Wang CH, Li SH, Weisel RD, Fedak PW, Dumont AS, Szmitko P, et al. C-reactive protein upregulates angiotensin type 1 receptors in vascular smooth muscle. Circulation. 2003;107:1783-90.
Pietri P, Vyssoulis G, Vlachopoulos C, Zervoudaki A, Gialernios T, Aznaouridis K, et al. Relationship between low-grade inflammation and arterial stiffness in patients with essential hypertension. J Hypertens. 2006;24(11):2231-8.
Kampus P, Muda P, Kals J, Ristimäe T, Fischer K, Teesalu R, et al. The relationship between inflammation and arterial stiffness in patients with essential hypertension. Int J Cardiol. 2006;112(1):46-51.
Kim JS, Kang TS, Kim JB, Seo HS, Park S, Kim C, et al. Significant association of C-reactive protein with arterial stiffness in treated non-diabetic hypertensive patients. Atherosclerosis. 2007;192(2):401-6.
Sung KC, Suh JY, Kim BS, Kang JH, Kim H, Lee MH, et al. High sensitivity C-reactive protein as an independent risk factor for essential hypertension. Am J Hypertens. 2003;16:429-33.
A. I. Qureshi, M. F. Suri, J. F. Kirmani, A. A. Divani, Y. Mohammad. Is prehypertension a risk factor for cardiovascular diseases? Stroke. 2005;36(9):1859-63.
S. Lewington, R. Clarke, N. Qizilbash, R. Peto, R. Collins. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet. 2002;360(9349):1903-13.
R. S. Vasan, M. G. Larson, E. P. Leip, W. B. Kannel, D. Levy. Assessment of frequency of progression to hypertension in non-hypertensive participants in the Framingham heart study: a cohort study. Lancet. 2001;358(9294):1682-6.
King DE, Egan BM, Mainous AG 3rd, Geesey ME. Elevation of C-reactive protein in people with prehypertension. J Clin Hypertens. 2004;6:562-8.
Gupta AK, Johnson WD. Prediabetes and prehypertension in disease free obese adults correlate with an exacerbated systemic proinflammatory milieu. J Inflammation. 2010;7:36.
Li Jinghua, Zhang Tie, Wang Ping, Cao Yongtong. The relationship between serum sialic acid and high-sensitivity C-reactive protein with prehypertension. Med Sci Monit. 2014;20:551-5.