Chukwuka, MC

Ike, SO

Nubila, T

Ozochi, JU

Ukaejiofo, EO

English

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6Nigerian Journal of Clinical PracticeMarch 2009. Vol 12(1):6-10PROTHROMBIN TIME, ACTIVATED PARTIAL THROMBOPLASTIN TIMEAND OTHER HAEMATOLOGICAL PARAMETERS AMONG NON-DIABETICHYPERTENSIVE PATIENTS*EO Ukaejiofo, *T Nubila, **SO Ike, *JU Ozochi, *MC ChukwukaABSTRACTObjectivesSubjects and Methods:Results:Conclusion:Key Words:Department of Medical Laboratory Sciences, Faculty of Health Sciences and Technology, College ofMedicine, University of Nigeria, Enugu Campus **Medicine, University of Nigeria Teaching Hospital,Enugu, Nigeria.(Accepted 19 February 2008)s *and: To screen non-diabetic hypertensive Nigerian patients with a view to determining theirhaematological and coagulation profiles.Thirty (30) consecutive non-diabetic hypertensive patients, aged 20-60 years and 30age and sex-matched, apparently healthy subjects, were investigated for some haematological and coagulationparameters, blood pressure, pulse, body weight, height and body mass index.There were statistically significant differences (p<0.05), in some haematological parameters, bloodpressure, body mass index and height in the total number of patients studied when compared with the totalcontrol group. The separate genders each showed statistically significant differences in both haematologicalparameters and blood pressure (P<0.05) when compared with their corresponding control groups. In addition,haematological values, body mass index and height showed statistically significant differences (p<0.05) whenthe male and female patients were compared. Overall, 25 (83.33%) of the patient's blood films werenormochromic and normocytic.It appears that hypertension has adverse effects on haematological parameters. We thereforerecommended that coagulations studies should be included in the investigation work-up of hypertensivepatients.Prothrombin Time, Activated Partial Thromboplastin Time, Haematological Parameters, Non-diabetic Hypertensives.INTRODUCTIONCardiovascular disease is the main cause of death inthe developed world , and there is growing evidencethat a similar epidemic is inevitable for thedeveloping world, if current trends continueunchecked . Hypertension has for long been globallyrecognized as the most prevalent cardiovasculardisease and is an acknowledged potent risk factor inthe development of such disease outcomes ascoronary heart disease, stroke, congestive heartfailure and renal insufficiency. A direct positiverelationship between blood pressure andcardiovascular risk has long been established . Thisrelationship is strong, continuous, graded,consistent , independent, predictive, andetiologically significant for those with and withoutcoronary heart disease ; it has been identified in bothmales and females, younger and older adults,different racial and ethnic groups, different1234Correspondence: Prof E O UkaejiofoE-Mail:tnubila@ yahoo.co.ukcountries; and applies to those within high-normalblood pressure as well as those with hypertension .After adjusting for age and in line with the revisedcriteria by the World Health Organization (WHO,1999) , an overall 16.6% or 7.8million of the46.91million Nigerian population aged 15years andabove were believed to be hypertensive. Patients withhypertension have a tendency to die prematurely; themost common cause of death being heart disease,stroke , and/or renal failure . The health burden inNigeria (the index country of study) resulting fromhypertension is quite considerable .Newly recognized risk factors that influence thedevelopment of cardiovascular disease includepolymorphisms in the gene that encode fibrinogenand platelet glycoprotein II /III receptors.Specifically, a positive association exists betweenpolymorphisms in the fibrinogen B 448 and plateletglycoprotein III P1 genes and the extent of coronaryartery disease . Transient thrombosis and vaso-constriction cause unstable angina. Platelet-initiatedthrombus increases local concentration of567 89A10b aaβwere divided into two equal groups of fifteen (15)males and females respectively. Two control groupsof 15 males and 15 females were also studied. Thisbrought the total number of subjects studied to sixty(60).History was taken from the patients, after whichclinical examination was done, in order to establishthe diagnosis of hypertension, by one of the authors, acardiologist. Biodata and clinical parameters wererecorded.Routine chest radiograph, serum electrolytes, bloodurea and creatinine, fasting blood glucose andurinalysis were carried out to rule out the exclusioncriteria indices.Necessary haematological tests were then done,employing standard manual methods withappropriate controls in all laboratory investigations.On enrolment of the non-diabetichypertensive cases, suitable controls were identified.These were matched to the patients in age and sex andwere not hypertensive. These control subjectsincluded volunteering students, hospital staff andother patients undergoing a clinical check up andfound to be healthy.Physical age, sex, height, heart rate and bloodpressure recordings were done.Heamatological profile Haemoglobin (Hb),packed cell volume (PCV), Mean corpuscularhaemoglobin concentration (MCHC), plateletcount, erythrocyte sedimentation rate (ESR),Total and differential white blood cell count,such as neutrophils, lymphocytes, eosinophils,monocytes, and basophils, prothrombin time(PT) and Activated partial thromboplastin time(APTT).Data analysis was by computer, using EPI Info(version 6) statistical software. Data Storage was inMicrosoft Word XP2000.Data are expressed as mean (standard deviation). P.values less than 0.05 were regarded as significant.Figure 1 shows that there were 30 males and 30females, with male, female ratio 1:1. The ages rangedfrom 20 to 60 years with mean 44.3. The 41 50 agedgroup recorded the highest number of subjects.There were statistical differences (p<0.05) in Hb.PCV, platelet, ESR, total WBC, neutrophil,lymphocyte, and monocyte counts, PT, APTT, BP,height and BMI in the patients when compared withthe control group (table 1).D. Study DesignControls:E. Measurements(i)(ii)F. StatisticalAnalysisRESULTS1213147Nigerian Journal of Clinical Practice March 2009, Vol.12(1) Prothrombin Time Ukaejiofo et al8Nigerian Journal of Clinical Practice March 2009, Vol.12(1) Prothrombin Time Ukaejiofo et alThere were also statistical differences (p<0.05) inHb, PCV, ESR, lymphocyte, eosinophil, monocytecounts, PT and BP in the male patients whencompared with the male controls (table 2).Table 3 reveals statistical significant differences inHb, ESR neutrphil, eosinophil counts, BP, height andBMI (p<0.05) in the female patients when comparedto the corresponding females control.The lymphocyte, monocyte counts, height and BMIindices showed statistically significant differences(p<0.05) when the male and female patients werecompared (table 4).Overall 25 (83.33%) of the non-diabetichypertensive patients blood film showed normal(normochromic and normocytic) blood picture.Figure 1:Table 1:P- Value when compared with the control group: pAge and Sex Distribution of Subjects.Comparison between the Patients withthe Control (Non-Diabetic Hypertensive) Group.*Table 2:P-Value when compared with control group * P <0.01, ** P< 0.001, *** P< 0.0001Table 3:P-value * = P<0.01, ** = P< 0.001, *** = P<0.0001Comparison between the Male Patientswith Male Controls.Comparison between the Female Patientswith Female Control9Table 4:P-value * = P<0.01, ** = P< 0.001, *** = P<0.0001.Studies in the United States in community surveysover a period of 20 years, from 1971-72 and from1988-91, showed an increase among hypertensivepatients of awareness of their condition from 51-84%, and those on treatment from 36-73%. Incontrast, only about a third of Nigerians who arehypertensive are aware of their condition, and about2/3 of those who are aware are on treatment .Among the haematological parameters studied,prothrombin time, activated partial thromboplastintime, haemoglobin, packed cell volume, platelet,erythrocyte sedimentation rate, total white blood cellcount, neutrophil, lymphocyte and monocyte valuesshowed statistically significant differences (p<0.05)in the patients when compared with the control group(table I). This is in line with results of similarstudies that established significant differencesamong hypertensive patients, although theprothrombin time and activated par tia lthromboplastin time were not studied in these works.The values obtained in the present work however,places hypertensive patients as being among thehigh-risk group for the detection of coagulationdisorders. This may therefore bear out the need toroutinely screen non-diabetic hypertensive patientsfor coagulation parameters/profile.The blood pressure, height and body mass indexshowed statistically significant differences (p<0.05),Comparison between the Male andFemale Patients Group.DISCUSSION1516between patients and controls (table 1). Thisobservation is in keeping with the results obtained inhypertensive Nigerians by Akinkugbe et al, whoreported a strong correlation between the body massindex and the prevalence of hypertension.This study has revealed statistically significantdifferences in prothrombin time, haemoglobin,packed cell volume, erythrocyte sedimentation rate,lymphocyte, eosinophil, monocyte counts and bloodpressure measurements (p<0.05) when male patientswere compared with apparently healthy male controls(table 2); however, there was no significantdifferences in other parameters studied. Furthermore,the haemoglobin, erythrocyte sedimentation rate,neutrophil, monocyte, height and body mass indexshowed statistically significant differences (p<0.05)when the female patients were compared with thefemale controls (table 3). Although the differences inprevalence of hypertension among medicaladmissions in both sexes (males, 15.4% and females14.9%) in Eastern Nigeria in a work done at the samestudy location, was not significant , the present studyrevealed that male non-diabetic hypertensive patientsare more predisposed to coagulation defects than theircorresponding female patients (tables 2 and 3). Thismay be attributed to more exerting physical activities,alcohol consumption, cigarette smoking and lowerlevel of awareness among male hypertensive patientsas compared to the female hypertensive patients .Also, lymphocytes, monocyte counts, and body massindex (BMI) demonstrated statistically significantdifferences (p<0.05) between the male and femalepatients, with higher levels in the latter. This may beattributable to the significantly higher BMI values infemales as compared to the males of the same age.This observation lends itself to further largerpopulation based study.Generally, 25 (83.33%) of the non-diabetichypertensive patients blood films revealed normal(normochromic and normocytic) blood picture.This study has shown that hypertensive patientspresent with abnormal prothrombim time, activatedpartial thromboplastin time and other haematologicalparameters. It is, therefore, being recommended that,regular routine coagulation studies should be carriedout on hypertensive patients, as part of their clinicalinvestigation.Totalmortality and morbidity from heart diseases,cancer and stroke from 1950-1987 in 27countries: NIH Pub, 92-3088:1992 WashingtonDC.1596CONCLUSIONREFERENCES1. Thom TJ, Epstein FH, Felman FF.Nigerian Journal of Clinical Practice March 2009, Vol.12(1) Prothrombin Time Ukaejiofo et al2. Amery A, Strasser T.3. Whelton PK, He J, Appel LJ.4. Flack JM, Neaton J.5. Vasan RS, Larson MG, Leip EP, Evans JC,O’Donnel CJ, Kannel WB, Levy D.6.7. Sacco RL.8. Alderman MH.9. Onwubere BJC, Ike SO.. .Control of Hypertensionin Developing Countries. With specialreference to Africa.eds: Tropical CardiologySuppl, 1987.Prevention ofhypertension. Clinical and public healthadvisory from the national high blood pressureeducation program: JAMA, 2002; 288:1882-1888.For the multiple riskfactor intervention trial research group. Bloodpressure and mortality among men with priormyocardial infarction: Circulation, 1995;92:2437-2445.Impact ofhigh normal blood pressure on the risk ofcardiovascular disease: N Eng. J Med, 2001;345:1291-1297.WHO/ISH. Guidelines for the management ofhypertension: Journal of hypertension, 1999;17:151-183.Preventing stroke among blacks.The challenges continue: JAMA, 2002;289:3005-3006.Hypertension control andKidney diseases. Some questions answered,many remain: JAMA, 2002; 288-2466-2467.Prevalence ofhypertension and its complication amongstmedical admissions at the University of NigeriaTeaching Hospital, Enugu: Nig. J Int Med,2000,3:17-20.10. Carter AM, Osse GN.11. Alexander TS, Arthur MP.12. Dacie JV, Lewis SM.13.14.15. Akinkugbe OO.16. Ukaej io fo EO, Mbonu GU.Association of plateletPITrend incommunity knowledge of the warning signs andrisk factors for stroke: JAMA, 2003; 289:343-346.Practical Haematology. 8ed. London, Churchill Livingstone, 1991; 49-82.EPI INFO 6. version 6.04. Disease Control andPrevention (CDC), U.S.A., for World HealthOrganization. Geneva 2001.MICROSOFT WORD VERSIO N XPCalifornia. Microsft Incorporated 2000.Non-communicable Disease inNigeria, Final Report of a National Survey:Lagos. Fed. Min. of health and Social Services,1997; 12 41.SomeHaematological Parameters in Hypertensivepatients in University of Nigeria TeachingHospital (UNTH) Enugu. Unpublished BMLSThesis. University of Nigeria, Enugu Campus.2002 : 1 65.Athpolymorphism of glycoprotein 11b/111a andthe fibrinogen Bβ448 polymorphism withmyocardial infection and extent of coronaryartery disease: Circulation; 1997:1421-1431.10Nigerian Journal of Clinical Practice March 2009, Vol.12(1) Prothrombin Time Ukaejiofo et al

Prothrombin time, activated partial thromboplastin time and other haematological parameters among non-diabetic hypertensive patients

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Prothrombin time, activated partial thromboplastin time and other haematological parameters among non-diabetic hypertensive patients

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