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The association between red cell distribution width and incident hypertension in Korean adults

A Comment to this article was published on 30 October 2019


Red cell distribution width (RDW), a measure of variation in red blood cell size, is routinely reported in the results of a complete blood count. Recent studies have found that RDW is a predictor of high cardiovascular morbidity and mortality. Furthermore, previous cross-sectional studies have shown a possible association between high RDW and hypertension. However, the longitudinal relationship between high RDW and incident hypertension is uncertain. The aim of this study was to investigate the association between RDW and the development of hypertension. In this retrospective cohort study, we analyzed 124,261 participants without hypertension at baseline who underwent two health checkups at 4-year intervals from 2005 to 2016. The subjects were divided into quartiles (Q1–Q4) according to their baseline RDW levels. Multivariate logistic regression was used to estimate the OR and 95% CI for the development of hypertension after 4 years. After 4 years, 6827 cases (5.5%) of incident hypertension were observed. The incidence rates of hypertension were 4.66%, 5.66%, 5.99%, and 5.46% for Q1, Q2, Q3 and Q4 of RDW, respectively. The ORs (95% CIs) for incident hypertension compared with Q1 were 1.19 (1.10–1.29), 1.28 (1.18–1.39), and 1.32 (1.22–1.44) for Q2, Q3, and Q4 of RDW, respectively. High RDW was significantly and independently associated with the development of hypertension in Korean adults. Further research is warranted to verify the mechanism underlying this relationship.

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  1. Sarma PR. Red cell indices. In: Walker HK, Hall WD, Hurst JW, editors. Clinical methods: the history, physical, and laboratory examinations, 3rd ed. Butterworths: Boston; 1990. p. 720–3.

  2. Marks PW. Approach to anemia in the adult and child. In: Hoffman R, editor. Hematology: basic principles and practice, 6th ed. Saunders/Elsevier: Philadelphia, PA; 2013. p. 418–26.

  3. Salvagno GL, Sanchis-Gomar F, Picanza A, Lippi G. Red blood cell distribution width: a simple parameter with multiple clinical applications. Crit Rev Clin Lab Sci. 2015;52:86–105.

    Article  Google Scholar 

  4. Li N, Zhou H, Tang Q. Red blood cell distribution width: a novel predictive indicator for cardiovascular and cerebrovascular diseases. Dis Markers. 2017;2017:7089493.

    PubMed  PubMed Central  Google Scholar 

  5. Kearney PM, Whelton M, Reynolds K, Muntner P, Whelton PK, He J. Global burden of hypertension: analysis of worldwide data. Lancet. 2005;365:217–23.

    Article  Google Scholar 

  6. Lim SS, Vos T, Flaxman AD, Danaei G, Shibuya K, Adair-Rohani H. et al A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380:2224–60.

    Article  Google Scholar 

  7. He FJ, MacGregor GA. Blood pressure is the most important cause of death and disability in the world. Eur Heart J Suppl. 2007;9 Suppl B:B23–B28.

    Article  Google Scholar 

  8. Tanindi A, Topal FE, Topal F, Celik B. Red cell distribution width in patients with prehypertension and hypertension. Blood Press. 2012;21:177–81.

    Article  CAS  Google Scholar 

  9. Danese E, Lippi G, Montagnana M. Red blood cell distribution width and cardiovascular diseases. J Thorac Dis. 2015;7:E402–411.

    PubMed  PubMed Central  Google Scholar 

  10. Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF 3rd, Feldman HI et al. A new equation to estimate glomerular filtration rate. Ann Intern Med. 2009;150:604–12.

    Article  Google Scholar 

  11. Gunebakmaz O, Kaya MG, Duran M, Akpek M, Elcik D, Eryol NK. Red blood cell distribution width in ‘non-dippers’ versus ‘dippers’. Cardiology. 2012;123:154–9.

    Article  Google Scholar 

  12. Jiang M, Zha X, Wu Z, Zhu X, Li W, Wu H et al. Inverted U-shaped curve relationship between red blood cell distribution width and hypertension in a large health checkup population in China. J Am Soc Hypertens. 2018;12:327–34.

    Article  Google Scholar 

  13. Pilling LC, Atkins JL, Kuchel GA, Ferrucci L, Melzer D. Red cell distribution width and common disease onsets in 240,477 healthy volunteers followed for up to 9 years. PLoS ONE. 2018;13:e0203504.

    Article  Google Scholar 

  14. Pereira M, Lunet N, Azevedo A, Barros H. Differences in prevalence, awareness, treatment and control of hypertension between developing and developed countries. J Hypertens. 2009;27:963–75.

    Article  CAS  Google Scholar 

  15. Patel KV, Mohanty JG, Kanapuru B, Hesdorffer C, Ershler WB, Rifkind JM. Association of the red cell distribution width with red blood cell deformability. Adv Exp Med Biol. 2013;765:211–6.

    Article  CAS  Google Scholar 

  16. Simchon S, Jan KM, Chien S. Influence of reduced red cell deformability on regional blood flow. Am J Physiol. 1987;253:H898–903.

    CAS  PubMed  Google Scholar 

  17. Stempien-Otero A, Karsan A, Cornejo CJ, Xiang H, Eunson T, Morrison RS et al. Mechanisms of hypoxia-induced endothelial cell death. Role of p53 in apoptosis. J Biol Chem. 1999;274:8039–45.

    Article  CAS  Google Scholar 

  18. Solak Y, Yilmaz MI, Saglam M, Caglar K, Verim S, Unal HU et al. Red cell distribution width is independently related to endothelial dysfunction in patients with chronic kidney disease. Am J Med Sci. 2014;347:118–24.

    Article  Google Scholar 

  19. Brandes RP. Endothelial dysfunction and hypertension. Hypertension. 2014;64:924–8.

    Article  CAS  Google Scholar 

  20. Dharmashankar K, Widlansky ME. Vascular endothelial function and hypertension: insights and directions. Curr Hypertens Rep. 2010;12:448–55.

    Article  Google Scholar 

  21. Vaya A, Carmona P, Badia N, Hernandez-Mijares A, Bautista D. Association between high red blood cell distribution width and metabolic syndrome. Influence Abdom Obes Clin Hemorheol Microcirc. 2011;47:75–77.

    Article  Google Scholar 

  22. Vaya A, Alis R, Hernandez-Mijares A, Sola E, Camara R, Rivera L et al. Red blood cell distribution width is not related with inflammatory parameters in morbidly obese patients. Clin Biochem. 2014;47:464–6.

    Article  CAS  Google Scholar 

  23. Hoffmann JJ, Nabbe KC, van den Broek NM. Effect of age and gender on reference intervals of red blood cell distribution width (RDW) and mean red cell volume (MCV). Clin Chem Lab Med. 2015;53:2015–9.

    CAS  PubMed  Google Scholar 

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Correspondence to Young Youl Hyun.

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This article was partly presented at the American Heart Association Scientific Sessions 2018 (Chicago, IL, USA).

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Seo, SG., Lee, MY., Park, S.H. et al. The association between red cell distribution width and incident hypertension in Korean adults. Hypertens Res 43, 55–61 (2020).

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