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CLINICAL RESEARCH: HYPERTENSION

Platelet indexes in relation to target organ damage in high-risk hypertensive patients

A substudy of the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT)

^* Haemostasis Thrombosis and Vascular Biology Unit, University Department of Medicine, City Hospital, Birmingham, United Kingdom

Manuscript received February 8, 2004; revised manuscript received March 17, 2004, accepted March 29, 2004.

^* Reprint requests and correspondence: Dr. Gregory Y. H. Lip, City Hospital NHS Trust, University Department of Medicine, Dudley Road, City Hospital, Birmingham B18 7QH, United Kingdom.
G.Y.H.LIP{at}bham.ac.uk

OBJECTIVES: We sought to investigate the relationship between target organ damage (TOD) in hypertension and a prothrombotic/hypercoagulable state, using a new technique of "platelet lysis" to quantify the amount of P-selectin per platelet (pP-sel), and to correlate it with other platelet markers (e.g., mass, volume and granularity, soluble P-selectin [sP-sel], and beta-thromboglobulin [beta-TG]).

BACKGROUND: The increased risk of TOD in hypertension may be related to a prothrombotic/hypercoagulable state, with abnormalities in platelets, such as increased expression of P-selectin.

METHODS: We studied 199 patients (mean age 68 years, 75% men) with hypertension. Of these, 125 had TOD (e.g., stroke, previous myocardial infarction, angina, left ventricular hypertrophy). Values obtained were compared with those from 59 healthy normotensive control subjects (mean age 68 years, 58% men).

RESULTS: Hypertensive patients had a higher mean platelet volume, mass, pP-sel, sP-sel, and beta-TG and lower platelet granularity (all p < 0.01), but a similar platelet count, as compared with controls. Within the hypertensive group, those with evidence of TOD had significantly larger platelets with greater mass but had lower granularity, sP-sel, and pP-sel levels than those without TOD, possibly reflecting increased aspirin use. On multivariate analysis, aspirin use was a determinant of pP-sel (p = 0.03) and sP-sel (p = 0.01), but the use of other drugs or other co-morbidity (e.g., diabetes, smoking) did not influence either P-selectin value.

CONCLUSIONS: Patients with hypertension have evidence of changes in platelet physiology, as reflected by a higher level of pP-sel. Patients with TOD also had larger platelets, with greater mass, and the use of aspirin lowered pP-sel and sP-sel levels. These changes may have implications for the pathophysiology of cardiovascular and cerebrovascular disease in hypertension.

Abbreviations and Acronyms   ASCOT = Anglo-Scandinavian Cardiac Outcomes Trial   beta-TG = beta-thromboglobulin   DBP = diastolic blood pressure   MI = myocardial infarction   MPG = mean platelet granularity   MPM = mean platelet mass   MPV = mean platelet volume   pP-sel = P-selectin per platelet   SBP = systolic blood pressure   sP-sel = soluble P-selectin   TOD = target organ damage

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