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International Journal of Applied, Physical

and Bio-Chemistry Research (IJAPBCR)


ISSN(P): 2277-4793; ISSN(E): 2319-4448
Vol. 4, Issue 4, Oct 2014, 1-6
TJPRC Pvt. Ltd.

STUDY OF C-REACTIVE PROTEIN AND FIBRINOGEN IN HYPERTENSION AND


THEIR ROLE IN DEVELOPMENT OF HYPERTENSION
MOHD SHAKEEL1, JAMIL MOHAMMAD2 & MOHAMMAD KHALID FAROOQUI3
1
2
3

Biochemistry, Government Medical College, Kota, Rajasthan, India

Biochemistry, Sardar Patel Medical College, Bikaner, Rajasthan, India

ENT, SHKM Government Medical College, Nalhar, Mewat, Haryana, India

ABSTRACT
The present study was conducted to evaluate the acute phase reactants regular C-reactive protein (CRP) and
fibrinogen in hypertensive subjects at MBS hospital, Govt. Medical College Kota, Rajasthan, India. All subjects were
divided in two groups 50 hypertensive and 50 healthy controls, between 30-60 years of age, of either gender were
evaluated for their serum CRP and plasma fibrinogen levels. During study 50 subjects with hypertension were evaluated
for CRP and fibrinogen levels, of which 29 (58 %) were males and 21 (42 %) were females, in addition to 50 apparently
healthy subject as a control group, 33 (66%) of them are males and 17(34%) were females. The mean serum CRP levels
were significantly higher in subjects with hypertension compared with control group of healthy subjects (17.2712.24mg/l
versus8.285.78mg/l, p<0.0001). Similarly mean plasma fibrinogen levels were also significantly higher in hypertensive
compared with control group (470.6150.9mg/dl versus298.54113.6mg/dl, p<0.05). The present study also detected
significant positive correlation between C-reactive protein and fibrinogen in subjects with hypertension (r= 0.42, p<0.05).

KEYWORDS: Hypertension, Systolic Blood Pressure, C - Reactive Protein, Fibrinogen


INTRODUCTION
Hypertension is one of the most important risk factors for cardiovascular disease and has become an increasingly
important contributor to the global health burden (He FJ 2003, Ezzati M et al. 2002). The estimated total number of adults
with hypertension in 2000 was 972 million. Of these, 333 million were estimated to be in economically developed
countries and 639 million in economically developing countries. By 2025, the number of people with hypertension will
increase by about 60% to a total of 1.56 billion as the proportion of elderly people will increase significantly (Kearney PM
et al. 2005). The prevalence of hypertension in India 59.9 and 69.9 per 1000 in males and females respectively in urban
population (Gupta SP et al. 1978) and 35.5 and 35.9 per 1000 in males and females respectively in the rural population
(Gupta SP et al. 1977).
Inflammation and mounting of inflammatory markers are important pathogenic mechanism in development of
hypertension (Kaptoge S et al. 2010). Among patients with hypertension, it is well established that pro-inflammatory
markers (such as fibrinogen, TNF-, high sensitive C-reactive protein [hs-CRP]) are increased, even after adjustment for
potential confounding factors (Bautista LE 2003). Elevated hs-CRP levels have also been shown to be predictive for the
development of hypertension in prehypertensive and normotensive patients (Chrysohoou C et al. 2004, King DE et al.
2004). Howard et al also considered that C-reactive protein levels are associated with future development of hypertension

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Mohd Shakeel, Jamil Mohammad & Mohammad Khalid Farooqui

(Howard D. sesso et al. 2003). Plasma fibrinogen may be associated with hypertension, but its correlation with smoking,
hypertension, obesity, has not been evaluated in large studies. In view of paucity of data from Indian studies, I attempt to
correlate plasma fibrinogen and CRP with blood pressure in hypertensive patients.

MATERIALS & METHODS


Study Population
For this study subjects between 30-60 years of age were selected from the general population of Kota district and
screened for hypertension. Hypertension was defined as a reading of 140/90 mmHg on three consecutive measurements at
least six hours apart. Subjects were distributed on the basis of increasing blood pressure in 2 groups of hypertensive (case)
and non-hypertensive (control). Each group comprised of 50 subjects.
Physical Examination
All the subjects had undergone through a complete physical examination. Socio-economic status of every
individual was assessed by living standard and monetary status. The family history regarding obesity, diabetes,
hypertension, coronary artery disease was carefully recorded by a questionnaire and subjects with Coronary Artery
Disease, C. O. P. D, rheumatoid arthritis, Gastrointestinal or Renal disorder, acute or chronic inflammatory conditions were
excluded. Complete physical Examination and clinical history of subjects were also recorded.
Collection and Analysis of Samples
After overnight fasting, venous blood of the subjects was drawn from anticubital vein using aseptic techniques.
Samples were collected in plain vials for C-reactive protein and in 3.2% trisodium citrated vials for fibrinogen estimation
(9 parts blood and 1 part anticoagulant). The samples were left standing for one hour and serum and plasma were
separated.
Investigations
Serum has been used for estimation of C-reactive protein levels and plasma for fibrinogen, using standard
protocol on TRANSASIA EM-360 auto-analyzer.
Statistical Analysis
Results are expressed as Mean SD. Data are analyzed with the help of Microsoft excel 2007, using students
t-test, and strength of association between two variables is measured by Pearson's correlation coefficient (r).

RESULTS
The mean serum CRP levels were significantly higher in patients with hypertension compared with control group
of healthy subjects (17.2712.24mg/l versus 8.285.78mg/l, p<0.0001). (Table 1) CRP level showed a significant positive
correlation with systolic blood pressure. (Table 2) Mean plasma fibrinogen levels were also significantly higher in
hypertensive compared with control group (470.6150.9mg/dl versus298.54113.6mg/dl, p<0.05). (Table 1) The present
study also detected significant positive correlation between C-reactive protein and fibrinogen in subjects with hypertension
(r= 0.42, p<0.05). (Figure 1)

Impact Factor (JCC): 1.1514

Index Copernicus Value (ICV): 3.0

Study of C-Reactive Protein and Fibrinogen in Hypertension and Their Role in Development of Hypertension

DISCUSSIONS
Serum-CRP is an acute phase reactant proteins synthesized by hepatocytes under the influence of interleukin-1
originating at sites of inflammation and trauma (Chensue SW et al. 1986). It has been shown to be beneficial in the clinical
evaluation of cardiovascular disorder in adults. CRP and blood pressure are independent determinants of cardiovascular
risk, and their predictive value is additive (Gavin J. Blake et al. 2003).
C-reactive protein & other acute phase reactants like fibrinogen are important positive acute phase proteins &
mounting of which may contribute to hypertension. (Howard D. sesso et al. 2003, Anoop Shankar et al. 2006)
The present study was conducted on 100 subjects to study the role of C-reactive protein and fibrinogen in
generation of hypertension. Subjects were distributed on the basis of increasing blood pressure in 2 groups of
non-hypertensive and hypertensive. In present study, it was observed that hypertensive subjects had significantly elevated
levels of serum C-reactive protein and fibrinogen as compare to non-hypertensive subjects, supporting the earlier studies
which state that C-reactive protein are associated with future development of hypertension (Howard D. sesso et al. 2003).
Essential hypertension is regarded as a multifactorial condition, the onset and severity of which are influenced by
both genetic and environmental factors. This fact is supported by various cross-sectional studies that document familial
aggregation of the disorder despite different environmental factors. This knowledge is fostering exploration of the
molecular and genetic basis of the disease and new approaches to its treatment and prevention (Zinner, S. H. et al. 1971,
Havlik, R. J. et al. 1982). It is proven fact that a link between hypertension and inflammation has been established in many
research works (Christopher J. Boos et al. 2006).

CONCLUSIONS
Hypertension is one of the most common public health problems of the 21st century which increases morbidity
and mortality in both developing and developed worlds. It is a positive risk factor in the development of dyslipidaemia,
diabetes, cardiovascular disease etc. It is one of the important components of metabolic syndrome, which is a cluster of
clinical and metabolic abnormalities including abdominal obesity, insulin resistance, hypertension, dyslipidaemia and all
these factors directly increase the risk of cardiovascular diseases (CVD).
Recently, chronic low-grade inflammation has been identified as an integral part in the pathogenesis of vascular
disease. The presence of inflammatory markers like C-reactive protein, fibrinogen, TNF-, IL-6 within the body can have a
significant role in the development and progression of many disease processes like CVD, cerebrovascular accident,
and diabetic complications.
In this study the role of C-reactive protein and fibrinogen in hypertensive persons has been explored. C-reactive
protein and fibrinogen levels were found to be significantly elevated in hypertensive subjects as compared to
Non-hypertensive subjects. So inflammation has an important role in development of hypertension. It can also be
considered that hypertension is an inflammatory process.

REFERENCES
1.

Anoop Shankar, Jie Jin Wang, Elena Rochtchina and Paul Mitchell. (2006). Positive Association between Plasma
Fibrinogen Level and Incident Hypertension among Men: Population-Based Cohort Study. Hypertension, 48,
1043-49.

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Mohd Shakeel, Jamil Mohammad & Mohammad Khalid Farooqui

2.

Bautista LE. (2003). Inflammation, endothelial dysfunction, and the risk of high blood pressure: epidemiologic
and biological evidence. J Hum Hypertens, 17, 223-30.

3.

Chensue SW, Davey MP, Remick DG, Kunkel SL. (1986). Release of Interleukin-I by Peripheral blood
mononuclear cells in patient with tuberculosis and active inflammation, Infection and Immunity, 52, 341-43.

4.

Christopher J. Boos and Gregory Y.H. Lip. (2006). Is Hypertension an Inflammatory Process. Current
Pharmaceutical Design, 12, 1623-35.

5.

Chrysohoou C, Pitsavos C, Panagiotakos DB, Skoumas J, Stefanadis C. (2004). Association between


prehypertension status and inflammatory markers related to atherosclerotic disease: The ATTICA Study. Am J
Hypertens, 17, 568-73.

6.

Ezzati M, Lopez AD, Rodgers A, Vander Hoorn S, Murray CJ. (2002). Comparative Risk Assessment
Collaborating Group. Selected major risk factors and global and regional burden of disease. Lancet, 360, 1347-60.

7.

Gavin J. Blake, Nader Rifai, Julie E. Buring, Paul M Ridker. (2003). Blood Pressure, C - reactive protein, and
Risk of Future Cardiovascular Events. Circulation, 108, 2993-99.

8.

Gupta SP, Siwach SB, Moda VK. (1977). Epidemiology of hypertension based on total community survey in the
rural population of Haryana. Indian Heart J, 29, 5362.

9.

Gupta SP, Siwach SB, Moda VK. (1978). Epidemiology of hypertension based on total community survey in the
urban population of Haryana. Indian Heart J, 30, 31522.

10. Havlik, R. J. and Feinleib, M. (1982). Epidemiology and genetics of hypertension. Hypertension, 4, III121III127.
11. He FJ, Mac Gregor GA. (2003). Cost of poor blood pressure control in the UK: 62, 000 unnecessary deaths per
year. J Hum Hypertens, 17, 455-57.
12. Howard D. sesso, Julie E. Buring, Nader Rifai, Gavin J. Blake, J. Michael Gaziano, Paul M Ridker. (2003).
C - reactive protein and the Risk of Developing Hypertension. JAMA, 290, 2945-51.
13. Kaptoge S, Di Angelantonio E, Lowe G, Pepys MB, Thompson SG, Collins R et al. (2010). Emerging Risk
Factors Collaboration: C-reactive protein concentration and risk of coronary heart disease, stroke, and mortality:
an individual participant meta-analysis. Lancet, 375, 132-40.
14. Kearney PM, Whelton M, Reynolds K, Muntner P, Whelton PK, He J. (2005). Global burden of hypertension:
analysis of worldwide data. Lancet, 365, 217-23.
15. King DE, Egan BM, Mainous AG 3rd, Geesey ME. (2004). Elevation of C-reactive protein in people with
pre-hypertension. J Clin Hypertens (Greenwich), 6, 562-68.
16. Zinner, S. H, Levy, P. S. and Kass, E. H. (1971). Familial aggregation of blood pressure in childhood. N. Engl.
J. Med, 284, 40104.

Impact Factor (JCC): 1.1514

Index Copernicus Value (ICV): 3.0

Study of C-Reactive Protein and Fibrinogen in Hypertension and Their Role in Development of Hypertension

APPENDICES
Table 1: Comparison of C - Reactive Protein and Fibrinogen Levels of Both Groups
Parameter

Non-Hypertensive
Subjects

C-reactive protein
8.285.78
(mg/l)
Fibrinogen
298.54113.64
(mg/dl)
Values are Mean SD

Unpaired t Test

Hypertensive
Subjects

t-Score

17.2712.24

4.7

470.6150.9

6.4

p-Value
P<0.0001
Significant
P<0.05
Significant

Table 2: Correlation of Systolic Blood Pressure with C - Reactive Protein in Hypertensive Subjects
Systolic Blood Pressure
(Hypertensive subjects)
Parameter
r-Score
C-reactive protein

0.43

p-Value
0.001
Significant

Figure 1: Correlation of C - Reactive Protein and Fibrinogen in Hypertensive Subjects

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