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Background: Chronic low-grade inflammation may contribute to vascular injury and atherogenesis, and has been described in association to high blood pressure (BP). However, as yet the prognostic significance of white blood cell (WBC) count in the setting of uncomplicated hypertension has not been investigated. Methods: In the Progetto Ipertensione Umbria Monitoraggio Ambulatoriale (PIUMA) study, 1617 white patients with essential hypertension (aged 49 ± 12 years, 55% men) without prevalent cardiovascular or renal disease underwent off-treatment baseline clinical evaluation and were then followed up for 11 years (average 4.9 years). Results: The WBC count had a direct association with smoking status, serum triglycerides, body mass index, and 24-h BP, and an inverse one with age (all P < .05). During follow-up, 146 patients developed a major fatal or nonfatal cardiovascular event (1.9 events per 100 patient-years). Patients who will develop a cardiovascular event had a higher WBC count (7.08 ± 1.6 v 6.68 ± 1.6 × 109 cells/L, P = .004). Event rate increased progressively from the first to the fourth quartile of WBC count distribution (1.2, 1.8, 1.9, and 2.3 events per 100 patient-years; P < .01 by log-rank test). After adjustment (Cox model) for the effect of age, gender, diabetes, serum cholesterol, glomerular filtration rate, smoking, left ventricular hypertrophy, and 24-h systolic BP, cardiovascular event risk increased by 24% (95% confidence interval +4% to +48%; P = .019) for each 2 × 109 cells/L increase in WBC. Conclusions: After adjustment for average 24-h BP, established risk factors and target organ damage, an elevated WBC count remains an independent predictor of cardiovascular morbidity in hypertensive patients. [Copyright &y& Elsevier]

Atherosclerosis is increasingly recognized as an inflammatory vascular disease, and high blood pressure (BP) has been suggested to exert a proinflammatory action. Whether plasma viscosity (PV), a major determinant of blood flow in microcirculation and a marker of systemic inflammation and cardiovascular risk, is increased in elderly subjects with isolated systolic hypertension is not known. In addition, the correlation of BP and its pulsatile component (ie, pulse pressure [PP]), with PV levels independent of the confounding effect of other cardiovascular risk factors has not been investigated. To this aim, we measured PV in 108 elderly men with never treated, uncomplicated isolated systolic hypertension, and in 60 healthy matched normotensive control subjects. The PV values were higher in hypertensive subjects than in controls (1.39 ± 0.11 v 1.34 ± 0.09 cP, P &#60; .01). The PV showed a significant direct relation with both systolic BP (r = 0.32) and PP (r = 0.37, both P &#60; .01), but not with diastolic BP (r = −0.03, P = .68). The PV was also directly associated with serum low-density lipoprotein cholesterol and triglycerides. In a multivariate analysis, PP was a significant predictor of PV levels when a consistent number of cardiovascular risk factors were simultaneously controlled for. In conclusion, PV is elevated in elderly subjects with isolated systolic hypertension. Systolic BP and PP appear to be major determinants of PV levels in these patients, independent of the potential proinflammatory action of traditional cardiovascular risk factors. [Copyright &y& Elsevier]

The article presents the authors' comments on the study by H. Y. Li and colleagues about the correlation between plasma adiponectin and blood pressure in obesity. They remark that the findings of the study confirm the possibility of the significant role of low adiponectin levels in the pathogenesis of human hypertension.