European Journal of Cardiovascular Medicine

Hypertension affects an estimated 1.28 billion adults worldwide and is a major risk factor for CVDs such as coronary artery disease, stroke, and heart failure¹.The pathophysiology of hypertension involves endothelial dysfunction, vascular inflammation, and platelet activation.² Mean platelet volume (MPV), a marker of platelet size and activity, has been linked to increased thrombotic potential. Elevated MPV has been reported in hypertensive patients, particularly those with comorbidities such as diabetes and dyslipidemia.³ The relationship between MPV and hypertension is of particular interest, as both are independently associated with increased cardiovascular risk. Some studies have demonstrated higher MPV values in hypertensive patients compared to normotensive individuals, while others have found correlations between MPV and blood pressure levels. However, the exact nature of this association and its clinical implications remain unclear.^4,5 However, the interplay between MPV and multiple cardiovascular risk factors in hypertensive patients remains under-explored. This study aimed to assess the association between MPV and various cardiovascular risk factors in hypertensive individuals.

AIM of Study

The primary objective of the present study is to evaluate the mean platelet volume (MPV) in patients diagnosed with hypertension. In addition, the study seeks to explore the relationship between MPV and various other established cardiovascular risk factors, thereby assessing whether MPV can serve as a potential marker for cardiovascular risk stratification in this population.

 Study Design & Setting: A hospital-based cross-sectional descriptive study was conducted in the Department of General Medicine, The Oxford Medical College Hospital and Research Centre, Bengaluru.

Duration: July 2023 – December 2024

 Sample Size:280 hypertensive patients

Inclusion Criteria:

• Age ≥18 years
• Newly diagnosed primary hypertension (as per ESC guidelines)
• Willing to provide informed consent

Exclusion Criteria:

• Recent blood transfusion (≤3 weeks)
• Antiplatelet or steroid therapy
• Chronic diseases (CKD, CLD, haematological malignancies)
• Viral infections with thrombocytopenia (e.g., dengue)
• Immune thrombocytopenia

Data Collection: A structured proforma captured demographic data, BMI, smoking history, diabetes status, and biochemical parameters. Blood pressure was classified according to ESC guidelines into grade 1, 2, and 3 hypertension. Fasting blood samples were analysed for lipid profile, HbA1c, and MPV (PENTRA ES60 analyser).

 Statistical Analysis: Continuous variables were expressed as mean ± SD. Categorical variables were compared using the chi-square test. Pearson correlation assessed relationships between MPV and continuous risk factors; multivariate linear regression identified independent predictors. A p-value <0.05 was considered statistically significant.

- Mean age: 54.3 ± 14.7 years

- Males: 55%

- MPV significantly increased with hypertension severity: Grade 1 (9.6 fl), Grade 2 (10.2 fl), Grade 3 (10.9 fl) (p < 0.001)

- MPV positively associated with BMI (p < 0.001)

- Smokers had higher MPV than non-smokers (p = 0.003)

- Diabetic patients had significantly higher MPV (p < 0.001)

- Positive correlation with TC, LDL, TG; negative correlation with HDL (r = −0.215)

Multivariate Regression:

- Independent predictors: Hypertension grade, BMI, HbA1c

- Odds ratio for high MPV (>10.5 fl) was highest in Grade 3 hypertension and obese individuals

Elevated MPV levels have been implicated in increased platelet activation, which may contribute to adverse cardiovascular events. Understanding this relationship could aid in early identification of high-risk patients and guide preventive strategies. In our study, the mean MPV is significantly higher in patients with Grade 2 and Grade 3 hypertension compared to Grade 1 hypertensives (p < 0.001). A significant association is found between HbA1c and increased MPV (p = 0.016) in the present study. In the context of dyslipidemia, our study found a statistically significant association between elevated MPV and raised LDL and total cholesterol levels (p = 0.002).

Our findings support previous literature indicating that MPV is elevated in hypertensive patients and correlates with traditional cardiovascular risk factors^.7,8 Platelet activation, reflected by increased MPV, may contribute to the prothrombotic state in hypertension, particularly in patients with metabolic comorbidities. The significant correlation with dyslipidemia and diabetes suggests a shared inflammatory and endothelial injury pathway. MPV could serve as an inexpensive adjunctive biomarker for cardiovascular risk stratification in primary care and tertiary settings. Limitations include the cross-sectional design and potential pre-analytical variability in MPV measurements. Prospective studies are warranted to explore causality and prognostic implications.

MPV correlates strongly with hypertension grade, BMI, smoking, diabetes, and dyslipidemia. It should be considered in the routine evaluation of hypertensive patients to aid in early identification of high-risk individuals.

1. World Health Organization. Hypertension [Internet]. 2021 [cited 2024 Aug 7]
2. Kjeldsen SE. Hypertension and cardiovascular risk: General aspects. Pharmacol Res. 2018;129:95-9.
3. Thompson CB, Eaton KA, Princiotta SM, Rushin CA, Valeri CR. Size dependent platelet subpopulations: relationship of platelet volume to ultrastructure. enzymatic activity, and function. Br J Haematol. 1982;50(3):509-19..
4. Nadar SK, Blann AD, Kamath S, Beevers DG, Lip GY. Platelet indexes in relation to target organ damage in high-risk hypertensive patients: a substudy of the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT). J Am Coll Cardiol. 2004;44(2):415-22.
5. Yarlioglues M, Kaya MG, Ardic I, Dogdu O, Kasapkara HA, Gunturk E, et al. Relationship between mean platelet volume levels and subclinical target organ damage in newly diagnosed hypertensive patients. Blood Press. 2011;20(2):92
6. Sansanayudh N, Muntham D, Yamwong S, Sritara P, Akrawichien T, Thakkinstian A. The association between mean platelet volume and cardiovascular risk factors. Eur J Intern Med. 2016;30:37–42. doi:10.1016/j.ejim.2015.11.028.
7. Nkambule BB, Mxinwa V, Nyambuya TM, Dludla PV. The mean platelet volume and atherosclerotic cardiovascular-risk factors in adults with obesity: a systematic review and meta-analysis of observational studies. BMC Nutr. 2022;8:47. doi:10.1186/s40795-022-00541-8.