Pattern of haemostatic parameters and their relationship with microalbuminuria among hypertensives in Northern Nigeria

  • IP Ijei
  • H Bello-Manga
  • R Yusuf
  • BG Sani
  • AI Mamman
Keywords: ACE Inhibitors, Hypertension, Haemostatic parameters, Microalbuminuria, Target Organ Damage


Background: Hypertension is a common, non-communicable disorder of public health significance. Abnormalities in haemostasis and blood rheology have been linked to target organ damage (TOD) in hypertension. Microalbuminuria (MA) is an independent predictor of TOD.

Methods: A cross-sectional study was carried out among 107 consecutively recruited hypertensives attending the Cardiology Clinic at ABUTH, Zaria, Nigeria. Complete blood counts, haemostatic screening tests and microalbuminuria assay were performed on blood and urine specimens.

Results: The mean age of participants was 50.2±11.3 years and 59.3±18.2 years for females and males respectively with a female predominance (91/107; 85%). The frequencies of abnormal platelet counts, prothrombin time, activated partial thromboplastin time, thrombin time, fibrinogen, D-dimer and MA were 15%, 57%, 54.2%, 64.5%, 100%, 25.2%, and 41% respectively. Participants with poor BP control had an increased risk of derangements in aPTT and platelet counts (OR = 1.4, 1.4) but there was no significant difference in means with BP for aPTT, fibrinogen, and platelets (p = 0.517, 0.257 and 0.525 respectively). The impact of the duration of hypertension was shown in D-dimer levels up to 10 years. Participants on ARB/ACEI- containing regimens showed a higher risk of derangement in TT, aPTT, PT and D-dimer in contrast to platelet counts (OR = 0.96, p = 0.836). Haemostatic parameters showed weakly positive, statistically significant correlation on regression analysis.

Conclusion: There is a high prevalence of, and positive correlation between haemostatic abnormalities and MA among hypertensives in Northern Nigeria. Abnormal haemostatic screening tests may indicate MA and increased risk of TOD.


Fisher NDL, Williams GH. Hypertensive vascular disease. In: Harrison’s Principles of Internal medicine. Casper DL, Braunwald E, Fauci AS, Hauser SL, Longo DL, Jameson JL (Eds). 16th Edition. New York. McGraw-Hill Medical Publishing Division. 2005. Pp 1463- 1480.

Whitworth JA; World Health Organization, International Society of Hypertension Writing Group. 2003 World Health Organization (WHO)/ International Society of Hypertension (ISH) statement on management of hypertension. J Hypertens 2003; 21(11): 1983-1992. Available at [Accessed 1st May 2019]

Giles TD. The new definition of hypertension. Program and abstracts of the 20th Annual Scientific Meeting of the American Society of Hypertension; May 14-18, 2005; San Francisco, California. Late-Breaking Clinical Trials. Available at [Accessed 1st May 2019]

Aigbe A, Famodu AA. Haemorrheological and fibrinolytic activity in hypertensive Nigerians. Clin Hemorheol Microcirc 1999; 21(3-4): 415-420.

Wolf-Maier K, Cooper RS, Banegas JR, Giampaoli S, Hense H, Joffres M, et al. Hypertension prevalence and blood pressure levels in 6 European countries, Canada, and the United States. JAMA.2003; 289: 2363-2369. Available at [Accessed on 1st May 2019].

Adeloye D, Basquil C, Aderemi AV, Thompson JY, Obi FA. An estimate of the prevalence of hypertension in Nigeria: a systematic review and meta-analysis. J Hypertens 2014, 32: 000-000 [Cross check the pagination]. DOI:10.1097/HJH.0000000000000413 [Accessed on 28th April 2019].

Ajayi IO, Sowemimo IO, Akpa OM, Ossai NE. Prevalence of hypertension and associated factors among residents of Ibadan-North Local Government Area of Nigeria. Niger J Cardiol 2016; 13: 67-75. DOI: 10.4103/0189-7969.165168 [Accessed on 28th April 2019].

Onwuchekwa AC, Chinenye S. Clinical profile of Hypertension at a University Teaching Hospital in Nigeria. Vasc Health Risk Manag 2010; 6: 511-516.

Ike SO, Ikeh VO. The prevalence of Diastolic Dysfunction in Adult Hypertensive Nigerians. Ghana Med J 2006; 40(2): 55-60.

Lip GYH. Hypertension, platelets and the endothelium. The ‘’Thrombotic Paradox’’ of Hypertension (or ’Birmingham Paradox’) Revisited. Hypertension 2003; 41: 199-200.

Sechi LA, Zingaro L, Catena C, Casaccio D, De Marchi S. Relationship of Fibrinogen Levels and Hemostatic Abnormalities with Organ Damage in Hypertension. Hypertension 2000; 36: 978-985.

Aldo T, Scamardi R, Pizzoleo MA, Sottilotta G, Barbera N, Frisina N. Increased Indexes of Thrombin Activation in Advanced Stages of Hypertension. Haemostasis 2001; 31: 49-54.

Yusuff KB, Balogun OB. Pattern of Drug Utilization among Hypertensives in a Nigerian Teaching Hospital. Pharmacoepidemiol Drug Safety 2005; 1(1): 69-74.

Nabbaale J, Kibirige D, Ssekasanvu E, Sebatta ES, Kayima J, Lwabi P, et al. Microalbuminuria and left ventricular hypertrophy among newly diagnosed black African hypertensive patients: a cross-sectional study from a tertiary hospital in Uganda. BMC Res Notes 2015 8: 198 DOI 10.1186/s13104-015-1156-2 [Accessed on 28th April 2019].

Hitha B, Pappachan JM, Balachandran Pillai H, Sujathan P, Ramakrishna CD, Jayaprakash K, et al. Microalbuminuria in Patients with Essential Hypertension and its Relationship to Target Organ Damage: An Indian Experience. Saudi J Kidney Dis Transpl 2008; 19(3): 411-419.

Rodney CP, Desmond R, Roseman JM, Bell DSH, Vanichanan C, Acton RT. Prevalence and Risk factors of Microalbuminuria in a Cohort of African-American Women with Gestational Diabetes. Diabetes Care 2001; 24(10): 1764-1769. [Accessed on 30th April 2019]

Gruden G, Cavallo-Perin P, Bazzan M, Stella S, Vuolo A, Pagano G. PAI-1, and Factor VII Activity are Higher in IDDM Patients with Microalbuminuria. Diabetes. 1994; 43(3): 426-429.

The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. NIH Publication No. 04-5230. August 2004: pp 11-12.

Isa AH; Hassan A; Garba Y; Ijei IP. Reference ranges of some haematological parameters in healthy Northern Nigerian adults. Jos J Med 2012; 6(3): 16-18.

Oladapo OO, Salako L, Sadiq L, Shoyinka K, Adedapo K, Falase AO. Target Organ Damage and Cardiovascular complications in Hypertensive Nigerian Yoruba Adults: a cross-sectional study. Cardiovasc J Afr 2012; 23: 379-384.

Laffan M, Manning R. Investigation of Haemostasis In: Dacie and Lewis Practical Haematology. Lewis SM, Bain BJ, Bates I (Eds.) Tenth Edition. Churchill Livingstone. An Imprint of Elsevier. Philadelphia.2006. pp 379-440.

Lewis SM, Tatsumi N. Collection and Handling of Blood In: Dacie and Lewis Practical Haematology. Lewis SM; Bain BJ; Bates I (ed.). Tenth Edition. Churchill Livingstone. An Imprint of Elsevier. Philadelphia.2006: 1-10.

Start4 Standardized Operating Procedures. Diagnostica Stago S.A.S. 9 Rue des Frères Chausson 92600 Asnières-Sur-Seine (France). Ref 26987-June 2002.

Jalal S, Sofi FA, Alai MS, Siddiqi MA, Bhat MA, Khan KA, et al. Prevalence of microalbuminuria in essential hypertension: A study of patients with mild to moderate hypertension. Indian J Nephrol. 2001; 11: 6-11.

Buch AC, Dharmadhikari M, Panicker NK, Chandanwale SS, Kumar H. Microalbuminuria: an early detector of diabetic and hypertensive nephropathy. Int J Basic Appl Med Sci 2012; 2(2): 218-225.

Badiger S, Sandeep HM, Talikoti SC, Biradar MS. A study of Microalbuminuria and target organ damage in patients with essential hypertension. Int J Biol Med Res. 2012; 3(1): 1351-1355.

Polonia J, Carmona J, Mendes E, Pisco L. Prevalence of Microalbuminuria in non-diabetic hypertensive patients attended by Portuguese GPs. Rev Port Cardiol 2007; 26(6): 637-644.

Agewall S, Fagerberg B, Attvall S, Ljungman S, Urbanavicius V, Tengborn I, Wickstrand Risk J. Microalbuminuria, insulin sensitivity and haemostatic factors in non-diabetic treated hypertensive men. J Internal Med 1995; 237(2): 195-203.

Tabak O, Gelisgen R, Uzun H, Kalender B, Balci H, Curgunlu A, et al. Hypertension and hemostatic/ fibrinolytic balance disorders. Clin Invest Med 2009; 32(6): E285-E292.

Sechi LA, Novello M, Colussi G, Di Fabio A, Chiuch A, Nadalini E, et al. Relationship of plasma renin with a prothrombotic state in hypertension: relevance for organ damage. Am J Hypertens 2008; 21: 1347-1353.

Catena C, Novello M, Lapena R, Baroselli S, Colussi G, Nadalini E et al. New risk factors for atherosclerosis in hypertension: focus on the prothrombotic state and lipoprotein (a). J Hypertens 2005; 23(9): 1617-1631. [Accessed on 30th April 2019].

Adaeze NN, Emeribe AU, Nasiru IA, Babayo A, Uko EK. Evaluation of prothrombin Time and Activated Partial Thromboplastin Time in Hypertensive Patients attending a Tertiary Hospital in Calabar, Nigeria. Adv Hematol 2014; Article ID 932039. [Accessed on 30th April 2019].

Remkova A, Kratochvilova H. Effect of ACEI perindopril on haemostasis in essential hypertension. Blood Coagul Fibrinolysis 2000; 11(7): 641-644.

Coban E, Ozdogan M, Akcit F. Levels of plasma fibrinogen and D-dimer in subjects with white-coat hypertension. J Human Hypertens 2004; 18: 291-292.

Levy PJ, Yunis C, Owen J, Brosnihan BK, Smith R, Ferrario CM. Inhibition of platelet aggregability by losartan in essential hypertension. Nefrologia 2002; XXII (2): 24-28.

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