Hemoglobin specific volume width promotes the prevalence and poor long-term prognosis of American adult hypertensive patients: the NHANES 1999-2020

Background Hypertensive patients are always accompanied by erythrocyte dysfunction. However, current erythrocyte-related indicators can’t explain hypertension’s prevalence and long-term prognosis. Therefore, hemoglobin specific volume width (HSW) was first created to explain this phenomenon. Methods 59,867 adult participants from National Health and Nutrition Examination Survey (NMAHES) were included. HSW’s quartiles were determined with Q1 [1.88,3.64] cL/g, Q2 (3.64,3.84] cL/g, Q3 (3.84,4.11] cL/g, and Q4 (4.11,11.74] cL/g. 21,006 hypertensive patients had a whole following time 97 (51, 151) months, 15,519 hypertensive patients were alive, and 5,487 were dead. The relationship between HSW and hypertension was analyzed. Results Among Controls n =35,677 and Hypertensive patients n =24,190, the percentages of hypertension in quartiles of HSW (Q1, Q2, Q3, and Q4) were 28.59%, 33.35%, 39.37%, and 47.74%. Adjusted odds ratio (OR) in HSW was still significant, 1.23 (95% CI 1.11,1.36). Among dead ( n =5,487) and alive hypertensive patients ( n =15,519), the percentages of hypertensive mortality in quartiles of HSW were 17.66%, 20.46%, 20.78%, and 25.02%. The adjusted HSW hazard ratio (HR) was 1.91(95%CI 1.69,2.16). Processing Q1 as reference, the HR for Q4 was 2.35 (95% CI 2.06, 2.69). Males had a higher risk (HR: 1.53 95% CI 1.24,1.89) of poor prognosis than females (HR: 1.48 95% CI 1.17,1.87). Individuals <=60 years old (HR: 2.25 95% CI 1.78,2.85) had a higher risk of poor prognosis than those >60. Hypertensive patients with HSW > 3.89 cL/g had a poor prognosis than HSW <= 3.89 cL/g. Conclusions HSW is an innovative independent risk factor for hypertensive prevalence and long-term prognosis. ### Competing Interest Statement The authors have declared no competing interest. ### Clinical Trial First, the study did not involve any intervention for the disease. Second, NHANES 'data is free and publicly available, with no registration required. ### Funding Statement Our research was supported by the Tianjin Committee of Science and Technology of China (22ZYJDSS00040) and the Science and Technology Project of Haihe Laboratory of Modern Chinese Medicine (22HHZYSS00007). ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The NHANES protocol was approved by the Ethics Review Committee of the National Center for Health Statistics. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes * ALT : alanine transaminase BaP : basophils percentage Ca : total calcium COPD : chronic obstructive pulmonary disease DM : diabetes mellitus Eo : eosinophils number count EoP : eosinophils percentage EV-SD : erythrocyte volume’s standard deviation GGT : gammaglutamyl transferase Hb : hemoglobin HCO3 : bicarbonate Hem : hematocrit HR : hazard ratios HSW : Hemoglobin specific volume width HSWQ : HSW’s quartiles KM : Kaplan–Meier MCH : mean cell hemoglobin MCHC : mean corpuscular haemoglobin concentration MCQ : medical conditions questionnaire MCV : mean corpuscular volume MonP : monocyte percentage MPV : mean platelet volume Na : sodium NHANES : national health and nutrition examination survey OR : odds ratio Plt : platelet count count RBC : red blood cells RCS : restricted cubic spline RDW : red blood distribution width SegneP : segmented neutrophils percentage. TC : total cholesterol TG : triglycerides TP : total protein; UA : uric acid.