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Red cell distribution width as a cardiovascular risk predictor in adults with hypertension in sub-Saharan Africa

Journal of Human Hypertension volume 39, pages 171–176 (2025)Cite this article

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Abstract

Red cell distribution width (RDW) quantifies the degree of variation in erythrocyte size, is identified as a potential marker of adverse cardiovascular events, and may be a surrogate marker for assessing cardiovascular disease (CVD) risk in low-resource settings. We evaluated RDW as a predictor of CVD risk compared to the World Health Organization (WHO) CVD risk score among adults with hypertension attending primary healthcare centers (PHCs) in Ghana and Nigeria. Adults with hypertension attending selected PHCs in Ghana and Nigeria participated in a cross-sectional study. Each participant underwent blood pressure (BP) measurement and laboratory evaluation (RDW, total cholesterol, and fasting blood sugar) following standard methods. We recruited 319 adults aged 40–74 years from the study sites. The mean (standard deviation) RDW was 13.96 (1.1%). The median CVD risk score was 8.11% [interquartile range (IQR) 4.00 to 11.00]. For participants with hemoglobin (Hb) levels ≥ 12 g/dL, RDW showed positive correlations with age (r = 0.136; p = 0.042); systolic BP (r = 0.183; p = 0.006), diastolic BP (r = 0.206, p = 0.002) and WHO CVD risk scores (r = 0.166, p = 0.013). Multiple linear regression showed an independent association between RDW and WHO CVD risk scores with an upward gradient, and was most significant at 3rd quartiles. Using receiver operating characteristic curve, the C-statistic was 0.673 (95% confidence interval: 0.618 to 0.724), p = 0.031. With a cut-off of >14, the RDW demonstrated a sensitivity of 81.82% and specificity of 55.84%. This study shows that at Hb levels ≥ 12 g/dL, RDW modestly predicted CVD risk in adults with hypertension in sub-Saharan Africa.

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Fig. 1: ROC for red cell distribution width [RDW] as a predictor of CVD risk.

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Data availability

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

We acknowledged the staff of Okelele Primary Healthcare Center, Ilorin, Nigeria, and St. Anthony Ann Hospital, Donyina, Ashanti Region, Ghana, for their support during this work.

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Authors and Affiliations

  1. Department of Pediatrics, Division of Clinical Medicine, University of Global Health Equity, Kigali, Rwanda

    Olayinka Rasheed Ibrahim

  2. Directorate of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana

    Kojo Awotwi Hutton-Mensah

  3. Department of Pediatrics, University College Hospital, Ibadan, Nigeria

    Funmi Temidayo Adeniyi

  4. Department of Family Medicine/Polyclinic, Korle Bu Teaching Hospital, Accra, Ghana

    George Bediako Nketiah

  5. Department of Internal Medicine, Gwarimpa General Hospital, Abuja, Nigeria

    Adaku M. Nwankwo

  6. St Anthony Ann Hospital, Donyina, Ghana

    Abukari Yakubu Natogmah

  7. Department of Medicine, University of Ilorin, Ilorin, Nigeria

    James Ayodele Ogunmodede

  8. Department of Internal Medicine, University of Abuja Teaching Hospital, FCT, Abuja, Nigeria

    Dike Ojji

  9. Institute of Child Health, University of Ibadan, Ibadan, Nigeria

    Adesola Olumide

  10. Department of ENT, University of Ilorin, Ilorin, Nigeria

    Biodun Sulyman Alabi

  11. Office of Health Equity Research, Yale School of Medicine, New Haven, CT 06510, USA

    Daniel F. Sarpong

  12. Department of Pediatrics and Child Health, University of Ilorin, Ilorin, Nigeria

    Olugbenga Ayodeji Mokuolu

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Contributions

ORI conceptualized the work, literature review, data collection, analysis, draft and appraished the manuscript. KAH conceptualized the work, literature review, data collection, analysis, draft and appraished the manuscript. FTA conceptualized the work, literature review, data collection, analysis, draft and appraished the manuscript GBN conceptualized the work, literature review, data collection, analysis, draft and appraished the manuscript. AMN conceptualized the work, literature review, data collection, analysis, draft and appraished the manuscript. AYN was inlvolved in literature review, data collection, data visualization, draft and appraished the manuscript. AO was invloved in the conceptualization, literature review, data visualization and analysis, draft and critically appraished the manuscript. DO was invloved in the conceptualization, literature review, data visualization and analysis, draft and critically appraished the manuscript. OA was invloved in the conceptualization, literature review, data visualization and analysis, draft and critically appraished the manuscript. BSA was invloved in the conceptualization, literature review, data visualization and analysis, draft and critically appraished the manuscript. DS was invloved in the conceptualization, literature review, data visualization and analysis, draft and critically appraished the manuscript. OAM was invloved in the conceptualization, literature review, data visualization and analysis, draft and critically appraished the manuscript

Corresponding author

Correspondence to Olayinka Rasheed Ibrahim.

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Competing interests

The authors declare no competing interests.

Ethics approval

Ghana Health Service Ethics Review Committee (Ghana) and Kwara State Ethical Review Committee (Nigeria) approved this study. We also sought permission from the appropriate authorities at both primary healthcare facilities. A detailed explanation of what the study entails in information sheets, including study procedures, was made available to all the participants in the language they best understood, and written informed consent was obtained. The data collected were coded to ensure the anonymity of the study participants and were stored in a password-encrypted computer.

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Ibrahim, O.R., Hutton-Mensah, K.A., Adeniyi, F.T. et al. Red cell distribution width as a cardiovascular risk predictor in adults with hypertension in sub-Saharan Africa. J Hum Hypertens 39, 171–176 (2025). https://doi.org/10.1038/s41371-025-00987-w

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