The Copper-Zinc Balance in Hypertension: A Cross-Sectional Study From Bangladesh

Q: What are the key findings of this study?

A fourth-quartile serum copper-to-zinc ratio was independently associated with 3.7-fold higher odds of hypertension compared to the first quartile (adjusted OR 3.723, p=0.043).

Q: What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Hypertension (n=100). Intervention: Serum copper-to-zinc (Cu/Zn) ratio (4th quartile) vs. Normotensive control / 1st quartile of serum Cu/Zn ratio. Primary outcome: Hypertension (association with serum Cu/Zn ratio) (OR 3.723, p=0.043).

Q: What does this research mean for the field?

A high serum copper-to-zinc ratio is independently associated with increased odds of hypertension, whereas individual serum copper and zinc levels do not show an independent association after adjustment. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Fahmida Sharmin; Tanusri Chakrabarty; Shohana Akter; Rimpi Romana; Md. Ashikul Islam; Raisa Badhan; Afrida Wasima; Md. Matiur Rahman

doi:10.7759/cureus.118010

October 16, 2026CureusOpen Access

The Copper-Zinc Balance in Hypertension: A Cross-Sectional Study From Bangladesh

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Key result

Highest quartile serum copper-to-zinc ratio is linked to ~3.7-fold higher odds of hypertension.

OR 3.723
P=0.043
n=100

Why the study?

Disturbances in trace-element homeostasis involving copper (Cu) and zinc (Zn) may contribute to hypertension (HTN) pathogenesis through their roles in antioxidant defense and vascular function. This study evaluated the association of serum Cu, Zn, and the Cu/Zn ratio with HTN among adults in Bangladesh.

Key Points

To evaluate the association of serum copper, zinc, and the copper-to-zinc ratio with hypertension among adults aged 40 years and older.
Conducted a cross-sectional comparative study of 100 adults (46 hypertensive and 54 normotensive participants) aged ≥40 years from cardiology and medicine outpatient clinics in Bangladesh.
Measured serum copper and zinc levels via spectrophotometric methods to calculate the copper-to-zinc ratio, and recorded salt intake, lipid profiles, and body mass index.
Analyzed group differences using independent-samples t-tests and Chi-square tests, examined blood pressure correlations using Spearman's rank test, and performed binary logistic regression adjusting for dyslipidemia and excess salt intake.
Hypertensive subjects showed significantly lower serum zinc (63.46±19.01 vs. 73.75±24.54 µg/dL, p=0.015) and a higher copper-to-zinc ratio (1.53±0.61 vs. 1.22±0.49, p=0.007) than normotensive subjects, while serum copper levels did not differ significantly (101.42±29.12 vs. 94.14±24.92 µg/dL, p=0.187).
Serum zinc correlated negatively with systolic blood pressure (ρ = -0.412, p<0.001) and diastolic blood pressure (ρ = -0.210, p=0.036), whereas the copper-to-zinc ratio correlated positively with systolic (ρ = 0.412, p<0.001) and diastolic blood pressure (ρ = 0.278, p=0.005).

Study Design

Type

Cross-Sectional (n=100)

Multicenter

No

Structured PICO

P

Population

100 Bangladeshi adults aged ≥40 years (median age 50 years, 59% female), comprising 46 hypertensive and 54 normotensive outpatients free of obesity, diabetes, and renal or liver disease, evaluated in a cross-sectional study.

C

Comparator

Normotensive adults aged >=40 years (n=54)

O

Outcome

Association of serum copper (Cu), serum zinc (Zn), and the copper-to-zinc (Cu/Zn) ratio with hypertensionsurrogate

Main Result

Odds Ratio: 3.723

Absolute Event Rate: 1.53% vs 1.22%

p-value: p=0.043

Limitations

Cross-sectional design does not allow causal inference
Relatively small sample size (N=100)
Single-center setting may limit generalizability
Non-random purposive sampling technique
Confidence intervals were not provided for the logistic regression odds ratios
Relatively small sample size
Single-center setting may limit the generalizability of the findings
Confidence intervals were not provided in the logistic regression table

Implication

An elevated serum copper-to-zinc ratio is positively correlated with systolic and diastolic blood pressure and is independently associated with hypertension in Bangladeshi adults aged 40 years and older, suggesting its potential utility as a marker of trace-element imbalance in hypertension.

Abstract

Background: Hypertension (HTN) is a major public health problem, and disturbances in trace-element homeostasis may contribute to its pathogenesis.Copper (Cu) and zinc (Zn) are involved in antioxidant defense and vascular function, while their relative balance may be reflected by the copper-to-zinc (Cu/Zn) ratio.Objective: The aim of this study was to evaluate the association of serum Cu, Zn, and Cu/Zn ratio with HTN among adults attending Bangladesh Medical University (BMU), Dhaka.Methods: This cross-sectional comparative study was conducted in the Department of Biochemistry and Molecular Biology, BMU, among 100 adults aged ≥40 years, comprising 46 hypertensive and 54 normotensive participants recruited from the Cardiology and Medicine outpatient departments.Serum Cu and Zn levels were measured using standard spectrophotometric methods, and the Cu/Zn ratio was calculated.Lifestyle factors, excess salt intake, dyslipidemia, and body mass index were also assessed.Independent-samples t-test, Chi-square test, and Spearman's correlation analysis were used as appropriate.Binary logistic regression was performed to determine the independent association of serum Zn and Cu/Zn ratio with HTN after adjustment for dyslipidemia and excess salt intake.A p-value of <0.05 was considered statistically significant.Results: The median age was 50 years in both groups.Excess salt intake was significantly more common among hypertensive participants (27; 58.70%) than normotensive participants (19; 35.19%), p=0.019, as was dyslipidemia (23; 50.00% vs. 10; 18.52%, p=0.003).Serum Cu levels did not differ significantly between hypertensive and normotensive participants (101.42±29.12 vs. 94.14±24.92µg/dL, p=0.187).In contrast, serum Zn levels were significantly lower in the hypertensive group (63.46±19.01 vs. 73.75±24.54µg/dL, p=0.015), while the Cu/Zn ratio was significantly higher (1.53±0.61 vs. 1.22±0.49,p=0.007).Serum Zn showed significant negative correlations with systolic blood pressure (SBP) (ρ = -0.412,p<0.001) and diastolic blood pressure (DBP) (ρ = -0.210,p=0.036), whereas the Cu/Zn ratio showed significant positive correlations with SBP (ρ=0.412,p<0.001) and DBP (ρ=0.278,p=0.005).Serum Cu showed no significant correlation with either SBP or DBP.After adjustment for dyslipidemia and excess salt intake, the fourth quartile of the Cu/Zn ratio was independently associated with HTN, with approximately 3.7-fold higher odds than the first quartile (adjusted odds ratio=3.723,p=0.043), whereas serum Zn showed no independent association.Conclusion: Serum Cu was not significantly associated with HTN, whereas lower serum Zn and a higher Cu/Zn ratio were observed among hypertensive individuals.The Cu/Zn ratio showed significant correlations with both SBP and DBP and remained independently associated with HTN after adjustment for selected confounders.The Cu/Zn ratio may therefore have potential as an additional marker of trace-element imbalance in HTN; however, larger prospective studies are required to establish its clinical and causal significance.

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Cite This Study

Sharmin et al. (2026) conducted a cross-sectional in Hypertension (n=100). Serum copper-to-zinc (Cu/Zn) ratio (4th quartile) vs. Normotensive control / 1st quartile of serum Cu/Zn ratio was evaluated on Hypertension (association with serum Cu/Zn ratio) (OR 3.723, p=0.043). A fourth-quartile serum copper-to-zinc ratio was independently associated with 3.7-fold higher odds of hypertension compared to the first quartile (adjusted OR 3.723, p=0.043).

synapsesocial.com/papers/6add4812322f548a006b13b9 https://doi.org/10.7759/cureus.118010

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The Copper-Zinc Balance in Hypertension: A Cross-Sectional Study From Bangladesh

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

The Copper-Zinc Balance in Hypertension: A Cross-Sectional Study From Bangladesh

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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