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March 18, 2026Open Access

Systemic immune-inflammation index: a novel tool for hypertension management in primary care

Key Points

This study aims to explore the connection between the systemic immune-inflammation index and hypertension, assessing its utility as a biomarker for screening.
Conducted a retrospective case–control study with 655 hypertensive patients and 669 healthy controls.
Excluded individuals with infections, malignancies, autoimmune, or rheumatologic diseases.
Calculated SII using the formula: platelet × neutrophil / lymphocyte.
Performed statistical analyses including Mann–Whitney U test, multivariate logistic regression, and ROC curve analysis.
Hypertensive patients had significantly higher median SII values (536.9) compared to healthy controls (381.3, p < 0.0001).
ROC analysis identified a cut-off value of 520.45 for predicting hypertension (AUC = 0.73).
SII > 520.45 correlated with a 7.3-fold higher odds of having hypertension (p < 0.0001).
Newly diagnosed hypertensive patients showed significantly higher SII levels than previously diagnosed ones (p < 0.001).
No significant difference in SII was found between 'Hypertension only' and 'Hypertension with comorbidity' groups (p = 0.596).

Abstract

Hypertension is a major global health problem and one of the most common chronic conditions managed in primary care. Increasing evidence indicates that chronic low-grade inflammation plays a key role in the development of hypertension. The systemic immune-inflammation index (SII), calculated from routine complete blood count parameters, reflects the balance between immune and inflammatory activity. This study aimed to investigate the association between systemic immune-inflammation index and hypertension and to evaluate its potential value as a screening and risk stratification biomarker in primary care. This retrospective case–control study included 655 hypertensive patients and 669 healthy controls aged ≥ 18 years. Individuals with acute or chronic infections, malignancy, autoimmune, or rheumatologic diseases were excluded. SII was calculated using the formula platelet × neutrophil / lymphocyte. Statistical analyses were performed using the Mann–Whitney U test, multivariate logistic regression, and receiver operating characteristic (ROC) curve analysis. A total of 1.324 participants were analyzed. Median SII values were significantly higher in hypertensive patients compared with healthy controls (536.9 vs. 381.3, p 520.45 (OR = 0.137, B = − 1.986, 95% CI: 0.099–0.191; p < 0.0001). Notably, SII levels were significantly higher in newly diagnosed hypertensive patients compared with those previously diagnosed (p < 0.001), suggesting a stronger inflammatory response at early disease stages. No significant difference in SII values was observed between the “Hypertension only” and “Hypertension with comorbidity” groups (p = 0.596), suggesting that elevated SII levels may be primarily associated with hypertension itself rather than the presence of additional comorbidities. SII levels are significantly elevated in patients with hypertension. Although its low sensitivity limits its use as a standalone screening tool, SII may serve as a specific and easily accessible adjunctive marker for risk stratification in primary care settings.

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