Interaction of neutrophil counts and folic acid treatment on new-onset proteinuria in hypertensive patients

Zhuxian Zhang, Mengyi Liu, Yuanyuan Zhang, Chun Zhou, Panpan He, Huan Li, Jianping Li, Yan Zhang, Min Liang, Binyan Wang, Xin Xu, Xiaobin Wang, Yong Huo, Fan Fan Hou, Jing Nie, Xiping Xu, Xianhui Qin

Research output: Contribution to journalArticlepeer-review


We aimed to examine whether baseline neutrophil counts affected the risk of new-onset proteinuria in hypertensive patients, and, if so, whether folic acid treatment is particularly effective in proteinuria prevention in such a setting. A total of 8,208 eligible participants without proteinuria at baseline were analyzed from the renal sub-study of the China Stroke Primary Prevention Trial (CSPPT). Participants were randomized to receive a double-blind daily treatment of 10mg enalapril and 0.8mg folic acid (n=4,101) or 10mg enalapril alone (n=4,107). The primary outcome was new-onset proteinuria, defined as a urine dipstick reading of ≥1+ at the exit visit. The mean age of the participants was 59.5 (SD, 7.4) years, 3,088 (37.6%) of the participants were male. The median treatment duration was 4.4 years. In the enalapril-alone group, a significantly higher risk of new-onset proteinuria was found among participants with higher neutrophil counts (quintile 5; ≥4.8×109/L, OR, 1.44; 95%CI: 1.00, 2.06), compared with those in quintile 1-4. For those with enalapril and folic acid treatment, compared with the enalapril-alone, the new-onset proteinuria risk was reduced from 5.2% to 2.8% (OR, 0.49; 95%CI: 0.29, 0.82) among participants with higher neutrophil counts (≥4.8×109/L), whereas there was no significant effect among those with neutrophil counts <4.8×109/L. In summary, among hypertensive patients, those with higher neutrophil counts had increased risk of new-onset proteinuria, and this risk was reduced by 51% with folic acid treatment. If confirmed, neutrophil counts may serve as a biomarker to identify high-risk individuals who could particularly benefit from folic acid treatment.

Original languageEnglish (US)
JournalBritish Journal of Nutrition
StateAccepted/In press - 2020


  • Folic acid
  • Hypertension
  • Keywords:
  • Neutrophil counts
  • New-onset proteinuria

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Nutrition and Dietetics

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