Neutrophil-to-lymphocyte ratio in patients with white-coat hypertension

Year 2021, Volume: 4 Issue: 6, 824 - 827, 24.09.2021

Esin Avşar Gökhan Tazegül Erkan Çoban

https://doi.org/10.32322/jhsm.969699

Abstract

Introduction: White coat hypertension (WCH), a distinct phenotype of hypertension, is defined as elevated office blood pressure (BP) measurements during repeat visits with normal out-of-office BP measurements. The association of WCH with cardiovascular risk remains unclear; however, current data support an association between untreated WCH and the risk for cardiovascular events, cardiovascular mortality, and all-cause mortality. Increased inflammatory processes may explain the underlying pathophysiology of the increased risk for cardiovascular events in WCH; therefore, we evaluated the neutrophil-to-lymphocyte ratio (NLR) of patients with WCH compared with matched normotensive controls.
Material and Method: Forty-five eligible subjects with WCH and 45 age, sex, and BMI matched healthy and normotensive subjects were included in the study. The subjects were assessed by office arterial BP and 24-hour ambulatory BP measurements. An automated blood count analyzer measured the NLR values.
Results: The mean NLR in the patients-with-WCH group was significantly higher than that in the control group (2.67±0.27 vs. 2.46±0.34, p<0.001, Student’s t-test); however, NLR was not correlated with BP measurements in either the WCH or control group.
Conclusion: NLR, a marker of inflammation, was increased in patients with WCH compared to the controls. Inflammation is a triggering mechanism for various cardiovascular and cerebrovascular events. Therefore, NLR has value as a potential independent risk factor that deserves further study, particularly in patients with WCH.

Keywords

high blood pressure, systemic hypertension, inflammation, neutrophil-to-lymphocyte ratio, white coat hypertension

Supporting Institution

The authors declare none.

Thanks

The authors declare none.

References

• Muntner P, Shimbo D, Carey RM, et al. Measurement of blood pressure in humans: a scientific statement from the American Heart Association Hypertension 2019; 73:e35-e66.
• Cuspidi C, Sala C, Grassi G, Mancia G. White coat hypertension: to treat or not to treat? Curr Hypertens Rep 2016; 18: 80.
• Campbell PT, White WB. Utility of ambulatory blood pressure monitoring for the management of hypertension. Curr Opin Cardiol 2017; 32: 365-72.
• Huang Y, Huang W, Mai W, et al. White-coat hypertension is a risk factor for cardiovascular diseases and total mortality. J Hypertens 2017; 35: 677-88.
• Piper MA, Evans CV, Burda BU, Margolis KL, O’Connor E, Whitlock EP. Diagnostic and predictive accuracy of blood pressure screening methods with consideration of rescreening intervals: a systematic review for the U.S. Preventive Services Task Force. Ann Intern Med 2015; 162: 192-204.
• Franklin SS, Thijs L, Asayama K, et al. Cardiovascular risk in white-coat hypertension. JACC 2016; 68: 2033-43.
• Briasoulis A, Androulakis E, Palla M, Papageorgiou N, Tousoulis D. White-coat hypertension and cardiovascular events: a meta-analysis. J Hypertens 2016; 34: 593-9.
• Cohen JB, Denker MG, Cohen DL, Townsend RR. Cardiovascular events and mortality in white coat hypertension. Ann Intern Med 2019; 171: 603-4.
• Blake GJ, Ridker PM. Inflammatory bio-markers and cardiovascular risk prediction. J Intern Med 2002; 252: 283-94.
• Ridker PM. Inflammation, atherosclerosis, and cardiovascular risk: an epidemiologic view. Blood Coagul Fibrinolysis 1999; 10: 9–12.
• Rifai N. C-reactive protein and coronary heart disease: diagnostic and therapeutic implications for primary prevention. Cardiovasc Toxicol 2001; 1: 153-7.
• Benzaquen LR, Yu H, Rifai N. High sensitivity C-reactive protein: an emerging role in cardiovascular risk assessment. Crit Rev Clin Lab Sci 2002; 39: 459-97.
• Ridker PM. High-sensitivity C-reactive protein and cardiovascular risk: rationale for screening and primary prevention. Am J Cardiol 2003; 92: 17K–22K.
• Ozdogan M, Bozcuk H, Coban E. Low-grade inflammation in white-coat hypertension. Med Sci Monit 2007; 13: CR570-573.
• Yavuzer H, Cengiz M, Yavuzer S, et al. Procalcitonin and Pentraxin-3: current biomarkers in inflammation in white coat hypertension. J Hum Hypertens 2016; 30: 424-9.
• Huang YQ, Jie LI, Chen JY, Tang ST, Huang C, Feng YQ. The relationship between soluble CD40 ligand level and atherosclerosis in white-coat hypertension. J Hum Hypertens 2017; 32: 40-5.
• Imtiaz F, Shafique K, Mirza SS, Ayoob Z, Vart P, Rao S. Neutrophil lymphocyte ratio as a measure of systemic inflammation in prevalent chronic diseases in Asian population. Int Arch Med 2012; 5: 2.
• Guo X, Zhang S, Zhang Q, et al. Neutrophil:lymphocyte ratio is positively related to type 2 diabetes in a large-scale adult population: a Tianjin chronic low-grade systemic inflammation and health cohort study. Eur J Endocrinol 2015; 173: 217-25.
• Azab B, Camacho-Rivera M, Taioli E. Average values and racial differences of neutrophil lymphocyte ratio among a nationally representative sample of United States subjects. PloS One 2014; 9: e112361.
• Templeton AJ, McNamara MG, Šeruga B, et al. Prognostic role of neutrophil-to-lymphocyte ratio in solid tumors: a systematic review and meta-analysis. J Natl Cancer Inst 2014; 106: dju124.
• Verdoia M, Barbieri L, Giovine GD, Marino P, Suryapranata H, De Luca G. Neutrophil to lymphocyte ratio and the extent of coronary artery disease: results from a large cohort study. Angiology 2016; 67: 75-82.
• Erturk M, Cakmak HA, Surgit O, Celik O, Aksu HU. The predictive value of elevated neutrophil to lymphocyte ratio for long-term cardiovascular mortality in peripheral arterial occlusive disease. J Cardiol 2014; 43: 61-9.
• Liu X, Zhang Q, Wu H, et al. Blood neutrophil to lymphocyte ratio as a predictor of hypertension. Am J Hypertens 2015 28: 1339-46.
• Yayla C, Canpolat U, Akyel A, et al. Association of neutrophil-lymphocyte ratio with impaired aortic elasticity in newly diagnosed and never-treated hypertensive patients. Blood Press Monit 2015; 20: 127-31.
• Karagoz A, Vural A, Gunaydın ZY, et al. The role of neutrophil to lymphocyte ratio as a predictor of diastolic dysfunction in hypertensive patients. Eur Rev Med Pharmacol Sci 2015; 19; 433-40.
• Demir M. The relationship between neutrophil lymphocyte ratio and non-dipper hypertension. Clin Exp Hypertens 2013; 35: 570-3.
• Mancia G, Fagard R, Narkiewicz K, et al. Task Force for the management of arterial hypertension of the European Society of Hypertension and the European Society of Cardiology. Blood Press 2014; 23: 3-16.
• Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP). JAMA 2001; 285: 2486-97.
• Shrivastava AK, Singh HV, Raizada A, Singh SK. C-reactive protein, inflammation and coronary heart disease Egypt Heart J 2015; 67: 89-97.
• Andrikou I, Tsioufis C, Dimitriadis K, et al. Similar levels of low-grade inflammation and arterial stiffness in masked and white-coat hypertension: comparisons with sustained hypertension and normotension. Blood Press Monit 2011; 16: 218-23.