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Relation of neutrophil/lymphocyte ratio to resistant hypertension

Year 2016, Volume: 2 Issue: 3, 211 - 218, 04.11.2016
https://doi.org/10.18621/eurj.2016.5000185856

Abstract

Objectives. Resistant hypertension has unfavourable effects on cardiovascular and other systems. The aim of this study was to investigate the association of neutrophil/lymphocyte (N/L) ratio and resistant hypertension. Methods. A total of 140 patients were included in the study. Ambulatory 24-hour blood pressure monitoring, transthoracic echocardiography and blood sample analyzing were performed in all patients. There were 60 patients with resistant hypertension group (mean age=55.1±9.7 years) and 80 patients with non-resistant hypertension group (mean age=56.8±14.1 years). Results. Mean neutrophil levels were significantly higher in resistant hypertension group (71.7±6.1% vs. 65.9±5.4%, p<0.001), while lymphocyte levels were significantly higher in non-resistant hypertension group (22±4.7% vs. 17.5±4.1%, p<0.001). N/L ratio was significantly higher in resistant hypertension group (4.3±1.2 vs. 3.1±0.9, p<0.001). In multivariate analysis, diabetes mellitus (odds ratio [OR]=2.857; 95% confidence interval [CI], 1.349-6.053; p=0.006), N/L ratio (OR=2.699; 95% CI, 1.821-4.002; p<0.001) and obesity (OR=3.429; 95% CI, 1.675-7.019; p=0.001) were independent predictors of resistant hypertension. Conclusion. The N/L ratio, which is cheaply and easily measurable laboratory data, is independently associated with resistant hypertension. 

References

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  • Parati G, Lombardi C, Hedner J, Bonsignore MR, Grote L, Tkacova R, et al. Position paper on the management of patients with obstructive sleep apnea and hypertension: joint recommendations by the European Society of Hypertension, by the European Respiratory Society and by the members of European COST (Co-operation in Scientific and Technological research) ACTION B26 on obstructive sleep apnea. J Hypertens 2012;30:633-46.
  • Akpek M, Kaya MG, Lam YY, Sahin O, Elcik D, Celik T, et al. Relation of neutrophil/lymphocyte ratio to coronary flow to in-hospital major adverse cardiac events in patients with ST-elevated myocardial infarction undergoing primary coronary intervention. Am J Cardiol 2012;110:621-7.
  • Kaya MG, Akpek M, Elcik D, Kalay N, Yarlioglues M, Koc F, et al. Relation of left atrial spontaneous echocardiographic contrast in patients with mitral stenosis to inflammatory markers. Am J Cardiol 2012;109:851-5.
  • Horne BD, Anderson JL, John JM, Weaver A, Bair TL, Jensen KR, et al. Which white blood cell subtypes predict increased cardiovascular risk? J Am Coll Cardiol 2005;45:1638-43.
  • Turak O, Ozcan F, Isleyen A, Tok D, Sokmen E, Buyukkaya E, et al. Usefulness of the neutrophil-to-lymphocyte ratio to predict bare-metal stent restenosis. Am J Cardiol 2012;110:1405-10.
  • Yildiz A, Kaya H, Ertas F, Oylumlu M, Bilik MZ, Yuksel M, et al. Association between neutrophil to lymphocyte ratio and pulmonary arterial hypertension. Arch Turk Soc Cardiol 2013;41:604-9.
  • Kalay N, Dogdu O, Koc F, Yarlioglues M, Ardic I, Akpek M, et al. Hematologic parameters and angiographic progression of coronary atherosclerosis. Angiology 2012;63:213-7.
  • Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, et al; American Society of Echocardiography's Nomenclature and Standards Committee; Task Force on Chamber Quantification; American College of Cardiology Echocardiography Committee; American Heart Association; European Association of Echocardiography, European Society of Cardiology. Recommendations for chamber quantification. Eur J Echocardiogr 2006;7:79-108.
  • Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A, Bohm M, et al. 2013 ESH/ESC guidelines for the management of arterial hypertension: the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J 2013;34:2159-219.
  • Kurtul A, Yarlioglues M, Murat SN, Ergun G, Duran M, Kasapkara HA, et al. Usefulness of the platelet-to-lymphocyte ratio in predicting angiographic reflow after primary percutaneous coronary intervention in patients with acute ST-segment elevation myocardial infarction. Am J Cardiol 2014;114:342-7.
  • Pauletto P, Rattazzi M. Inflammation and hypertension: the search for a link. Nephrol Dial Transplant 2006;21:850-3.
  • Tatsukawa Y, Hsu WL, Yamada M, Cologne JB, Suzuki G, Yamamoto H, et al. White blood cell count, especially neutrophil count, as a predictor of hypertension in a Japanese population. Hypertens Res 2008;31:1391-7.
  • Tian N, Penman AD, Mawson AR, Manning RD, Flessner MF. Association between circulating specific leukocyte types and blood pressure: the atherosclerosis risk in communities (ARIC) study. J Am Soc Hypertens 2010;4:272-83.
  • Trayhurn P, Wood IS. Adipokines: inflammation and the pleiotropic role of white adipose tissue. Br J Nutr 2004;92:347-55.
  • Straczkowski M, Dzienis-Straczkowska S, Stepien A, Kowalska I, Szelachowska M, Kinalska I. Plasma interleukin-8 concentrations are increased in obese subjects and related to fat mass and tumor necrosis factor-α system. J Clin Endocrinol Metab 2002;87:4602-6.
  • Herder C, Haastert B, Muller-Scholze S, Koenig W, Thorand B, Holle R, et al. Association of systemic chemokine concentrations with impaired glucose tolerance and type 2 diabetes: results from the Cooperative Health Research in the Region of Augsburg Survey S4 (KORA S4). Diabetes 2005;54:S11-7.
  • Boekholdt SM, Peters RJ, Hack CE, Day NE, Luben R, Bingham SA, et al. IL-8 plasma concentrations and the risk of future coronary artery disease in apparently healthy men and women: the EPIC-Norfolk prospective population study. Arterioscler Thromb Vasc Biol 2004;24:1503-8.
  • Baggiolini M, Dewald B, Moser B. Interleukin-8 and related chemotactic cytokines-CXC and CC chemokines. Adv Immunol 1994;55:97-179.
  • Mugge A, Lopez JA. Do leukocytes have a role in hypertension? Hypertension 1991;17:331-3.
  • Smedly LA, Tonnesen MG, Sandhaus RA, Haslett C, Guthrie LA, Johnston RB, et al. Neutrophil-mediated injury to endothelial cells. Enhancement by endotoxin and essential role of neutrophil elastase. J Clin Invest 1986;77:1233-43.
  • Weiss SJ. Tissue destruction by neutrophils. N Engl J Med 1989;320:365-76.
  • Griendling KK, FitzGerald GA. Oxidative stress and cardiovascular injury. Part II: Animal and human studies. Circulation 2003;108:2034-40.
  • Caetano EP, Zatz R, Praxedes JN. The clinical diagnosis of hypertensive nephrosclerosis—how reliable is it? Nephrol Dial Transplant 1999;14:288-90.
  • Harrison DG, Guzik TJ, Goronzy J, Weyand C. Is hypertension an immunologic disease? Curr Cardiol Rep 2008;10:464-9.
  • Rodriguez-Iturbe B, Quiroz Y, Herrera-Acosta J, Johnson RJ, Pons HA. The role of immune cells infiltrating the kidney in the pathogenesis of salt-sensitive hypertension. J Hypertens 2002;20:S9-14.
  • Guzik TJ, Hoch NE, Brown KA, McCann LA, Rahman A, Dikalov S, et al. Role of the T cell in the genesis of angiotensin II induced hypertension and vascular dysfunction. J Exp Med 2007;204:2449-60.
  • Takeichi N, Ba D, Kobayashi H. Natural cytotoxic autoantibody against thymocytes in spontaneously hypertensive rats. Cell Immunol 1981;60:181-90.
  • Bramlage P, Pittrow D, Wittchen HU, Kirch W, Boehler S, Lehnert H, et al. Hypertension in overweight and obese primary care patients is highly prevalent and poorly controlled. Am J Hypertens 2004;17:904-10.
  • Solini A, Zoppini G, Orsi E, Fondelli C, Trevisan R, Vedovato M, et al; Renal Insufficiency And Cardiovascular Events (RIACE) Study Group. Resistant hypertension in patients with type 2 diabetes: clinical correlates and association with complications. J Hypertens 2014;32:2401-10.
Year 2016, Volume: 2 Issue: 3, 211 - 218, 04.11.2016
https://doi.org/10.18621/eurj.2016.5000185856

Abstract

References

  • James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J, et al. 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA 2014;311:507-20.
  • Parati G, Lombardi C, Hedner J, Bonsignore MR, Grote L, Tkacova R, et al. Position paper on the management of patients with obstructive sleep apnea and hypertension: joint recommendations by the European Society of Hypertension, by the European Respiratory Society and by the members of European COST (Co-operation in Scientific and Technological research) ACTION B26 on obstructive sleep apnea. J Hypertens 2012;30:633-46.
  • Akpek M, Kaya MG, Lam YY, Sahin O, Elcik D, Celik T, et al. Relation of neutrophil/lymphocyte ratio to coronary flow to in-hospital major adverse cardiac events in patients with ST-elevated myocardial infarction undergoing primary coronary intervention. Am J Cardiol 2012;110:621-7.
  • Kaya MG, Akpek M, Elcik D, Kalay N, Yarlioglues M, Koc F, et al. Relation of left atrial spontaneous echocardiographic contrast in patients with mitral stenosis to inflammatory markers. Am J Cardiol 2012;109:851-5.
  • Horne BD, Anderson JL, John JM, Weaver A, Bair TL, Jensen KR, et al. Which white blood cell subtypes predict increased cardiovascular risk? J Am Coll Cardiol 2005;45:1638-43.
  • Turak O, Ozcan F, Isleyen A, Tok D, Sokmen E, Buyukkaya E, et al. Usefulness of the neutrophil-to-lymphocyte ratio to predict bare-metal stent restenosis. Am J Cardiol 2012;110:1405-10.
  • Yildiz A, Kaya H, Ertas F, Oylumlu M, Bilik MZ, Yuksel M, et al. Association between neutrophil to lymphocyte ratio and pulmonary arterial hypertension. Arch Turk Soc Cardiol 2013;41:604-9.
  • Kalay N, Dogdu O, Koc F, Yarlioglues M, Ardic I, Akpek M, et al. Hematologic parameters and angiographic progression of coronary atherosclerosis. Angiology 2012;63:213-7.
  • Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, et al; American Society of Echocardiography's Nomenclature and Standards Committee; Task Force on Chamber Quantification; American College of Cardiology Echocardiography Committee; American Heart Association; European Association of Echocardiography, European Society of Cardiology. Recommendations for chamber quantification. Eur J Echocardiogr 2006;7:79-108.
  • Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A, Bohm M, et al. 2013 ESH/ESC guidelines for the management of arterial hypertension: the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J 2013;34:2159-219.
  • Kurtul A, Yarlioglues M, Murat SN, Ergun G, Duran M, Kasapkara HA, et al. Usefulness of the platelet-to-lymphocyte ratio in predicting angiographic reflow after primary percutaneous coronary intervention in patients with acute ST-segment elevation myocardial infarction. Am J Cardiol 2014;114:342-7.
  • Pauletto P, Rattazzi M. Inflammation and hypertension: the search for a link. Nephrol Dial Transplant 2006;21:850-3.
  • Tatsukawa Y, Hsu WL, Yamada M, Cologne JB, Suzuki G, Yamamoto H, et al. White blood cell count, especially neutrophil count, as a predictor of hypertension in a Japanese population. Hypertens Res 2008;31:1391-7.
  • Tian N, Penman AD, Mawson AR, Manning RD, Flessner MF. Association between circulating specific leukocyte types and blood pressure: the atherosclerosis risk in communities (ARIC) study. J Am Soc Hypertens 2010;4:272-83.
  • Trayhurn P, Wood IS. Adipokines: inflammation and the pleiotropic role of white adipose tissue. Br J Nutr 2004;92:347-55.
  • Straczkowski M, Dzienis-Straczkowska S, Stepien A, Kowalska I, Szelachowska M, Kinalska I. Plasma interleukin-8 concentrations are increased in obese subjects and related to fat mass and tumor necrosis factor-α system. J Clin Endocrinol Metab 2002;87:4602-6.
  • Herder C, Haastert B, Muller-Scholze S, Koenig W, Thorand B, Holle R, et al. Association of systemic chemokine concentrations with impaired glucose tolerance and type 2 diabetes: results from the Cooperative Health Research in the Region of Augsburg Survey S4 (KORA S4). Diabetes 2005;54:S11-7.
  • Boekholdt SM, Peters RJ, Hack CE, Day NE, Luben R, Bingham SA, et al. IL-8 plasma concentrations and the risk of future coronary artery disease in apparently healthy men and women: the EPIC-Norfolk prospective population study. Arterioscler Thromb Vasc Biol 2004;24:1503-8.
  • Baggiolini M, Dewald B, Moser B. Interleukin-8 and related chemotactic cytokines-CXC and CC chemokines. Adv Immunol 1994;55:97-179.
  • Mugge A, Lopez JA. Do leukocytes have a role in hypertension? Hypertension 1991;17:331-3.
  • Smedly LA, Tonnesen MG, Sandhaus RA, Haslett C, Guthrie LA, Johnston RB, et al. Neutrophil-mediated injury to endothelial cells. Enhancement by endotoxin and essential role of neutrophil elastase. J Clin Invest 1986;77:1233-43.
  • Weiss SJ. Tissue destruction by neutrophils. N Engl J Med 1989;320:365-76.
  • Griendling KK, FitzGerald GA. Oxidative stress and cardiovascular injury. Part II: Animal and human studies. Circulation 2003;108:2034-40.
  • Caetano EP, Zatz R, Praxedes JN. The clinical diagnosis of hypertensive nephrosclerosis—how reliable is it? Nephrol Dial Transplant 1999;14:288-90.
  • Harrison DG, Guzik TJ, Goronzy J, Weyand C. Is hypertension an immunologic disease? Curr Cardiol Rep 2008;10:464-9.
  • Rodriguez-Iturbe B, Quiroz Y, Herrera-Acosta J, Johnson RJ, Pons HA. The role of immune cells infiltrating the kidney in the pathogenesis of salt-sensitive hypertension. J Hypertens 2002;20:S9-14.
  • Guzik TJ, Hoch NE, Brown KA, McCann LA, Rahman A, Dikalov S, et al. Role of the T cell in the genesis of angiotensin II induced hypertension and vascular dysfunction. J Exp Med 2007;204:2449-60.
  • Takeichi N, Ba D, Kobayashi H. Natural cytotoxic autoantibody against thymocytes in spontaneously hypertensive rats. Cell Immunol 1981;60:181-90.
  • Bramlage P, Pittrow D, Wittchen HU, Kirch W, Boehler S, Lehnert H, et al. Hypertension in overweight and obese primary care patients is highly prevalent and poorly controlled. Am J Hypertens 2004;17:904-10.
  • Solini A, Zoppini G, Orsi E, Fondelli C, Trevisan R, Vedovato M, et al; Renal Insufficiency And Cardiovascular Events (RIACE) Study Group. Resistant hypertension in patients with type 2 diabetes: clinical correlates and association with complications. J Hypertens 2014;32:2401-10.
There are 30 citations in total.

Details

Primary Language English
Subjects Cardiovascular Surgery
Journal Section Original Articles
Authors

Necati Dagli This is me

Orhan Dogdu

Omer Senarslan This is me

Hasan Yucel This is me

Hakki Kaya This is me

Mahmut Akpek This is me

Semih Eriten This is me

Publication Date November 4, 2016
Submission Date April 17, 2016
Acceptance Date August 22, 2016
Published in Issue Year 2016 Volume: 2 Issue: 3

Cite

AMA Dagli N, Dogdu O, Senarslan O, Yucel H, Kaya H, Akpek M, Eriten S. Relation of neutrophil/lymphocyte ratio to resistant hypertension. Eur Res J. November 2016;2(3):211-218. doi:10.18621/eurj.2016.5000185856

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