Comparison of diagnostic values of monocyte-lymphocyte ratio, neutrophil-lymphocyte ratio, red cell distribution width-lymphocyte ratio, and systemic inflammatory index in predicting patients with non-dipper hypertension

Abstract

Objective: Hypertension (HTN) is related to myocardial ischemia, malignant arrhythmias, and cardiovascular mortality. However, inflammatory biomarkers are an important predictor of cardiovascular events. This study aimed to examine the diagnostic utility of inflammatory biomarkers in determining non-dipper hypertensive individuals and the relative superiority of the biomarkers. Methods: The research was carried out as a retrospective observational study. Patients diagnosed with HTN were included in this study. Blood pressure (BP) measurements were obtained from Holter records. The patients were classified into two groups: non-dipper (n=54) and dipper (n=143) based on Holter monitoring. The cut-off value of MLR (monocyte/lymphocyte ratio), NLR (neutrophil/lymphocyte ratio), SII (systemic inflammatory index), and RLR (red cell distribution width/lymphocyte ratio) for predicting non-dipper hypertension was determined using a receiver operating characteristic (ROC) analysis. Results: A total of 197 patients, comprising 84 females (42.6%) and, 113 males (57.4%) with a median age of 62 (54-69) years, participated in the research. Age, FPG, CRP, WBC, NEU, LYM, MONO, RDW, NLR, MLR, RLR, and SII were higher in the non-dipper group (p<0.05). MLR, NLR, RLR, and SII were found to have acceptable diagnostic capabilities in identifying non-dipper hypertension patients (AUC: 0.70-0.76). When ROC analysis was performed to determine the main similarities, it was found that there were no differences between inflammatory indicators (p>0.05). When the odds ratios of putative variables were evaluated, it was found that increasing MLR (OR: 7.22; 95%CI: 3.52-14.78; p<0.001), NLR (OR: 8.63; 95%CI: 4.19-17.68; p<0.001), RLR (OR: 4.29; 95%CI: 2.18-8.54; p<0.001), and SII (OR: 6.31; 95%CI: 3.09-12.85; p<0.001) were independent predictors for non-dipper positivity. Conclusion: In hypertensive patients, hematological inflammatory biomarkers MLR, NLR, RLR, and SII are valuable in determining non-dipper hypertension.

Keywords

• Non-dipper hypertension
• monocyte-lymphocyte
• neutrophil-lymphocyte ratio
• RDW-lymphocyte ratio
• systemic inflammatory index

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