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

Year 2024, Volume: 15 Issue: 51, 27 - 33, 29.04.2024

Serhat Günlü , Fethullah Kayan , Mehmet Zülkif Karahan

https://doi.org/10.17944/interdiscip.1312657

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

References

• GBD 2019 Cancer Risk Factors Collaborators. The global burden of cancer attributable to risk factors, 2010-19: a systematic analysis for the Global Burden of Disease Study 2019.Lancet. 2022;400(10352):563-591. https://doi.org/10.1016/S0140-6736(22)01438-6
• Williams B, Mancia G, Spiering W, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension [published correction appears in Eur Heart J. 2019 Feb 1;40(5):475].Eur Heart J. 2018;39(33):3021-3104. https://doi.org/10.1093/eurheartj/ehy339
• Seo WS, Oh HS.: The circadian rhythms of blood pressure and heart rate in the hypertensive subjects: dippers and non-dippers. Yonsei Med J. 2002, 43: 320–38. https://doi.org/10.3349/ymj.2002.43.3.320
• Liu J, Su X, Nie Y, et al.: Dosing Time Matters? Nighttime vs. Daytime Administration of Nifedipine Gastrointestinal Therapeutic System (GITS) or Amlodipine on Non-dipper Hypertension: A Randomized Controlled Trial of NARRAS. Front Cardiovasc Med. 2021, 8:755403. http://doi: 10.3389/fcvm.2021.755403
• Seo HS, Kang TS, Park S, et al. Non-dippers are associated with adverse cardiac remodeling and dysfunction (R1). Int J Cardiol. 2006;112(2):171-177. https://doi.org/10.1016/j.ijcard.2005.08.038
• Virdis A, Dell’Agnello U, Taddei S. Impact of inflammation on vascular disease in hypertension. Maturitas. 2014;78(3):179-183. https://doi.org/10.1016/j.maturitas.2014.04.012
• Banyeh M, Akilla MA, Adams Y, Depare PP, Bannison SB, et al. Neutrophil to lymphocyte ratio versus monocyte to lymphocyte ratio in predicting hypertensive diseases of pregnancy. Annals of Medical Laboratory Science. 2021; 1(1): 8-17.http://doi: 10.51374/annalsmls.2021.1.1.0014
• Duyan M, Vural N. Diagnostic value of systemic immune-inflammation index and red cell distribution width-lymphocyte ratio in predicting troponin elevation in carbon monoxide poisoning. Cukurova Medical Journal. 2022;47(4): 1584-90. https://doi.org/10.17826/cumj.1171643
• Mancia G, Parati G. The role of blood pressure variability in end-organ damage. J Hypertens Suppl. 2003; 21(6): S17-S23. https://doi.org/10.1097/00004872-200307006-00004
• Hermida RC, Ayala DE, Mojón A, Fernández JR. Blunted sleep-time relative blood pressure decline increases cardiovascular risk independent of blood pressure level--the “normotensive non-dipper” paradox.Chronobiol Int. 2013;30(1-2):87-98. https://doi.org/10.3109/07420528.2012.701127
• Kim S, Kim NH, Kim YK, et al. The number of endothelial progenitor cells is decreased in patients with non-dipper hypertension. Korean Circ J. 2012, 42:329-34.https://doi.org/10.4070/kcj.2012.42.5.329
• Furman D, Campisi J, Verdin E, et al. Chronic inflammation in the etiology of disease across the life span.Nat Med. 2019;25(12):1822-1832. https://doi.org/10.1038/s41591-019-0675-0
• Grygiel-Górniak B, Limphaibool N, Puszczewicz M. Cytokine secretion and the risk of depression development in patients with connective tissue diseases.Psychiatry Clin Neurosci. 2019;73(6):302-316. https://doi.org/10.1111/pcn.12826
• Yang YL, Wu CH, Hsu PF, et al. Systemic immune-inflammation index (SII) predicted clinical outcome in patients with coronary artery disease.Eur J Clin Invest. 2020;50(5):e13230. https://doi.org/10.1111/eci.13230
• Caillon A, Paradis P, Schiffrin EL. Role of immune cells in hypertension.Br J Pharmacol. 2019;176(12):1818-1828. https://doi.org/10.1111/bph.14427
• Fonkoue IT, Le NA, Kankam ML, et al. Sympathoexcitation and impaired arterial baroreflex sensitivity are linked to vascular inflammation in individuals with elevated resting blood pressure.Physiol Rep. 2019; 7(7): e14057. https://doi.org/10.14814/phy2.14057
• Tanase DM, Gosav EM, Radu S, et al. Arterial Hypertension and Interleukins: Potential Therapeutic Target or Future Diagnostic Marker?Int J Hypertens. 2019; 2019: 3159283. https://doi.org/10.1155/2019/3159283
• Isayeva A, Matiashova L. Inflammation markers in subjects with dipper and non-dipper blood pressure patterns.Journal of Hypertension. 2022; 40(Suppl 1): e241-e242.https://doi.org/10.1097/01.hjh.0000837956.80211.8d
• Liu X, Zhang Q, Wu H, et al. Blood Neutrophil to Lymphocyte Ratio as a Predictor of Hypertension.Am J Hypertens. 2015;28(11):1339-1346. https://doi.org/10.1093/ajh/hpv034
• Balta S, Ozturk C, Yildirim AO, Aparci M, Demir M, Celik T. The Relation Between Neutrophil-Lymphocyte Ratio and Hypertension.Am J Hypertens. 2015; 28(11): 1386. https://doi.org/10.1093/ajh/hpv137
• Belen E, Sungur A, Sungur MA, Erdoğan G. Increased Neutrophil to Lymphocyte Ratio in Patients With Resistant Hypertension.J Clin Hypertens (Greenwich). 2015;17(7):532-537. https://doi.org/10.1111/jch.12533
• Yu X, Xue Y, Bian B, et al. NLR-A Simple Indicator of Inflammation for the Diagnosis of Left Ventricular Hypertrophy in Patients with Hypertension.Int Heart J. 2020;61(2):373-379. doi:10.1536/ihj.19-138
• Wang H, Hu Y, Geng Y, et al. The relationship between neutrophil to lymphocyte ratio and artery stiffness in subtypes of hypertension.J Clin Hypertens (Greenwich). 2017;19(8):780-785. https://doi.org/10.1111/jch.13002
• Derya MA, Demir V, Ede H. Relationship between neutrophil-lymphocyte ratio and epicardial fat tissue thickness in patients with newly diagnosed hypertension.Journal of International Medical Research. 2018;46(3):940-950. https://doi.org/10.1177/0300060517749130
• JhuangYH, Kao TW, Peng TC, et al. Neutrophil to lymphocyte ratio as predictor for incident hypertension: a 9-year cohort study in Taiwan.Hypertens Res. 2019;42(8):1209-1214. https://doi.org/10.1038/s41440-019-0245-3
• Sun X, Luo L, Zhao X, Ye P, Du R. The neutrophil-to-lymphocyte ratio on admission is a good predictor for all-cause mortality in hypertensive patients over 80years of age.BMC Cardiovasc Disord. 2017;17(1):167. https://doi.org/10.1186/s12872-017-0595-1
• Orozco SL, Canny SP, Hamerman JA. Signals governing monocyte differentiation during inflammation. CurrOpin Immunol. 2021; 73: 16-24.https://doi.org/10.1016/j.coi.2021.07.007
• Narasimhan PB, Marcovecchio P, HamersAAJ, Hedrick CC. Nonclassical monocytes in health and disease. Annu Rev Immunol. 2019; 37: 439-56. https://doi.org/10.1146/annurev-immunol-042617-053119
• Zuo B, Zhu S, Meng X, Zhao D, Zhang J. Monocyte-lymphocyte ratio is associated with carotid stenosis in ischemic stroke: A retrospective analysis.Brain Behav. 2019; 9(10): e01429. https://doi.org/10.1002/brb3.1429
• Zhang M, Wang K, Zheng H, Zhao X, Xie S, Liu C. Monocyte lymphocyte ratio predicts the new-onset of chronic kidney disease: A cohort study.Clin Chim Acta. 2020;503:181-189. https://doi.org/10.1016/j.cca.2019.11.021
• Musiał K, Bargenda-Lange A, Mazurkiewicz P, Gaik M, Gralec S, Zwolińska D. Lymphocyte to monocyte ratio and blood pressure variability in childhood hypertension-a pilot study [published online ahead of print, 2022 Apr 4].Pediatr Res. 2022;10.1038/s41390-022-02056-1. https://doi.org/10.1038/s41390-022-02056-1
• Xiang F, Chen R, Cao X, et al. Monocyte-lymphocyte ratio as a better predictor of cardiovascular and all-cause mortality in hemodialysis patients: A prospective cohort study.Hemodial Int. 2018;22(1):82-92. https://doi.org/10.1111/hdi.12549
• YıldırımKöpük Ş, Naci N ,Özcan C, Ulu İ. Monocyte to HDL Ratio in Preeclamptic Patients: Can It Be a Predictive Marker? Clinical and Experimental Health Sciences. 2022; 12(4): 835-839.https://doi.org/10.33808/clinexphealthsci.1094774
• Kato H, Ishida J, Imagawa S, Saito T, Suzuki N, Matsuoka T, et al. Enhanced erythropoiesis mediated by activation of the renin–angiotensin system via angiotensin II type 1a receptor. FASEB J 2005; 19: 2023– 5.https://doi.org/10.1096/fj.05-3820fje
• Tanindi A, Topal FE, Topal F, Celik B. Red cell distribution width in patients with prehypertension and hypertension.Blood Press. 2012;21(3):177-181. https://doi.org/10.3109/08037051.2012.645335
• Buyukkaya E, Erayman A, Karakas E, et al. Relation of red cell distribution width with dipper and non-dipper hypertension.Med Glas (Zenica). 2016;13(2):75-81. https://doi.org/10.17392/859-16
• Sarikaya S, Şahin Ş, Akyol L, et al. Is there any relationship between RDW levels and atrial fibrillation in hypertensive patients?Afr Health Sci. 2014;14(1):267-272. https://doi.org/10.4314/ahs.v14i1.41
• He LM, Gao CY, Wang Y, Wang H, Zhao HY. Red cell distribution width and homocysteine act as independent risk factors for cardiovascular events in newly diagnostic essential hypertension.Oncotarget. 2017;8(60):102590-102599. https://doi.org/10.18632/oncotarget.21964
• Yaşar E, Bayramoğlu A. Systemic immune- inflammation index as a predictor of microvascular dysfunction in patients with cardiac syndrome X. Angiology. 2022;73:615-21.https://doi.org/10.1177/00033197221087777
• Akyüz A, Işık F. Systemic Immune-Inflammation Index: A Novel Predictor for Non-dipper Hypertension.Cureus. 2022; 14(8): e28176. https://doi.org/10.7759/cureus.28176
• Saylik F, Sarıkaya R. Can Systemic Immune-Inflammation Index Detect the Presence of Exxaggerated Morning Blood Pressure Surge in Newly Diagnosed Treatment-Naive Hypertensive Patients?Clin Exp Hypertens. 2021;43(8):772-779. https://doi.org/10.1080/10641963.2021.1960366
• ÇırakoğluÖF, Yılmaz AS. Systemic immune-inflammation index is associated with increased carotid intima-media thickness in hypertensive patients.Clin Exp Hypertens. 2021;43(6):565-571. https://doi.org/10.1080/10641963.2021.1916944