Year 2016, Volume 2, Issue 3, Pages 211 - 218 2016-08-28

Relation of neutrophil/lymphocyte ratio to resistant hypertension

Necati Dagli [1] , Orhan Dogdu [2] , Omer Senarslan [3] , Hasan Yucel [4] , Hakki Kaya [5] , Mahmut Akpek [6] , Semih Eriten [7]

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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. 

Resistant hypertension, ambulatory blood pressure monitoring; neutrophil/lymphocyte ratio
  • 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.
Journal Section Original Articles
Authors

Author: Necati Dagli
Institution: Department of Cardiology, Firat University School of Medicine, Elazig
Country: Turkey


Author: Orhan Dogdu
Institution: Department of Cardiology, Firat University School of Medicine, Elazig
Country: Turkey


Author: Omer Senarslan
Institution: Department of Cardiology, Private Medifema Hospital, Izmir
Country: Turkey


Author: Hasan Yucel
Institution: Department of Cardiology, Cumhuriyet University School of Medicine, Sivas
Country: Turkey


Author: Hakki Kaya
Institution: Department of Cardiology, Cumhuriyet University School of Medicine, Sivas
Country: Turkey


Author: Mahmut Akpek
Institution: Department of Cardiology, Adnan Menderes University School of Medicine, Aydin
Country: Turkey


Author: Semih Eriten
Institution: Department of Emergency Medicine, Malatya State Hospital, Malatya
Country: Turkey


EndNote %0 The European Research Journal Relation of neutrophil/lymphocyte ratio to resistant hypertension %A Necati Dagli , Orhan Dogdu , Omer Senarslan , Hasan Yucel , Hakki Kaya , Mahmut Akpek , Semih Eriten %T Relation of neutrophil/lymphocyte ratio to resistant hypertension %D 2016 %J The European Research Journal %P -2149-3189 %V 2 %N 3 %R doi: 10.18621/eurj.2016.5000185856 %U 10.18621/eurj.2016.5000185856