The relationship between the prognostic nutritional index and non-dipping blood pressure pattern in patients with newly diagnosed hypertension

Year 2023, Volume: 5 Issue: 3, 287 - 294, 28.07.2023

Tufan Günay , Selvi Coşar

https://doi.org/10.38053/acmj.1258111

Abstract

Aims: It has been suggested that immuno-nutritional status may play a role in blood pressure (BP) variations. This study aimed to investigate whether prognostic nutritional index (PNI) values differ between normotensive individuals and patients with newly diagnosed untreated hypertension (NDHT) and to clarify the relationship between the PNI and circadian BP patterns in NDHT patients.
Methods: This retrospective study included 328 adult participants, comprising 164 NDHT patients and 164 normotensive individuals. The non-dipper BP pattern (NDP) was defined as a nighttime decline in BP of less than 10%. The PNI was calculated using the following formula: PNI=([10 × serum albumin (g/dL)] + [0.005 × total lymphocyte count]).
Results: The mean PNI value was lower in the NDHT group than the normotensive group (53.6±6.1 vs. 58.2±5.3, p<0.001). There was a positive correlation between the PNI and the decline in nighttime BP levels (r=0.517; p<0.001). NDP was identified in 45.1% (n=74) of the NDHT patients. The mean PNI value was lower in the NDP group compared to the dipper BP group (49.9±5.6 vs. 56.6±4.8, p<0.001). Decreased PNI was an independent predictor of NDP (OR=0.70, 95% CI=0.61-0.81, p<0.001). The cut-off value of the PNI in predicting NDP was established as ≤51.3 with 72.4% sensitivity and 69.8% specificity.
Conclusion: Patients with hypertension had poorer immuno-nutritional statuses and a low PNI value was an important predictor of NDP. The PNI may be a useful screening tool for circadian BP patterns in patients with NDP.

Keywords

Circadian rhythm, hypertension, nutritional status, prognostic nutritional index

References

• Zhang J, Sun R, Jiang T, Yang G, Chen L. Circadian blood pressure rhythm in cardiovascular and renal health and disease. Biomolecules. 2021;11:868.
• Mahabala C, Kamath P, Bhaskaran U, Pai ND, Pai AU. Antihypertensive therapy: nocturnal dippers and nondippers. Do we treat them differently? Vasc Health Risk Manag. 2013;9:125-33.
• Douma LG, Gumz ML. Circadian clock-mediated regulation of blood pressure. Free Radic Biol Med. 2018;119:108-14.
• Salazar MR, Espeche WG, Stavile RN, et al. Nocturnal but not diurnal hypertension is associated to insulin resistance markers in subjects with normal or mildly elevated office blood pressure. Am J Hypertens. 2017;30:1032-8.
• Putz Z, Németh N, Istenes I, et al. Autonomic dysfunction and circadian blood pressure variations in people with impaired glucose tolerance. Diabet Med. 2013;30:358-62.
• Russo B, Menduni M, Borboni P, Picconi F, Frontoni S. Autonomic nervous system in obesity and insulin-resistance-the complex interplay between leptin and central nervous system. Int J Mol Sci. 2021;22:5187.
• Pongratz G, Straub RH. The sympathetic nervous response in inflammation. Arthritis Res Ther. 2014;16:504.
• Park EJ, Yoo SD. Nutritional biomarkers and heart rate variability in patients with subacute stroke. Nutrients. 2022;14:5320.
• Medina-Gomez G, Virtue S, Lelliott C, et al. The link between nutritional status and insulin sensitivity is dependent on the adipocyte-specific peroxisome proliferator-activated receptor-gamma2 isoform. Diabetes. 2005;54:1706-16.
• Usuda D, Kanda T. Peroxisome proliferator-activated receptors for hypertension. World J Cardiol. 2014;6:744-54.
• Bao Y, Bing C, Hunter L, Jenkins JR, Wabitsch M, Trayhurn P. Zinc-alpha2-glycoprotein, a lipid mobilizing factor, is expressed and secreted by human (SGBS) adipocytes. FEBS Lett. 2005;579:41-7.
• Rajamanickam A, Munisankar S, Dolla CK, Thiruvengadam K, Babu S. Impact of malnutrition on systemic immune and metabolic profiles in type 2 diabetes. BMC Endocr Disord. 2020;20:168.
• Schenk S, Saberi M, Olefsky JM. Insulin sensitivity:modulation by nutrients and inflammation. J Clin Invest. 2008;118:2992-3002.
• Olofsson PS, Steinberg BE, Sobbi R, et al. Blood pressure regulation by CD4(+) lymphocytes expressing choline acetyltransferase. Nat Biotechnol. 2016;34:1066-71.
• Siedlinski M, Jozefczuk E, Xu X, et al. White blood cells and blood pressure:a mendelian randomization study. Circulation. 2020;141:1307-17.
• Larochelle P. Circadian variation in blood pressure:dipper or nondipper. J Clin Hypertens (Greenwich). 2002;4:3-8.
• Radaeva OA, Simbirtsev AS, Kostina JA. The change in the circadian rhythm of macrophage colony-stimulating factor content in the blood of patients with essential hypertension. Cytokine X. 2019;1:100010.
• Sun Z, Li L, Yan Z, et al. Circadian rhythm disorders elevate macrophages cytokines release and promote multiple tissues/organs dysfunction in mice. Physiol Behav. 2022;249:113772.
• Fabbian F, Smolensky MH, Tiseo R, Pala M, Manfredini R, Portaluppi F. Dipper and non-dipper blood pressure 24-hour patterns:circadian rhythm-dependent physiologic and pathophysiologic mechanisms. Chronobiol Int. 2013;30:17-30.
• Stewart NR, Heiston EM, Miller SL, et al. Role of blood pressure responses to exercise and vascular insulin sensitivity with nocturnal blood pressure dipping in metabolic syndrome. J Vasc Res. 2022;59:151-62.
• Savica V, Bellinghieri G, Kopple JD. The effect of nutrition on blood pressure. Annu Rev Nutr. 2010;30:365-401.
• Baldemir R, Doğanay GE, Cirik MÖ, Ülger G, Yurtseven G, Zengin M. The relationship between acute physiology and chronic health evaluation-II, sequential organ failure assessment, Charlson comorbidity index and nutritional scores and length of intensive care unit stay of patients hospitalized in the intensive care unit due to chronic obstructive pulmonary disease. J Health Sci Med. 2022;5:1399-404.
• Sattler ELP, Ishikawa Y, Trivedi-Kapoor R, Zhang D, Quyyumi AA, Dunbar SB. Association between the prognostic nutritional index and dietary intake in community-dwelling older adults with heart failure:findings from NHANES III. Nutrients. 2019;11.
• Akbuga K, Ferik OK, Yayla KG, et al. Prognostic nutritional index as a new prediction tool for coronary collateral development. Acta Cardiol Sin. 2022;38:21-6.
• Hu X, Sang K, Chen C, et al. Prognostic nutritional index and major cardiovascular events in patients undergoing invasive coronary angiography:a clinical retrospective study. J Pers Med. 2022;12:1679.
• Chen XL, Wei XB, Huang JL, et al. The prognostic nutritional index might predict clinical outcomes in patients with idiopathic dilated cardiomyopathy. Nutr Metab Cardiovasc Dis. 2020;30:393-9.
• Yilmaz F, Keles M, Bora F. Relationship between the prognostic nutritional index and resistant hypertension in patients with essential hypertension. Clin Exp Hypertens. 2022;44:326-33.
• Friedewald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem 1972;18:499-502.
• Williams B, Mancia G, Spiering W, et al.. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J. 2018;39:3021-104.
• Suliburska J, Bogdanski P, Duda G, Pupek-Musialik D, Piatek J, Zukiewicz-Sobczak W. An assessment of dietary intake and state of nutritional in hypertensive patients from rural and urban areas of Greater Poland. Ann Agric Environ Med. 2012;19:339-43.
• Siritharan SS, Henry A, Gow ML, et al. Maternal macro- and micronutrient intake six months after hypertensive versus normotensive pregnancy:is poor diet quality contributing to future cardiometabolic disease risk? Pregnancy Hypertens. 2021;23:196-204.
• Yang ZW, Wei XB, Fu BQ, Chen JY, Yu DQ. Prevalence and prognostic significance of malnutrition in hypertensive patients in a community setting. Front Nutr. 2022;9:822376.
• Luo D, Xie N, Yang Z, Zhang C. Association of nutritional status and mortality risk in patients with primary pulmonary hypertension. Pulm Circ. 2022;12:e12018.
• Arslan K, Süleyman B. The relationship between the prognostic nutritional index and the clinical course of COVID-19:a single-center experience. J Med Palliat Care. 2022;3:92-7.
• Alwarawrah Y, Kiernan K, MacIver NJ. Changes in nutritional status impact immune cell metabolism and function. Front Immunol. 2018;9:1055.
• Lelong H, Galan P, Kesse-Guyot E, Fezeu L, Hercberg S, Blacher J. Relationship between nutrition and blood pressure:a cross-sectional analysis from the NutriNet-Sante Study, a French web-based cohort study. Am J Hypertens. 2015;28:362-71.
• Wei T, Liu J, Zhang D, et al. The relationship between nutrition and atherosclerosis. Front Bioeng Biotechnol. 2021;9:635504.
• Zhang R, Lahens NF, Ballance HI, Hughes ME, Hogenesch JB. A circadian gene expression atlas in mammals:implications for biology and medicine. Proc Natl Acad Sci U S A. 2014;111:16219-24.
• Lempiainen PA, Vasunta RL, Bloigu R, Kesaniemi YA, Ukkola OH. Non-dipping blood pressure pattern and new-onset diabetes in a 21-year follow-up. Blood Press. 2019;28:300-8.
• Sabio JM, Vargas-Hitos JA, Martinez-Bordonado J, Mediavilla-Garcia JD. Association between non-dipper hypertension and vitamin D deficiency in women with systemic lupus erythematosus. Clin Exp Rheumatol. 2019;37:286-92.
• Wang C, Zhang J, Liu X, et al. Reversed dipper blood-pressure pattern is closely related to severe renal and cardiovascular damage in patients with chronic kidney disease. PLoS One. 2013;8:e55419.
• O’Riordan A, Young DA, Ginty AT. Disordered eating is associated with blunted blood pressure reactivity and poorer habituation to acute psychological stress. Biol Psychol. 2023;179:108553.
• Ukkola O, Vasunta RL, Kesaniemi YA. Non-dipping pattern in ambulatory blood pressure monitoring is associated with metabolic abnormalities in a random sample of middle-aged subjects. Hypertens Res. 2009;32:1022-7.
• Hassan MO, Jaju D, Albarwani S, et al. Non-dipping blood pressure in the metabolic syndrome among Arabs of the Oman family study. Obesity (Silver Spring). 2007;15:2445-53.
• Akbal ÖY, Kültürsay B, Fındıkçıoğlu U, et al. Do malnutrition scores have a role in prediction of non-dipper hypertension? Koşuyolu Heart J. 2021;24:88-93.
• Tekce H, Kursat S, Bahadir Colak H, Aktas G. Effects of nutritional parameters on nocturnal blood pressure in patients undergoing hemodialysis. Ren Fail. 2013;35:946-50.
• Ando D, Hirawa N, Yasuda G. Hypoalbuminemia and hyperalbuminuria as major factors regulating circadian blood pressure rhythm in normal subjects and non-diabetic patients with early stages of chronic kidney disease. J Hypertens. 2014;3:2167-1095.1000142.
• Oosterman JE, Kalsbeek A, la Fleur SE, Belsham DD. Impact of nutrients on circadian rhythmicity. Am J Physiol Regul Integr Comp Physiol. 2015;308:R337-50.
• Hoyas I, Leon-Sanz M. Nutritional challenges in metabolic syndrome. J Clin Med. 2019;8:1301.
• Okutucu S, Kabakci G, Deveci OS, et al. Relationship between exercise heart rate recovery and circadian blood pressure pattern. J Clin Hypertens (Greenwich). 2010;12:407-13.
• Doğanay B, Başar V. Association between triglyceride-glucose index and heart rate recovery affecting circadian rhythm of blood pressure in patients with normoglycemic primary hypertension. EJCM. 2023;11:39-48.
• Saylik F, Cinar T, Selcuk M, Akbulut T. Triglyceride-to-glucose index to detect a non-dipping circadian pattern in newly diagnosed hypertensive patients. J Cardiovasc Thorac Res. 2022;14:147-52.