Can neutrophil to lymphocyte ratio and platelet to lymphocyte ratio be used as biomarkers for non-dipper blood pressure?

Yıl 2019, , 4 - 7, 27.01.2019

Özge Turgay Yıldırım , Ercan Akşit , Fatih Aydın , Ayse Hüseyinoglu Aydın Evrin Dağtekin

https://doi.org/10.28982/josam.436951

Öz

Aim: Hypertension is a major risk factor for cardiovascular diseases and non-dipper status is associated with increased risk for cardiovascular events. Neutrophil lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR) are related to inflammation and cardiovascular risk. The purpose of the study is to investigate the relationship between NLR and PLR with non-dipper status of hypertensive and normotensive patients.  

Methods:  A total of 482 patients were enrolled for the study. The study was planned as retrospective cohort study. Four groups were formed according to 24-h ambulatory blood pressure monitoring results. Group 1 was defined as hypertensive, non-dipper patients; group 2 as hypertensive, dipper patients; group 3 as normotensive, non-dipper patients and group 4 as normotensive, dipper patients.

Results: Mean age of the study population was 50.1±15.5 years, 38.1% were male. According to the statistical analysis of Group 1 (n=165), Group 2 (n=88), Group 3 (n=123) and Group 4 (n=91) NLR was statistically different among groups (p<0.001). Group 1 had significantly higher values compared to Group 2 (p=0.001), Group 3 (p=0.002) and Group 4 (p=0.023). In hypertensive patient group, PLR values of Group 1 was significantly higher than Group 2 (p=0.002). Pearson correlation analysis showed that NLR and PLR were correlated with BP variability (r=-0.188, p<0.001 for NLR and r=-0.182 and p<0.001 for PLR). Regression analysis showed NLR (p=0.040), PLR (p=0.021), age (p=0.006) and hypertension (p<0.001) were independent predictors of BP variability.

Conclusion: Our findings suggest that NLR and PLR can be used as inexpensive and easily accessible markers to detect non-dipper status in hypertensive patients.

Anahtar Kelimeler

Neutrophil to lymphocyte ratio, Platelet to lymphocyte ratio, Hypertension, Ambulatory blood pressure monitoring, Non-dipper blood pressure

Nötrofil/lenfosit oranı ve platelet/lenfosit oranı non-dipper kan basıncı için biyobelirteç olarak kullanılabilir mi?

Öz

Amaç: Hipertansiyon, kardiyovasküler hastalıklar için önemli bir risk faktörüdür ve non-dipper kan basıncı kardiyovasküler olaylar için artmış risk ile ilişkilidir. Nötrofil lenfosit oranı (NLR) ve platelet lenfosit oranı (PLR) inflamasyon ve kardiyovasküler risk ile ilişkilidir. Bu çalışmanın amacı, hipertansif ve normotansif hastalarda NLR, PLR ve non-dipper kan basıncı arasındaki ilişkiyi araştırmaktır.

Yöntemler: Çalışmaya toplam 482 hasta alındı. Çalışma retrospektif kohort çalışma olarak planlandı. 24 saatlik ayaktan kan basıncı monitorizasyonu sonuçlarına göre dört grup oluşturuldu. Grup 1 hipertansif, non-dipper hastalar, Grup 2 hipertansif, dipper hastalar; Grup 3 normotansif, non-dipper hastalar ve Grup 4 normotansif, dipper hastalar olarak sınıflandırıldı.

Bulgular: Çalışma popülasyonunun yaş ortalaması 50,1±15,5 yıl idi ve %38,1'i erkekti. Grup 1 (n = 165), Grup 2 (n=88), Grup 3 (n=123) ve Grup 4 (n=91) NLR açısından karşılaştırıldığında sonuç istatistiksel olarak anlamlı farklıydı (p<0,001). Grup 1'de; Grup 2'ye (p=0,001), Grup 3'e (p=0,002) ve Grup 4'e (p=0,023) göre NLR değeri istatistiksel anlamlı yüksekti. Hipertansif hasta grubunda, Grup 1'in PLR değerleri Grup 2'den anlamlı olarak yüksekti (p=0,002). Pearson korelasyon analizine göre NLR ve PLR, diurnal kan basıncı değişkenliği ile korelasyon gösterdi (NLR için r=-0,188, p<0,001 ve PLR için r =-0,182, p<0,001). Regresyon analizinde NLR (p=0,040), PLR (p=0,021), yaş (p=0,006) ve hipertansiyon (p<0,001), kan basıncı değişkenliğinin bağımsız belirleyicileri olarak saptandı.

Sonuç: Bulgularımız, NLR ve PLR'nin hipertansif hastalarda non-dipper kan basıncı için ucuz ve kolay erişilebilir işaretleyiciler olarak kullanılabileceğini göstermektedir.

Anahtar Kelimeler

Nötrofil lenfosit oranı, Platelet lenfosit oranı, Hipertansiyon, Ayaktan kan basıncı monitorizasyonu, Non-dipper kan basıncı

Kaynakça

• 1. Lewington S, Clarke R, Qizilbash N, Peto R, Collins R. Age-specific relevance of usual blood pressure to vascular mortality: a meta-analysis of individual data for one million adults in 61 prospective studies. Lancet. 2002;360:1903-13.
• 2. Roush GC, Fagard RH, Salles GF, Pierdomenico SD, Reboldi G, Verdecchia P, et al. Prognostic impact from clinic, daytime, and night-time systolic blood pressure in nine cohorts of 13,844 patients with hypertension. J Hypertens. 2014;32:2332-40.
• 3. Mancia G, Parati G. Ambulatory blood pressure monitoring and organ damage. Hypertension. 2000;36:894-900.
• 4. Salles GF, Reboldi G, Fagard RH, Cardoso CR, Pierdomenico SD, Verdecchia P, et al. Prognostic effect of the nocturnal blood pressure fall in hypertensive patients: The ambulatory blood pressure collaboration in patients with hypertension (ABC-H) meta-analysis. Hypertension. 2016;67:693-700.
• 5. Savoia C, Schiffrin EL. Inflammation in hypertension. Curr Opin Nephrol Hypertens. 2006;15:152-8.
• 6. Chae CU, Lee RT, Rifai N, Ridker PM. Blood pressure and inflammation in apparently healthy men. Hypertension. 2001;38:399-403.
• 7. Yamada S, Gotoh T, Nakashima Y, Kayaba K, Ishikawa S, Nago N, et al. Distribution of serum C-reactive protein and its association with atherosclerotic risk factors in a Japanese population: Jichi Medical School Cohort Study. Am J Epidemiol. 2001;153:1183-90.
• 8. Ozcan F, Turak O, Durak A, Işleyen A, Uçar F, Giniş Z, et al. Red cell distribution width and inflammation in patients with non-dipper hypertension. Blood Press. 2013;22:80-5.
• 9. Kaya MG, Yarlioglues M, Gunebakmaz O, Gunturk E, Inanc T, Dogan A, et al. Platelet activation and inflammatory response in patients with non-dipper hypertension. Atherosclerosis. 2010;209:278-82.
• 10. Li H, Zhou Y, Ma Y, Han S, Zhou L. The prognostic value of the platelet-to-lymphocyte ratio in acute coronary syndrome: a systematic review and meta-analysis. Kardiol Pol. 2017;75:666-73.
• 11. Arbel Y, Finkelstein A, Halkin A, Birati EY, Revivo M, Zuzut M, et al. Neutrophil/lymphocyte ratio is related to the severity of coronary artery disease and clinical outcome in patients undergoing angiography. Atherosclerosis. 2012;225:456-60.
• 12. Mancia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A, Böhm M, et al. 2013 ESH/ESC Guidelines for management of arterial hypertension. Eur Heart J. 2013;34:2159-219.
• 13. Mancia G, Parati G. The role of blood pressure variability in end organ damage. J Hypertens Suppl. 2003; 21:S17-23.
• 14. Liu M, Takahashi H, Morita Y, Maruyama S, Mizuno M, Yuzawa Y, et al. Non-dipping is a potent predictor of cardiovascular mortality and is associated with autonomic dysfunction in haemodialysis patients. Nephrol Dial Transplant. 2003;18:563–9.
• 15. Ino-Oka E, Yumita S, Sekino H, Ohtaki Y, Takahashi T, Inooka H, et al. The effects of physical activity and autonomic nerve tone on the daily fluctuation of blood pressure. Clin Exp Hypertens. 2004;26:129–36.
• 16. Kim S, Kim NH, Kim YK, Yoo JH, Shin SN, Ko JS, al. The Number of Endothelial Progenitor Cells is Decreased in Patients With Non-Dipper Hypertension. Korean Circ J. 2012;42:329-34.
• 17. Ross R. Atherosclerosis--an inflammatory disease. N Engl J Med. 1999;340:115-6.
• 18. Stenvinkel P, Alvestrand A. Inflammation in end-stage renal disease: sources, consequences, and therapy. Semin Dial. 2002;15:329-37.
• 19. Garcia C, Feve B, Ferre P, Halimi S, Baizri H, Bordies L, et al. Diabetes and inflammation: fundamental aspects and clinical implications. Diabetes Metab. 2010;36:327-38.
• 20. Feldmann M, Brennan FM, Maini RN. Role of cytokines in rheumatoid arthritis.Annu Rev Immunol. 1996;14:397-440.
• 21. Coussens LM, Werb Z. Inflammation and cancer. Nature. 2002;420:860-7.
• 22. Mangge H, Becker K, Fuchs D, Gostner JM. Antioxidants, inflammation and cardiovascular disease. World J Cardiol. 2014;6:462-77.
• 23. Wang H, Hu Y, Geng Y, Wu H, Chu Y, Liu R, et al. The relationship between neutrophil to lymphocyte ratio and artery stiffness in subtypes of hypertension. J Clin Hypertens (Greenwich). 2017;19:780-5.
• 24. Arbel Y, Finkelstein A, Halkin A, Birati EY, Revivo M, Zuzut M, et al. Neutrophil/lymphocyte ratio is related to the severity of coronary artery disease and clinical outcome in patients undergoing angiography. Atherosclerosis. 2012;225:456-60.
• 25. Projahn D, Koenen RR. Platelets: key players in vascular inflammation. J Leukoc Biol. 2012;92:1167-75.
• 26. Kaito K, Otsubo H, Usui N, Yoshida M, Tanno J, Kurihara E, et al. Platelet size deviation width, platelet large cell ratio, and mean platelet volume have sufficient sensitivity and specificity in the diagnosis of immune thrombocytopenia. Br J Haematol. 2005;128:698-702.
• 27. Yildiz A, Yuksel M, Oylumlu M, Polat N, Akyuz A, Acet H, et al. The Utility of the Platelet-Lymphocyte Ratio for Predicting No Reflow in Patients With ST-Segment Elevation Myocardial Infarction. Clin Appl Thromb Hemost. 2015;21:223-8.
• 28. Azab B, Shah N, Akerman M, McGinn JT Jr. Value of platelet/ lymphocyte ratio as a predictor of all-cause mortality after non- ST-elevation myocardial infarction. J Thromb Thrombolysis. 2012;34:326-34.
• 29. Kılıçaslan B, Dursun H, Kaymak S, Aydın M, Emekçi Ç, Susam İ, et al. The relationship between neutrophil to lymphocyte ratio and blood pressure variability in hypertensive and normotensive subjects. Turk Kardiyol Dern Ars. 2015;43:18-24.
• 30. Sunbul M, Gerin F, Durmus E, Kivrak T, Sari I, Tigen K, et al. Neutrophil to lymphocyte and platelet to lymphocyte ratio in patients with dipper versus non-dipper hypertension. Clin Exp Hypertens. 2014;36:217-21.