The Importance of the De Ritis Ratio and Glasgow Prognostic Score in prehypertensive patients

Yıl 2021, Cilt: 5 Sayı: 3, 257 - 262, 31.12.2021

Ozge Ozcan Abacıoglu Arafat Yıldırım Mustafa Doğduş Ferhat Dindaş Fethi Yavuz

https://doi.org/10.30565/medalanya.927573

Öz

Aim: To evaluate Glasgow prognostic score (GPS) and De Ritis ratio in optimal blood pressure and prehypertensive patients, and investigate whether these parameters can predict antihypertensive treatment in the follow-up period.

Methods: A total of 402 patients who were followed up with a 24-hour ambulatory blood pressure with a pre-diagnosis of hypertension between January 2018 and December 2018 were included in the study. Routine laboratory parameters of the patients were recorded in the hospital digital system. The common health system data of the patients was analyzed until June 2020, and those who were started on antihypertensive treatment were recorded.

Results: 402 patients (mean age 40.16 ± 13.01 years, 49% male) were included in the study. 226 of these were in prehypertension group. The mean GPS and the De Ritis ratio, aspartate transferase levels, mean systolic and diastolic blood pressures were different between the groups (p=0.035, p=0.023, p=0.039, p<0.001 and p=0.012, respectively). When patients whose antihypertensive treatment was started and those who did not receive antihypertensive treatment were compared, age, De Ritis ratio and mean diastolic blood pressure differed between the two subgroups (p<0.001, p=0.015 and p=0.040, respectively). Multivariate logistic regression analysis showed that De Ritis ratio and age were, independently, predictors for antihypertensive treatment (OR:3.064, p=0.015 and OR:1.050, p= 0.001 respectively). In ROC curve analysis, both age and De Ritis ratio were successful at predicting the initiation of antihypertensive treatment with an AUC:0.697 and p<0.001 and AUC:0.630 and p=0.018 respectively.

Conclusion: Both GPS and the De Ritis ratio were found to be significantly higher in prehypertensive patients than those with optimal blood pressure. Moreover, the De Ritis ratio, an easily calculated laboratory parameter, can be used as a predictive value for antihypertensive treatment.

Anahtar Kelimeler

De Ritis, Glasgow prognostic score, prehypertension

Prehipertansif Hastalarda De Ritis Oranı ve Glasgow Prognostik Skorunun Önemi

Öz

Amaç: Optimal kan basıncı ve prehipertansif hastalarda glasgow prognostik skoru (GPS) ve De ritis (AST/ALT) oranını değerlendirmek ve bu parametrelerin takip döneminde antihipertansif tedaviyi tahmin edip edemeyeceğini araştırmayı amaçladık.

Yöntemler: Ocak 2018-Aralık 2018 tarihleri arasında kliniğimizde hipertansiyon ön tanısıyla 24 saat ambulatuvar kan basıncı monitörizasyonu ile izlenen toplam 402 hasta çalışmaya dahil edildi. Hastaların rutin laboratuvar parametreleri hastane dijital sisteminden kaydedildi. Hastaların medikasyon verileri ulusal sağlık sisteminden Haziran 2020'ye kadar analiz edilerek antihipertansif tedavi başlanan hastalar kayıt altına alındı.

Bulgular: Çalışmaya 402 hasta (ortalama yaş 40.16 ± 13.01 yıl) dahil edildi (% 49 erkek). Bunların 226'sı prehipertansiyon grubundaydı. Prehipertansiyon grubunda ortalama GPS ve De Ritis oranı, aspartat transferaz seviyeleri, ortalama sistolik ve diyastolik kan basınçları daha yüksek ve istatistiksel olarak anlamlı belirlendi (sırasıyla p = 0,035, p = 0,023, p = 0,039, p = <0,001 ve p = 0,012). Antihipertansif tedavi başlanan ile başlanmayan hastalar karşılaştırıldığında; yaş, De Ritis oranı ve ortalama diyastolik kan basıncı antihipertansif tedavi alan grupta daha yüksek belirlendi (sırasıyla p <0,001, p = 0,015 ve p = 0,040). Çok değişkenli lojistik regresyon analizinde De Ritis oranı ve yaş antihipertansif tedavi başlanması için bağımsız öngördücüler oldukları saptandı (sırasıyla OR: 3.064, p = 0.015 ve OR: 1.050, p = 0.001). ROC eğrisi analizinde, hem yaş hem de De Ritis oranı sırasıyla EAA: 0.697 ve p <0.001 ve EAA: 0.630 ve p = 0.018 ile antihipertansif tedavinin başlamasını öngörmede başarılıydı.

Sonuç: Hem GPS hem de De Ritis oranı prehipertansif hastalarda optimal kan basıncına sahip olanlara göre anlamlı olarak daha yüksek bulundu. Ayrıca kolay hesaplanan bir laboratuvar parametresi olan De Ritis oranı, antihipertansif tedavi başlanması için bir tahmin değeri olarak kullanılabilir.

Anahtar Kelimeler

De Ritis, Glasgow prognostik skoru, prehipertansiyon

Kaynakça

• 1. Taddei S, Bruno RM, Masi S, Solini A. Epidemiology and pathophysiology of hypertension. In: Calm AJ, editor. ESC CardioMed. 3rd ed. Oxford: Oxford University; 2018.p.2377-88.
• 2. Whelton PK, Carey RM, Aronow WS, Casey JrDE, Collins KJ, Himmelfarb CD, et al. ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. 2018;71:e13-e115. DOI:10.1161/HYP.0000000000000065
• 3. Achhab YE, Nazek L, Maalej M, Alami M, Nejjari C. Prevalence, control and risk factors related to hypertension among Moroccan adults: a multicentre study EMHJ. 2019;25: 447-56. DOI:10.26719/emhj.18.057
• 4. Konukoglu D, Uzun H. Endothelial Dysfunction and Hypertension. Adv Exp Med Biol 2017;956:511-40. DOI:10.1007/5584_2016_90
• 5. Sun HJ, Wu ZY, Nie XW, Bian JS. Role of Endothelial Dysfunction in Cardiovascular Diseases: The Link Between Inflammation and Hydrogen Sulfide. Front Pharmacol. 2020 Jan 21;10:1568. DOI:10.3389/fphar.2019.01568
• 6. Huang Z, Chen C, Li S, Kong F, Shan P, Huang W. Serum Markers of Endothelial Dysfunction and Inflammation Increase in Hypertension with Prediabetes Mellitus. Genet Test Mol Biomarkers .2016;20:322-7. DOI:10.1089/gtmb.2015.0255
• 7. Tsounis D, Bouras G,Giannopoulos G, Papadimitriou C, Alexopoulos D, Deftereos S. Inflammation markers in essential hypertension. Med Chem. 2014;10:672-81. doi: 10.2174/1573406410666140318111328.
• 8. Polónia J. Neutrophil-to-lymphocyte ratio and ambulatory blood pressure: Exploring the link between inflammation and hypertension. Rev Port Cardiol. 2017;36:107-9. DOI:10.1016/j.repce.2017.02.005
• 9. Steininger M, Winter MP, Reiberger T, Koller L, El-Hamid F, Forster S. et al. De-Ritis Ratio Improves Long-Term Risk Prediction after Acute Myocardial Infarction. J Clin Med 2018;7:474. doi: 10.3390/jcm7120474.
• 10. Nam JS, Kim WJ, An SM, Choi DK, Chin JH, Lee EH. et al. Age-dependent relationship between preoperative serum aminotransferase and mortality after cardiovascular surgery. Aging. 2019;11: 9060-74. doi: 10.18632/aging.102374.
• 11. Ha YS, Kim SW, Chun SY, Chung JW, Choi SH, Lee JN. et al. Association between De Ritis ratio (aspartate aminotransferase/alanine aminotransferase) and oncological outcomes in bladder cancer patients after radical cystectomy. BMC Urology 2019; 10:439-7. DOI:10.1186/s12894-019-0439-7
• 12. Shigeto N, Tadashi S, Kenya S, Toru T, Akira S, Atsushi K. The systemic inflammation-based Glasgow Prognostic Score as a prognostic factor in patients with acute heart failure. J Cardiovasc Med (Hagerstown) 2015;16:409-15. doi: 10.2459/JCM.0000000000000184.
• 13. Jia Y, Li D, Cao Y. Inflammation-based Glasgow Prognostic Score in patients with acute ST-segment elevation myocardial infarction: A prospective cohort study. Medicine (Baltimore). 2018;97:e13615. doi: 10.1097/MD.0000000000013615.
• 14. Ferguson TS, Younger N, Tulloch-Reid MK., Lawrence-Wright MB., Forrester TE., Cooper RS. et al. Progression from prehypertension to hypertension in a Jamaican cohort: incident hypertension and its predictors. West Indian Med J 2010;59:486-93.
• 15. Fuchs SC, Poli‐de‐Figueiredo CE, Figueiredo Neto JA, Scala JCN, Whelton PK, Mosele F. et al. Effectiveness of Chlorthalidone Plus Amiloride for the Prevention of Hypertension: The PREVER‐Prevention Randomized Clinical Trial. J Am Heart Assoc 2016;5:e004248. doi: 10.1161/JAHA.116.004248.
• 16. Lüders S, Schrader J, Berger J, Unger T, Zidek W, Böhm M. et al. The PHARAO study: prevention of hypertension with the angiotensin-converting enzyme inhibitor ramipril in patients with high-normal blood pressure: a prospective, randomized, controlled prevention trial of the German Hypertension League Hypertens 2008;26:1487-96. doi: 10.1097/HJH.0b013e3282ff8864.
• 17. Landi F, Calvani R, Anna Picca A, Tosato M, Martone AM, Ortolani E. et al. Body Mass Index is Strongly Associated with Hypertension: Results from the Longevity Check-up 7+ Study. Nutrients .2018;10:1976. doi: 10.3390/nu10121976.
• 18. Liu L, Gu Y, Li C. Serum uric acid is an independent predictor for developing prehypertension: a population-based prospective cohort study. Journal of Human Hypertension 2017;31:116–20. doi: 10.1038/jhh.2016.48.
• 19. Kuwabara M, Hisatome I, Niwa K, Hara S, Roncal-Jimenez CA, Bjornstad P. et al. Uric Acid is a Strong Risk Marker for Developing Hypertension from Prehypertension: A 5-year Japanese Cohort Study. Hypertension. 2018; 71: 78–86. doi: 10.1161/HYPERTENSIONAHA.117.10370.
• 20. Everett B, Zajacova A. Gender differences in hypertension and hypertension awareness among young adults. Biodemography Soc Biol 2015;61:1-17. doi: 10.1080/19485565.2014.929488.
• 21. Kumar P, Kumar D, Ranjan A, Singh CM, Pandey S, Agarwal N. Prevalence of Hypertension and its Risk Factors Among School Going Adolescents of Patna, India. J Clin Diagn Res 2017;11:SC01-SC04 . doi: 10.7860/JCDR/2017/23886.9196.
• 22. Dharmashankar K, Widlansky ME. Vascular endothelial function and hypertension: insights and directions. Curr Hypertens Rep 2010;12:448-55. doi: 10.1007/s11906-010-0150-2.