The relationship between platelet to lymphocyte ratio and the diurnal variation of hypertension

Öz

Aim: Platelet to lymphocyte ratio (PLR) predicts worse outcome in cardiovascular disease. However data is limitted about the role of PLR in the diurnal variation of hypertension. In this study we evaluated the relationship between the diurnal variation of hypertension and PLR.

Material and Methods: The study included a total of 247 essential hypertensive patients. All patients underwent 24-hour ambulatory blood monitoring. Thereafter hypertensive patients were divided into two groups: 64 dipper patients (30 female, mean age 53.8±12.9 years) and 38 non-dipper patients (18 female, mean age 52.6±12.5years). Complete blood count and biochemistry were measured by standard methods.  PLR was measured by dividing platelet count to lymphocyte count.

Results: Non-dipper hypertensives had signifi cantly higher PLR levels than dippers (127.9±32.16 vs 103.4±10.67, p<0.001). There was a negatif correlation between percentage of sistolic and diastolic blood pressure fall and PLR.

Conclusion: We demonstrated that PLR, an inexpensive and easily accessible biomarker, is significantly higher in nondipper hypertensives than the dipper hypertensives. 

Anahtar Kelimeler

• Hypertension,non-dipper,dipper,platelet to lymphocyte ratio

Platelet lenfosit oranı ve hipertansiyonun diürnal ritmi arasındaki ilişki

Öz

Amaç: Platelet lenfosit oranı (PLR) kardiyovasküler kötü sonlanımlar için öngördürücüdür. Ancak PLR’nın hipertansiyonun diürnal ritmindeki rolü ile ilgili veri sınırlıdır. Biz bu çalışmada PLR ile hipertansiyonun diürnal ritmi arasındaki ilişkiyi değerlendirmeyi amaçladık.

Gereç ve Yöntemler: Çalışmaya toplamda 247 esansiyel hipertansiyon hastası dahil edildi. Tüm hastalara 24-saat ambulatuar kan basıncı monitorizasyonu yapıldı. Takiben hastalar iki gruba ayrıldı: 64 dipper hasta (30 kadın, ortalama yaş 53.8±12.9) ve 38 non-dipper hasta (18 kadın, ortalama yaş 52.6±12.5). Tam kan sayımı ve biyokimyasl değerlendirme standart metodlarla yapıldı. PLR platelet sayısının lenfosit sayısına bölünmesiyle hesaplandı.

Bulgular: Nondipper hipertansifler dipper hipertansiflere kıyasla daha yüksek PLR’ye sahipti (127.9±32.16’e 103.4±10.67, p<0.001). Sistolik ve diastolik kan basıncının düşüş oranı ile PLR arasında negatif korelasyon mevcuttu.

Sonuç: Ucuz ve kolay ulaşılabilir bir biobelirteç olan PLR, nondipper hipertansiflerde dipper hipertansiflere kyasla daha yüksektir.

Anahtar Kelimeler

• Hipertansiyon,non-dipper,dipper,platelet lenfosit oranı

Kaynakça

1. 1- O’ Brien E , Sheridan J , O ’ Malley K . Dippers and non-dippers. Lancet 1988; 2: 397
2. 2- Ohkubo T, Hozawa A, Yamaguchi J et al. Prognostic significance of the nocturnal decline in blood pressure in individuals with and without high 24-h blood pressure: the Ohasama study. J Hypertens 2002; 20: 2183–89.
3. 3- Izzedine H , Launay-Vacher V , Deray G . Abnormal blood pressure circadian rhythm: A target organ damage? Int J Cardiol 2006; 107: 343 – 49
4. 4- von Kanel R, Jain S, Mills PJ et al. Relation of nocturnal blood pressure dipping to cellular adhesion, inflammation and hemostasis. J Hypertens 2004; 22: 2087–93
5. 5- Sunbul M, Gerin F, Durmus E, Kivrak T, Sari I, Tigen K, Cincin A. Neutrophil to lymphocyte and platelet to lymphocyte ratio in patients with dipper versus non-dipper hypertension. Clin Exp Hypertens 2014; 36: 217-21
6. 6- Yildiz A, Yuksel M, Oylumlu M 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: 223–28
7. 7- Zhou D, Wang G, Fan Y, Wan Z, Liu X. Platelet to lymphocyte ratio is associated with the severity of coronary artery disease and clinical outcomes of percutaneous coronary intervention in the Chinese Han population. Exp Ther Med 2017; 13: 731-38.
8. 8- Sari I, Sunbul M, Mammadov C, Durmus E, Bozbay M, Kivrak T, Gerin F. Relation of neutrophil-to-lymphocyte and platelet-to-lymphocyte ratio with coronary artery disease severity in patients undergoing coronary angiography. Kardiol Pol. 2015; 73: 1310-16.

9. 9- James PA, Oparil S, Carter BL 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
10. 10- Verdecchia P , Porcellati C, Schillaci G et al . Ambulatory blood pressure. An independent predictor of prognosis in essential hypertension . Hypertension 1994; 24: 793–801.
11. 11- Mancia G, Parati G. The role of blood pressure variability in endorgan damage. J Hypertens Suppl 2003; 21: 17–23.
12. 12- Liu M, Takahashi H, Morita 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: 563–69
13. 13- Salles GF, Reboldi G, Fagard RH 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
14. 14- Fagard RH, Thijs L, Staessen JA, Clement DL, De Buyzere ML, De Bacquer DA. Night-day blood pressure ratio and dipping pattern as predictors of death and cardiovascular events in hypertension. J Hum Hypertens 2009; 23: 645-53.
15. 15- Sherwood A , Routledge FS , Wohlgemuth WK et al. Blood pressure dipping: Ethnicity, sleep quality, and sympathetic nervous system activity. Am J Hypertens 2011; 24: 982 – 88
16. 16- 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
17. 17- Inanc T, Kaya MG, Yarlioglues M et al.The mean platelet volume in patients with non-dipper hypertension compared to dippers and normotensives. Blood Press 2010; 19: 81-85
18. 18- Ye GL, Chen Q, Chen X et al. The prognostic role of platelet-to-lymphocyte ratio in patients with acute heart failure: A cohort study. Sci Rep 2019; 9: 10639
19. 19- Kurtul A, Murat SN, Yarlioglues M, et al. Association of platelet-to-lymphocyte ratio with severity and complexity of coronary artery disease in patients with acute coronary syndromes. Am J Cardiol 2014; 114: 972-78
20. 20- Gary T, Pichler M, Belaj K, et al. Platelet-to-lymphocyte ratio: a novel marker for critical limb ischemia in peripheral arterial occlusive disease patients. PLoS One 2013; 8: 67688
21. 21- Demir M. The relationship between neutrophil lymphocyte ratio and non-dipper hypertension. Clin Exp Hypertens 2013; 35: 570-73