The Relationship Between Neutrophil/lymphocyte Ratio And Target Organ Damage In Patients With Essential Hypertension

BACKGROUNDHypertension is an increasingly prevalent chronic non-communicable disease in the world.its incidence is increasing year by year.The pathogenesis of hypertension is yet to be clearly stated.The target organ damage and cardiovascular complications caused by hypertension are more common and harmful and cause personal health damage,long-term negative impact on the family,while increasing the socio-economic burden.In recent years,studies have shown that systemic subclinical,low-grade inflammatory conditions are closely related to most cardiovascular risk factors,especially in hypertension,diabetes,acute coronary syndrome,as well as in atherosclerosis,arteriosclerosis and impaired arterial elasticity stage.Inflammation and the innate immune system play a key role in cardiovascular events associated with atherosclerosis and atherosclerotic lesions.Neutrophil lymphocyte ratio(NLR),the ratio of absolute neutrophil count to absolute lymphocyte count,can be used as an indicator which can react the systemic inflammation.NLR is of concern because of its potential as an independent predictor of coronary heart disease and even it can predict cardiovascular mortality.There are few large domestic and international data reports about the association between NLR and target organ damage in hypertensive patients.OBJECTIVE1.Screening for the incidence of the three-major target organ damage(carotid atherosclerosis,proteinuria,left ventricular hypertrophy)in patients with essential hypertension(EHT).2.To detect the levels of neutrophil lymphocyte ratio(NLR)in blood of patients with essential hypertension(EHT)and investigate whether there is a relationship between NLR and the three-major target organ damage in essential hypertension(carotid atherosclerosis,proteinuria,left ventricular hypertrophy).3.We preliminary study the value of NLR on the diagnosis of target organ damage in patients with hypertension.METHODS1.Inclusion objects:all of them were the local community residents from chronic disease prevention and treatment base in Liaobu,Dongguan City,Guangdong Province,who participated in our physical examination in January 2014 to December 2014.We signed an informed consent form with all of the objects.1731 patients were finally enrolled in this study.Record the general information of hypertension patients.Blood routine tests,biochemical markers,detection of urinary albumin creatinine ratio,examination of cardiac ultrasound and carotid ultrasound were taken and NLR values were calculated according to blood routine tests.2.The incidence of carotid arteries arteriosclerosis(CAS)was calculated.Data were compared between the atherosclerosis group(AS group)and group of patients without target-organ damage and the relationship between NLR and carotid atherosclerosis was analyzed.3.The incidence of proteinuria was calculated.The data of the two groups that patients with no target organ damage and proteinuria positive group were compared and the relationship between NLR and proteinuria was analyzed.4.The incidence of left ventricular hypertrophy was calculated.The data of the two groups that patients without target-organ damage and left ventricular hypertrophy group were compared and the relationship between NLR and left ventricular hypertrophy was analyzed.RERULT1.In 1731 cases of essential hypertension,the number of carotid atherosclerosis were detected in 834 cases(362 males and 472 females).The overall incidence was 48.2%.NLR was significantly higher in the atherosclerotic group than in the group of patients with no target organ damage.(p<0.001).Multivariate logistic regression analysis:NLR,age,smoking,and LDL-C were independent risk factors for the development of carotid atherosclerosis in patients with essential hypertension.NLR was independently associated with carotid atherosclerosis in patients with essential hypertension[p = 0.048.OR 1.165,95%CI(1.001-1.364)].Correlation analysis between NLR and independent risk factors of carotid atherosclerosis(Age,smoking,LDL-C)showed that NLR was positively correlated with age(p<0.05),but not with smoking and LDL-C(p>0.05).Single NLR for the diagnosis of hypertensive carotid atherosclerosis is weaker,the area under the ROC curve is 0.621.The area under the ROC curve of age-diagnosed hypertensive carotid atherosclerosis is 0.737.However,NLR combined with age can significantly improve the diagnosis value of hypertensive carotid atherosclerosis,which area under the ROC curve is 0.741.2.In 1731 cases of essential hypertension,subjects with proteinuria target organ damage were a total of 473 cases(180 males and 293 females).The overall incidence rate was 27.3%.NLR in proteinuria group was significantly higher than that in patients with no target organ damage.(p<0.05).Multivariate Logistic analysis:NLR,age,systolic blood pressure and uric acid were independent risk factors for proteinuria in patients with essential hypertension.NLR was independently associated with proteinuria in patients with essential hypertension[p= 0.011,OR 1.255,95%CI(1.054-1.494)].Correlation analysis between NLR and independent risk factors of proteinuria showed that NLR was positively correlated with age(p<0.05),but not with systolic blood pressure and uric acid(p>0.05).Single NLR for the diagnosis of hypertensive proteinuria is weaker,the area under the ROC curve were 0.572.The area under the ROC curve of age-diagnosed hypertensive proteinuria is 0.594.However,NLR combined with age can significantly improve the diagnosis value of hypertensive proteinuria,the area under the ROC curve is 0.604.3.In 1731 cases of essential hypertension,hypertensive patients with left ventricular hypertrophy target organ damage were a total of 258 cases(52 males and 206 females).The overall incidence rate was 15%.Pearson correlation analysis:there was a significant positive correlation between NLR and left ventricular mass index(r = 0.087,p = 0.017).There is no independent relationship between NLR and left ventricular hypertrophy in patients with essential hypertension.CONCLUSION:1.NLR is associated with target organ damage(carotid atherosclerosis,proteinuria)in patients with essential hypertension.It can be used for more sophisticated risk stratification of hypertension.2.NLR is easy to obtain in clinic and can early identify hypertensive target organ damage(carotid atherosclerosis,proteinuria)and suitable for primary care units.