ASSOCIATION OF NEUTROPHIL/LYMPHOCYTE RATIO WITH AMBULATORY BLOOD PRESSURE VARIABILITY AND CIRCADIAN RHYTHM IN PATIENTS WITH ESSENTIAL HYPERTENSION

Objective: We aim to investigate the association of neutrophil/lymphocyte ratio (NLR) with ambulatory blood pressure variability (BPV) and blood pressure circadian rhythm in patients with essential hypertension. Design and method: We included patients with essential hypertension who were admitted in the First Center of Chinese PLA General Hospital during January 2020 to January 2021. NLR was defined as lymphocyte count divided by neutrophil count. Patients were grouped according to the quartile of NLR. We used standard deviation (SD), coefficient of variation (CV), and variation independent of mean (VIM) to evaluate the ambulatory BPV. We used multiple linear regression to examine the association between NLR and ambulatory BPV, and multivariable logistic regression to examine the association of NLR with non-dipping and reverse-dipping blood pressure circadian rhythm. Results: A total of 936 patients with essential hypertension were included in the current study. The mean age of study patients was 51.09±13.37 years. Patients with the highest quartile of NLR had higher BPV and higher proportion of non-dipping and reverse-dipping blood pressure circadian rhythm compared with those with the lowest quartile of NLR. After adjusting for potential confounders, we found positive linear association of NLR with 24 h systolic blood pressure (SBP) SD (B=0.25), SBP-CV (B=0.98), SBP-VIM (B=0.15), diastolic blood pressure (DBP) CV (B=1.23), diurnal SBP-SD (B=0.62), SBP-CV (B=1.11), SBP-VIM (B=0.30), DBP-CV (B=0.99), and nocturnal SBP-SD (B=0.69), SBP-CV (B=1.39), SBP-VIM (B=0.29), DBP-SD (B=1.54), DBP-CV (B=1.72), DBP-VIM (B=0.42). Multivariable logistic regression showed that compared with the lowest quartile of NLR, the highest quartile of NLR was associated with 93% higher risk of non-dipping and reverse-dipping blood pressure (OR, 95% CI: 1.93, 1.17-3.19). Conclusions: NLR was positively and linearly associated with ambulatory BPV. Elevated NLR was associated with higher risk of non-dipping and reverse-dipping blood pressure circadian rhythm.