The Association between the HALP Score and All-Cause and Cardiovascular Mortality in Adults with Hypertension: A NHANES Cohort Study

BACKGROUND: The hemoglobin-albumin-lymphocyte-platelet (HALP) score integrates pathways of anemia, malnutrition, inflammation, and thrombosis that are central to hypertensive organ damage. We therefore hypothesized that HALP would serve as a robust predictor of all-cause and cardiovascular mortality, specifically in adults with hypertension. METHODS: This cohort study included 23,564 U.S. adults from NHANES (2005-2018), comprising 12,319 with hypertension and 11,245 without, linked to mortality data through 2019. Hypertension was defined as self-reported diagnosis, antihypertensive medication use, or measured blood pressure ≥130/80 mmHg. Multivariable Cox models and restricted cubic spline analysis were used to assess HALP-mortality associations. Effect modification by hypertension status was formally tested. RESULTS: During a mean follow-up of 7.4 years, 1,738 all-cause deaths and 451 cardiovascular deaths occurred among adults with hypertension. In this group, each one-SD higher HALP score was associated with a lower risk of all-cause mortality (HR, 0.89; 95% CI, 0.83-0.94) and cardiovascular mortality (HR, 0.74; 95% CI, 0.65-0.83). In contrast, no association was observed in adults without hypertension (all-cause mortality HR, 0.96; 95% CI, 0.83-1.13; cardiovascular mortality HR, 0.85; 95% CI, 0.65-1.15). An interaction was observed between HALP score and hypertension status for both all-cause (p for interaction = 0.008) and cardiovascular mortality (p for interaction < 0.001). Furthermore, restricted cubic spline analysis within the cohort with hypertension revealed L-shaped nonlinear relationships between the HALP score and mortality risks. CONCLUSION: A higher HALP score was associated with lower mortality risk among adults with hypertension but not among those without hypertension.