Comparison of Novel Systemic Inflammatory Indices for Identification of Left Ventricular Hypertrophy in Hypertensive Patients: A Large-Scale Cross-Sectional Study in China

Background: Inflammation plays a key role in the onset of hypertension and left ventricular hypertrophy (LVH); large-scale studies on inflammatory markers in hypertension-related LVH are lacking. This study aims to investigate the relationship between inflammatory markers and LVH in hypertensive patients and evaluate their clinical diagnostic value. Methods: The present cross-sectional study included 21,486 patients diagnosed with hypertension from a China Hospital. Six inflammatory indices are calculated based on complete blood counts, including the aggregate index of systemic inflammation (AISI), Systemic Inflammation Response Index (SIRI), Systemic Immune Inflammation Index (SII), Neutrophil-to-Lymphocyte Ratio (NLR), Neutrophil-to-Platelet Ratio (NPR) and the Platelet-to-Lymphocyte Ratio (PLR). Multivariate logistic regression models, receiver operating characteristic (ROC) curves, the area under the curve (AUC), the net reclassification improvement (NRI), the improved discriminant index (IDI), decision curve analysis (DCA), sensitivity analysis and subgroup analysis were performed. Results: Levels of all inflammatory indices were significantly higher in hypertensive patients with LVH compared to those without LVH. Following multivariate adjustment, the odds of prevalent LVH increased by 76%, 48% and 39% for each one-standard-deviation increase in SII, NLR and AISI, respectively. After incorporating SII into the traditional risk factor model, the AUC of the combined diagnostic model increased significantly to 0.750, with an NRI of 0.437 and an IDI of 0.047. The AUC values for the combined models incorporating NLR, AISI, SIRI, PLR and NPR were 0.736, 0.728, 0.726, 0.720 and 0.719, respectively. Conclusions: In hypertensive patients, inflammatory indices, particularly SII, demonstrate a significant association with LVH and may provide incremental value for risk stratification beyond traditional risk factors. Further studies are needed to evaluate the clinical efficacy of these indices in management LVH.