Özyaşar Mehmet, Memioğlu Tolga
Konya City Hospital Cardiology Department, Karatay, Konya, Turkey.
Izzet Baysal Training and Research Hospital Cardiology Department, Faculty of Medicine, Bolu Abant Izzet Baysal University, Golkoy, Bolu, Turkey.
Medicine (Baltimore). 2025 May 9;104(19):e42371. doi: 10.1097/MD.0000000000042371.
Circadian hypertension patterns, classified as dipper and non-dipper, influence cardiovascular risk and are linked to systemic inflammation. This study aimed to examine the relationship between hypertension phenotypes and inflammatory biomarkers. This retrospective cross-sectional study included 160 hypertensive patients with elevated office blood pressure (BP) who underwent 24-hour ambulatory BP monitoring and were categorized into dipper and non-dipper groups. Inclusion criteria comprised newly diagnosed, untreated individuals without hematological disorders, chronic inflammatory conditions, active infections, or moderate to severe chronic kidney disease. Inflammatory indices derived from complete blood counts were analyzed alongside demographic and clinical data. The cohort consisted of 79 dippers and 81 non-dippers, with a mean age of 46 ± 5 ± 11 ± 1 years. Non-dippers were more likely to be smokers (P = .006) and exhibited significantly higher 24-hour, awake, and sleep systolic BPs and sleep diastolic BPs than dippers (P = .001, P = .003, P < .001, and P < .001, respectively). Non-dippers also had elevated white blood cell counts, neutrophil (NEU) levels, neutrophil-to-lymphocyte ratio (NLR), derived NLR (dNLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), and systemic inflammation response index (SIRI) scores (P < .001, P < .001, P < .001, P < .001, P < .001, P = .002, P < .001, and P < .001, respectively), while dippers exhibited higher lymphocyte counts (P < .001). Logistic regression analyses indicated that NLR, dNLR, MLR, PLR, SII, and SIRI scores significantly predicted the inflammatory status of non-dipper hypertensive patients. Notably, dNLR demonstrated the highest specificity, sensitivity, and area under the curve values in the receiver operating characteristic analysis. This study identified significant differences in inflammatory status between dipper and non-dipper hypertensive groups, with inflammatory biomarkers strongly correlating with non-dipper hypertension. The dNLR score exhibited the strongest predictive value for non-dipper hypertension. Routine screening of inflammatory markers in clinical practice could facilitate early identification of at-risk patients and potentially improve treatment outcomes. However, further research is needed to validate these findings.
昼夜血压模式分为杓型和非杓型，会影响心血管风险并与全身炎症相关。本研究旨在探讨高血压表型与炎症生物标志物之间的关系。这项回顾性横断面研究纳入了160例诊室血压（BP）升高的高血压患者，这些患者接受了24小时动态血压监测，并被分为杓型和非杓型组。纳入标准包括新诊断的、未经治疗的个体，且无血液系统疾病、慢性炎症性疾病、活动性感染或中度至重度慢性肾脏病。在分析人口统计学和临床数据的同时，还分析了全血细胞计数得出的炎症指标。该队列由79例杓型患者和81例非杓型患者组成，平均年龄为46±5±11±1岁。非杓型患者更有可能是吸烟者（P = 0.006），并且24小时、清醒和睡眠时的收缩压以及睡眠舒张压均显著高于杓型患者（分别为P = 0.001、P = 0.003、P < 0.001和P < 0.001）。非杓型患者的白细胞计数、中性粒细胞（NEU）水平、中性粒细胞与淋巴细胞比值（NLR）、衍生NLR（dNLR）、单核细胞与淋巴细胞比值（MLR）、血小板与淋巴细胞比值（PLR）、全身免疫炎症指数（SII）和全身炎症反应指数（SIRI）评分也升高（分别为P < 0.001、P < 0.001、P < 0.001、P < 0.001、P < 0.001、P = 0.002、P < 0.001和P < 0.001），而杓型患者的淋巴细胞计数较高（P < 0.001）。逻辑回归分析表明，NLR、dNLR、MLR、PLR、SII和SIRI评分显著预测了非杓型高血压患者的炎症状态。值得注意的是，在受试者工作特征分析中，dNLR表现出最高的特异性、敏感性和曲线下面积值。本研究发现杓型和非杓型高血压组之间的炎症状态存在显著差异，炎症生物标志物与非杓型高血压密切相关。dNLR评分对非杓型高血压具有最强的预测价值。在临床实践中常规筛查炎症标志物有助于早期识别高危患者，并可能改善治疗效果。然而，需要进一步研究来验证这些发现。
