The neutrophil-lymphocyte ratio (NLR) has been identified as an inflammation-related predictor of cardiovascular disease, and its association with hypertension has been reported. However, the relationship between NLR and hypertension in diabetic patients remains insufficiently explored. This study aimed to investigate the relationship between NLR and hypertension in diabetic patients using data obtained from the National Health and Nutrition Examination Survey (NHANES) database from 2005 to 2018. After excluding participants with missing data on NLR and hypertension, the baseline characteristics of diabetic patients aged 18 years and older were analyzed. The relationship between NLR and hypertension was assessed using weighted multiple regression models and restricted cubic spline (RCS) analysis. A total of 6,472 participants were included in the study. The weighted multiple regression analysis revealed that higher NLR quartiles were positively associated with hypertension. In Model 3, after adjusting for covariates, the positive correlation remained significant (Q3: OR = 1.39, 95% CI [1.08, 1.80], p = 0.011; Q4: OR = 1.35, 95% CI [1.06, 1.71], p = 0.017), indicating that the risk of hypertension increased by 39% and 35% for participants in the middle and high NLR quartiles, respectively, compared to those in the low NLR quartile. Additionally, RCS analysis demonstrated a significant non-linear relationship between NLR levels and the risk of hypertension in diabetic patients. Specifically, lower NLR levels were associated with a higher risk of hypertension, while the risk escalated once NLR exceeded a certain threshold. The study suggests that elevated NLR is a significant risk factor for hypertension in diabetic patients, with a non-linear relationship observed. These findings highlight the potential utility of NLR as a biomarker for identifying hypertension risk in this population.

Shunqiong Zhang, Taoqing Liang, Chunlai Zeng. Association of Neutrophil-to-Lymphocyte Ratio (NLR) with Hypertension in US Diabetic Populations: Insights from NHANES Database (2005-2018). Frontiers in Medical Science Research (2024), Vol. 6, Issue 12: 28-36. https://doi.org/10.25236/FMSR.2024.061205.

[1] RICHARDSON L C, VAUGHAN A S, WRIGHT J S, et al. Examining the Hypertension Control Cascade in Adults With Uncontrolled Hypertension in the US [J]. JAMA Netw Open, 2024, 7(9): e2431997. 

[2] ROTH G A, MENSAH G A, JOHNSON C O, et al. Global Burden of Cardiovascular Diseases and Risk Factors, 1990-2019: Update From the GBD 2019 Study [J]. J Am Coll Cardiol, 2020, 76(25): 2982-3021.

[3] HENGEL F E, BENITAH J P, WENZEL U O. Mosaic theory revised: inflammation and salt play central roles in arterial hypertension [J]. Cell Mol Immunol, 2022, 19(5): 561-76.

[4] BUFORD T W. Hypertension and aging [J]. Ageing Res Rev, 2016, 26: 96-111.

[5] GARCíA-ESCOBAR A, VERA-VERA S, TéBAR-MáRQUEZ D, et al. Neutrophil-to-lymphocyte ratio an inflammatory biomarker, and prognostic marker in heart failure, cardiovascular disease and chronic inflammatory diseases: New insights for a potential predictor of anti-cytokine therapy responsiveness [J]. Microvasc Res, 2023, 150: 104598.

[6] JHUANG Y H, KAO T W, PENG T C, et al. Neutrophil to lymphocyte ratio as predictor for incident hypertension: a 9-year cohort study in Taiwan [J]. Hypertens Res, 2019, 42(8): 1209-14.

[7] CHEN X, LI A, MA Q. Neutrophil-lymphocyte ratio and systemic immune-inflammation index as predictors of cardiovascular risk and mortality in prediabetes and diabetes: a population-based study [J]. Inflammopharmacology, 2024, 32(5): 3213-27.

[8] CHEN G, CHE L, LAI M, et al. Association of neutrophil-lymphocyte ratio with all-cause and cardiovascular mortality in US adults with diabetes and prediabetes: a prospective cohort study [J]. BMC Endocr Disord, 2024, 24(1): 64.

[9] CHEN H L, WU C, CAO L, et al. The association between the neutrophil-to-lymphocyte ratio and type 2 diabetes mellitus: a cross-sectional study [J]. BMC Endocr Disord, 2024, 24(1): 107.

[10] Lloyd-Jones D M, Ning H, Labarthe D, et al. Status of cardiovascular health in US adults and children using the American Heart Association’s new “Life’s Essential 8” metrics: prevalence estimates from the National Health and Nutrition Examination Survey (NHANES), 2013 through 2018[J]. Circulation, 2022, 146(11): 822-835.

[11] JOHNSON C L, DOHRMANN S M, BURT V L, et al. National health and nutrition examination survey: sample design, 2011-2014 [J]. Vital Health Stat 2, 2014, (162): 1-33.

[12] LOPRINZI P D, RAMULU P Y. Objectively measured physical activity and inflammatory markers among US adults with diabetes: implications for attenuating disease progression [J]. Mayo Clin Proc, 2013, 88(9): 942-51. 

[13] MUNTNER P, HARDY S T, FINE L J, et al. Trends in Blood Pressure Control Among US Adults With Hypertension, 1999-2000 to 2017-2018 [J]. Jama, 2020, 324(12): 1190-200.

[14] DONG G, GAN M, XU S, et al. The neutrophil-lymphocyte ratio as a risk factor for all-cause and cardiovascular mortality among individuals with diabetes: evidence from the NHANES 2003-2016 [J]. Cardiovasc Diabetol, 2023, 22(1): 267.

[15] DE MIGUEL C, PELEGRíN P, BAROJA-MAZO A, et al. Emerging Role of the Inflammasome and Pyroptosis in Hypertension [J]. Int J Mol Sci, 2021, 22(3).

[16] MOUTON A J, LI X, HALL M E, et al. Obesity, Hypertension, and Cardiac Dysfunction: Novel Roles of Immunometabolism in Macrophage Activation and Inflammation [J]. Circ Res, 2020, 126(6): 789-806.

[17] MADHUR M S, ELIJOVICH F, ALEXANDER M R, et al. Hypertension: Do Inflammation and Immunity Hold the Key to Solving this Epidemic? [J]. Circ Res, 2021, 128(7): 908-33.

[18] WENZEL U, TURNER J E, KREBS C, et al. Immune Mechanisms in Arterial Hypertension [J]. J Am Soc Nephrol, 2016, 27(3): 677-86.

[19] DIKALOVA A E, PANDEY A, XIAO L, et al. Mitochondrial Deacetylase Sirt3 Reduces Vascular Dysfunction and Hypertension While Sirt3 Depletion in Essential Hypertension Is Linked to Vascular Inflammation and Oxidative Stress [J]. Circ Res, 2020, 126(4): 439-52.

[20] SMALL H Y, MIGLIARINO S, CZESNIKIEWICZ-GUZIK M, et al. Hypertension: Focus on autoimmunity and oxidative stress [J]. Free Radic Biol Med, 2018, 125: 104-15.

[21] TOUYZ R M. Reactive oxygen species, vascular oxidative stress, and redox signaling in hypertension: what is the clinical significance? [J]. Hypertension, 2004, 44(3): 248-52.

[22] LAWLER P R, BHATT D L, GODOY L C, et al. Targeting cardiovascular inflammation: next steps in clinical translation [J]. Eur Heart J, 2021, 42(1): 113-31.

[23] XU J P, ZENG R X, ZHANG Y Z, et al. Systemic inflammation markers and the prevalence of hypertension: A NHANES cross-sectional study [J]. Hypertens Res, 2023, 46(4): 1009-19.

[24] ZHANG X, WEI R, WANG X, et al. The neutrophil-to-lymphocyte ratio is associated with all-cause and cardiovascular mortality among individuals with hypertension [J]. Cardiovasc Diabetol, 2024, 23(1): 117.

[25] OU-YANG H, FU H Y, LUO Y, et al. Inflammation markers and the risk of hypertension in people living with HIV [J]. Front Immunol, 2023, 14: 1133640.

[26] HOES L L F, RIKSEN N P, GELEIJNSE J M, et al. Relationship of neutrophil-to-lymphocyte ratio, in addition to C-reactive protein, with cardiovascular events in patients with type 2 diabetes [J]. Diabetes Res Clin Pract, 2024, 213: 111727.

[27] VERDOIA M, SCHAFFER A, BARBIERI L, et al. Impact of diabetes on neutrophil-to-lymphocyte ratio and its relationship to coronary artery disease [J]. Diabetes Metab, 2015, 41(4): 304-11.

[28] HE J, BIAN X, SONG C, et al. High neutrophil to lymphocyte ratio with type 2 diabetes mellitus predicts poor prognosis in patients undergoing percutaneous coronary intervention: a large-scale cohort study [J]. Cardiovasc Diabetol, 2022, 21(1): 156.