Association Between Highly-Sensitive C- Reactive Protein and Neutrophil to Lymphocyte Ratio as Markers of Inflammation Among Adult Nigerians with Essential Hypertension

Authors

  • SS Udofia
  • JE Effiong
  • EA Iniobong
  • MA Emokpae University of Benin

DOI:

https://doi.org/10.30442/ahr.0904-06-218

Abstract

Background: Hypertension is a medical condition with global public health importance that is associated with significant morbidity and mortality in both developed and developing countries. It is important to identify readily available parameters that may indicate the level of inflammation that is associated with hypertension.

Objective: To assess the relationship between highly-sensitive C-Reactive Protein (hs-CRP) and neutrophil-to-lymphocyte ratio (NLR) in hypertensive adults.

Methods: Three hundred and sixty adults comprising 240 hypertensive and 120 healthy normotensive subjects (control) were studied. The full blood count (FBC) and highly-sensitive C-Reactive Protein (hs-CRP) levels were determined using standard methods.

Results: The mean values of Total White Blood Cells count (WBC) (p = 0.03), absolute neutrophil count (p = 0.03), absolute lymphocyte count (p = 0.01), NLR (p = 0.001) and hs-CRP (p <0.001) in the hypertensive subjects were significantly higher than in the normotensive subjects. The mean values also differed significantly with increasing severity of hypertension. There was a significant but weak positive correlation between NLR and hs-CRP (r = 0.248, p <0.001). The Areas Under the Curve (AUC) of the Receiver Operating Characteristic (ROC) of NLR and hs-CRP (p = 0.01) were 0.68 and 0.639 respectively.

Conclusion: NLR is closely associated with hs- CRP among hypertensive subjects. Therefore, NLR may be utilised routinely instead of hs-CRP as a screening test for inflammation in essential hypertension.

References

World Health Organization (WHO). A global brief on Hypertension, silent, global public health crisis: WHO/DCC /WHO, Geneva. 2013.

Mills, KT, Stefanescu A, He J. The global epidemiology of hypertension. Nature Rev Nephrol 2020;16:223-237. https://doi.org/10.1038/s41581-019-0244-2

Ogah OS, Sliwa K, Akinyemi JO, Falase AO, Stewart S. Hypertensive heart failure in Nigerian Africans: insights from the Abeokuta Heart Failure Registry. J Clin Hyperten (Greenwich) 2015;4:263-72. https://doi.org/10.1111/jch.12496.

Ogah OS, Ogaha S, Ikechi II, Chukwuonye JO, Akinyemi BJC, Onwubere AO, et al. Blood pressure, prevalence of hypertension and hypertension related complications. World J Cardiol 2012;4:327-340. https://doi.org/10.4330/wjc.v4.i12.327.

Zhang ZZ, Lin XZ, Xu M, Xianliang Z. Role of inflammation, immunity, and oxidative stress in hypertension: New insights and potential therapeutic targets. Frontiers Immunol 2023;13:1098725. https://doi.org/10.3389/fimmu.2022.1098725.

Pacurari M, Kafoury R, Tchounwou PB, Ndebele K. The Renin-Angiotensin-Aldosterone System in Vascular Inflammation and Remodeling. Int J Inflamm 2014;12:137-149. https://doi.org/10.1155/2014/689360

Ogura S, Latapati R, Shimosawa T, Nakayama T. Vascular Inflammation and Hypertension. Austin J Cardiovasc Dis Atherosclerosis 2016;3:1017.

Ibrahim MM, Damasceno N. Hypertension in Developing Countries. Lancet 2012;380:611-619. https://doi.org/10.1016/S0140-6736(12)60861-7.

Angeli F, Reboldi G, Verdecchia P. The link between Inflammation and Hypertension: Unmasking Mediators. Am J Hypertens 2021;34:683–685. https://doi.org/10.1093/ajh/hpab034.

Jayedi A, Rahimi K, Bautista LE, Nazarzadeh M, Zargar MS, Shab-Bidar S. Inflammation markers and risk of developing hypertension: a meta-analysis of cohort studies. Heart. 2019;105:686-692. https://doi.org/10.1136/heartjnl-2018-314216.

Stumpt C, Jonh CJ. Enhanced levels of platelet P selectin and circulating cytokines in young patients with mild arterial hypertension. J Human Hypertens 2005;227:13–17.

Shrivastavag AK, Singh HV, Arum R, Singh SK. C- reactive protein, inflammation and coronary heart disease. Egy Heart J 2015;67:89-97. https://doi.org/10.1016/j.ehj.2014.11.005.

Emokpae MA, Aruomarren A, Osime EO. Relationship between Neutrophil to lymphocyte Ratio and inflammatory markers in sickle cell anaemia patients with proteinuria. Med Sci 2016;4:11.

Singgih R, Firmansyah Y, Dewi AK. Clinical Ability of Neutrophil–Lymphocyte Ratio in Pregnancy as a Predictor of Pre-eclampsia. J South Asian Federation Obstet Gynaecol 2021;13:125–130. https://doi.org/10.5005/jp-journals-10006-1892.

Caglayan EK, Engin-Ustun Y, Gocmen AY, Seckin L, Kara M, et al. Is there any relationship between serum sirtuin-1 level and neutrophil- lymphocyte in hyper emesis gravidarum? Journal of Perinatal Medicine 2015;44:315-320.

Wang D, Yang JX, Wan XR, Feng FZ, Huang H. Pre- operative neutrophil- lymphocyte and platelet – lymphocyte ratios as independent predictors of cervical stromal involvement in surgically treated endometrial adenocarcinoma. Oncol Target Therapy 2013;6:211-216.

Emokpae MA, Adesina OO. The Neutrophil-to lymphocyte Ratio in Anaemic Pregnant Women and Association with Traditional Marker of Inflammation. Niger Hosp Pract 2018;21:34-38.

Zahorec R. Neutrophil – to –lymphocyte ratio, past, present and future perspectives. Bratisl Lek Listy 2021;122:474-488. https://doi.org/10.4149/BLL_2021_078.

World Health Organization (WHO). Guideline for the pharmacological treatment of hypertension in adults. Geneva 2021.

Patrick DM, Van Beusecum JP, Kirabo A. The role of inflammation in hypertension: Novel concepts. Current Opinion Physiol 2021;19:92–98. https://doi.org/10.1016/j.cophys.2020.09.016.

Caillon A, Schiffrin EL. Role of Inflammation and Immunity in Hypertension: Recent Epidemiological, Laboratory, and Clinical Evidence. Current Hypertension Report 2016;18:21 https://doi.org/10.1007/s11906-016-0628-7.

Abernathy T, Avery O. The occurrence during acute infections of protein not normally present in the blood. Distribution of the reactive protein in patients’ serum and the effect of calcium on the flocculation reaction with C polysaccharide of pneumococcus. J Exp Med 1941;73:173-182.

Hage FG. C-Reactive Protein and hypertension. J Human Hyperten 2014;28:410-415. https://doi.org/10.1038/jhh.2013.111.

Qian B, Zheng Y, Jia H, Zheng X, Gao R, Li W. Neutrophil - lymphocyte ratio as a predictive marker for postoperative infectious complications: A systematic review and meta-analysis. Heliyon 2023;9:15586. https://doi.org/10.1016/j.heliyon.2023.e15586.

Buonacera A, Stancanelli B, Colaci M, Malatino L. Neutrophil to Lymphocyte Ratio: An Emerging Marker of the Relationships between the Immune System and Diseases. Int J Mole Sci 2022;26;23:3636. https://doi.org/10.3390/ijms23073636.

Sayed AA, Allam AA, Sayed AI, Alraey MA, Joseph MV. The use of neutrophil-to-lymphocyte ratio (NLR) as a marker for COVID-19 infection in Saudi Arabia: A case-control retrospective multicenter study. Saudi Med J 2021;42:370-376. https://doi.org/10.15537/smj.2021.42.4.20200818.

He J, Bian X, Song C. High neutrophil to lymphocyte ratio with type 2 diabetes mellitus predicts poor prognosis in patients undergoing percutaneous coronary intervention: a large-scale cohort study. Cardiovasc Diabetol 2021;21:156. https://doi.org/10.1186/s12933-022-01583-9.

Liu D, Heij LR, Czigany Z. The prognostic value of neutrophil-to-lymphocyte ratio in cholangiocarcinoma: a systematic review and meta-analysis. Sci Rep 2022;12:12691. https://doi.org/10.1038/s41598-022-16727-w.

Aygun F, Efe D. Association of Neutrophil to Lymphocyte ratio with Obstructive Coronary Artery calcium score detected by multislice computed tomography in type 2 diabetes mellitus patients. Patient Prefer Adherence 2015;9:1023–1034. https://doi.org/10.2147/PPA.S85577.

Osime EO, Innih SO. Effect of highly active antiretroviral therapy on neutrophil / lymphocyte ratio using white rabbit. Sahel Med J 2017;20:72-74. https://doi.org/10.4103/1118-8561.215034.

Horne BD, Jeffrey LA, Jerry MJ, Aaron W, Tami L, Bair KR, et al. An intermountain Heart Collaborative (IHC) Study group. Journal of American College of. Cardiology 2005;45:1638–1643.

Pan L, Li G, Wan S, Yihou W, Yang F, Li Z, Shan G. The association between high-sensitivity C-reactive protein and blood pressure in Yi people. BMC Public Health 2019;19:991. https://doi.org/10.1186/s12889-019-7324-x

Idemudia JO, Idogun ES. High sensitive C-Reactive Protein (Hs-CRP) as a cardiovascular risk factor in hypertensive Nigerians. Niger Postgrad Med J 2012;19:163-166.

Arnett DK, Blumenthal RS, Albert MA. ACC/AHA Guideline on the primary prevention of cardiovascular disease: Executive summary: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation 2019;140:e563-e595. https://doi.org/10.1161/CIR.0000000000000677.

Agbaje AO. Arterial stiffness precedes hypertension and metabolic risks in youth: a review. J Hypertens 2022;40:1887-1896. https://doi.org/10.1097/HJH.0000000000003239.

Lieb W, Pencina MJ, Wang TJ. Association of parental hypertension with concentration of select biomarkers in non-hypertensive offspring. Hypertension 2008;52:381–386. https://doi.org/10.1161/HYPERTENSIONAHA.108.113589

Welsh PI. Inflammatory markers as novel predictors of cardiovascular diseases. A Ph.D Thesis. University of Glasgow, Scotland. 2008. http://theses.gla.ac.uk.

Kaplan NM. Systemic hypertension: Mechanism and Diagnosis. Braunwald’s Heart Disease: Elsevier Saunders; 2005. pp. 959 – 987.

Durmus E, Kivrak T, Gerin F, Sunbul M, Sari I, Erdogan O (2015). Neutrophil-to-Lymphocyte Ratio and Platelet-to – Lymphocyte Ratio are Predictors of Heart Failure. Arq Bras Cardiology 2015;105:606-613. https://doi.org/10.5935/abc.20150126

Nahm FS. Receiver operating characteristic curve: overview and practical use for clinicians. Korean J Anesthesiol 2022;75:25-36. https://doi.org/10.4097/kja.21209.

Downloads

Published

2023-12-23

Issue

Section

Original Research