Linking Inflammation to Nondipper Hypertension: Diagnostic Utility of Neutrophil Percentage-to-Albumin Ratio

Hypertension (HT) constitutes a pervasive global health challenge, standing as a principal contributor to cardiovascular morbidity and mortality. Limited data are available regarding the relationship between neutrophil percentage-to-albumin ratio (NPAR) and nondipper HT. we aimed to investigate whether NPAR is independently associated with nondipper status in newly diagnosed hypertensive patients.

Prospectively, 160 hypertensive patients were included in the study. After a 24-h ABP monitoring assessment, the patients were divided into 2 groups, a dipper group and a nondipper group, and 80 healthy control subjects were enrolled in the study. Baseline laboratory and echocardiographic parameters were measured and then the NPAR was calculated.

Levels of white blood cell, neutrophil-to-lymphocyte ratio, and high-sensitivity C-reactive protein (hs-CRP) were significantly higher in patients with nondipper HT than dipper HT and control subjects. Echocardiographic assessments revealed that the left ventricular (LV) wall was thicker and LV mass index was higher in the hypertensive group than the control group. NPAR levels were significantly different among the 3 groups (P < .001) and also the multivariate analysis revealed that higher NPAR and hs-CRP levels were independently associated with a nondipping pattern. Receiver operating characteristic analysis showed that NPAR levels higher than 22.2 can predict nondipping status (P < .001).

Our study shows that higher NPAR levels are independently associated with nondipper HT in newly diagnosed hypertensive patients. These findings emphasize the role of inflammation in the pathophysiology of circadian BP variation and suggest that NPAR may serve as a useful tool in identifying hypertensive patients at higher risk for cardiovascular complications.