The relationship between the systemic immune‐inflammation index and reverse‐dipper circadian pattern in newly diagnosed hypertensive patients

Although hypertension is considered high intravascular pressure, impairing circadian blood pressure (BP) has been shown to potentially contribute to poor clinical outcomes. Systemic immune‐inflammation index (SII), based on platelet, neutrophil, and lymphocyte counts, has been established as a strong prognostic marker in cardiovascular disease. The role of inflammation in the pathogenesis of hypertension is a well‐known issue and inflammatory markers are associated with BP variability. We aimed to investigate whether there is a relationship between circadian BP changes and SII in newly diagnosed hypertensive patients. The study population consisted of 196 newly diagnosed hypertensive patients without LVH. In total, 76 (38%) patients had a dipper BP pattern, 60 (31%) patients had a non‐dipper BP pattern, and 60 (31%) patients had a reverse‐dipper BP pattern. SII was calculated according to Multivariate logistic regression analysis revealed SII and HDL‐C as an independent predictors of reverse‐dipper circadian pattern in newly diagnosed hypertensive patients. The cut‐off value of the SII for reverse‐dipper hypertension in a ROC curve analysis was >639.73 with 63.3% sensitivity and 84.2% specificity. Our study showed that the SII level was higher in the reverse‐dipper hypertension patient group than in the dipper and non‐dipper hypertension groups. Furthermore, SII was an independent predictor of newly diagnosed reverse‐dipper hypertensive patients. The high SII value in newly diagnosed hypertensive patients can be used as an early warning parameter to identify reverse‐dipper hypertension patients.

[1]  N. Zhang,et al.  Association between Systemic Immunity-Inflammation Index and Hyperlipidemia: A Population-Based Study from the NHANES (2015–2020) , 2023, Nutrients.

[2]  Yancheng Song,et al.  Systemic immune-inflammation index is associated with diabetic kidney disease in Type 2 diabetes mellitus patients: Evidence from NHANES 2011-2018 , 2022, Frontiers in Endocrinology.

[3]  Abdurrahman Akyüz,et al.  Systemic Immune-Inflammation Index: A Novel Predictor for Non-dipper Hypertension , 2022, Cureus.

[4]  M. Yamat,et al.  Three-Dimensional Echocardiography Deconstruction: Feasibility of Clinical Evaluation from 2D Views Derived From a 3D Dataset. , 2022, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[5]  Kürşat Akbuğa,et al.  Relationship between C-reactive protein/albumin ratio and dipper/nondipper pattern in normotensive individuals , 2022, Blood pressure monitoring.

[6]  Qinbo Yang,et al.  Systemic Immune-Inflammation Index Is Associated With Increased Urinary Albumin Excretion: A Population-Based Study , 2022, Frontiers in Immunology.

[7]  F. Şaylık,et al.  Can Systemic Immune-Inflammation Index Detect the Presence of Exxaggerated Morning Blood Pressure Surge in Newly Diagnosed Treatment-Naive Hypertensive Patients? , 2021, Clinical and experimental hypertension.

[8]  N. Emlek,et al.  Could the systemic immune-inflammation index be a predictor to estimate cerebrovascular events in hypertensive patients? , 2021, Blood pressure monitoring.

[9]  S. Bakker,et al.  High-Density Lipoprotein Anti-Inflammatory Capacity and Incident Cardiovascular Events , 2021, Circulation.

[10]  Murat Gok,et al.  A novel marker for predicting severity of acute pulmonary embolism: systemic immune-inflammation index , 2020, Scandinavian cardiovascular journal : SCJ.

[11]  Yenn-Jiang Lin,et al.  Systemic immune‐inflammation index (SII) predicted clinical outcome in patients with coronary artery disease , 2020, European journal of clinical investigation.

[12]  B. Stricker,et al.  The systemic immune‐inflammation index is associated with an increased risk of incident cancer—A population‐based cohort study , 2019, International journal of cancer.

[13]  S. Karakoyun,et al.  Assessment of Relationship Between C-Reactive Protein to Albumin Ratio and Coronary Artery Disease Severity in Patients With Acute Coronary Syndrome , 2019, Angiology.

[14]  I. Tanboğa,et al.  Assessment of the relationship between preprocedural C-reactive protein/albumin ratio and stent restenosis in patients with ST-segment elevation myocardial infarction. , 2019, Revista portuguesa de cardiologia : orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology : an official journal of the Portuguese Society of Cardiology.

[15]  Thomas Kahan,et al.  [2018 ESC/ESH Guidelines for the management of arterial hypertension. The Task Force for the management of arterial hypertension of the European Society of Cardiology (ESC) and the European Society of Hypertension (ESH)]. , 2018, Giornale italiano di cardiologia.

[16]  G. Lip,et al.  2018 ESC/ESH Guidelines for the management of arterial hypertension. , 2018, European heart journal.

[17]  Z. Tanriverdi,et al.  The importance of frontal QRS-T angle for predicting non-dipper status in hypertensive patients without left ventricular hypertrophy , 2018, Clinical and experimental hypertension.

[18]  G. Wang,et al.  Blood Pressure Reverse-Dipping is Associated With Early Formation of Carotid Plaque in Senior Hypertensive Patients , 2015, Medicine.

[19]  S. Taddei,et al.  Impact of inflammation on vascular disease in hypertension. , 2014, Maturitas.

[20]  F. Hage.  C-reactive protein and Hypertension , 2014, Journal of Human Hypertension.

[21]  I. Sari,et al.  Neutrophil to lymphocyte and platelet to lymphocyte ratio in patients with dipper versus non-dipper hypertension , 2014, Clinical and experimental hypertension.

[22]  Jinho Shin,et al.  A Reverse Dipping Pattern Predicts Cardiovascular Mortality In a Clinical Cohort , 2013, Journal of Korean medical science.

[23]  Jeroen J. Bax,et al.  2007 ESH-ESC Guidelines for the management of arterial hypertension: the task force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). , 2007, Blood pressure.

[24]  Jun Zhang,et al.  Reversed Dipper Blood-Pressure Pattern Is Closely Related to Severe Renal and Cardiovascular Damage in Patients with Chronic Kidney Disease , 2013, PloS one.

[25]  R. Abbate,et al.  Ang II Upregulation of the T-lymphocyte renin-angiotensin system is amplified by low-grade inflammation in human hypertension. , 2011, American journal of hypertension.

[26]  E. Schiffrin,et al.  T Regulatory Lymphocytes Prevent Angiotensin II–Induced Hypertension and Vascular Injury , 2011, Hypertension.

[27]  A. Dogan,et al.  Platelet activation and inflammatory response in patients with non-dipper hypertension. , 2009, Atherosclerosis.

[28]  R. Fagard.  Dipping pattern of nocturnal blood pressure in patients with hypertension , 2009, Expert review of cardiovascular therapy.

[29]  M. Emdin,et al.  Awake Blood Pressure Variability, Inflammatory Markers and Target Organ Damage in Newly Diagnosed Hypertension , 2008, Hypertension Research.

[30]  G. Mancia,et al.  Adrenergic, Metabolic, and Reflex Abnormalities in Reverse and Extreme Dipper Hypertensives , 2008, Hypertension.

[31]  N. Kohno,et al.  White Blood Cell Count, Especially Neutrophil Count, as a Predictor of Hypertension in a Japanese Population , 2008, Hypertension Research.

[32]  I. Kallikazaros,et al.  Disturbed circadian blood pressure rhythm and C-reactive protein in essential hypertension , 2008, Journal of Human Hypertension.

[33]  Hyuk-Jae Chang,et al.  Association between blood pressure variability and inflammatory marker in hypertensive patients. , 2008, Circulation journal : official journal of the Japanese Circulation Society.

[34]  Jan A. Staessen,et al.  Daytime and Nighttime Blood Pressure as Predictors of Death and Cause-Specific Cardiovascular Events in Hypertension , 2008, Hypertension.

[35]  Michael Böhm,et al.  2013 ESH/ESC Guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). , 2007, Journal of hypertension.

[36]  R. Hermida.  Ambulatory Blood Pressure Monitoring in the Prediction of Cardiovascular Events and Effects of Chronotherapy: Rationale and Design of the MAPEC Study , 2007, Chronobiology international.

[37]  William Stewart,et al.  Recommendations for chamber quantification. , 2006, European journal of echocardiography : the journal of the Working Group on Echocardiography of the European Society of Cardiology.

[38]  H. Izzedine,et al.  Fanconi syndrome associated with didanosine therapy. , 2005, AIDS.

[39]  R. Devereux,et al.  Normalization for body size and population-attributable risk of left ventricular hypertrophy: the Strong Heart Study. , 2005, American journal of hypertension.

[40]  S. Sela,et al.  Primed Polymorphonuclear Leukocytes, Oxidative Stress, and Inflammation Antecede Hypertension in the Sabra Rat , 2004, Hypertension.

[41]  R. Klein,et al.  Relationship between white blood cell count and incident hypertension , 2004 .

[42]  H. Inooka,et al.  The Effects of Physical Activity and Autonomic Nerve Tone on the Daily Fluctuation of Blood Pressure , 2004, Clinical and experimental hypertension.

[43]  J. Manson,et al.  Interrelationships Among Circulating Interleukin-6, C-Reactive Protein, and Traditional Cardiovascular Risk Factors in Women , 2002, Arteriosclerosis, thrombosis, and vascular biology.

[44]  J E Schwartz,et al.  Stroke Prognosis and Abnormal Nocturnal Blood Pressure Falls in Older Hypertensives , 2001, Hypertension.

[45]  R. Ross,et al.  Atherosclerosis is an Inflammatory Disease , 1998 .

[46]  A. Quyyumi,et al.  Mechanisms underlying the morning increase in platelet aggregation: a flow cytometry study. , 1996, Journal of the American College of Cardiology.

[47]  L. Kuller,et al.  Relation of C-reactive protein and coronary heart disease in the MRFIT nested case-control study. Multiple Risk Factor Intervention Trial. , 1996, American journal of epidemiology.

[48]  K. Kohara,et al.  Autonomic nervous function in non-dipper essential hypertensive subjects. Evaluation by power spectral analysis of heart rate variability. , 1995, Hypertension.

[49]  T. Pickering.  The clinical significance of diurnal blood pressure variations. Dippers and nondippers. , 1990, Circulation.

[50]  Ashutosh Kumar Singh,et al.  Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015 , 2016, Lancet.

[51]  B. Hoogwerf,et al.  Relation of diurnal blood pressure variation and triglyceride-to-high-density lipoprotein cholesterol ratio in patients without diabetes mellitus. , 2005, The American journal of cardiology.