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Bozduman F, Yildirim E, Cicek G. Biomarkers of nondipper hypertension in prehypertensive and hypertensive patients. Biomark Med 2019; 13:371-378. [PMID: 30919653 DOI: 10.2217/bmm-2018-0247] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: The aim of this study was to evaluate the relation of gamma glutamyl transferase (GGT), neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) with nondipper hypertension. Methods: This study included a total of 409 patients. Patients were grouped into hypertension, prehypertension and normotensive groups, according to their clinical blood pressure. All patients were also followed by ambulatory blood pressure. Results: Mean PLR and NLR were higher in the nondippers compared with dippers among both prehypertensive and hypertensive patients. In addition, PLR (OR: 1.011; 95% CI: 1004-1017; p = 0.001), NLR (OR: 2.296, 95% CI: 1634-3225; p < 0.001), and GGT (OR: 1.067; 95% CI: 1042-1092; p < 0.001) were found to be associated with nondipper pattern among whole study population. Conclusion: The PLR, NLR and GGT values are easily accessible and fairly useful, independently associated with nondipper hypertension for both hypertensive and prehypertensive patients.
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Affiliation(s)
- Fadime Bozduman
- Ankara Numune Education and Research Hospital, University of Health Sciences, Ankara, Turkey Istanbul Umraniye Education and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Ersin Yildirim
- Department of Cardiology, Istanbul Umraniye Education & Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Gokhan Cicek
- Ankara Numune Education and Research Hospital, University of Health Sciences, Ankara, Turkey Istanbul Umraniye Education and Research Hospital, University of Health Sciences, Istanbul, Turkey
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Srinivasagopalane B, Andrew Rajarathinam S, Balasubramaiyan T. Clinical pertinence of neutrophil-to- lymphocyte ratio among hypertensives with different grades and duration of hypertension - an insight. Clin Exp Hypertens 2018; 41:394-399. [PMID: 30183451 DOI: 10.1080/10641963.2018.1510942] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Over the recent years, the pathophysiology of the inflammatory component in hypertension has been a challenge, because this inflammatory response is mainly contributed by an increased oxidative stress with the release of inflammatory mediators. Identification of a simple and early inflammatory marker such as the neutrophil-to-lymphocyte ratio (NLR) is the need of the hour. This study correlates the same specifically taking into account the duration and the grades of hypertension. OBJECTIVE The response of the NLR among the hypertensives and its correlation with duration and stages of hypertension. METHOD Totally, 80 subjects and 40 controls of age between 20 and 60 years and both genders were included. Three recordings of blood pressure were measured with a standard mercury sphygmomanometer. The differential leukocyte count was estimated with an automated Beckman Coulter. OBJECTIVE Variations in the neutrophil and lymphocyte counts were significant among the hypertensives with a p-value < 0.001. The NLR was also significantly altered among the hypertensives with a p-value = 0.001. The NLR showed a rise in value among the normotensives, prehypertensives, and stage 1 of systolic hypertension, though not statistically significant. An increase in the NLR was observed in hypertensives with duration of 1-2 years. CONCLUSION Our study gives a new insight with a rise in NLR in early years and even among prehypertensives and stage 1 systolic hypertension under strict criterion. This could be utilized as an early predictive tool, relating the inflammatory process and hypertension which on further intervention could slow the progression of the disease process. ABBREVIATIONS NLR: Neutrophil-to-lymphocyte ratio; BP: Blood pressure.
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Affiliation(s)
- Brinda Srinivasagopalane
- a Department of Physiology, Physiology , ACS Medical College and Hospital, Vellapanchavadi , Chennai , India
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Moody G, Miller BJ. Total and differential white blood cell counts and hemodynamic parameters in first-episode psychosis. Psychiatry Res 2018; 260:307-312. [PMID: 29223800 DOI: 10.1016/j.psychres.2017.11.086] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 11/28/2017] [Accepted: 11/28/2017] [Indexed: 10/18/2022]
Abstract
There is evidence for blood inflammatory abnormalities in patients with first-episode psychosis (FEP). The monocyte- and neutrophil-to-lymphocyte ratios (MLR; NLR) are markers of inflammation and endothelial dysfunction, and predictors of cardiovascular disease, the leading cause of death in schizophrenia. We investigated relationships between white blood cell (WBC) counts and hemodynamic parameters associated with cardiovascular disease risk in 25 subjects age 18-50 hospitalized for FEP and 44 controls. Subjects had a blood draw, vital signs, and medical history. Patients with FEP had significantly higher NLR, MLR, pulse pressure, and rate pressure product (RPP) than controls (p < 0.05 for each), after controlling for potential confounders. In linear regression analyses, higher monocytes were a significant predictor of higher pulse pressure (p = 0.033) and higher MLR predicted RPP at the trend level (p = 0.051) in FEP, after controlling for potential confounders. To our knowledge, ours is the first report of increased RPP, a measure of myocardial workload, in FEP. We also replicated findings of increased NLR, MLR and pulse pressure in FEP. Our findings underscore that measurement of routine vital signs and blood total and differential WBC counts are germane to the clinical care of patients with psychosis as markers of cardiovascular disease risk.
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Affiliation(s)
- Grant Moody
- Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Brian J Miller
- Department of Psychiatry and Health Behavior, Augusta University, 997 Saint Sebastian Way, Augusta, GA 30912, USA.
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Houston M. Dyslipidemia. Integr Med (Encinitas) 2018. [DOI: 10.1016/b978-0-323-35868-2.00027-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Wang H, Hu Y, Geng Y, Wu H, Chu Y, Liu R, Wei Y, Qiu Z. The relationship between neutrophil to lymphocyte ratio and artery stiffness in subtypes of hypertension. J Clin Hypertens (Greenwich) 2017; 19:780-785. [PMID: 28480636 DOI: 10.1111/jch.13002] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 01/31/2017] [Accepted: 02/13/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Huan Wang
- Department of Cardiology; Guang'anmen Hospital; China Academy of Chinese Medical Sciences; Beijing China
| | - Yuanhui Hu
- Department of Cardiology; Guang'anmen Hospital; China Academy of Chinese Medical Sciences; Beijing China
| | - Yanting Geng
- Department of Cardiology; Guang'anmen Hospital; China Academy of Chinese Medical Sciences; Beijing China
| | - Huaqin Wu
- Department of Cardiology; Guang'anmen Hospital; China Academy of Chinese Medical Sciences; Beijing China
| | - Yuguang Chu
- Department of Cardiology; Guang'anmen Hospital; China Academy of Chinese Medical Sciences; Beijing China
| | - Ruihua Liu
- Department of Immunology Laboratory; China Academy of Chinese Medical Sciences; Beijing China
| | - Yi Wei
- Department of Cardiology; Guang'anmen Hospital; China Academy of Chinese Medical Sciences; Beijing China
| | - Zhiling Qiu
- Graduate School; China Academy of Chinese Medical Sciences; Beijing China
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Dluzen DF, Noren Hooten N, Zhang Y, Kim Y, Glover FE, Tajuddin SM, Jacob KD, Zonderman AB, Evans MK. Racial differences in microRNA and gene expression in hypertensive women. Sci Rep 2016; 6:35815. [PMID: 27779208 PMCID: PMC5078799 DOI: 10.1038/srep35815] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 10/06/2016] [Indexed: 12/20/2022] Open
Abstract
Systemic arterial hypertension is an important cause of cardiovascular disease morbidity and mortality. African Americans are disproportionately affected by hypertension, in fact the incidence, prevalence, and severity of hypertension is highest among African American (AA) women. Previous data suggests that differential gene expression influences individual susceptibility to selected diseases and we hypothesized that this phenomena may affect health disparities in hypertension. Transcriptional profiling of peripheral blood mononuclear cells from AA or white, normotensive or hypertensive females identified thousands of mRNAs differentially-expressed by race and/or hypertension. Predominant gene expression differences were observed in AA hypertensive females compared to AA normotensives or white hypertensives. Since microRNAs play important roles in regulating gene expression, we profiled global microRNA expression and observed differentially-expressed microRNAs by race and/or hypertension. We identified novel mRNA-microRNA pairs potentially involved in hypertension-related pathways and differently-expressed, including MCL1/miR-20a-5p, APOL3/miR-4763-5p, PLD1/miR-4717-3p, and PLD1/miR-4709-3p. We validated gene expression levels via RT-qPCR and microRNA target validation was performed in primary endothelial cells. Altogether, we identified significant gene expression differences between AA and white female hypertensives and pinpointed novel mRNA-microRNA pairs differentially-expressed by hypertension and race. These differences may contribute to the known disparities in hypertension and may be potential targets for intervention.
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Affiliation(s)
- Douglas F. Dluzen
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, National Institutes of Health, Baltimore, MD 21224, USA
| | - Nicole Noren Hooten
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, National Institutes of Health, Baltimore, MD 21224, USA
| | - Yongqing Zhang
- Laboratory of Genetics and Genomics; National Institute on Aging, National Institutes of Health, Baltimore, MD 21224, USA
| | - Yoonseo Kim
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, National Institutes of Health, Baltimore, MD 21224, USA
| | - Frank E. Glover
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, National Institutes of Health, Baltimore, MD 21224, USA
| | - Salman M. Tajuddin
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, National Institutes of Health, Baltimore, MD 21224, USA
| | - Kimberly D. Jacob
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, National Institutes of Health, Baltimore, MD 21224, USA
| | - Alan B. Zonderman
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, National Institutes of Health, Baltimore, MD 21224, USA
| | - Michele K. Evans
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, National Institutes of Health, Baltimore, MD 21224, USA
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Increased neutrophil to lymphocyte ratio in persons suffering from hypertension with hyperhomocysteinemia. Hypertens Res 2016; 39:606-11. [PMID: 27009577 DOI: 10.1038/hr.2016.30] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Revised: 12/15/2015] [Accepted: 02/02/2016] [Indexed: 11/09/2022]
Abstract
The neutrophil to lymphocyte ratio (NLR) is increased in various cardiovascular diseases. The objective of this study is to determine whether the NLR is increased in persons suffering from hypertension with hyperhomocysteinemia (HTH). We retrospectively analyzed the results of a large cohort of individuals undergoing health examinations with respect to NLR values, homocysteine (HCY) concentration, total cholesterol, triglyceride (TG) concentration, glucose concentration, creatinine (Cr) concentration, smoking status, drinking status and blood pressure. When participants were grouped according to the NLR quartiles, there were strong, graded increases in HCY (P<0.001) and the numbers of patients suffering from HTH were up to two-fold higher in the fourth vs. the first quartile. The NLR of the participants suffering from HTH group was significantly higher than the participants suffering from hypertension in the non-HTH group and the normotension group. In an unconditional multiple logistic regression analysis, NLR predicted HTH independently of age, sex, body mass index, smoking, drinking, TG and Cr. The present study demonstrated that the NLR value increased in the HTH group and positively correlated with HCY but not with blood pressure.
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Quantitative Indexes of Leukocytes in Spontaneously Hypertensive Rats During Various Periods of Arterial Hypertension Development. Bull Exp Biol Med 2015; 159:715-7. [DOI: 10.1007/s10517-015-3056-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Indexed: 11/27/2022]
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Fülöp T, Tapolyai M. Beauty in Simplicity: Abnormal Neutrophil to Lymphocyte Ratio in Resistant Hypertension. J Clin Hypertens (Greenwich) 2015; 17:538-40. [PMID: 25810379 DOI: 10.1111/jch.12526] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Tibor Fülöp
- Department of Internal Medicine, University of Mississippi Medical Center, Jackson, MS
| | - Mihály Tapolyai
- Fresenius Medical Care Hungary, Semmelweis University, Budapest, Hungary
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Belen E, Sungur A, Sungur MA, Erdoğan G. Increased Neutrophil to Lymphocyte Ratio in Patients With Resistant Hypertension. J Clin Hypertens (Greenwich) 2015; 17:532-7. [DOI: 10.1111/jch.12533] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 12/30/2014] [Accepted: 01/02/2015] [Indexed: 11/27/2022]
Affiliation(s)
- Erdal Belen
- Department of Cardiology; Okmeydanı Training and Research Hospital; Istanbul Turkey
| | - Aylin Sungur
- Department of Cardiology; Kahramanmaras Necip Fazıl City Hospital; Kahramanmaras Turkey
| | - Mustafa Azmi Sungur
- Department of Cardiology; Kahramanmaras Necip Fazıl City Hospital; Kahramanmaras Turkey
| | - Güney Erdoğan
- Department of Cardiology; Ordu Training and Research Hospital; Ordu Turkey
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Aygün F, Efe D. Association of neutrophil/lymphocyte ratio with obstructive coronary artery disease and coronary artery calcium score detected by multislice computed tomography in type 2 diabetes mellitus patients. Patient Prefer Adherence 2015; 9:1023-31. [PMID: 26229449 PMCID: PMC4514314 DOI: 10.2147/ppa.s85577] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE The aim of the present study was to investigate the association of neutrophil/lymphocyte ratio (NLR) with coronary artery calcium score (CACS) and obstructive coronary artery disease (CAD) detected by multislice computed tomography (MSCT) angiography in type 2 diabetes mellitus (T2DM) patients. METHODS Two hundred and ninety-two T2DM patients, who were either asymptomatic or symptomatic (but noncharacteristic) for coronary artery disease (CAD) and underwent MSCT angiography in our clinic between May 2009 and June 2014, were enrolled. All patients were divided into two groups according to their mean NLR values. Patients with NLR ≤2.05 were assigned to Group 1 and patients with NLR >2.05 were assigned to Group 2. The association of NLR with CACS and obstructive CAD, which were detected by MSCT angiography, was investigated in T2DM patients. RESULTS According to the Agatston scoring method, the mean CACS was 129.5±209.8 Au in Group 1 and 290.3±399.6 Au in Group 2 (P<0.001). Obstructive CAD was detected in 40 (26.8%) patients in Group 1 and in 56 (39.2%) patients in Group 2 (P<0.05, P<0.021). CONCLUSION The rate of obstructive CAD was significantly higher in the T2DM patients with NLR >2.05 than that in the T2DM patients with NLR ≤2.05. In addition, the CACS was also significantly higher in the T2DM patients with NLR >2.05 than that in the T2DM patients with NLR ≤2.05.
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Affiliation(s)
- Fatih Aygün
- Department of Cardiovascular Surgery, Konya Medical and Research Center, Başkent University, Konya, Turkey
- Correspondence: Fatih Aygün, Hocacihan Mahalle Saray Cad No 1, 42000 Selçuklu, Konya, Turkey, Tel +90 332 322 94 10, Fax +90 332 322 94 19, Email
| | - Duran Efe
- Department of Radiology, Faculty of Medicine, Mevlana University, Konya, Turkey
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12
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Neutrophil-lymphocyte ratio may predict in-hospital mortality in patients with acute type A aortic dissection. Herz 2014; 40:716-21. [PMID: 25059935 DOI: 10.1007/s00059-014-4121-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2013] [Revised: 01/20/2014] [Accepted: 05/19/2014] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Inflammation has been reported to be associated with aortic dissection (AD), from the development to the prognosis of AD. In this study we aimed to find the role of the neutrophil-lymphocyte ratio (NLR) in the prediction of clinical events in patients with acute AD type A. PATIENTS AND METHODS The study comprised 37 patients who were hospitalized at our center between 2009 and 2013 with the diagnosis of acute AD type A. RESULTS The mean NLR was significantly higher in patients with pericardial effusion than those without effusion (15.6 ± 11.4 vs. 7.5 ± 4.8, p = 0.005). An NLR value > 8.51 yielded an area under the curve (AUC) value of 0.829 [95 % confidence interval (CI) 0.674-0.984, p = 0.004], which demonstrated a sensitivity of 77 % and specificity of 74 % for the prediction of mortality. CONCLUSIONS The novel inflammatory marker NLR could be used to predict pericardial effusion and in-hospital mortality in patients with acute AD type A.
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Demir M, Demir C, Keçeoğlu S. Relationship between serum bilirubin concentration and nondipper hypertension. Int J Clin Exp Med 2014; 7:1454-1458. [PMID: 24995111 PMCID: PMC4073772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2014] [Accepted: 05/12/2014] [Indexed: 06/03/2023]
Abstract
BACKGROUND Although nondipper hypertension has been associated with increased cardiovascular morbidity and mortality, the relationship between bilirubin levels and nondipper hypertension remains unclear. Several studies have demonstrated that higher serum bilirubin levels inhibit inflammation and the proliferation of vascular smooth muscle cells, which may suggest a relationship between serum bilirubin levels and cardiovascular disease. The aim of this study was to compare serum bilirubin levels between dipper and nondipper hypertensive patients. METHODS The present study included 80 hypertensive patients who were stratified into two groups: 50 dipper patients (mean [± SD] age 51.5 ± 8 years; 29 male) and 30 nondipper patients (mean age 50.6 ± 5.4 years; 17 male). All patients underwent 24 h ambulatory blood pressure monitoring. RESULTS No statistically significant differences were found between the two groups in terms of basic characteristics. Total, direct and indirect serum bilirubin levels were significantly lower among individuals with nondipper hypertension compared with patients with dipper hypertension (0.78 ± 0.6 mg/dL versus 0.42 ± 0.32 mg/dL; and 0.29 ± 0.1 mg/dL versus 0.18 ± 0.05 mg/dL; and 0.48 ± 0.52 mg/dL versus 0.25 ± 0.22 mg/dL, respectively; all P<0.001). Additionally, leukocyte counts were higher in patients with nondipper hypertension. CONCLUSION The present study revealed a potential relationship between lower serum bilirubin levels and a nondipping pattern in hypertensive patients.
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Affiliation(s)
- Mehmet Demir
- Department of Cardiology, Bursa Yüksek İhtisas Education and Research HospitalBursa, Turkey
| | - Canan Demir
- Department of Infectious Disease, Bursa Şevket Yılmaz Education and Research HospitalBursa, Turkey
| | - Serdar Keçeoğlu
- Department of Cardiology, Bursa Yüksek İhtisas Education and Research HospitalBursa, Turkey
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Alexander W. Hypertension: is it time to replace drugs with nutrition and nutraceuticals? P & T : A PEER-REVIEWED JOURNAL FOR FORMULARY MANAGEMENT 2014; 39:291-295. [PMID: 24757368 PMCID: PMC3989080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Many hypertension patients want to learn about ways to reduce reliance on pharmaceuticals, says functional medicine practitioner Mark Houston, who believes it is often possible to reduce or eliminate reliance on drugs using nutrition and nutraceuticals.
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Houston M. The role of nutrition and nutraceutical supplements in the treatment of hypertension. World J Cardiol 2014; 6:38-66. [PMID: 24575172 PMCID: PMC3935060 DOI: 10.4330/wjc.v6.i2.38] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Revised: 10/22/2013] [Accepted: 12/17/2013] [Indexed: 02/06/2023] Open
Abstract
Vascular biology, endothelial and vascular smooth muscle and cardiac dysfunction play a primary role in the initiation and perpetuation of hypertension, cardiovascular disease and target organ damage. Nutrient-gene interactions and epigenetics are predominant factors in promoting beneficial or detrimental effects in cardiovascular health and hypertension. Macronutrients and micronutrients can prevent, control and treat hypertension through numerous mechanisms related to vascular biology. Oxidative stress, inflammation and autoimmune dysfunction initiate and propagate hypertension and cardiovascular disease. There is a role for the selected use of single and component nutraceutical supplements, vitamins, antioxidants and minerals in the treatment of hypertension based on scientifically controlled studies which complement optimal nutrition, coupled with other lifestyle modifications.
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Affiliation(s)
- Mark Houston
- Mark Houston, Hypertension Institute, Saint Thomas Medical Plaza, Nashville, TN 37205, United States
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Houston M. Nutrition and nutraceutical supplements for the treatment of hypertension: part I. J Clin Hypertens (Greenwich) 2013; 15:752-7. [PMID: 24088285 PMCID: PMC8033896 DOI: 10.1111/jch.12188] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Revised: 07/19/2013] [Accepted: 07/21/2013] [Indexed: 12/16/2022]
Abstract
Vascular biology, endothelial and vascular smooth muscle, and cardiac dysfunction play a primary role in the initiation and perpetuation of hypertension, cardiovascular disease, and target organ damage. Nutrient-gene interactions and epigenetics are predominant factors in promoting beneficial or detrimental effects in cardiovascular health and hypertension. Macronutrients and micronutrients may be able to prevent, control, or treat hypertension through numerous mechanisms related to vascular biology or other mechanisms. Oxidative stress, inflammation, and autoimmune dysfunction are some of the primary factors that initiate and propagate hypertension and cardiovascular disease. The literature suggests that there may be a complementary role of single and component nutraceutical supplements, vitamins, antioxidants, and minerals in the treatment of hypertension when combined with optimal nutrition and other lifestyle modifications. However, many of these studies are small and do not have long-term follow-up for efficacy and safety. The role of these nutrition and nutraceutical supplements will require careful review and additional studies to determine their exact role in the management of hypertension.
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Affiliation(s)
- Mark Houston
- Department of Medicine, Vanderbilt University School of Medicine, Hypertension Institute of Nashville, Saint Thomas Medical Group and Health ServicesSaint Thomas HospitalNashvilleTN
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17
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Houston MC. The role of nutrition and nutraceutical supplements in the prevention and treatment of hypertension. ACTA ACUST UNITED AC 2013. [DOI: 10.2217/cpr.13.2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Demir M. The relationship between neutrophil lymphocyte ratio and non-dipper hypertension. Clin Exp Hypertens 2013; 35:570-3. [PMID: 23387864 DOI: 10.3109/10641963.2013.764893] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Non-dipper hypertension is associated with increased cardiovascular morbidity and mortality. Neutrophil/lymphocyte ratio (NLR) has been associated with poor outcomes in patients with cardiovascular diseases. However, little is known about the role of NLR in patients with non-dipper hypertension. In this study, NLR between dipper and non-dipper hypertensive patients was compared.This study included 80 hypertensive patients. Hypertensive patients were divided into two groups: 50 dipper patients (29 male, mean age 51.5 ± 8 years) and 30 non-dipper patients (17 male, mean age 50.6 ± 5.4 years). Transthoracic echocardiography and ambulatory 24-hour blood pressure monitoring were performed on all patients. No patient had a recent history of an acute infection or an inflammatory disease. Baseline NLR was measured by dividing neutrophil count to lymphocyte count. No statistically significant difference was found between the two groups in terms of basic characteristics. Mean NLR was significantly higher among persons with non-dipper compared with dipper patients (3.1 ± 0.95 vs. 1.8 ± 0.52, P < .001). Additionally, leukocytes and monocytes counts were higher in patients with non-dipper hypertension.In conclusion, our results suggest that higher NLR, an emerging marker of inflammation, has a positive correlation with blood pressure and is elevated in non-dippers compared with dippers.
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Affiliation(s)
- Mehmet Demir
- Cardiology Department, Bursa Yüksek İhtisas Education and Research Hospital , Bursa , Turkey
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Prenatal stress enhances severity of atherosclerosis in the adult apolipoprotein E-deficient mouse offspring via inflammatory pathways. J Dev Orig Health Dis 2012; 4:90-7. [DOI: 10.1017/s2040174412000608] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Atherosclerosis is the underlying cause of cardiovascular disease and stroke. Endothelial cell dysfunctions are early events in atherosclerosis, resulting in the recruitment of circulating monocytes. The immune system can elicit an inflammatory response toward the atherosclerotic lesion, thereby accelerating lesion growth. Risk factors for atherosclerosis include hypertension, smoking, stress perception or low birth weight. As prenatal stress challenge decreases the birth weight and affects the offspring's postnatal immune response, we aimed to investigate whether prenatal stress contributes to the development of atherosclerosis in mice. Syngenic pregnant apolipoprotein E-deficient (apoE−/−) dams were exposed to sound stress on gestation days 12.5 and 14.5. The presence and size of atherosclerotic plaques in the offspring at the age of 15 weeks was evaluated by histomorphology, accompanied by flow cytometric analysis of the frequency and phenotype of monocytes/macrophages and regulatory T (Treg) cells in the blood. Further, cytokine secretion of peripheral blood lymphocytes was analyzed. In response to prenatal stress challenge, an increased frequency of large atherosclerotic plaques was detectable in apoE−/− offspring, which was particularly profound in females. Prenatal stress also resulted in alterations of the offspring's immune response, such as a decreased frequency of Treg cells in blood, alterations of macrophage populations in blood and an increased secretion of inflammatory cytokines. We provide novel evidence that prenatally stressed adult offspring show an increased severity of atherosclerosis. As Treg cells are key players in dampening inflammation, the observed increase in atherosclerosis may be due to the lack of Treg cell frequency. Future interdisciplinary research is urgently required to understand the developmental origin of prenatal stress-induced atherosclerosis. The availability of our model may facilitate and foster such research endeavors.
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Zia E, Melander O, Björkbacka H, Hedblad B, Engström G. Total and differential leucocyte counts in relation to incidence of stroke subtypes and mortality: a prospective cohort study. J Intern Med 2012; 272:298-304. [PMID: 22303818 DOI: 10.1111/j.1365-2796.2012.02526.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Elevated levels of total leucocyte as well as leucocyte subtypes have been associated with increased risk of atherosclerotic disease. Atherosclerosis is an important cause of cerebral infarction, whereas its significance in intracerebral haemorrhage (ICH) is less clear. A small number of prospective studies have revealed the relationship between leucocyte counts and incident stroke, in particular incidence of stroke subtypes. We evaluated the associations between total leucocyte count (TLC) as well as leucocyte subtypes and the incidence of and mortality caused by different stroke subtypes. DESIGN AND SUBJECTS Of 28 449 participants from the Malmö Diet and Cancer Study, 26 927 stroke-free subjects (mean age at screening, 58 ± 8 years) were included in a prospective cohort study. The screening period was between 1991 and 1996. Incidence of stroke, 1-year mortality and 1-month case-fatality rate (CFR) were assessed by linkage to local and national registers. Cox regression analysis was used to assess stroke risk and 1-year mortality, and 1-month CFR was assessed by logistic regression analysis. RESULTS During a follow-up period of 13.6 ± 3.3 years, 1515 participants had a first-ever stroke (cerebral infarction, n = 1314; ICH, n = 201). After adjustments for other risk factors, TLC and neutrophil count were significantly associated with increased incidence of cerebral infarction (hazards ratio (HR), 1.4; 95% confidence interval (CI), 1.2-1.7 and 1.3; 95% CI, 1.1-1.5, respectively). There was an inverse association between elevated TLC and incident ICH (HR, 0.7; 95% CI, 0.4-0.99). No associations were found between leucocyte counts and mortality for either stroke subtype. CONCLUSION The results suggest that the relationships with inflammation for ischaemic stroke and ICH are different.
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Affiliation(s)
- E Zia
- Department of Neurology, Skåne University Hospital, Malmö, Sweden.
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Beitelshees AL, Aquilante CL, Allayee H, Langaee TY, Welder GJ, Schofield RS, Zineh I. CXCL5 polymorphisms are associated with variable blood pressure in cardiovascular disease-free adults. Hum Genomics 2012; 6:9. [PMID: 23245743 PMCID: PMC3505480 DOI: 10.1186/1479-7364-6-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2012] [Accepted: 05/18/2012] [Indexed: 12/20/2022] Open
Abstract
Objective Leukocyte count has been associated with blood pressure, hypertension, and hypertensive complications. We hypothesized that polymorphisms in the CXCL5 gene, which encodes the neutrophilic chemokine ENA-78, are associated with blood pressure in cardiovascular disease (CVD)-free adults and that these polymorphisms are functional. Methods and results A total of 192 community-dwelling participants without CVD or risk equivalents were enrolled. Two CXCL5 polymorphisms (−156 G > C (rs352046) and 398 G > A (rs425535)) were tested for associations with blood pressure. Allele-specific mRNA expression in leukocytes was also measured to determine whether heterozygosity was associated with allelic expression imbalance. In −156 C variant carriers, systolic blood pressure (SBP) was 7 mmHg higher than in −156 G/G wild-type homozygotes (131 ± 17 vs. 124 ± 14 mmHg; P = 0.008). Similarly, diastolic blood pressure (DBP) was 4 mmHg higher in −156 C variant carriers (78 ± 11 vs. 74 ± 11 mmHg; P = 0.013). In multivariate analysis of SBP, age, sex, body mass index, and the −156 G > C polymorphism were identified as significant variables. Age, sex, and the −156 G > C SNP were further associated with DBP, along with white blood cells. Allelic expression imbalance and significantly higher circulating ENA-78 concentrations were noted for variant carriers. Conclusion CXCL5 gene polymorphisms are functional and associated with variable blood pressure in CVD-free individuals. The role of CXCL5 as a hypertension- and CVD-susceptibility gene should be further explored.
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Affiliation(s)
- Amber L Beitelshees
- Division of Endocrinology, Diabetes and Nutrition, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
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Marketou ME, Kontaraki JE, Zacharis EA, Kochiadakis GE, Giaouzaki A, Chlouverakis G, Vardas PE. TLR2 and TLR4 gene expression in peripheral monocytes in nondiabetic hypertensive patients: the effect of intensive blood pressure-lowering. J Clin Hypertens (Greenwich) 2012; 14:330-5. [PMID: 22533660 DOI: 10.1111/j.1751-7176.2012.00620.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The activation of innate immune receptors, such as Toll-like receptors (TLRs), participates in the pathogenesis of cardiovascular diseases. The authors evaluated TLR2 and TLR4 gene expression in the peripheral monocytes of nondiabetic hypertensive patients compared with normotensive individuals and investigated the effect of intensive systolic blood pressure (SBP)-lowering. Included were 43 nondiabetic hypertensive patients with essential hypertension who were randomly assigned to an intensive treatment arm, with an SBP target of <130 mm Hg, or a standard arm, with an SBP target of <140 mm Hg. TLR2 and TLR4 messenger RNA (mRNA) levels in monocytes were estimated before and 12 weeks after therapy initiation. Sixteen healthy individuals were included for comparison. Hypertensives revealed significantly higher TLR4 mRNA levels compared with normotensives (985 ± 885 vs 554 ± 234, P=.005). In contrast, no statistically significant difference was found in TLR2. Compared with standard treatment, intensive treatment significantly downregulated TLR2 and TLR4 mRNAs, expressed as fold induction (0.66 ± 0.49 vs 1.38 ± 1.65 and 0.62 ± 0.3 vs 1.9 ± 1.2, respectively; P<.001 for both). In conclusion, TLR4 mRNA levels in peripheral monocytes are significantly elevated in nondiabetic hypertensive patients. Intensive control of SBP results in attenuation of TLR2 and TLR4 gene expression in those patients. Our findings suggest that a strict SBP target in nondiabetic hypertensive patients may offer additional benefits.
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Houston M. The Role of Nutraceutical Supplements in the Treatment of Dyslipidemia. J Clin Hypertens (Greenwich) 2012; 14:121-132. [DOI: 10.1111/j.1751-7176.2011.00576.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Tian N, Penman AD, Manning RD, Flessner MF, Mawson AR. Association between circulating specific leukocyte types and incident chronic kidney disease: the Atherosclerosis Risk in Communities (ARIC) study. ACTA ACUST UNITED AC 2011; 6:100-8. [PMID: 22054781 DOI: 10.1016/j.jash.2011.10.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2011] [Revised: 10/02/2011] [Accepted: 10/03/2011] [Indexed: 12/24/2022]
Abstract
Progressive renal fibrosis is a characteristic of all the diseases that cause renal failure and is invariably accompanied by a prominent leukocyte infiltration in the kidney. The goal of this study was to determine the association between the circulating specific leukocyte types and incident chronic kidney disease (CKD). In a cohort of 10,056 middle-aged white and African American adults, levels of circulating neutrophils, lymphocytes, and monocytes were measured at baseline; blood pressure (BP) and serum creatinine were measured and estimated glomerular filtration rate (eGFR) was calculated at baseline and 3 and 9 years later; and surveillance for first hospitalization or death with CKD was carried out over a mean follow-up of 7.4 years (maximum, 11.9 years). Increased neutrophil levels and decreased lymphocyte levels were significantly associated with greater CKD incidence after adjustment for covariates. African Americans tended to have similar but stronger patterns of association between circulating leukocytes and CKD incidence than whites, although the differences between race groups were not statistically significant. We also found that eGFR and BP were higher at each visit in African Americans than whites between ages 45 and 65. These findings support a potential role for circulating specific leukocytes in the pathogenesis of kidney dysfunction, especially in African Americans, indicating the leukocyte-related renal mechanism of essential hypertension (HT).
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Affiliation(s)
- Niu Tian
- Department of Pediatrics, University of Mississippi Medical Center, Jackson, MS, USA.
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