J Cardiovasc Ultrasound.  2016 Dec;24(4):294-302. 10.4250/jcu.2016.24.4.294.

Epicardial Fat Thickness and Neutrophil to Lymphocyte Ratio are Increased in Non-Dipper Hypertensive Patients

• Kim BJ
• Cho KI
• Choi JH
• Park DH
• Yu GI
• Im SI
• Kim HS
• Heo JH
• Cha TJ

• KMID: 2364647
• DOI: http://doi.org/10.4250/jcu.2016.24.4.294

Abstract

BACKGROUND
In this study, we aimed to investigate the relationship between echocardiographic epicardial fat thickness (EFT), neutrophil to lymphocyte ratio (NLR; an important inflammatory marker), and diurnal blood pressure (BP) changes in patients with recently diagnosed essential hypertension.
METHODS
A total of 647 patients underwent echocardiography and 24 hours of ambulatory BP monitoring. EFT was measured by echocardiography, while NLR was measured by dividing the neutrophil count by the lymphocyte count. Patients were categorized into three groups according to BP pattern: the normotensive group, the dipper group, and the non-dipper group.
RESULTS
The mean EFT was highest in the non-dipper group (non-dipper group, 7.3 ± 3.0 mm; dipper group, 6.1 ± 2.0 mm; control group, 5.6 ± 2.0 mm; p < 0.001). NLR was also highest in the non-dipper group (non-dipper, 2.75 ± 2.81; dipper, 2.01 ± 1.32; control, 1.92 ± 1.11; p < 0.001). EFT was significantly correlated with age (r = 0.160, p < 0.001) and NLR (r = 0.353, p < 0.001). Furthermore, an EFT ≥ 7.0 mm was associated with the non-dipper BP pattern with 51.3% sensitivity and 71.6% specificity [95% confidence interval (CI) = 0.56-0.65, p < 0.001]. In a multivariate analysis, EFT [adjusted odds ratio (OR) = 3.99, 95% CI = 1.22-13.10, p = 0.022] and NLR (OR = 1.34, 95% CI = 1.05-1.71, p = 0.018) were independent parameters that distinguished a non-dipper pattern after adjustment for cardiovascular risk factors.
CONCLUSION
EFT and NLR are independently associated with impaired diurnal BP profiles in hypertensive individuals. EFT (as measured by echocardiography) and NLR appear to be helpful in stratifying cardiometabolic risk.

Keyword

Epicardial fat thickness; Neutrophil to lymphocyte ratio; Hypertension; Non-dipper

MeSH Terms

Blood Pressure
Echocardiography
Humans
Hypertension
Lymphocyte Count
Lymphocytes*
Multivariate Analysis
Neutrophils*
Odds Ratio
Risk Factors
Sensitivity and Specificity

Figure

• 

  Fig. 1 Comparison of NLR and EFT on circardian BP pattern. A: NLR was the highest in the non-dippers compared to the other two groups (nondipper, 2.75 ± 2.81; dipper, 2.01 ± 1.32; control, 1.92 ± 1.11; p < 0.001). B: The mean EFT was significantly higher in both hypertensive groups compared to the control group and was highest in the non-dipper group (non-dipper group, 7.3 ± 3.0 mm; dipper group, 6.1 ± 2.0 mm; control group, 5.6 ± 2.0 mm; p < 0.001). NLR: neutrophil to lymphocyte ratio, BP: blood pressure, EFT: epicardial fat thickness.

• 

  Fig. 2 Correlations between EFT, NLR, and clinical parameters. EFT was significantly correlated with age (r = 0.160, p < 0.001) (A), body mass index (r = 0.091, p = 0.042) (B), 24-hour mean BP variability (r = 0.152, p = 0.001) (C), and NLR (r = 0.353, p < 0.001) (D). NLR was also significantly correlated with 24-hour mean BP variability (r = 0.270, p = 0.001) (E). EFT: epicardial fat thickness, NLR: neutrophil to lymphocyte ratio, BP: blood pressure.

• 

  Fig. 3 Receiver operating characteristic (ROC) analysis. EFT ≥ 7.0 mm was associated with the non-dipper BP pattern with 51.3% sensitivity and 71.6% specificity (ROC area under curve of 0.606, 95% CI 0.56–0.65, p < 0.001) (A) and NLR ≥ 2.1 was also associated with non-dipper BP pattern with 52.2% sensitivity and 65.3% specificity (ROC area under curve of 0.596, 95% CI 0.55–0.64, p < 0.001) (B). EFT: epicardial fat thickness, NLR: neutrophil to lymphocyte ratio, BP: blood pressure, CI: confidence interval.

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