The Relationship between Neutrophil to Lymphocyte Ratio and Left Ventricular Function in Drug-naïve Asymptomatic Hypertensive Adults in Port Harcourt, Nigeria

Abstract

Background: Systemic hypertension is the commonest cardiovascular disease, affecting over a billion people all over the world and causing deaths due to target organs damage. Left ventricular dysfunction could be the result of hypertension causing a mechanical alteration of cardiac performance. More importantly it can be the main cause of congestive heart failure.  Lastly, left ventricular dysfunction can be either systolic or diastolic. Left ventricular dysfunction is thought to be related to endothelial dysfunction and several substrates have been identified as surrogate markers of this target organ damage including neutrophil to lymphocyte ratio (NLR). We aim to study the relationship of NLR to left ventricular function in treatment-naive African black hypertensive patients in Port Harcourt, Southern Nigeria. Methods: A descriptive cross-sectional study of newly diagnosed, treatment-naive hypertensive patients, consecutively recruited over a six months’ period. All underwent routine investigations for hypertension including a full blood count and a transthoracic echocardiography. The NLR was calculated using the total absolute neutrophil and lymphocyte count and correlated to the echocardiographically-determined left ventricular systolic and diastolic function. Results: One hundred and forty-four patients and seventy-two controls were evaluated. The mean ages in subjects and controls were 51.4±12.9 years (Range 25–86 years) and 48.8±12.6 years (\Range 24 – 78 years) respectively. The mean body mass indices were 29.5±4.9 kg/m2 and 27.2±5.0 kg/m2 (P=0.001) in subjects and control respectively. Mean systolic blood pressure were 149.0±22.5 and 115.0±11.3 mmHg in subjects and controls respectively (P<0.001) while mean diastolic pressures were 93.0±13.6 mmHg and 70.6±9.1 mmHg respectively (P <0.001). Mean NLR in the subjects and controls were 1.35±0.8 and 1.23±0.6 respectively (P= 0.272). Mean NLR in subjects with normal left ventricular function was significantly lower compared with those with different grades of systolic dysfunction, (1.35 ±0.66 Vs 1.43. ±0.78 Vs 1.34± 0.56 Vs 2.43 ±1.11   (P = 0.009). The left ventricular ejection fraction and fractional wall shortening decreased with increasing NLR tertiles and the difference between tertiles was statistically significant (p=0.004 and 0.009).  Conclusion: NLR was highest in the subjects with LV systolic dysfunction and in those with severe LV systolic dysfunction. NLR is related to LV systolic dysfunction in patients with hypertension even in the absence of overt features of heart failure.