The role of neutrophil-to-lymphocyte ratio in left ventricular hypertrophy development in patients with comorbid course of hypertension, diabetes mellitus, and obesity

Objective: The patients with concurrent hypertension, diabetes mellitus (DM), and obesity are among the most common associated conditions in contemporary clinical practice. It is of crucial importance to investigate the development of left ventricular hypertrophy (LVH) in above mentioned complicated comorbid patients. The association of neutrophil-to-lymphocyte ratio (NLR) with the development of LVH is not researched enough. The aim of the work was to study the role of NLR in the development of LVH in hypertensive patients burdened with type 2 diabetes and obesity. Methods: 297 hypertensive patients with diabetes mellitus type 2 and obesity were enrolled into the study. Two groups were created: the first group - LVH, n = 153, with left ventricular hypertrophy and the second one, n = 144, without the presence of LVH. The calculation of LV mass employed the modifi ed Devereux formula, where values exceeding 95 g/m 2 (females) and 115 g/m 2 (males) were indicative of LVH. Data analysis was conducted using MedCalc version 20.111 statistical software. Logistic regression analysis was utilized to explore the risk factors for LVH. Results: The NLR was significantly elevated in LVH group 3.21 +/- 1.33 vs 2.65 +/- 1.19, p = 0.0002, and duration of essential hypertension (EH) was also significantly longer in LVH group 17.87 +/- 7.23 years vs 15.35 +/- 6.41 years, p = 0.0017. The percentage of "non-dippers" blood pressure circadian rhythm was significantly higher in LVH group 53 (34.64%) vs 31 (22.92%), p = 0.0263. The increased NLR levels were associated with higher risk of LVH with odds ratio (OR) 1.570, 95% confidence interval (CI) = 1.080-2.911, p = 0.019. The multivariate logistic analysis revealed that NLR together with duration of hypertension continued to be substantial predictors of LVH development in individuals with EH, DM, and obesity OR - 1.299; 95% CI: 1.009-2.105; p = 0.037 and OR - 1.089; CI: 1.019-3.539; p = 0.043, respectively. Conclusion: The study findings affirm the impact of the neutrophil-to-lymphocyte ratio on the progression of left ventricular hypertrophy in individuals with essential hypertension associated with diabetes and obesity. It can be suggested that NLR could emerge as a novel indicator for LVH in essential hypertension risk stratification. Identification of NLR in hypertensive patients with diabetes and obesity could be helpful in more effective management of these patients.