The relationship between prognostic nutritional index and dipping patern in primary hypertansive patients

Purpose: Hypertension is the disease with the highest prevalence among all cardiovascular risk factors. Non-dipping hypertension is associated with higher cardiovascular risk and worse outcome. There is evidence that endothelial repair is negatively affected and the inflammatory process is more severe in non-dipping hypertensive individuals than in dipping hypertensive individuals. In our study, we aimed to evaluate the relationship between prognostic nutritional index (PNI) and dipping pattern as metabolic and inflammatory markers. Material and Methods: A total of 380 patients who applied to Dicle University Faculty of Medicine Nephrology and Cardiology polyclinics between 01/01/2020-01/09/2022 with the results of 24-hour ambulatory blood pressure monitoring (ABPI) after home and office blood pressure monitoring 140/90 mmHg were included in our study. The patients were divided into two groups as dipping hypertensive and non-dipping hypertensive patients according to the ambulatory blood pressure measurement results. Demographic characteristics (age, gender, height, weight, body mass index) of the patients in both groups and laboratory tests performed after 12 hours of fasting were retrospectively analyzed from the patient files. The laboratory and clinical findings between the two groups were compared and the predictive factors for the dipping pattern were determined. Results: There were 163 (43%) patients in the dipping HT group and 217 (57%) patients in the non-dipping HT group. The number of patients diagnosed with diabetes mellitus was 39 (18%) in the non-dipping HT group and 16 (9.8%) in the dipping HT group, while the number of patients with DM was higher in the non-dipping HT group (p=0.025). The mean age in all patients was 50.1±12.2 years, 49.19±10.86 years in the dipping HT group and 50.98±12.84 in the non-dipping HT group (p=0.079). Triglyceride level was 162.93±83.92 mg/dL in the whole group, 182.69±86.06 mg/dL in the dipping HT group, and 149.09±80.28 mg/dL in the non-dipping HT group, with higher triglyceride levels in the dipping HT group (p=0.001). Cholesterol was 207.45±44.27 mg/dL in the whole group, 212.79±46.15 mg/dL in the dipping HT group, and 201.60±41.99 mg/dL in the non-dipping HT group, with a higher level in the dipping HT group (p=0.026). The prognostic nutritional index was 54.45±6.11 in the whole group, 56.03±5.27 in the dipping HT group and 53.42±6.41 in the non-dipping HT group, and it was found to be lower in the non-dipping HT group than in the dipping HT group (p<0.001). RDW was 13.26±1.5% in the whole group, 13.0±1.4% in the dipping HT group and 13.56±1.65% in the non-dipping HT group (p=0.012). The 24-hour mean SBP and DBP values of the patients were higher in the non-dipping HT group (p=0.001, p=0.001, respectively). There was no difference between the groups in mean daytime SBP and DBP (p=0.573, p=0.966, respectively). Nighttime mean SBP and DBP values were higher in the non-dipping HT group (p<0.001, p<0.001, respectively). Triglyceride, RDW, and PNI were found to be independent predictive factors for the dipping pattern (p=0.017, p=0.028, p=0.009, respectively). Conclusion: It should be kept in mind that patients with primary hypertension with low PNI may show non-dipping characteristics and therefore may be predictive of more cardiovascular events and poor prognosis. In line with all this information, it will be possible to determine the blood pressure pattern in hypertensive patients and reduce their morbidity and mortality with early treatment and precautions. Keywords: Prognostic nutritional index, dipping hypertension, non-dipping hypertension, inflammation, target organ damage.