Identifying reliable prognostic markers is crucial for the effective management of hypertension. The neutrophil-to-lymphocyte ratio (NLR) has emerged as a potential inflammatory marker linked to cardiovascular outcomes. This study aims to investigate the association of NLR with all-cause and cardiovascular mortality among patients with hypertension. This study analyzed data from 3067 hypertensive adults in the National Health and Nutritional Examination Surveys (NHANES) from 2009 to 2014. Mortality details were obtained from the National Death Index (NDI). Restricted cubic spline (RCS) was deployed to visualize the association of the NLR with mortality risk. Weighted Cox proportional hazards models were employed to assess the independent association of NLR with mortality risk. Time-dependent receiver operating characteristic curve (ROC) analysis was conducted to access the predictive ability of NLR for survival. Mediation analysis was used to explore the indirect impact of NLR on mortality mediated through eGFR. Over a median 92.0-months follow-up, 538 deaths occurred, including 114 cardiovascular deaths. RCS analysis revealed a positive association between NLR and both all-cause and cardiovascular mortality. Participants were stratified into higher (> 3.5) and lower (≤ 3.5) NLR groups. Weighted Cox proportional hazards models demonstrated that individuals with higher NLR had a significantly increased risk of all-cause (HR 1.96, 95% confidence interval (CI) 1.52–2.52, p < 0.0001) and cardiovascular mortality (HR 2.33, 95% CI 1.54–3.51, p < 0.0001). Stratified and interaction analysis confirmed the stability of the core results. Notably, eGFR partially mediated the association between NLR and both all-cause and cardiovascular mortality by a 5.4% and 4.7% proportion, respectively. Additionally, the areas under the curve (AUC) of the 3-, 5- and 10- year survival was 0.68, 0.65 and 0.64 for all-cause mortality and 0.68, 0.70 and 0.69 for cardiovascular mortality, respectively. Elevated NLR independently confers an increased risk for both all-cause and cardiovascular mortality in individuals with hypertension.

中文翻译：

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中性粒细胞与淋巴细胞的比率与高血压患者的全因死亡率和心血管死亡率相关

确定可靠的预后标志物对于有效管理高血压至关重要。中性粒细胞与淋巴细胞比率（NLR）已成为与心血管结局相关的潜在炎症标志物。本研究旨在探讨 NLR 与高血压患者全因死亡率和心血管死亡率的关系。本研究分析了 2009 年至 2014 年国家健康和营养检查调查 (NHANES) 中 3067 名高血压成人的数据。死亡率详细信息来自国家死亡指数 (NDI)。使用受限三次样条 (RCS) 来可视化 NLR 与死亡风险的关联。采用加权 Cox 比例风险模型来评估 NLR 与死亡风险的独立关联。进行时间依赖性受试者工作特征曲线 (ROC) 分析，以了解 NLR 对生存的预测能力。中介分析用于探讨 NLR 通过 eGFR 介导的对死亡率的间接影响。在中位 92.0 个月的随访中，发生了 538 例死亡，其中 114 例因心血管疾病死亡。 RCS 分析显示 NLR 与全因死亡率和心血管死亡率之间呈正相关。参与者被分为较高（> 3.5）和较低（≤ 3.5）NLR 组。加权 Cox 比例风险模型表明，NLR 较高的个体的全因风险（HR 1.96，95% 置信区间 (CI) 1.52–2.52，p < 0.0001）和心血管死亡率（HR 2.33，95% CI 1.54）显着增加–3.51，p < 0.0001）。分层和交互分析证实了核心结果的稳定性。值得注意的是，eGFR 部分介导了 NLR 与全因死亡率和心血管死亡率之间的关联，比例分别为 5.4% 和 4.7%。此外，全因死亡率的 3 年、5 年和 10 年生存率曲线下面积 (AUC) 分别为 0.68、0.65 和 0.64，心血管死亡率的曲线下面积 (AUC) 分别为 0.68、0.70 和 0.69。 NLR 升高独立地导致高血压患者全因死亡和心血管死亡的风险增加。