An Inverted U-shaped Relationship between Neutrophil-to-Lymphocyte Ratio and Hypertension in Overweight and Obese Populations: Evidence from a Large-scale Health Screening Data

Abstract

Background The Neutrophil-to-Lymphocyte Ratio (NLR) is associated with the development and progression of hypertension, and obesity is a significant risk factor for hypertension. However, the relationship between NLR and overweight and obese hypertension remains unclear. Methods This study was a cross-sectional analysis of data from 40,623 participants with body mass index (BMI) ≥ 24 kg/m² who were health screened from January 2018 to December 2023 at Henan Provincial People's Hospital. Participants were divided into groups with hypertension and those without hypertension, according to hypertension diagnostic criteria. The NLR, our dependent variable, was determined using the equation [neutrophil/ lymphocyte]. We explored the association between NLR and hypertension in overweight and obese individuals through multivariate logistic regression, generalized additive models, smoothed curve fitting, analysis of threshold effects, and subgroup analysis. Results After adjusting for other covariates, increased risk of hypertension was still associated with an elevated NLR [OR = 1.27, 95% CI = 1.20–1.36; P < 0.001; P for trend < 0.001, when Q4 was compared with Q1 in model II]. Smoothed curve fitting showed an inverse U-shaped relationship between NLR and risk of hypertension, with a decreased risk of hypertension when NLR was greater than 2.91. In addition, subgroup analyses showed that the relationship between NLR and hypertension was robust across gender, age, BMI, and occupational subgroups. Conclusion Our study demonstrated a significant inverted U-shaped association between NLR and hypertension in overweight and obese Chinese adults.