title: Epicardial Fat Thickness and Neutrophil to Lymphocyte Ratio are Increased in Non-Dipper Hypertensive Patients.
abstract: BACKGROUND
  In this study, we aimed to investigate the relationship between echocardiographic epicardial fat thickness (EFT), neutrophil to lymphocyte ratio (NLR; an important inflammatory marker), and diurnal blood pressure (BP) changes in patients with recently diagnosed essential hypertension.
  
  
  METHODS
  A total of 647 patients underwent echocardiography and 24 hours of ambulatory BP monitoring. EFT was measured by echocardiography, while NLR was measured by dividing the neutrophil count by the lymphocyte count. Patients were categorized into three groups according to BP pattern: the normotensive group, the dipper group, and the non-dipper group.
  
  
  RESULTS
  The mean EFT was highest in the non-dipper group (non-dipper group, 7.3 ± 3.0 mm; dipper group, 6.1 ± 2.0 mm; control group, 5.6 ± 2.0 mm;p< 0.001). NLR was also highest in the non-dipper group (non-dipper, 2.75 ± 2.81; dipper, 2.01 ± 1.32; control, 1.92 ± 1.11;p< 0.001). EFT was significantly correlated with age (r = 0.160,p< 0.001) and NLR (r = 0.353,p< 0.001). Furthermore, an EFT ≥ 7.0 mm was associated with the non-dipper BP pattern with 51.3% sensitivity and 71.6% specificity [95% confidence interval (CI) = 0.56-0.65,p< 0.001]. In a multivariate analysis, EFT [adjusted odds ratio (OR) = 3.99, 95% CI = 1.22-13.10,p= 0.022] and NLR (OR = 1.34, 95% CI = 1.05-1.71,p= 0.018) were independent parameters that distinguished a non-dipper pattern after adjustment for cardiovascular risk factors.
  
  
  CONCLUSIONS
  EFT and NLR are independently associated with impaired diurnal BP profiles in hypertensive individuals. EFT (as measured by echocardiography) and NLR appear to be helpful in stratifying cardiometabolic risk.
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea.
authors.forename: Bong Joon
authors.initials: BJ
authors.lastname: Kim
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea.
authors.forename: Kyoung Im
authors.initials: KI
authors.lastname: Cho
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea.
authors.forename: Ji Hun
authors.initials: JH
authors.lastname: Choi
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea.
authors.forename: Dong Hyun
authors.initials: DH
authors.lastname: Park
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea.
authors.forename: Ga In
authors.initials: GI
authors.lastname: Yu
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea.
authors.forename: Sung Il
authors.initials: SI
authors.lastname: Im
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea.
authors.forename: Hyun Su
authors.initials: HS
authors.lastname: Kim
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea.
authors.forename: Jeong Ho
authors.initials: JH
authors.lastname: Heo
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea.
authors.forename: Tae-Joon
authors.initials: TJ
authors.lastname: Cha
keywords: Epicardial fat thickness; Hypertension; Neutrophil to lymphocyte ratio; Non-dipper