Association Between Neutrophil-Percentage-To-Albumin Ratio Level and Heart Failure in Hypertensive Population.

Abstract

The neutrophil-to-albumin ratio (NPAR), which represents a surrogate sign of systemic inflammation, has recently garnered interest as a novel prognostic biomarker in cardiovascular pathology, with a particular focus on heart failure (HF) in patients diagnosed with hypertension. The present analysis explored the relationship between NPAR and HF prevalence based on cross-sectional data derived from the 2017-2020 cycle of the National Health and Nutrition Examination Survey (NHANES). A total of 3045 hypertensive adults were analyzed, and multivariable logistic regression was employed with sequential adjustment for a comprehensive range of demographic, lifestyle, and clinical variables, including age, sex, ethnicity, body mass index, smoking status, alcohol consumption, diabetes, coronary artery disease, previous myocardial infarction, and history of stroke. The overall weighted prevalence of HF in this hypertensive cohort was 6.27%, and participants with HF had significantly higher NPAR levels than those without HF. After comprehensive adjustment for potential confounders, elevated NPAR remained independently associated with greater odds of HF (OR = 1.17, 95% CI: 1.09-1.25, p < 0.001). Additional quartile, blood pressure-adjusted sensitivity, and spline analyses further supported the robustness and approximately linear nature of this association. ROC analysis indicated that NPAR had acceptable discriminatory ability for HF, with an AUC of 0.649 and an optimal cutoff value of 14.24. Subgroup analyses further identified notable interaction effects for alcohol use and stroke history (interaction p < 0.05), indicating potential effect modification. These findings suggest that NPAR may serve as an accessible and cost-effective marker for HF risk stratification in hypertensive individuals.