The Relation of Epicardial Fat Thickness, Neutrophil to Lymphocyte Ratio and Circadian Rhythm of Blood Pressure

Is this issue of the journal, Kim et al. aimed to explain the association between epicardial fat thickness (EFT) and neutrophil to lymphocyte ratio (NLR) as systemic inflammatory markers in hypertensive patients according to diurnal variation of blood pressure (BP). They concluded that EFT and NLR are independently associated with impaired diurnal variation of BP in hypertensive patients. Recently, epicardial fat tissue has been proposed as a new cardiometabolic risk factor, carrying more risk than subcutaneous fat accumulation. Epicardial fat tissue is the true visceral fat deposition of the heart, and active organ that produces several pro-inflammatory and pro-atherogenic cytokines such as angiotensinogen and free fatty acids. The major difference between epicardial adipose tissue and other visceral adipose tissue is its greater capacity for free fatty acid release. Elevated plasma free fatty acid concentrations may stimulate cardiac autonomic nervous system activity through an increase in plasma catecholamine concentrations. Therefore, high level of free fatty acid may cause autonomic dysfunction and sympathetic overactivity, both of which are known mechanisms of the nocturnal hypertension may be related to decrease in nocturnal BP fall. Since, O’Brien et al. firstly demonstrated the lack of decrease in nocturnal BP, known as non-dipping, is associated with advanced organ damage. In these days, it is well known that the non-dipper BP pattern is associated with increased cardiovascular mortality and cerebrovascular disease. Therefore, the early detection of a non-dipper BP pattern through increased EFT may help identify high-risk individuals for adverse cardiovascular events. However, there is a small limitation in the present study. The echocardiographic method might not be the optimal techpISSN 1975-4612/ eISSN 2005-9655 Copyright © 2016 Korean Society of Echocardiography www.kse-jcu.org https://doi.org/10.4250/jcu.2016.24.4.272