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Neutrophil counts and the risk of first stroke in general hypertensive adults

Hypertension Research volume 44, pages 830–839 (2021)Cite this article

Abstract

We aimed to investigate the association between neutrophil counts and first stroke and examine possible effect modifiers among treated hypertensive adults. This is a post hoc analysis of the China Stroke Primary Prevention Trial (CSPPT). A total of 11,878 hypertensive adults with data on neutrophil counts at baseline were included in the current study. The primary outcome was first stroke. During a median follow-up of 4.5 years, 414 (3.5%) participants experienced a first stroke, including 358 with ischemic stroke, 55 with hemorrhagic stroke and one with uncertain type of stroke. Compared with participants in quartile 1 (<2.9 × 109/L) of neutrophil counts, those in the upper quartiles (quartile 2–4 [≥2.9 × 109/L]) had a significantly higher risk of first stroke (HR, 1.35; 95% CI: 1.02, 1.78) or first ischemic stroke (HR, 1.38; 95% CI: 1.02, 1.86). Moreover, a strong positive association between neutrophil counts and first ischemic stroke was found in participants with total homocysteine (tHcy) levels <15 μmol/L (HR, 1.74; 95% CI: 1.17, 2.58; vs. ≥15 μmol/L; HR, 0.91; 95% CI: 0.57, 1.46, P interaction = 0.042) at baseline or time-averaged mean arterial pressure (MAP) ≥102 mmHg (median) (HR, 1.92; 95% CI: 1.27, 2.89; vs. <102 mmHg; HR, 0.89; 95% CI: 0.57, 1.41, P interaction = 0.015) during the treatment period. However, no such association between neutrophil counts and first hemorrhagic stroke was found. In summary, high baseline neutrophil counts were associated with an increased risk of first ischemic stroke among hypertensive patients, especially in those with low tHcy at baseline or high time-averaged MAP during the treatment period.

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Data availability

The data and study materials that support the findings will be available from the corresponding authors upon request after a request is submitted, formally reviewed, and approved by the Ethics Committee of the Institute of Biomedicine, Anhui Medical University.

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Funding

The study was supported by the National Natural Science Foundation of China [81973133, 81730019]; the National Key Research and Development Program [2016YFE0205400, 2018ZX09739010, 2018ZX09301034003]; the Science and Technology Planning Project of Guangzhou, China [201707020010]; the Science, Technology and Innovation Committee of Shenzhen [JSGG20170412155639040, GJHS20170314114526143, JSGG20180703155802047]; the Economic, Trade and Information Commission of Shenzhen Municipality [20170505161556110, 20170505160926390]; and the Clinical Innovation Research Program of Guangzhou Regenerative Medicine and Health Guangdong Laboratory [2018GZR0201003].

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Authors and Affiliations

  1. National Clinical Research Center for Kidney Disease, State Key Laboratory for Organ Failure Research, Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China

    Zhuxian Zhang, Chun Zhou, Mengyi Liu, Yuanyuan Zhang, Huan Li, Panpan He, Jing Nie, Min Liang, Xiping Xu & Xianhui Qin

  2. Shenzhen Evergreen Medical Institute, Shenzhen, 518057, China

    Chengzhang Liu

  3. Beijing Advanced Innovation Center for Food Nutrition and Human Health, Key Laboratory of Functional Dairy, College of Food Science and Nutritional Engineering, China Agricultural University, Beijing, 100083, China

    Yun Song & Lishun Liu

  4. Institute of Biomedicine, Anhui Medical University, Hefei, 230032, China

    Binyan Wang

  5. Department of Cardiology, Peking University First Hospital, Beijing, 100034, China

    Yan Zhang, Jianping Li & Yong Huo

  6. Department of Population, Family and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, E4132, Baltimore, MD, 21205-2179, USA

    Xiaobin Wang

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  1. Zhuxian Zhang
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Contributions

XQ, XX, and ZZ contributed to the conception or design of the work. XQ, ZZ, HL, and CL contributed to the acquisition, analysis, or interpretation of data for the work. XQ, ZZ, and YZ drafted the manuscript. All critically revised the manuscript, gave final approval, and agreed to be accountable for all aspects of work ensuring integrity and accuracy.

Corresponding authors

Correspondence to Xiping Xu or Xianhui Qin.

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Conflict of interest

XX reports grants from the National Key Research and Development Program [2016YFE0205400, 2018ZX09739010, 2018ZX09301034003], the Science and Technology Planning Project of Guangzhou, China [201707020010], the Science, Technology and Innovation Committee of Shenzhen [JSGG20170412155639040, GJHS20170314114526143, JSGG20180703155802047], and the Economic, Trade and Information Commission of Shenzhen Municipality [20170505161556110, 20170505160926390]. XQ reports grants from the National Natural Science Foundation of China [81973133, 81730019]. No other disclosures were reported.

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Zhang, Z., Zhou, C., Liu, M. et al. Neutrophil counts and the risk of first stroke in general hypertensive adults. Hypertens Res 44, 830–839 (2021). https://doi.org/10.1038/s41440-021-00625-1

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