Elevated neutrophil-percentage-to-albumin ratio predicts increased all-cause and cardiovascular mortality in hypertensive patients: Evidence from NHANES 1999-2018.

Background: This study investigates the association between the neutrophil-percentage-to-albumin ratio (NPAR) and all-cause mortality in patients with hypertension, and its relationship with cardiovascular mortality.

Methods: This study examined data from 18,469 adults with hypertension in the National Health and Nutrition Examination Survey (1999-2018) and the mortality data from the National Death Index. The link between NPAR and mortality risk was visualized using restricted cubic splines. The optimal NPAR cut-off value for the prediction of survival outcomes was identified via maximally selected rank statistics. We employed weighted multivariate Cox regression and subgroup analyses to evaluate the relationship between NPAR and risk of all-cause and cardiovascular mortality. We assessed NPAR's predictive accuracy for survival outcomes using time-related receiver operating characteristic analysis.

Results: During a median follow-up of 105 months, 31.8 % of 18,469 participants died, with 8.9 % from cardiovascular causes. Restricted cubic splines analysis showed a positive link between NPAR and both all-cause and cardiovascular mortality. Cox models indicated that higher NPAR (>1602.08) significantly raised risks of all-cause (HR 1.80, 95 % CI 1.54-2.12, p < 0.0001) and cardiovascular mortality (HR 1.54, 95 % CI 1.24-1.91, p < 0.0001). The stability of results was confirmed through stratified and interaction analyses. The area under the curve for 3-, 5-, and 10-year survival were 0.67, 0.65, and 0.63 for all-cause mortality and 0.61, 0.62, and 0.63 for cardiovascular mortality.

Conclusions: Elevated NPAR independently raises the risk of all-cause and cardiovascular mortality in hypertensive patients, indicating its potential in the clinic as a practical tool for predicting long-term mortality risks and influencing treatment strategies.