The older adult often experiences a low-grade chronic inflammation that commonly manifests in various conditions without infection, including hypertension. The serum neutrophil-to-lymphocyte ratio (NLR) and hyperuricemia are important markers for various diseases including hypertension. Older adult accounts for 17.33% of the total population of Yogyakarta Special Province, which is the highest compared to other provinces. The study aimed to evaluate the relationship between NLR and hyperuricemia with hypertension among adult patients in Sleman District, Yogyakarta, Indonesia. It was a community-based cross-sectional nested study involving 90 older adults aged ≥70 y.o. living around of the Sleman Health and Demographic Surveillance System (HDSS). Data of demographic and health characteristics of the subjects were collected. Independent t test, and Mann Whitney test were used to analyze mean differences between normotensive and hypertensive groups.  Multivariate analysis with logistic regression was used to analyze correlation between all variables. The results showed 59 respondents (65%) suffered from hypertension and 31 (35%) respondents had normal and pre-hypertension. No significantly different in almost of the subject characteristics between the normotensive and the hypertensive groups was observed (p>0.05). However, significantly different between the normotensive group and the hypertensive group was observed in the history of hypertension, blood pressure/BP, mean arterial pressure/MAP, abdominal circumstance/AC, fasting blood glucose/FBG, triglyceride, and hemoglobin (p<0.05). No significantly different in the NLR and HsCRP levels of the normotensive group compared to the hypertensive groups were observed (p>0.05). However, the uric acid level of the hypertensive group [5.6 (2.9-9.4 mg/dL)] was significantly higher than that the normotensive group [4.7 (2.9-8.0 mg/dL)] (p=0.042), although it was no significantly relationship with hypertension (p>0.05). In conclusion, there is no relationship between NLR, HsCRP and uric acid with hypertension among middle old and oldest old in Sleman District.

1.Institute for Health Metric and Evaluation. Global burden of disease study. 2016. Available from: ghdx.healtdata.org
2.Kementerian Kesehatan Republik Indonesia. Usia harapan hidup dan proyeksi penduduk Indonesia. 2017. Available from: www.kemkes.go.id
3.Badan Perencanaan Pembangunan Nasional Republik Indonesia. Statistik penduduk lanjut usia. 2020. Available from: www.bappenas.go.id
4.Rodgers JL, Jones J, Bolleddu SI, Vanthenapalli S, Rodgers LE, Shah K, et al. Cardiovascular risks associated with gender and aging. J Cardiovasc Dev Dis 2019; 6(2):19.
https://doi.org/10.3390/jcdd6020019
5.Sanada F, Taniyama Y, Muratsu J, Otsu R, Shimizu H, Rakugi H, et al. Source of chronic inflammation in aging. Front Cardiovasc Med 2018; 5:12.
https://doi.org/10.3389/fcvm.2018.00012
6.Cohen DL, Townsend RR. Update on pathophysiology and treatment of hypertension in the elderly. Curr Hypertens Rep 2011; 13(5):330-7.
https://doi.org/10.1007/s11906-011-0215-x
7.Liu X, Zhang Q, Wu H, Du H, Liu L, Shi H, et al. Blood neutrophil to lymphocyte ratio as a predictor of hypertension. Am J Hypertens 2015; 28(11):1339-46.
https://doi.org/10.1093/ajh/hpv034
8.Sevencan NO, Ozkan AE. Associations between neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, albuminuria and uric acid and the estimated glomerular filtration rate in hypertensive patients with chronic kidney disease stages 1-3. Arch Med Sci 2019; 15(5):1232-9.
https://doi.org/10.5114/aoms.2018.76262
9.Albu A, Para I, Porojan M. Uric acid and arterial stiffness. Ther Clin Risk Manag 2020; 16:39-54.
https://doi.org/10.2147/TCRM.S232033
10.Belen E, Sungur A, Sungur MA, Erdoğan G. Increased neutrophil to lymphocyte ratio in patients with resistant hypertension. J Clin Hypertens 2015; 17(7):532-7.
https://doi.org/10.1111/jch.12533
11.Hussain M, Babar MZM, Akhtar L, Hussain MS. Neutrophil lymphocyte ratio (NLR): A well assessment tool of glycemic control in type-2 diabetic patients. Pak J Med Sci 2017; 33(6):1366-70.
https://doi.org/10.12669/pjms.336.12900
12.Ito S, Ohno Y, Tanaka T, Kobuchi S, Ayajiki K, Manabe E, et al. Neutrophil/lymphocyte ratio elevation in renal dysfunction is caused by distortion of leukocyte hematopoiesis in bone marrow. Ren Fail 2019; 41(1):284-93.
https://doi.org/10.1080/0886022X.2019.1597736
13.Kuo YT, Wang YY, Lin SY, Chang WD. Age and sex differences in the relationship between neutrophil-to-lymphocyte ratio and chronic kidney disease among an adult population in Taiwan. Clin Chim Acta 2018; 486:98-103.
https://doi.org/10.1016/j.cca.2018.07.025
14.Zahorec R. Neutrophil-to-lymphocyte ratio, past, present and future perspectives. Bratisl Lek Listy 2021; 122(7):474-88.
https://doi.org/10.4149/BLL_2021_078
15.Dewi FST, Choiriyyah I, Indriyani C, Wahab A, Lazuardi L, Nugroho A, et al. Designing and collecting data for a longitudinal study: the Sleman health and demographic surveillance system (HDSS). Scand J Public Health 2018; 46(7):704-10.
https://doi.org/10.1177/1403494817717557
16.Badan Pusat Statistik Sleman. 2021. Banyaknya Penduduk menurut Kelompok Umur dan Jenis Kelamin di Kabupaten Sleman, 2020-2021. Slemankab.bps.go.id
17.Cem O, Yilmaz S, Korkmaz A, Fahrettin T, Sahin I, Demir V. Evaluation of the neutrophyl-lymphocyte ratio in newly diagnosed nondiabetic hypertensive patients with ascending aortic dilatation. Blood Press Monit 2016; 21(4):238-43
https://doi.org/10.1097/MBP.0000000000000187
18.Avşar E, Tazegül G, Coban E. Neutrophil-to-lymphocyte ratio in patients with white-coat hypertension. J Health Sci Med 2021; 4(6):824-7.
https://doi.org/10.32322/jhsm.969699
19.Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL, et al. Seventh report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure. Hypertension 2003; 42(6):1206-52.
https://doi.org/10.1161/01.HYP.0000107251.49515.c2
20.Lionakis N, Mendrinos D, Sanidas E, Favatas G, Georgopoulou M. Hypertension in the elderly. World J Cardiol 2012; 4(5):135-47.
https://doi.org/10.4330/wjc.v4.i5.135
21.Musso CG, Jauregui JR. Renin-angiotensin-aldosterone system and the aging kidney. Expert Rev Endocrinol Metab 2014; 9(6):543-6.
22.https://doi.org/10.1586/17446651.2014.956723Sun Z. Aging, Arterial stiffness, and hypertension. Hypertension 2015; 65(2):252-6.
https://doi.org/10.1161/hypertensionaha.114.03617
23.Alfie J, Cuffaro PE. Hypertension in the older adult. Encyclo Biomed Gerontol 2019; 4(5):258-70.
24.Dowey R, Iqbal A, Heller SR, Sabroe I, Prince LR. A bittersweet response to infection in diabetes; targeting neutrophils to modify inflammation and improve host immunity. Front Immunol 2021; 12678771.
https://doi.org/10.3389/fimmu.2021.678771
25.Ning P, Yang F, Kang J, Yang J, Zhang J, Tang Y, et al. Predictive value of novel inflammatory markers platelet to lymphocyte ratio, neutrophil-to-lymphocyte ratio, and monocyte-to-lymphocyte ratio in arterial stiffness in patients with diabetes: a propensity score-matched analysis. Front Endocrinol (Lausanne) 2022; 13:1039700.
https://doi.org/10.3389/fendo.2022.1039700
26.Peng J, Luo F, Ruan G, Peng R, Li X. Hypertriglyceridemia and atherosclerosis. Lipids Health Dis 2017; 16(1):233.
https://doi.org/10.1186/s12944-017-0625-0
27.Bano S, Joshi AR, Vaidya SM. Correlation between serum uric acid level with obesity indices and blood pressure in young males. Natl J Physiol Pharm Pharmacol 2019; 9(11):1103-6.
https://doi.org/10.5455/njppp.2019.9.0724426082019
28.Stewart DJ, Langlois V, Noone D. Hyperuricemia and hypertension: links and risk. I.ntegr Blood Press Control 2019; 12:43-62
https://doi.org/10.2147/IBPC.S184685
29.Shen L, Li M, Sun B, Zhou Z, Zhang J, Liu Y, et al. The relationship between leukocyte level and hypertension in elderly patient with hyperuricemia. Medicine (Baltimore) 2022; 101(51):e32327
https://doi.org/10.21203/rs.3.rs-31127/v1
30.Gao Y, Jia S, Huang C, Meng Z, Yu M, Xu T, et al. Risk factors of hyperuricemia calculated by random forest machine learning. Res Square 2020; 1-20.
https://doi.org/10.21203/rs.2.24675/v1
31.Magnaca S, Costanzo S, Curtis AD, Castenulnuovo AD, Olivier M, Carletti C, et al. Determinants of serum uric acid levels in an adult general population: results from the Moli-Sani study. Clin Rheumatol 2021; 40(3):857-65.
https://doi.org/10.1007/s10067-020-05288-w