Role of prognostic markers in the pathogenesis of hypertension

Abstract

Hypertension is a chronic medical condition characterized by persistently elevated arterial blood pressure (BP) and represents one of the leading global risk factors for cardiovascular morbidity and mortality. Prognostic markers are defined as clinical, biochemical, histopathological, or molecular parameters that provide information regarding disease progression and clinical outcomes. This review provides an updated and comprehensive overview of the fundamental role of various prognostic markers involved in the pathogenesis and progression of hypertension. Although numerous prognostic indicators have been reported in the literature, this review specifically focuses on selected markers, including C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR), microalbuminuria, N-terminal pro-B-type natriuretic peptide (NT-proBNP), carotid intima-media thickness (CIMT), glomerular filtration rate (GFR), triglycerides (TG), body mass index (BMI), total cholesterol, fasting plasma glucose (FPG), right atrial pressure (RAP), and mixed venous oxygen saturation. CRP directly causes endothelial dysfunction, which hinders blood vessel relaxation and raises BP. Additionally, greater NLR levels were linked to higher degrees of diastolic dysfunction. Microalbuminuria exhibit a range of biochemical and hormonal abnormalities with pathogenic potential, leading to a higher incidence of cardiovascular events and a higher decline in renal function in hypertensive patients compared to patients with normal urine albumin excretion. Elevated NT-proBNP levels strongly suggest structural alterations such as left atrial enlargement or left ventricular (LV) hypertrophy, as well as subclinical LV dysfunction. Hypertension-related structural vascular damage is indicated by elevated CIMT. Long-term high BP eventually damages the glomeruli structurally, which lowers GFR. Increased blood viscosity, or thickness, caused by elevated TG, impairs blood flow and raises the strain on artery walls. Also, increased visceral fat from an elevated BMI induces insulin resistance, activates the sympathetic nervous system, and causes the kidneys to retain salt, all of which raise BP. BP rises as a result of blood vessel blockage and stiffness brought on by cholesterol accumulation. Even in the prediabetes range, elevated FPG levels are independently linked to a higher risk of hypertension. Increased severity of pulmonary arterial hypertension, decreased exercise capacity, and mortality are all strongly correlated with elevated RAP. Mixed venous oxygen saturation is independently correlated with both mean pulmonary artery stroke volume and right atrial area. Comprehensive assessment and monitoring of these prognostic markers may facilitate a more individualized evaluation of disease prognosis and support the implementation of targeted therapeutic strategies aimed at reducing cardiovascular complications and improving clinical outcomes in patients with hypertension.

Keywords: Hypertension; Prognostic markers; C-reactive protein; Neutrophil-to-lymphocyte ratio; Microalbuminuria; N-terminal pro-B-type natriuretic peptide; Carotid intima-media thickness

Core Tip: The present review provides an updated and comprehensive overview of the fundamental role of various prognostic markers, including C-reactive protein, neutrophil-to-lymphocyte ratio, microalbuminuria, N-terminal pro-B-type natriuretic peptide, carotid intima-media thickness, glomerular filtration rate, triglycerides, body mass index, total cholesterol, fasting plasma glucose, right atrial pressure, and mixed venous oxygen saturation, involved in the pathogenesis of hypertension.