DOI: 10.4103/jascp.jascp_3_26 ISSN: 2772-364X

A Study of Heart Rate Variability and Neutrophil-to-lymphocyte Ratio as Markers of Cognitive Impairment in Hypertensive Subjects Attending a Tertiary Care Hospital

Muhammad H. Khan, Shah Mohammad Abbas Waseem, Syed Haider Mehdi Husaini
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Background:

Hypertension is a significant risk factor for cognitive decline, yet the roles of systemic inflammation and autonomic dysfunction in this progression remain poorly understood. This study aimed to evaluate the associations between the neutrophil-to-lymphocyte ratio (NLR), heart rate variability (HRV), and cognitive impairment in hypertensive patients.

Methods:

A cross-sectional study was conducted among 161 subjects (88 hypertensive and 73 normotensive). Cognitive function was assessed using the Hindi mini-mental state examination and the Hindi Montreal Cognitive Assessment (MoCA). Autonomic function was measured via HRV parameters, including standard deviation of normal to normal intervals (SDNN) and low-frequency power. Systemic inflammation was evaluated using the NLR. Independent predictors were identified using multivariate regression analysis.

Results:

Hypertensive subjects demonstrated significantly lower cognitive scores (MoCA: 24.89 ± 2.67 vs. 26.90 ± 1.78; P < 0.001) and higher NLR (2.89 ± 1.18 vs. 1.01 ± 0.24; P = 0.034) compared to normotensives. Within the hypertensive group, 19.3% exhibited cognitive impairment. These individuals had significantly higher NLR (3.01 ± 0.78 vs. 2.23 ± 0.49; P = 0.02) and lower SDNN (31.78 ± 19.38 vs. 36.12 ± 22.81 ms; P = 0.023). Multivariate analysis identified age (β = −0.312), elevated systolic blood pressure (SBP) (β = −0.245), NLR (β = −0.198), and SDNN (β = 0.186) as independent predictors of cognitive status. Adjusting for confounders, the risk of cognitive impairment was 4.12 times higher with SBP > 140 mmHg ( P < 0.001), 2.84 times higher with NLR >2.5 ( P = 0.003), and 2.31 times higher with SDNN <30 ms ( P = 0.014).

Conclusion:

Elevated systemic inflammation (NLR) and reduced autonomic flexibility (SDNN) are independent predictors of cognitive decline in hypertensive patients. These markers, alongside SBP, provide critical prognostic value for identifying patients at high risk of cognitive impairment.

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