Plasma Levels of Neutrophil Extracellular Traps Differ Across Cardiovascular Risk Categories in Newly Diagnosed Hypertensive Patients

Objective: Neutrophil extracellular traps (NETs), an innate immune mechanism of the neutrophils, are actively implicated in the pathophysiology of cardiovascular disease. Increased production of thrombo-fibrotic NETs has been documented in hypertensive patients compared to normotensives. Moreover, NETs have been correlated with blood pressure (BP) parameters and markers of micro- and macrovascular damage. The aim of this study was to compare plasma levels of NETs among hypertensive patients from different cardiovascular risk categories. Design and method: We recruited newly diagnosed, untreated hypertensives (UHTs) without overt cardiovascular disease. Office BP was measured according to European guidelines. Ambulatory peripheral and central BP parameters were measured with the Mobil-O-Graph device. Plasma levels of NETs, including myeloperoxidase (MPO)-DNA complex, were determined by ELISA. Cardiovascular risk was calculated using the Atherosclerotic Cardiovascular Disease (ASCVD) risk calculator. Patients were stratified as low (<5%), borderline (5-7.4%), intermediate (7.5-19.9%), or high risk accordingly (>20%). Results: A total of 86 individuals (48.3±8.13 years, 50% female) were included in the study. 49 participants were classified as low, 14 as borderline, and 23 as intermediate ASCVD risk. No participants were classified as high risk. The three groups did not differ significantly in demographic, laboratory or BP parameters, except for age, smoking status, triglycerides, high density lipoprotein (HDL), 24 h peripheral and central diastolic BP (DBP) and daytime peripheral and central DBP. MPO-DNA levels differed significantly between low, borderline and intermediate risk groups (0.046 ± 0.037 vs 0.061± 0.09 vs 0.069 ± 0.062, respectively, Kruskal-Wallis test, p=0.013). Post hoc analysis revealed higher MPO-DNA levels in the intermediate ASCVD risk group compared to the low and borderline risk groups (Dunn's test, p=0.034 and p=0.001, respectively). Conclusions: In a cohort of newly diagnosed, treatment-naïve hypertensive patients plasma levels of NETs significantly differed across various ASCVD risk groups. Further studies are needed to determine the potential of MPO-DNA complexes to serve as a biomarker of increased cardiovascular risk.