Background: The ambulatory arterial stiffness index (AASI) is a non-invasive surrogate marker of arterial stiffness; however, the relative contributions of hemodynamic, cardiometabolic, and renal factors to the AASI remain incompletely understood. This study aimed to identify the independent clinical factors associated with the AASI. Methods: This retrospective cross-sectional study included 290 individuals aged 18–65 years who underwent ABPM between 2020 and 2024. Participants were classified as hypertensive or normotensive based on ABPM criteria. Hemodynamic parameters, cardiometabolic indices, and renal biomarkers, including the urine albumin-to-creatinine ratio (uACR), were assessed. Results: Associations between the AASI and clinical variables were evaluated using the following correlation analyses and hierarchical multivariable linear regression models: Model 1-1b (hemodynamic), Model 2 (hemodynamic plus cardiometabolic) and Model 3 (hemodynamic plus cardiometabolic plus renal). The AASI was significantly higher in hypertensive individuals compared with normotensive controls. In correlation analyses, the AASI was positively associated with age, systolic blood pressure parameters, atherogenic lipid indices, and uACR and negatively associated with diastolic blood pressure parameters and the estimated glomerular filtration rate (eGFR). In multivariable regression analyses, age, maximum systolic blood pressure, and maximum diastolic blood pressure remained independently associated with the AASI across models. uACR was also independently associated with the AASI in the fully adjusted model. Conclusions: The AASI is primarily associated with hemodynamic load and age-related vascular changes. Among non-hemodynamic factors, albuminuria demonstrated the strongest association with the AASI after multivariable adjustment. These findings suggest the potential clinical value of the AASI as a practical marker for early cardiorenal risk assessment using routine ABPM data.
Background/Objectives: Dietary adherence to the Dietary Approaches to Stop Hypertension (DASH) pattern is associated with lower blood pressure; however, most prior studies have relied on office-based measurements and non-specific dietary assessment tools. This study examined the association between DASH diet quality, assessed by the validated DASH-Q questionnaire, and 24-h ambulatory blood pressure in treatment-naive adults referred for diagnostic ambulatory blood pressure monitoring (ABPM). Materials and Methods: This cross-sectional study enrolled 227 consecutive treatment-naive adults referred for diagnostic 24-h ABPM at a cardiology outpatient clinic. DASH diet quality was assessed using the validated Turkish version of the DASH-Q questionnaire and categorized as low (<36), moderate (36–49), or high (≥50). Hypertension was defined by ABPM-based thresholds. Multivariable linear regression was performed to identify independent predictors of 24-h mean systolic and diastolic blood pressure, and binary logistic regression was used to evaluate independent predictors of ABPM-defined hypertension, with both models adjusted for age, sex, BMI, smoking, physical activity, and self-reported discretionary salt-adding behavior. Results: DASH-Q total score was the sole statistically significant independent predictor of both 24-h mean systolic blood pressure (B = −1.068, 95% CI: −1.270 to −0.866; β = −0.589; p < 0.001) and diastolic blood pressure (B = −0.560, 95% CI: −0.706 to −0.414; β = −0.470; p < 0.001) in the adjusted models. Each one-unit higher DASH-Q score was also associated with 14.6% lower odds of ABPM-defined hypertension (OR = 0.854, 95% CI: 0.820–0.890; p < 0.001). Higher DASH-Q scores were further associated with a more favorable metabolic profile, including lower LDL cholesterol, triglycerides, glucose, and C-reactive protein levels. Conclusions: DASH diet quality was independently and inversely associated with 24-h ambulatory blood pressure and the odds of ABPM-defined hypertension in this treatment-naive population. Given the cross-sectional design and the possibility of reverse causality, these results should be interpreted as hypothesis-generating and require confirmation in prospective studies.
Background: A non-dipping blood pressure pattern, defined as an insufficient nocturnal decline in systolic blood pressure, is associated with increased cardiovascular risk and target organ damage. While metabolic abnormalities contribute to circadian blood pressure dysregulation, the independent roles of systemic inflammation and atherogenic burden in individuals without overt metabolic disease remain insufficiently characterized. We aimed to evaluate the associations of systemic inflammatory response index (SIRI) and atherogenic index of plasma (AIP) with nocturnal blood pressure pattern. Methods: This retrospective cross-sectional study included 469 adults who underwent 24 h ambulatory blood pressure monitoring (ABPM) at a single tertiary cardiology outpatient clinic. Participants were classified as dippers (≥10% nocturnal systolic BP decline) or non-dippers (<10%). Hierarchical logistic regression models were constructed sequentially: Model 1 (age, sex), Model 2 (Model 1 + AIP, fasting glucose), and Model 3 (Model 2 + SIRI). Discriminative performance was assessed using receiver operating characteristic (ROC) analysis. Results: Non-dipping was present in 62.5% of participants. LDL cholesterol, AIP, and SIRI were higher in non-dippers, whereas CRP was higher in dippers. In hierarchical regression, AIP was independently associated with non-dipping in Model 2 (OR = 3.672, p = 0.003). After addition of SIRI, SIRI remained independently associated (OR = 1.913, p < 0.001), and model explanatory power increased (Nagelkerke R2 = 0.104). AIP, fasting glucose (inverse association), and age also remained significant. Individual discrimination was modest for SIRI (AUC = 0.572) and AIP (AUC = 0.576), while the multivariable model achieved an area under the curve (AUC) of 0.660. Non-dipping prevalence increased across SIRI quartiles (p for trend = 0.009). Conclusions: Both inflammatory and atherogenic burden were associated with a non-dipping blood pressure pattern in individuals without overt metabolic disease. Although the discriminative capacity was modest, combined inflammatory–metabolic assessment may provide additional biological insight into circadian blood pressure dysregulation.
Background: Chronic low-grade inflammation contributes to early glucose dysregulation, but comparative evidence on complete blood count-derived inflammatory indices in prediabetes remains limited. This study aimed to compare the associations of five complete blood count-derived inflammatory indices with prediabetes and to assess their discriminative performance. Methods: In this retrospective cross-sectional study, 255 adults (128 with prediabetes and 127 with normoglycemia) were identified from 12,540 individuals screened at the internal medicine outpatient clinics of a university hospital. The neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, systemic immune-inflammation index, and systemic inflammation response index were compared between groups. Adjusted logistic regression, hierarchical regression, and receiver operating characteristic curve analyses were performed. Results: All indices except the monocyte-to-lymphocyte ratio were significantly higher in the prediabetes group (all p < 0.001). Among the evaluated indices, the neutrophil-to-lymphocyte ratio showed the strongest association with prediabetes, with the largest standardized odds ratio (2.691; 95% confidence interval, 1.839–3.938) and the highest explanatory power (Nagelkerke R2 = 0.326). Its addition to the base model significantly improved model fit (likelihood ratio χ2 = 33.62, p < 0.001), and the association remained significant after adjustment for body mass index, C-reactive protein, and lipid parameters. It also yielded the highest area under the curve (0.714). Conclusions: In this cross-sectional analysis, the neutrophil-to-lymphocyte ratio showed the most robust independent association with prediabetes among the evaluated complete blood count-derived inflammatory indices. However, the overall discriminative performance was modest, supporting the use of these indices as adjunctive rather than standalone screening markers.
Background/Objectives: Ultra-processed food (UPF) consumption has been linked to type 2 diabetes mellitus (T2DM) incidence, but its association with glycemic control in individuals already living with T2DM remains less well characterized. We evaluated the relationship between UPF consumption, assessed with the Turkish version of the short Screening Questionnaire of Highly Processed Food Consumption (sQ-HPF), and HbA1c and poor glycemic control in adults with T2DM. Methods: In this single-centre, cross-sectional observational study, 425 adults aged 18–65 years with T2DM of at least 6 months’ duration were consecutively recruited at a tertiary general internal medicine outpatient clinic. UPF consumption was assessed with the Turkish sQ-HPF (range 0–11; scores ≥ 6 = high UPF consumption). HbA1c was the primary outcome (continuous and dichotomized at 7.0%). Multiple linear and binary logistic regression analyses were performed with hierarchical adjustment for age, sex, body mass index (BMI), diabetes duration, and insulin-based treatment. Results: Total UPF score was positively correlated with HbA1c (r = 0.423, p < 0.001). In the fully adjusted linear model, each one-point increase in total UPF score was associated with a 0.418% higher HbA1c (95% CI: 0.333–0.503; β = 0.413; p < 0.001), explaining 28.9% of HbA1c variance. In the fully adjusted logistic model, each one-point increase in total UPF score was associated with 25.0% higher odds of poor glycemic control (OR = 1.250, 95% CI: 1.110–1.408, p < 0.001). Insulin-based treatment and male sex were also independent predictors. UPF score was not significantly associated with lipid parameters or C-reactive protein. Conclusions: Higher UPF consumption, captured by a brief validated screener, was independently associated with poorer glycemic control in Turkish adults with T2DM. Brief UPF screening may help identify patients who would benefit from targeted nutritional intervention.