Elevated monocyte-lymphocyte ratio as an independent predictor of all-cause and cardiovascular mortality in hypertensive patients: A retrospective cohort study

The monocyte-to-lymphocyte ratio (MLR) has been proposed as a promising inflammatory biomarker, with potential implications for cardiovascular prognosis. However, its association with mortality in hypertensive patients remains unclear. This study aimed to investigate the correlation between MLR and all-cause and cardiovascular mortality in this population. We included 15,871 hypertensive patients from the National Health and Nutrition Examination Survey (2003–2010), with external validation using National Health and Nutrition Examination Survey (2011–2018) data. Mortality details were obtained from the National Death Index. Weighted multivariable Cox regression evaluated the independent association between MLR and mortality risk; restricted cubic spline analysis visualized the relationship, and receiver operating characteristic curves assessed predictive performance. Over a median follow-up of 141 months, 2999 all-cause deaths (18.9%) and 956 cardiovascular deaths (6.0%) occurred. Using an MLR threshold of 0.39, participants were stratified into higher (>0.39) and lower (≤0.39) groups. Fully adjusted models showed that elevated MLR significantly increased all-cause mortality risk (hazard ratio = 1.42, 95% confidence interval: 1.29–1.50, P < .0001) and cardiovascular mortality risk (hazard ratio = 1.59, 95% confidence interval: 1.36–1.80, P < .0001). Restricted cubic spline revealed a U-shaped association ( P < .05). External validation confirmed that higher MLR correlated with increased mortality. The area under the curve for 1-, 3-, 5-, and 10-year survival was 0.73, 0.69, 0.67, and 0.66 for all-cause mortality and 0.70, 0.69, 0.71, and 0.68 for cardiovascular mortality, respectively. Elevated MLR is independently associated with higher all-cause and cardiovascular mortality risks in hypertensive patients.