Studies have shown that nutritional status is an important predictor of mortality and morbidity in various diseases. Patients with malnutrition are more prone to vascular endothelial dysfunction and have a higher risk of adverse cardiovascular events. Emerging evidence suggests that malnutrition may be a new risk factor in hypertensive patients. Previous studies have found that malnutrition can alter autonomic nervous system activity, which may in turn affect blood pressure. Recently, a study conducted by Professor Jiguang Wang’s team from Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, was published in the American Journal of Hypertension, investigating the correlation between the Geriatric Nutritional Risk Index (GNRI) and ambulatory blood pressure in elderly hypertensive patients.
The Geriatric Nutritional Risk Index (GNRI) is a simple and effective prognostic evaluation tool that can rapidly assess the nutritional status of elderly individuals. In recent years, numerous studies have confirmed the significant value of GNRI in predicting the prognosis of patients with various diseases, including hemodialysis, cancer, heart failure, and chronic obstructive pulmonary disease. Several long-term studies have also indicated that GNRI is associated with the risk of renal events, cardiovascular events, and all-cause mortality in hypertensive patients. However, studies on the correlation between GNRI and blood pressure remain scarce. Accordingly, this study used GNRI to evaluate the nutritional status of elderly hypertensive patients and explored its correlation with their ambulatory blood pressure.
This was a retrospective cross-sectional study that enrolled 626 elderly hypertensive patients (aged ≥65 years) admitted to the hypertension ward of Ruijin Hospital, Shanghai. The patients were hospitalized for further diagnosis and treatment of hypertension, including screening for secondary hypertension, medication adjustment for refractory hypertension, and evaluation of hypertensive target organ damage, with a hospital stay of 1–2 weeks.
Exclusion criteria included secondary hypertension, cardiac arrhythmia, malignant tumor, and severe hepatic or renal insufficiency. The study protocol was approved by the Ethics Committee of Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, and all patients provided written informed consent.
The results of this study showed a high prevalence of malnutrition among elderly hypertensive patients; those with malnutrition had higher systolic blood pressure levels; and GNRI was significantly correlated with systolic blood pressure, suggesting that malnutrition may be a risk factor for hypertension. Intensive nutritional intervention and rational dietary planning may help reduce systolic blood pressure in elderly hypertensive patients. Previous studies have confirmed that malnutrition is associated with poor prognosis in various disease populations, and multiple investigations have identified malnutrition as a risk factor for all-cause mortality and cardiovascular events.
GNRI is a simple and accurate indicator of nutritional status, incorporating serum albumin and body mass index, both of which are objective measurements. Clinicians can systematically use GNRI to identify patients suitable for nutritional support. Malnutrition among the elderly remains highly prevalent in developing countries. In this study, the prevalence of malnutrition in elderly hypertensive patients reached 37%, with most cases being mild malnutrition. Such patients carry nutrition-related risks and may benefit from nutritional supplementation interventions.
This study confirmed a significant correlation between GNRI and systolic blood pressure. Although previous research has linked GNRI to the risk of adverse outcomes in hypertensive patients, studies on the association between malnutrition and blood pressure remain limited.
To date, no study has explored the correlation between nutritional status assessed by GNRI and blood pressure in elderly hypertensive patients. This study is the first to demonstrate that reduced GNRI levels are significantly associated with elevated systolic blood pressure and may directly affect the prognosis of hypertensive patients.
Potential Mechanisms Underlying the Correlation between GNRI and Blood Pressure
The potential mechanisms underlying the correlation between GNRI and blood pressure have not been fully elucidated. In recent years, some scholars have proposed the concept of the “malnutrition-inflammation-atherosclerosis syndrome”, which consists of three core components: malnutrition, inflammation, and atherosclerosis. These three components interact and exacerbate each other, forming a vicious cycle. Malnutrition can induce chronic inflammation, which in turn promotes the progression of atherosclerosis, including vascular wall lesions and calcification. Therefore, malnutrition may elevate blood pressure by accelerating the atherosclerotic process.
Previous studies have shown that GNRI can predict the risk of renal injury in hypertensive patients. In this study, patients in the malnutrition group had higher serum creatinine levels and lower estimated glomerular filtration rates, and abnormal renal function can further affect blood pressure.
There is an interactive relationship between hypertension and malnutrition. Hypertension itself may induce malnutrition for the following reasons:① Many hypertensive patients excessively restrict their diet to control body weight, leading to insufficient intake of protein, vitamins, and energy;② Adverse effects of some antihypertensive drugs may affect appetite and nutrient absorption;③ Hypertension can impair renal function, which in turn disturbs nutrient metabolism.
In conclusion, GNRI is significantly correlated with systolic blood pressure in elderly hypertensive patients. It is well known that overnutrition causes metabolic disorders and thus induces hypertension. Therefore, a reasonable dietary structure and balanced nutrient intake are crucial for the prevention and control of hypertension. Hypertension management requires not only sodium restriction but also optimized nutritional status through increased intake of potassium, calcium, magnesium, high-quality protein, and multiple vitamins. GNRI should be used clinically as a routine indicator for evaluating nutritional status in the elderly, especially elderly patients with chronic diseases.