Systemic inflammation and nutritional status are recognized as key contributors to hypertension pathogenesis. The Advanced Lung Cancer Inflammation Index (ALI), combining body mass index, serum albumin, and neutrophil-to-lymphocyte ratio, reflects these processes. However, its association with hypertension in general populations remains unclear.
Methods
Using data from a public database of 43,886 adults, we investigated the relationship between ALI and hypertension prevalence. ALI was calculated as BMI × serum albumin/neutrophil-to-lymphocyte ratio. Hypertension was defined by blood pressure, self-reported diagnosis, or antihypertensive treatment. Logistic regression models, adjusted for demographic, behavioral, and clinical confounders, assessed associations, with nonlinear and age-stratified analyses.
Results
Elevated ALI was strongly associated with higher odds of hypertension (adjusted OR per 10-unit increase: 1.035; 95% CI, 1.028–1.042). Individuals in the top ALI tertile had a 33.7% increased risk of hypertension compared to those in the lowest tertile (OR: 1.337; 95% CI, 1.261–1.417). Nonlinear modeling revealed stronger associations below age-specific ALI cutoffs (67.45 for ≤60 years; 78.48 for >60 years), with weaker effects above these thresholds, especially among older adults.
Conclusions
ALI is a novel biomarker associated with hypertension risk, offering potential for early screening and personalized management. Longitudinal studies are needed to confirm causality and clarify mechanisms.
MartinSSAdayAWAlmarzooqZI, et al.2024 Heart disease and stroke statistics: a report of US and global data from the American Heart Association. Circulation2024; 149: e347–e913.
2.
RahimiKEmdinCAMacMahonS. The epidemiology of blood pressure and its worldwide management. Circ Res2015; 116: 925–936.
3.
SinghVVan WhySK. Monogenic etiology of hypertension. Med Clin North Am2024; 108: 157–172.
4.
LambFSChoiHMillerMR, et al.Vascular inflammation and smooth muscle contractility: the role of Nox1-derived superoxide and LRRC8 anion channels. Hypertens Dallas Tex 19792024; 81: 752–763.
5.
SuzukiYGilesWRZamponiGW, et al.Ca2+ signaling in vascular smooth muscle and endothelial cells in blood vessel remodeling: a review. Inflamm Regen2024; 44: 50.
6.
MandaliyaHJonesMOldmeadowC, et al.Prognostic biomarkers in stage IV non-small cell lung cancer (NSCLC): neutrophil to lymphocyte ratio (NLR), lymphocyte to monocyte ratio (LMR), platelet to lymphocyte ratio (PLR) and advanced lung cancer inflammation index (ALI). Transl Lung Cancer Res2019; 8: 886–894.
7.
SongMZhangQSongC, et al.The advanced lung cancer inflammation index is the optimal inflammatory biomarker of overall survival in patients with lung cancer. J Cachexia Sarcopenia Muscle2022; 13: 2504–2514.
8.
CatalanoGAlaimoLChatzipanagiotouOP, et al.Prognostic value of the advanced lung cancer inflammation index in intrahepatic cholangiocarcinoma. Eur J Surg Oncol J Eur Soc Surg Oncol Br Assoc Surg Oncol2024; 50: 108773.
9.
PangHYChenXFYanMH, et al.Clinical significance of the advanced lung cancer inflammation index in gastrointestinal cancer patients: a systematic review and meta-analysis. Front Oncol2023; 13: 1021672.
10.
LiuXRWangLLZhangB, et al.The advanced lung cancer inflammation index is a prognostic factor for gastrointestinal cancer patients undergoing surgery: a systematic review and meta-analysis. World J Surg Oncol2023; 21: 81.
11.
ZhangYPanYTuJ, et al.The advanced lung cancer inflammation index predicts long-term outcomes in patients with hypertension: national health and nutrition examination study, 1999–2014. Front Nutr2022; 9: 989914.
12.
ChenYGuanMWangR, et al.Relationship between advanced lung cancer inflammation index and long-term all-cause, cardiovascular, and cancer mortality among type 2 diabetes mellitus patients: NHANES, 1999–2018. Front Endocrinol2023; 14: 1298345.
13.
ChenXHongCGuoZ, et al.Association between advanced lung cancer inflammation index and all-cause and cardiovascular mortality among stroke patients: NHANES, 1999–2018. Front Public Health2024; 12: 1370322.
14.
ChenWZhangGLeiQ, et al.Prognostic value of advanced lung cancer inflammation index in heart failure patients: a comprehensive analysis. ESC Heart Fail2025; 12: 2298–2309.
15.
ChiaYCLimHMChingSM. Long-term visit-to-visit blood pressure variability and renal function decline in patients with hypertension over 15 years. J Am Heart Assoc Cardiovasc Cerebrovasc Dis2016; 5: e003825.
16.
LiuSPaiMPLesterCA. Medication use among U.S. Adults after bariatric surgery: a population-based analysis of NHANES 2015–2018. Diabetes Care2022; 45: e54–e55.
17.
BhargavaVLeeJSSmithTA, et al.A measure of nutrition security using the national health and nutrition examination survey dataset. JAMA Netw Open2025; 8: e2462130.
18.
LiuZKuoPLHorvathS, et al.A new aging measure captures morbidity and mortality risk across diverse subpopulations from NHANES IV: a cohort study. PLoS Med2018; 15: e1002718.
19.
Paulose-RamRGraberJEWoodwellD, et al.The national health and nutrition examination survey (NHANES), 2021–2022: adapting data collection in a COVID-19 environment. Am J Public Health2021; 111: 2149–2156.
20.
Systemic Inflammatory Response Index (SIRI) is associated with all-cause mortality and cardiovascular mortality in population with chronic kidney disease: evidence from NHANES (2001–2018) - PubMed [Internet]. [cited 2025 June 30]. Available from: https://pubmed.ncbi.nlm.nih.gov/38558798/
21.
WheltonPKCareyRMAronowWS, et al.2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines. Circulation2018; 138: e484–e594.
22.
SatohMYoshidaTMetokiH, et al.The long-term reproducibility of the white-coat effect on blood pressure as a continuous variable from the ohasama study. Sci Rep2023; 13: 4985.
23.
HuangQFYangWYAsayamaK, et al.Ambulatory blood pressure monitoring to diagnose and manage hypertension. Hypertens Dallas Tex 19792021; 77: 254–264.
24.
ParkYMKwockCKKimK, et al.Interaction between single nucleotide polymorphism and urinary sodium, potassium, and sodium-potassium ratio on the risk of hypertension in Korean adults. Nutrients2017; 9: 235.
25.
ZhouNXieZPLiuQ, et al.The dietary inflammatory index and its association with the prevalence of hypertension: a cross-sectional study. Front Immunol2022; 13: 1097228.
26.
RosaDDDiasMMSGrześkowiakŁM, et al.Milk kefir: nutritional, microbiological and health benefits. Nutr Res Rev2017; 30: 82–96.
27.
MurrayECNosalskiRMacRitchieN, et al.Therapeutic targeting of inflammation in hypertension: from novel mechanisms to translational perspective. Cardiovasc Res2021; 117: 2589–2609.
28.
XiaoLHarrisonDG. Inflammation in hypertension. Can J Cardiol2020; 36: 635–647.
29.
NguyenBAAlexanderMRHarrisonDG. Immune mechanisms in the pathophysiology of hypertension. Nat Rev Nephrol2024; 20: 530–540.
30.
MountziosGSamantasESenghasK, et al.Association of the advanced lung cancer inflammation index (ALI) with immune checkpoint inhibitor efficacy in patients with advanced non-small-cell lung cancer. ESMO Open2021; 6: 100254.
31.
MaSLiZWangL. The advanced lung cancer inflammation index (ALI) predicted the postoperative survival rate of patients with non-small cell lung cancer and the construction of a nomogram model. World J Surg Oncol2024; 22: 158.
32.
ShiTWangYPengY, et al.Advanced lung cancer inflammation index combined with geriatric nutritional risk index predict all-cause mortality in heart failure patients. BMC Cardiovasc Disord2023; 23: 565.
33.
SunXZhangXTangR, et al.Advanced lung cancer inflammation index is associated with mortality in critically ill patients with heart failure. ESC Heart Fail2025; 12: 508–516.
34.
AleksandrovaKKoelmanLRodriguesCE. Dietary patterns and biomarkers of oxidative stress and inflammation: a systematic review of observational and intervention studies. Redox Biol2021; 42: 101869.
35.
XiaoRMansourAGHuangW, et al.Adipocytes: a novel target for IL-15/IL-15Rα cancer gene therapy. Mol Ther2019; 27: 922–932.
36.
BeamishELJohnsonJShawEJ, et al.Loop ileostomy-mediated fecal stream diversion is associated with microbial dysbiosis. Gut Microbes2017; 8: 467–478.
37.
SuwartoSSasmonoRTSintoR, et al.Association of endothelial glycocalyx and tight and adherens junctions with severity of plasma leakage in dengue infection. J Infect Dis2017; 215: 992–999.
38.
IslamMMSaticiMOErogluSE. Unraveling the clinical significance and prognostic value of the neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, systemic immune-inflammation index, systemic inflammation response index, and delta neutrophil index: an extensive literature review. Turk J Emerg Med2024; 24: 8–19.
39.
BuonaceraAStancanelliBColaciM, et al.Neutrophil to lymphocyte ratio: an emerging marker of the relationships between the immune system and diseases. Int J Mol Sci2022; 23: 3636.
40.
SuvoravaTMetrySPickS, et al.Alterations in endothelial nitric oxide synthase activity and their relevance to blood pressure. Biochem Pharmacol2022; 205: 115256.
41.
ChuQLiYWuJ, et al.Oxysterol sensing through GPR183 triggers endothelial senescence in hypertension. Circ Res2024; 135: 708–721.
42.
CaiYZhouHZhuY, et al.Elimination of senescent cells by β-galactosidase-targeted prodrug attenuates inflammation and restores physical function in aged mice. Cell Res2020; 30: 574–589.
43.
WangXLWangJXChenJL, et al.Asprosin in the paraventricular nucleus induces sympathetic activation and pressor responses via cAMP-dependent ROS production. Int J Mol Sci2022; 23: 12595.
