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The relationship between white blood cell counts and pediatric hypertension: a prospective cohort study

Journal of Human Hypertension (2026)Cite this article

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Abstract

This study investigated the relationship between white blood cell counts and pediatric hypertension, addressing the limited evidence on white blood cell counts/subtypes and pediatric hypertension. A prospective cohort study was conducted involving 5971 children aged 6–12 years in Chongqing, China, with baseline data collected in 2014–2015 and 1282 children completed a 5-year follow-up in 2019. White blood cell indicators, including total white blood cell counts (WBC), lymphocyte counts and percentage (LC, LP), monocyte counts and percentage (MC, MP), neutrophil counts and percentage (ANC, NR), and lymphocyte-monocyte ratio (LMR) were measured using Complete Blood Count (CBC) tests. Blood pressure (BP), and anthropometric indices were also measured. Multilevel linear mixed models and logistic regression models, adjusted for confounders were applied to illustrate the relevance of cell counts indicators and blood pressure. Results showed that compared to normal BP (NBP) group, the elevated BP (EBP) group had significant lower MC(OR(95%CIs) = 0.79(0.68,0.90)) and MP(OR(95%CIs) = 0.78(0.68,0.88)) but higher LMR(OR(95%CIs) = 1.31(1.15,1.50)). Multivariate analyses adjusted for confounding factors revealed that MP was negatively correlated with SBP, DBP and MAP, while LMR positively correlated with these blood pressure(P < 0.05). MC and MP were associated with a reduced risk of hypertension, whereas LMR was associated with an increased risk, particularly in boys. No significant mediation effect of WBC indices between BMI and BP was observed. In conclusion, Peripheral MC, MP, and LMR were significantly associated with pediatric hypertension; MC and MP act as protective factors and LMR acts as a risk factor, suggesting that these indices may serve as potential biomarkers for childhood hypertension.

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Data availability

Datasets are available from the corresponding author (xiaohualiang@hospital.cqmu.edu.cn) upon reasonable request with appropriate ethical approvals and data use agreements that ensure participant privacy protection.

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Acknowledgements

The authors would like to acknowledge all the children and the staffs of the surveyed schools in Chongqing.

Funding

This work was supported by the Natural Science Foundation Project (82373590), Chongqing Science and Technology Bureau and Health Commission joint project (2025ZDXM008, 2023MSXM036), General Project of Clinical Medical Research from National Clinical Research Center for Child Health and Disorders (No. NCRCCHD-2022-GP-01,NCRC-2020-GP-13), Major Health Project of Chongqing Science and Technology Bureau (No. CSTC2021jscx-gksb-N0001, CSTB2024NSCQ-MSX0180), Intelligent Medicine Project (No.ZHYX202109). The funders had no role in the whole study research process, including study design, data collection and analysis, the decision to publish, or the preparation of the manuscript.

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Author notes

  1. These authors contributed equally: Di Hu, Lanling Chen.

Authors and Affiliations

  1. Department of Clinical Epidemiology and Biostatistics, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Children and Adolescents’ Health and Diseases, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatric Metabolism and Inflammatory Diseases, Chongqing, China

    Di Hu, Lanling Chen, Shunqing Luo, Xizhou An & Xiaohua Liang

  2. Department of Otolaryngology, Children’s Hospital of Chongqing Medical University, Chongqing, China

    Di Hu

  3. Department of General Medicine, Children’s Hospital of Chongqing Medical University, Chongqing, China

    Shunqing Luo

  4. Disease Control and Prevention Center of Jiulongpo District, Chongqing, China

    Lun Xiao

  5. Department of Hematology and Oncology, Children’s Hospital of Chongqing Medical University, Chongqing, China

    Xizhou An & Xianmin Guan

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  1. Di Hu
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Contributions

DH, LC: Methodology; DH, XA, LC: Writing – Original Draft; XA, LC, XL: Writing - Review & Editing; XL: Study Design; SL, LX: Validation; XG, LX, XL:Resources; DH, LC, XA, XL: Investigation; XG, XA, XL: Supervision; XL: Conceptualization.

Corresponding authors

Correspondence to Xizhou An, Xianmin Guan or Xiaohua Liang.

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Competing interests

The authors declare no competing interests

Ethical approval and consent to participate

Ethics Committee of the Children’s Hospital of Chongqing Medical University approved the study (No. 2019-86), and all procedures were conducted following the Declaration of Helsinki. All participants and their legal guardians provided written informed consents before inclusion in the study.

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Supplementary information

41371_2026_1115_MOESM1_ESM.docx

Supplementary table 1. The difference of hemodynamic indexes for children under different levels of the variables for a cohort study

41371_2026_1115_MOESM2_ESM.docx

Supplementary table 2. The increased risk of the variables in men on elevated blood pressure compared with Q1 for a cohort study

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Hu, D., Chen, L., Luo, S. et al. The relationship between white blood cell counts and pediatric hypertension: a prospective cohort study. J Hum Hypertens (2026). https://doi.org/10.1038/s41371-026-01115-y

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