The association between the hemoglobin-albumin-lymphocyte-platelet score and all-cause and cardiovascular mortality in adults with hypertension: a National Health and Nutrition Examination Survey cohort study

BACKGROUND: The hemoglobin-albumin-lymphocyte-platelet (HALP) score integrates pathways of anemia, malnutrition, inflammation, and thrombosis that are central to hypertensive organ damage. We therefore hypothesized that HALP would serve as a robust predictor of all-cause and cardiovascular mortality, specifically in adults with hypertension. METHODS: This cohort study included 23,564 US adults from National Health and Nutrition Examination Survey (NHANES, 2005-2018), comprising 12,319 with hypertension and 11,245 without, linked to mortality data through 2019. Hypertension was defined as self-reported diagnosis, antihypertensive medication use, or measured blood pressure ≥130/80 mm Hg. Multivariable Cox models and restricted cubic spline analysis were used to assess HALP-mortality associations. Effect modification by hypertension status was formally tested. RESULTS: During a mean follow-up of 7.4 years, 1738 all-cause deaths and 451 cardiovascular deaths occurred among adults with hypertension. In this group, each one-SD higher HALP score was associated with a lower risk of all-cause mortality (HR, 0.89; 95% CI, 0.83-0.94) and cardiovascular mortality (HR, 0.74; 95% CI, 0.65-0.83). In contrast, no association was observed in adults without hypertension (all-cause mortality HR, 0.96; 95% CI, 0.83-1.13; cardiovascular mortality HR, 0.85; 95% CI, 0.65-1.15). An interaction was observed between HALP score and hypertension status for both all-cause (P for interaction = .008) and cardiovascular mortality (P for interaction