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Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."
Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011
Dr. Shankar P.R.
"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."
Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011 Anuradha
Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.
Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020
Original article / research
Full Version
Correlation of Blood Pressure with Microalbuminuria and Dyslipidaemia in Patients with Essential Hypertension: A Case-control Study
Correspondence Address :
Dr. Jyotsna Kiro,
Assistant Professor, Department of Biochemistry, Veer Surendra Sai Institute of Medical Sciences and Research (VIMSAR), GV2M+JJR, PG Chowk, Burla, Sambalpur-768017, Odisha, India.
E-mail: jyotsnakiro9@gmail.com
Introduction: Hypertension (HTN) is one of the most common disease affecting the people around the world. Microalbuminuria and dyslipidaemia has been considered as an early indicator of vascular damage, endothelial dysfunction and renal disease. Studies, conducted to evaluate microalbuminuria, dyslipidaemia in essential hypertensive patients are scarce.
Aim: To assess the microalbuminuria, dyslipidaemia in essential hypertensive patients and also, to correlate these parameters with Blood Pressure (BP).
Materials and Methods: This case-control study was conducted in the Department of Biochemistry at Veer Surendra Sai Institute of Medical Sciences and Research (VIMSAR), Sambalpur, Odisha, India, from January 2020 to February 2021. The study included 70 healthy individuals as controls and 70 essential hypertensive patients as cases in the age group of 25 to 55 years. According to Joint National Committee (JNC) 7 guidelines, out of 70, 20 cases were categorised as stage I (BP≥140-159/90-99 mmHg) and 50 as stage II (BP≥160/100 mmHg). Renal profile, lipid profile, total protein and albumin, microalbumin and Albumin-creatinine Ratio (ACR) were evaluated. Pearson correlation coefficient was applied to statistically analyse the data.
Results: In the present study, 38 (54.3%) were males and 32 (45.7%) were females. Whereas, in controls, 44 (62.8%) were males and 26 (37.2%) were females. The mean age in cases 44.4±8.58 years, Systolic Blood Pressure (SBP) 156.0±35.1 mmHg, Diastolic Blood Pressure (DBP) 101±12.9 mmHg, serum creatinine 1.08±0.29 mg/dL, serum uric acid 7.37±1.8 mg/dL, serum total cholesterol 171±44.7 mg/dL, serum triglycerides 173±48.4 mg/dL, Low-density Lipoprotein Cholesterol (LDL-C) 107±38.8 mg/dL, Very Low-density Lipoprotein Cholesterol (VLDL-C) 35.1±10.2 mg/dL, microalbuminuria 75±31.9 mg/L, and urinary ACR 78±44.1 were significantly increased and serum High-density Lipoprotein Cholesterol (HDL-C) 31.7±7.07 mg/dL levels were decreased in cases than controls. Urinary ACR was significantly increased in stage II. ACR was positively correlated with SBP, DBP, creatinine, uric acid, total cholesterol, triglycerides, VLDL-C and negatively correlated with HDL-C.
Conclusion: Blood pressure was positively correlated with lipid profile parameters, except HDL-C. Increased urinary albumin excretion rate may be useful and inexpensive marker for the identification of patients with higher cardiovascular risk and organ damage.
Atherosclerosis, Cardiovascular disease, Lipid profile, Myocardial infarction
Hypertension (HTN), one of the most common disease affecting the people around the world, is often called the silent killer (1). In India, hypertension accounts for 10.8% of all deaths. Its incidence in urban areas is 20-40% and in rural areas is 12-17% (1). Hypertension leads to the risk of cardiovascular complications such as dyslipidaemia, atherosclerosis, myocardial infarction, heart failure, peripheral arterial disease, stroke and renal complications. Renal complications are most common in hypertensive patients and around 20% of hypertensive patients experience deterioration of renal function (2),(3),(4).
Therefore, essential hypertension should be treated. If left untreated, around 50% of patients may develop heart diseases, 33% may develop stroke, and renal failure in 10%-15% (5). It has been reported that, microalbuminuria has become a prognostic marker for cardiovascular disorders (6). Microalbuminuria is defined as urinary albumin excretion of >30-300 mg/24 hours or albumin/creatinine ratio ranged between 30-300 mg/g (7). Microalbuminuria, due to consequence of an augmented intraglomerular capillary pressure; intrinsic glomerular damage and tubular changes may also result in increased excretion of albumin in urine. Microalbuminuria, considered as an early indicator of vascular damage, endothelial dysfunction and renal disease (7). An increase in urinary albumin excretion by 10 units increases the risk of stroke by 1.5 times (8). Microalbuminuria also linked with cerebral vasculopathy, alzheimer’s disease, memory loss etc., (9). Khairallah MA et al., reported the association between microalbuminuria and hypertension and suggested that, microalbuminuria may be a useful marker to assess risk management of cardiovascular disease and renal disease (10). Roopa AN et al., reported that microalbuminuria was observed in 70% of hypertensives and correlated with duration of HTN. Similarly, patients with dyslipidaemia also had (70%) microalbuminuria. The study suggested that, microalbuminuria patients had a higher degree of end organ involvement (11). Onyegbutulem HC et al., reported that, dyslipidaemias is common in hypertensive patients. The most common dyslipidaemic type is low High-density Lipoprotein (HDL), followed by increased Low-density Lipoprotein (LDL), total cholesterol and triglycerides (12).
However, previous studies (10),(11),(12),(13) reported separately on dyslipidaemia and microalbuminuria. Therefore, there is a need to study the correlation of BP with microalbuminuria and dyslipidaemia in patients with essential hypertension. Hence, present study was conducted to evaluate microalbuminuria, dyslipidaemia in essential hypertensive patients and their correlation with BP.
The present case-control study was conducted in the Department of Biochemistry, Veer Surendra Sai Institute of Medical Sciences and Research (VIMSAR), Sambalpur, Odisha, India, from January 2020 to February 2021. The study has been approved by the Institutional Ethics Committee (IEC/IRB No:121/2020) and informed consent was obtained from the study subjects.
Inclusion criteria: Patients with essential hypertension (BP ≥140/90 mmHg), aged between 25 to 55 years were included as cases. Subjects with normal BP (≤120/80 mmHg), aged between 25 to 55 years were included as controls.
Exclusion criteria: Subjects with renal diseases, diabetes mellitus, congestive cardiac failure, cerebrovascular disease, patients with urinary tract infection, pregnant women, patients with obstructive uropathy and nephrolithiasis were excluded from the study.
Sample size calculation: Sample size was calculated with 80% power and 95% confidence interval by using the formula
N=(Z1-α/2+Z1-β)2 S1×S2/d2 (13). The sample size arrived for each group was 70.
Study Procedure
A total of 70 essential hypertensions diagnosed patients attending Outpatient Department (OPD). According to JNC 7 guidelines, 20 cases were categorised as stage I (BP≥140-159/90-99 mmHg) and 50 as stage II (BP≥160/100 mmHg) (14). Under aseptic conditions, 5 mL of fasting venous blood samples were collected. The blood samples were allowed to clot and centrifuged at 3000 rpm for 10 minutes to obtain the clear serum and obtained sample was used for the estimation of renal profile (urea, creatinine, uric acid), lipid profile (total cholesterol, triglycerides, HDL-C, LDL-C, VLDL-C), total protein and albumin. Urine sample was collected to measure microalbumin (30-300 mg/g) and ACR (15). Blood pressure was recorded.
Statistical Analysis
Data were analysed by using Statistical Package for Social Sciences (SPSS) version 22.0. The results were represented in mean±SD. Mann-Whitney U test was applied to compare the parameters between cases and controls. Pearson correlation coefficient was applied between urinary ACR with blood pressure, renal profile and lipid profile of hypertensive patients. The p<0.05 considered as significant.
In the present study, 70 essential hypertensive patients as cases and 70 healthy subjects as controls were enrolled. In healthy controls, 44 (62.8%) were males and 26 (37.2%) were females. In the hypertensive cases, 38 (54.3%) were male and 32 (45.7%) were female. In the present study, SBP (p<0.001), DBP (p<0.001), serum creatinine (p<0.001), serum uric acid (p<0.001), serum total cholesterol (p< 0.001), serum triglycerides (p<0.001), LDL-C (p<0.001), VLDL-C (p<0.001) microalbuminuria (p<0.001), and urinary ACR (p<0.001) were significantly increased in cases than controls, whereas, serum HDL-C (p<0.001) showed significant decrease in cases than controls (Table/Fig 1).
In the present study, the cases were divided into two groups- stage I and II. SBP, DBP, urea, uric acid, microalbumin and ACR were significantly increased in stage II than stage I (Table/Fig 2). Urinary ACR was positively correlated to SBP (r 0.690), DBP (r 0.669), serum urea (r 0.385), serum creatinine (r 0.566), serum uric acid (r 0.595), serum total cholesterol (r 0.219), serum triglycerides (r 0.519), VLDL-C (r 0.522), of hypertensive patients and negatively correlated with HDL-C (r -0.180) which was statistically significant (Table/Fig 3).
In the present study, DBP (r 0.767), total cholesterol (r 0.693), triglycerides (r 0.341), LDL-C (r 0.603), VLDL (r 0.252) were positively correlated with SBP whereas, HDL-C (r -0.545) negatively correlated and was significant. Similarly, SBP (r 0.767), total cholesterol (r 0.470), triglycerides (r 0.380), LDL-C (r 0.511) were positively correlated with DBP whereas, HDL-C (r -0.388) negatively correlated and was significant (Table/Fig 4).
The present study was conducted to evaluate microalbuminuria, dyslipidaemia in essential hypertensive patients and their correlation with blood pressure. In the present study, significant positive correlation was observed between ACR with blood pressure, lipid profile parameters, except HDL-C, showed negative correlation. Hypertension, one of the most common disease affecting the people around the world, affecting the end organs of the body and it causes morbidity and mortality. Hypertension affects almost all organs in the body. To assess end organ damage, patients will not present with symptoms, unless severely affected. Most of them remain asymptomatic and the disease remains inadequately recognised (16). Augmented afferent glomerular hydrostatic pressure, accentuated permeability of basal membrane of glomerulus, defects in tubular functions are some of the pathogenic changes in essential hypertension which are implicated in increased urinary excretion of albumin (17).
In the present study, blood urea, creatinine and uric acid levels were elevated in hypertensive cases than controls. Among these, elevated serum creatinine is thought to reflect derangement in endothelial structure and function or renal impairment (2). In a study conducted by Schillaci G et al., reported that a serum creatinine value is a predictor of cardiovascular morbidity in patients with hypertension (18). Hypertension and microalbuminuria commonly coexist. Microalbuminuria occurs in essential hypertensive patients is due to the consequence of an elevated transglomerular passage of albumin rather than the result of a reduction in the reabsorption of albumin in proximal tubule. It may also occur from haemodynamic-mediated mechanisms and/or functional or structural impairment of the glomerular barrier. Early detection of microalbuminuria in hypertensive patients is helpful to prevent end organ damage (19).
Hypertension increases the risk of Coronary Artery Disease (CAD), including myocardial infarction and Chronic Heart Failure (CHF). In the current study, serum total cholesterol, serum triglycerides, LDL-C, VLDL-C levels were significantly increased in hypertensive patients compared to healthy controls. Serum HDL-C showed significant decrease in hypertensive cases than controls. Ayoade OG et al., conducted a cross-sectional study on 544 Nigerian hypertensive patients to evaluate lipid profile parameters. They reported that 60.0% of the hypertensive patients had dyslipidaemia, with 43% having high total cholesterol, 30% high LDL-C, 20% elevated triglycerides and 12.9% low HDL-C, respectively, suggested that, high plasma Total Count (TC) is the most dominant pattern of dyslipidaemia (20). Ariyanti R et al., conducted a case-control study in Jakarta to determine whether dyslipidaemia associated with hypertension increases the risks for the incidence of Coronary Heart Disease (CHD) or not by involving 82 cases and 81 controls. In the CHD group, dyslipidaemia was observed in 50% and in control group 17.3%. According to hypertension status, relationship of dyslipidaemia with CHD incidence was changed. In CHD cases, patients with dyslipidaemia were 18.1 times more likely to develop CHD than those non dyslipidaemic. In non hypertensives, those with dyslipidaemia were 2.5 times more likely to develop CHD than those non dyslipidaemia (21).
Recently, Cheng W et al., conducted a cross-sectional study to assess the association between atherosclerotic indices and hypertension prevalence in Chinese adults. They reported that, increased atherosclerosis indices in hypertensive population than normotensives. BP was positively correlated with atherosclerotic indices. Multivariate logistic regression analysis showed that, cholesterol index and non HDL-C were positively associated with the prevalence of hypertension (22). Another study by Otsuka T et al., reported increased levels of total cholesterol, LDL-C and non HDL-C were linked with risk of hypertension (23). Similarly, Rekha K et al., study from India, reported dyslipidaemia in hypertensive patients than controls. Microalbuminuria, indicator of subclinical atherosclerotic thickening of blood vessels. Therefore, dietary and lifestyle changes along with appropriate drug therapies to reduce the BP, as well as, correcting lipid alterations are essential to prevent development of CAD (24). In addition, dysfunctional endothelium and inflammation have been suggested as possible causes to explain the association between microalbuminuria and cardiovascular disease (25). In a study conducted by Brantsma AH et al., reported microalbuminuria to be a sensitive marker for detecting onset of cardiovascular risk factors (26). Monfared A et al., study showed increased microalbuminuria is a risk factor for Left Ventricular Hypertrophy (LVH) which in turn an indicator of cardiovascular risk (27). In a study by Maggon RR et al., reported that presence of microalbuminuria in a significant number of newly detected and untreated patients of essential hypertension. Further, microalbuminuria had a statistically significant relationship with LVH and Common Carotid Intima-media Thickness (CCIMT) (5).
In the present study, urinary ACR was significantly increased in hypertensive patients compared to healthy controls. Urinary ACR was higher in stage II hypertensive patients as compared to the stage I hypertensive patients. Jian G et al., conducted a cross-sectional study to evaluate the relationship between urinary ACR and microvascular disease hypertension patients without co-morbidities. They reported that, elevated urinary ACR was associated with microvascular disease in males whereas, in females, lower and higher urinary ACR was associated without co-morbidities (28). Khattak MS et al., reported that the in hypertension, the frequency of microalbuminuria increases with increasing age. Therefore, it is essential to evaluate hypertensive patients to prevent end organ damage (29).
Limitation(s)
The study was limited with assessment of vascular damage markers and the subjects were not age and sex-matched.
The present study results may conclude increase in BP, serum creatinine, serum uric acid, serum total cholesterol, serum triglycerides, LDL-C, VLDL-C, microalbuminuria, urinary ACR and decrease in serum HDL-C in hypertensive cases than controls. Significant positive correlation was observed between urinary ACR and BP, renal profile and dyslipidaemia. Similarly, significant positive correlation was observed between dyslipidaemia and blood pressure. Increased urinary albumin excretion rate may be useful and inexpensive marker for the identification of patients with higher cardiovascular risk and organ damage. Further studies with large sample size are required.
DOI: 10.7860/JCDR/2023/59714.17810
Date of Submission: Aug 17, 2022
Date of Peer Review: Nov 07, 2022
Date of Acceptance: Feb 11, 2023
Date of Publishing: May 01, 2023
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA
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