Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Mohan Z Mani

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Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
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I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


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

Important Notice

Original article / research
Year : 2022 | Month : April | Volume : 16 | Issue : 4 | Page : BC08 - BC12 Full Version

Evaluation of Lipid Profile and Antioxidant Status in Hypertensive Smokers: A Case-control Study


Published: April 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/55196.16223
Syed Sadath Ulla, Vivian D’Souza, Bhagyajyothi M Bhat

1. Research Scholar, Department of Biochemistry, Kanachur Institute of Medical Sciences, Mangalore, Karnataka, India. 2. Professor and Head, Department of Biochemistry, Kanachur Institute of Medical Sciences, Mangalore, Karnataka, India. 3. Associate Professor, Department of Biochemistry, Kanachur Institute of Medical Sciences, Mangalore, Karnataka, India.

Correspondence Address :
Dr. Bhagyajyothi M Bhat,
Associate Professor, Department of Biochemistry, Kanachur Institute of Medical Sciences, Mangalore-575018, Karnataka, India.
E-mail: dr.bhagyajyothi@kanachur.edu.in

Abstract

Introduction: Hypertension and smoking are two independent risk factors for oxidative stress and dyslipidaemia, thereby development of cardio and cerebrovascular diseases are common. The effect of smoking on oxidants, antioxidants and lipid profile in hypertensive individuals is the matter of concern.

Aim: To compare fasting serum lipid profile, Glutathione (GSH) and Thiobarbituric Acid Reactive Substances (TBARS) of hypertensive smokers and hypertensive non smokers.

Materials and Methods: This case-control study was conducted in the Department of Biochemistry, Kanachur Institute of Medical Sciences, Mangalore, Karnataka, India, between September 2021 to December 2021. The study population consisted of 58 hypertensive smokers and 58 hypertensive non smokers visiting the Department of Internal Medicine, tertiary care hospital. Height, weight, smoking intensity, family history of hypertension was recorded, fasting serum lipid profile, GSH and TBARS were estimated. Smoking intensity was expressed as pack-years. Body Mass Index (BMI) was calculated using the measured height and weight. The data were analysed using Chi-square test, independent sample t-test and Pearson’s correlation.

Results: The mean age of cases were 40.38±14.96 years whereas among controls, it was 45.98±14.96 years. Among cases, 50 were males and eight were females, whereas among the controls, 47 were males and 11 were females. Out of total 58 subjects in each group, 43 in cases and 45 in controls had a family history of hypertension. A significant increase in the levels of serum TC, TAG, LDL-C, TBARS and a significant decrease in GSH, BMI in cases compared to the control (p<0.001) was observed. Total Cholesterol (TC), Triacylglycerol (TAG), Low Density Lipoprotein- Cholesterol (LDL-C) and TBARS exhibited a significant positive correlation whereas, BMI, HDL-C and GSH showed a negative correlation with pack-years.

Conclusion: Smoking was found to be significantly associated with dyslipidaemia and oxidative stress in hypertensive individuals. It was observed that the dyslipidaemia and oxidative damage was correlated with the pack-years in hypertensive smokers.

Keywords

Cholesterol, Cigarette, Glutathione, Hypertension, Malondialdehyde, Triacylglycerol

Hypertension is a major growing global health issue leading to mortality by being one of the causative factors for various disorders such as cardiovascular disease, renal disease, metabolic syndrome, diabetes mellitus, preeclampsia and many more (1). Hypertension causes upregulation of the renin-angiotensin-aldosterone system, inflammatory response, activation of the immune system and increased oxidative stress which may end up in both micro and macrovascular complications (2). Studies showed that reactive oxygen species have a considerable role to play in the pathophysiology of hypertension (3),(4). There are pieces of evidence that elevated lipid peroxidation indicated by Malondialdehyde (MDA) which is estimated as TBARS and dyslipidaemia are observed in hypertensive individuals (3),(5),(6).

Cigarette smoking is a commonly observed habit in individuals of both genders regardless of socio-economic status. The risk of several complications like cerebral and cardiovascular diseases increases with cigarette smoking (7). The mechanism involved in the development of coronary heart diseases by cigarette smoke is not yet very clear (8). Dyslipidaemia was observed in smokers and the degree of dyslipidaemia showed a dose-dependent relationship with the grades of smoking (9),(10),(11). Smoking was found to affect the oxidant, antioxidant status of the body, where the serum antioxidant levels, such as that of vitamin A, E, C reduced GSH and superoxide dismutase were lowered whereas the extent of lipid peroxidation was increased, the product being MDA, which is measured as TBARS (12). Earlier studies documented that smoking decreases the body weight (13),(14),(15). Authors obtained sufficient materials on the effect of smoking and hypertension separately on general population, to the best of the knowledge, the effect of smoking on lipid profile and antioxidant status in hypertensive individuals has not been documented. Knowing the ill-effects of smoking, the effect of the same on hypertension and its complications is a matter of concern. Thus, the present study was aimed to compare the levels of serum MDA, GSH and lipid profile of hypertensive smokers and hypertensive non smokers.

Material and Methods

This case-control study was conducted in the Department of Biochemistry, Kanachur Institute of Medical Sciences, Mangalore, Karnataka, India, between September 2021 to December 2021. Ethical clearance was obtained from the Institutional Ethical Committee (IEC) before starting the project work (IEC/31-08-2021).

Inclusion criteria: The study included hypertensive individuals visiting the Outpatient Department (OPD) having a Systolic Blood Pressure (SBP) >140 mmHg or Diastolic Blood Pressure (DBP) >90 mmHg (16), of either sex, aged between 18-65 years. Cases included hypertensive smokers who have been smoking atleast from past one year. The controls were age and sex-matched hypertensive non smokers.

Exclusion criteria: Hypertensive individuals who quit smoking and female subjects diagnosed with gestational hypertension were excluded.

Sample size: Sample size for the present study was calculated using the formula: n={2(Z1-α+Z1-B)2σ2}/d2, Where, Z1-α=1.96 for 95% confidence interval, Z1-B=0.84 for 80% statistical power, σ=3.92 is anticipated standard deviation (3), d=1.22 is acceptable margin of error. The minimum sample size was estimated to be 58 subjects each in case and control group. Non probability convenience sampling technique was used.

The study subjects were explained about the protocol, informed consent was obtained from the willing individuals. Personal information such as the age, blood pressure, smoking habit, frequency of smoking, past history of illness was collected by interacting with the individuals. A general physical examination including measurement of height and weight of the individual was conducted and the findings were noted. The serum lipid profile estimation included TC, TAG, LDL-C, High Density Lipoprotein Cholesterol (HDL-C) and Very Low Density Lipoprotein Cholesterol (VLDL-C). Serum TBARS and GSH were also estimated.

Serum TC, TAG, LDL-C, HDL-C were estimated using appropriate kits from ortho-clinical diagnostics in dry-chemistry analyser, Vitros 5600, as per the standard procedures mentioned in the kits. VLDL-C was calculated using the formula, VLDL-C=1/5×TAG (17).

TBARS was estimated as a measure of MDA (18) and GSH was estimated by its reaction with 5,5’-dithio nitrobenzoic acid (19) using UV/Vis analyser Labotech from BD instrumentation using standard procedures. The biological reference intervals of the lipid profile parameters in the central clinical laboratory are given in (Table/Fig 1).

Using the measured values of height and weight, BMI was calculated using the formula, BMI=W/H², where W=weight in kg, H=height in meters (20). BMI was categorised according to the World Health Organisation (WHO) Asia-pacific classification, where BMI of <18.5 kg/m2 was considered as underweight, 18.5-22.9 kg/m2 as normal BMI, 23-24.9 kg/m2 as overweight and obese when BMI was >25 kg/m2 (21). The smoking burden was expressed as pack-years, which is the product of the average number of cigarettes smoked in a day and the duration of smoking in years (22).

Statistical Analysis

Statistical Package for the Social Sciences (SPSS) version 20.0 was used for the analysis of data. Qualitative data was represented as frequency and percentage whereas quantitative data were expressed as mean±Standard Deviation (SD) for both case and control groups. Independent t-test was used to compare the values of serum TBARS, GSH, lipid profile and BMI between case and control groups. Correlation between serum TBARS, GSH, lipid profile parameters and BMI in cases was done by using Pearson’s correlation test. The p<0.05 was considered to be statistically significant.

Results

In the present study, the mean age of cases were 40.38±14.96 years whereas among controls the mean age was 45.98±14.96 years (p=0.216). No significant difference was observed between cases and control in terms of gender (p=0.451) and family history of hypertension (p=0.664) (Table/Fig 2). There was a significant association of BMI with cases and controls (p=0.001) (Table/Fig 3). The intensity of smoking, expressed as pack-years in cases, was on average 7.89 with a standard deviation of 4.5.

(Table/Fig 4) demonstrates that mean TC level, TAG, LDL-C, TBARS among cases were comparatively higher than controls and the difference was found to be statistically significant (p-value=0.001). A significant decrease in serum GSH was observed in cases compared to controls (p-value=0.001). There was no statistically significant difference in HDL-C and VLDL-C levels between the cases and controls (p=0.774 and 0.968, respectively). A significant positive correlation of parameters was observed in TC, TAG, LDL-C, VLDL-C and TBARS with the pack-years of smoking among the cases, whereas GSH and HDL-C showed a significant negative correlation with the pack-years (p=0.001). However, BMI did not show significant correlation with the pack-years (Table/Fig 5).

Discussion

The present study showed elevated levels of serum TC, TAG, LDL-C and MDA and lowered levels of BMI, HDL-C and GSH in hypertensive smokers compared to hypertensive non smokers. Hypertension and dyslipidaemia are the risk factors for the development of cardiovascular diseases (23). The observed higher BMI in hypertensive controls indicated that the majority of this population was obese. Obesity was found to be one of the causative factors for hypertension and cardiovascular disease by the activation of the rennin angiotensin-aldosterone system, increased sympathetic activity, increased insulin resistance, elevated leptin resistance, intense procoagulatory activity and endothelial dysfunction (24).

Nicotine present in tobacco may increase energy utilisation, may reduce appetite leading to less food intake and more energy expenditure resulting in low body weight (13). This may be the probable reason in present study finding of low BMI in cases when compared to the controls.

An earlier study on the effect of smoking on Blood Pressure (BP) in normotensive individuals has shown that smoking causes an increase in BP, where, the non smokers had a SBP of 119±3 mmHg and DBP of 80±2 mmHg, whereas smokers who smoke an average number of 20±5 cigarettes daily for a period of 12±5 years had a SBP of 137±5 and DBP of 90±4 mmHg (12). A slightly different observation was obtained in a retrospective cohort study by Andriani H et al., (25). In this study, the effect of smoking for seven years was studied, where they have found that male and female smokers had different presentations of BP. The male smokers had SBP and DBP of 130.72±18.43 and 80.44±10.95 mmHg against male non smokers, who presented SBP and DBP of 136.47±20.57 and 82.55±mm Hg, respectively. In female population, smokers had SBP and DBP of 140.46±24.86 and 82.51±10.33 mmHg against non smokers, who presented SBP and DBP of 133.71±23.66 and 81.77±11.70 mm Hg, respectively (25). The explanation for this finding was that the male smokers experienced relief from stress. However, protracted smoking further exacerbates hypertension.

The present observation of dyslipidaemia in hypertensive smokers was in agreement with a few other studies where normotensive smokers showed dyslipidaemia compared to non smokers (26),(27),(28). Smokers exhibited dyslipidaemia with low HDL (p=0.001) along with high systolic and diastolic BP compared to non smokers (29). Smoking induces the release of catecholamines, which may cause increased circulatory free fatty acids, resulting in increased VLDL-C and LDL-C levels and lower HDL-C (30). Insulin resistance induced by smoking causes hyperinsulinaemia which may reduce the lipoprotein lipase activity resulting in dyslipidaemia (31). Contradictory to the present observation, one of the earlier studies explained dyslipidaemia associated with smoking only with respect to changes in TC (mmol/L), where smokers and non smokers had the values of 4.05±0.81 and 4.21±0.87 (p=0.017) (32). Hypertension and smoking are two individual risk factors of dyslipidaemia. As dyslipidaemia is a risk factor of coronary artery disease, hypertensive smokers have a further increased risk of suffering from cardiovascular diseases. As observed in the present study, hypertensive smokers showed further disturbed lipid profile. Findings of a study conducted by Moradinazar M et al., was that the heavy smokers who smoked on an average more than 20 cigarettes per day had a normalised level of lipid profile upon quitting smoking compared to the population who smoke fewer cigarettes with an average of less than 10 cigarettes per day (10).

Lipid peroxidation results in the generation of MDA as the product. Estimation of MDA is useful to find the extent of lipid peroxidation by free radicals (33). Cigarette smoke contains reactive oxygen species like H2O2, which is taken up and reduced by GSH with the help of selenium-dependent peroxidase (34). Elevated serum MDA with decreased antioxidants vitamin C and vitamin E was observed in hypertensive individuals compared to normotensive controls (p-value <0.05) (35). In the case of hypertensive smokers the cigarette smoke induces generation of more free radicals and thus more antioxidants are utilised for scavenging these reactive oxygen species which may result in a decreased availability of antioxidants for protection of lipids by peroxidative damage and thus generation of reactive oxygen species (12),(36). This may be the possible reason for the present observation of decreased GSH in cases. GSH is a major intracellular antioxidant, which tries to normalise the free radicals generated, moreover, it also plays a role in maintaining optimum levels of vitamin antioxidants in plasma (37). The sulfhydryl group (-SH) in GSH is responsible for this effect (37). In this context, in a study by Dikalov S et al., it was observed that the mitochondrial oxidative stress induced by tobacco smoke is responsible to cause endothelial dysfunction, which further aggravates hypertension (38). A list of earlier published works in this regard and the present findings may help in better understanding of the outcomes (Table/Fig 6) (11),(12),(25),(26),(28),(29),(30),(31),(32),(35).

Thus hyperlipidaemia and oxidative stress are more in hypertensive smokers. In the present era, knowledge about such ill effects is readily available in different electronic media. Despite smokers justify themselves with interesting explanations. Some of such reasons were socialisation in younger generations, relief of pain in older people, prevention of weight gain in females, whereas, enjoyment and relief of stress were the main reasons in adult males (13),(39). Family history is a non modifiable risk factor for hypertension, but smoking begins purely as an enjoyable act that subconsciously turns into addiction. Chronic smokers may encounter difficulty in quitting smoking where they may experience temporary withdrawal symptoms. However, this population, especially of younger age, maybe encouraged to quit smoking by making them understand the protracted ill effects of smoking.

Limitation(s)

Limitation of the present study was that duration of hypertension was not taken into account and the sample size was small.

Conclusion

The present study demonstrated that smoking further disrupted the existing dyslipidaemia in hypertensive individuals. Moreover, the oxidative stress induced by smoking causes further oxidative damage indicated by elevated oxidant and lower antioxidant levels. A more controlled study with respect to the duration of both hypertension and smoking may be more useful in understanding the extent of damage caused by smoking in individuals diagnosed with hypertension and to advise this population to quit smoking.

Acknowledgement

Authors sincere gratitude to Ms. Preeval Shreya Crasta, Statistician and Assistant Professor, Department of Community Medicine for the timely assistance with the statistical part of the project. Authors would like to thank the Head of Deparment and faculty, Department of Internal Medicine for their support.

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DOI and Others

DOI: 10.7860/JCDR/2022/55196.16223

Date of Submission: Jan 25, 2022
Date of Peer Review: Feb 09, 2022
Date of Acceptance: Mar 15, 2022
Date of Publishing: Apr 01, 2022

AUTHOR DECLARATION:
• Financial or Other Competing Interests: The first author received ICMR STS grant for undertaking the project (Reference ID: 2020-07410).
• 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

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Jan 30, 2022
• Manual Googling: Feb 07, 2022
• iThenticate Software: Mar 14, 2022 (12%)

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