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 : 2023 | Month : June | Volume : 17 | Issue : 6 | Page : CC01 - CC06 Full Version

Comparison of Demographic Factors and Personal Lifestyle Characteristics with 2020 ISH Guidelines for High Normal Blood Pressure in Relation to Absence and Presence of ECG Diagnosed LVH in Healthy Adults: A Cross-sectional Study


Published: June 1, 2023 | DOI: https://doi.org/10.7860/JCDR/2023/58405.18014
Pravin Sainikrao Gowardipe, Kiran R Bagale, Saurabh K Sahu, Satyajit Singh

1. Senior Resident, Department of Physiology, AIIMS, Raipur, Chhattisgarh, India. 2. Associate Professor, Department of Biochemistry, Shri Balaji Institute of Medical Sciences, Raipur, Chhattisgarh, India. 3. Senior Resident, Department of School of Public Health, AIIMS, Raipur, Chhattisgarh, India. 4. Associate Professor, Department of Cardiology, AIIMS, Raipur, Chhattisgarh, India.

Correspondence Address :
Kiran R Bagale,
Associate Professor, Department of Biochemistry, Shri Balaji Institute of Medical Sciences, Raipur-492014, Chhattisgarh, India.
E-mail: avikiran.ingle@gmail.com

Abstract

Introduction: Early identification of Left Ventricular Hypertrophy (LVH), a powerful and independent predictor of Cardiovascular Disease (CVD), is a key element for preventing Cardiovascular Events (CVE). High-Normal Blood Pressure (HNBP) was significantly associated with a new-onset Electrocardiogram (ECG) diagnosed LVH. The demographic and personal lifestyle characteristics could be related to HNBP in ECG diagnosed LVH. This relation, if found, can be useful as a factor for early identification of HNBP in relation to ECG diagnosed LVH.

Aim: To compare demographic and personal lifestyle characteristics with HNBP in relation to ECG diagnosed LVH in healthy adults.

Materials and Methods: The cross-sectional study was conducted in AIIMS Raipur (CG) Raipur, Amboli, Maharashtra, India from April 2021 to March 2022 among 95 healthy adult males between 20-39 years with a Blood Pressure (BP) of 130-139/85-89 mmHg and no antihypertensive medications. Permission was obtained from the Ethics committee of AIIMS Raipur (CG). Data was collected from the individuals using health questionnaire, Personal Lifestyle Questionnaire (PLQ), validated anthropometric equipment stature metre for measuring height and weighing machine, a working electronic BP measuring instrument, and ECG. The present study included demographic factors like age, height, weight, Body Mass Index (BMI), educational level, marital status, occupation, and Socio-Economic Status (SES) classified based on Kuppuswamy’s classification. The personal lifestyle characteristics included physical activity, use of substances (alcohol, smoking, tobacco, gutkha), and diet. The unpaired t-test, Chi-square test and regression analysis were applied for the analysis of the collected data.

Results: Representation of demographic factors were age (31.9±5.08), height (1.69±0.06), weight (68.3±10.2), BMI (23.8±3.05) in terms of (mean±SD) and SES in terms of n (%) were upper I-7 (7.4), upper middle II-31 (32.6), lower middle III-30 (31.6), upper lower IV-25 (26.3), lower V-2 (2.1). SES classes of modified Kuppuswamy’s SES scale had a significant relationship with LVH {p-value <0.05 (0.003)}. All LVH (+) individuals were from the lower middle III SES class {7 (7.4%)}. Daily use of substances (alcohol, smoking, tobacco, gutkha) had a significant association with LVH {p-value <0.05 (0.005)}. Group-IV (35-39 years) (standard coefficient 0.4621059, 95%CI-0.0385065 to 0.4686115; p-value-0.021) had more positive relation than Group-II (25-29 years) (std. coef. 0.4422758, 95% CI-0.0501719 to 0.4566986; p-value-0.015). Primary Educational level (std. coef.-0.2473403, 95% CI-0.8019454 to-0.0982954; p-value-0.013) had a negative relation with SL-LVH (p<0.05).

Conclusion: The study concluded that lower middle III class SES and daily use of substances (alcohol, smoking, tobacco, gutkha), age Group-IV (35-39 years), and primary educational level were the predicted demographic and lifestyle characteristics of HNBP in relation to ECG diagnosed LVH.

Keywords

Electocardiogram diagnosed, High normal blood pressure, International society of hypertension

Essential Hypertension (HTN) is one of the most common modifiable risk factors in the general population, being strongly and independently related to an increased risk of Cardiovascular (CV) morbidity and mortality, independently by age and gender (1). The Primary prevention of HTN is an attractive approach to reducing CV morbidity and mortality. The heart is a key target organ for HNBP, and the cardiac muscle responds to increased afterload (i.e., systemic BP) by developing hypertrophy. Even a mild increase in ECG voltage that indicates an increase in left ventricular mass could be an early symptom of HTN (2). LVH is a powerful and independent predictor of CVD in a non hypertensive population, more than twice as likely to suffer premature CVE or death and beyond traditional risk factors. Achievement of LVH regression is possible with lifestyle modifications and antihypertensive therapy (if a trial of lifestyle modification fails to reduce their BP to 130/80 mmHg or less). It is associated with an improvement in cardiovascular prognosis. Early identification of LVH is a key element for preventing CVE in HTN (1),(3),(4),(5),(6).

The seventh report of the Joint National Committee (JNC 7) introduced a new classification in 2003 that includes the term “pre HTN” for those with BP. BP Classification of JNC 7 is Normal (<120 and <80 mmHg), Pre HTN (120-139 or 80-89 mmHg), Stage 1 HTN (140-159 or 90-99 mmHg) and Stage 2 HTN (≥160 or ≥100 mmHg). This new designation intended to identify those individuals in whom early intervention by adopting healthy lifestyles could reduce BP, decrease the rate of progression of BP to hypertensive levels with age, or prevent HTN entirely (4). The term “pre HTN” introduced by JNC 7 report gets modified. The International Society of Hypertension (ISH) introduced a recent classification of BP (4).

To reduce the global burden of raised BP, the ISH has developed worldwide practice guidelines for managing HTN in adults aged 18 years and older. Recommendations for office BP measurement are: 1) Conditions: quiet room with a comfortable temperature. Before measurements: Avoid smoking, caffeine, and exercise for 30 minutes; empty bladder; remain seated and relaxed for 3-5 minutes. Neither patient nor staff should talk before, during, and between measurements; 2) Positions: sitting: arm resting on table with mid-arm at heart level; back supported on a chair; legs uncrossed and feet flat on the floor; 3) Device: validated electronic (oscillometric) upper-arm cuff device. Lists of accurate electronic devices for office, home, and ambulatory BP measurement in adults, children, and pregnant women are available at www.stridebp.org. Alternatively, a calibrated auscultatory device (aneroid or hybrid as banned mercury sphygmomanometers in most countries) with 1st Korotkoff sound for Systolic Blood Pressure (SBP) and 5th for diastolic with a low deflation rate can be used; 4) Cuff: size according to the individual’s arm circumference (smaller cuff overestimates and larger cuff underestimates BP). For manual auscultatory devices, the inflatable bladder of the cuff must cover 75%-100% of the individual’s arm circumference. For electronic devices, use cuffs according to device instructions; 5) Protocol: At each visit, take three measurements with one minute between them. Calculate the average of the last two measurements. If the BP in the first reading is <130/85 mmHg, no further measurement is required; 6) Interpretation: whenever possible, consideration of a single office visit should not be for the diagnosis. Usually, 2-3 office visits at 1-4-week intervals (depending on the BP level) are required to confirm the diagnosis of HTN. The diagnosis might be made on a single visit if BP is ≥180/110 mmHg and there is evidence of CVD. If possible and available, confirmation of the diagnosis of HTN should be by out-of-office BP measurement. This recent classification of HTN followed in the present study, based on office BP measurement. It includes normal BP (<130/<85 mmHg), HNBP (130-139/85-89 mmHg), grade 1 HTN (140-159/90-99 mmHg), and grade 2 HTN (≥160/≥100 mmHg). HNBP intends to identify individuals who could benefit from lifestyle interventions and receive pharmacological treatment if compelling indications exist (7).

Major risk factors for pre HTN are lower education, a sedentary lifestyle, and alcohol use (8). Pre HTN individuals’ LVMI values and LVH prevalence are intermediate between normal and sustained HTN individuals. On average, the detection of abnormal values is relatively low (3). HNBP was significantly associated with new-onset ECG LVH (9). There is a well-known fact that lifestyle characteristics are associated with HTN. There is also a strong relationship between HTN and ECG-diagnosed LVH. However, there are very few studies comparing demographic factors and lifestyle characteristics with HNBP in relation to LVH, which is said to be a powerful and independent risk factor for CVE.

The study intends to compare demographic factors and lifestyle characteristics with HNBP in relation to the absence and presence of ECG-diagnosed LVH. Also, to access and predict lifestyle characteristics, priority should be given to lifestyle modification and demographic indices: Age, height, weight and BMI dependent onset of ECG-diagnosed LVH among healthy adults.

Material and Methods

The present cross-sectional study was conducted in the Department of Physiology AIIMS Raipur (CG) Raipur, Amboli, Maharashtra, India. Raipur Municipal Corporation divides Raipur city, the capital of Chhattisgarh, into ten zones, among which zone 8 {ward no. 1) Veer Savarkar Nagar, ward no. 2) Pt. Jawaharlal Nehru, ward no. 19) Dr. APJ Abdul Kalam, ward no. 20) Ramakrishna Paramhansa, ward no. 21) Shaheed Bhagat Singh, ward no. 69) Madhavrao 2Sapre, ward no. 70). Sant Ravidas} were randomly selected to recruit participants, and a single sample of the target population was selected. The duration of the study was April 2021 to March 2022. The Institute’s Ethics Committee AIIMS Raipur (CG) approved the study (IEC Proposal No.: AIIMSRPR/IEC/2021/712). The participants gave informed written consent.

Sample size calculation: Calculation of the sample size from the formula=Z1-α/2 2p (1-p)/d2 using a 95% confidence level, 5% margin of error, and design effect of 1 based on the prevalence of HNBP of 6.62%. A qualitative variable in this study had a formula for identifying the proportion of HNBP in a population. It should use for sample size=Z1-α/2 2p (1-p)/d2 {Z1-α/2=standard normal variate at 5% type 1 error (p-value <0.05) is 1.96., p=Expected proportion in population based on previous studies or pilot studies (prevalence)=6.62% (0.0662), d=Absolute error or precision}=1.962×0.0662 (1-0.0662)/0.052=94.92 [10,11]. Thus, the total study population was determined to be 95 healthy adult males.

Inclusion criteria: Apparently, healthy adults with a BP of 130-139/85-89 mmHg and not on any antihypertensive medications, age group between 20-39 years were included in the study.

Exclusion criteria: Individuals with a history of recent surgeries, with normal BP, i.e., <130/85 mmHg. Presently diagnosed unknown or known case of primary/secondary HTN or known history of antihypertensive medications, hypertrophic cardiomyopathy based on the echocardiographic findings, any other co-morbidities like a known history of Diabetes Mellitus, Obesity, Chronic Obstructive Pulmonary Disease (COPD)/Asthma, kidney disease, and thyroid dysfunction, Ischaemic heart disease, arrhythmias, Congenital, infective, valvular heart disease, pericardial effusion, Congestive heart failure, and any other acute illness.

The participants were explained about the procedure, investigations, and examination.

Study Procedure

Anthropometric measurements and questionnaires: Age (years), Standing height (cm), weight (kg) recorded and BMI calculated using the formula of BMI=weight in kg/height in m2 (12). Validated anthropometric equipments {stature meter for measuring height (cm), weighing machine for measuring weight (kg)}; Questionnaires used were a health questionnaire and Personal Lifestyle Questionnaire (PLQ) in this study [13,14]. A detailed medical history was taken from all participants using a health questionnaire. A lifestyle questionnaire was given to participants to collect the information for evaluation of demographic factors and personal lifestyle characteristics. The PLQ includes demographic factors, educational level, marital status, occupation, SES according to the modified Kuppuswamy’s SES scale (15), and Personal lifestyle characteristics, physical activity, use of substances (Alcohol, Smoking, Tobacco, Gutkha), and diet.

Blood Pressure (BP) measurement and interpretation: According to the 2020 ISH Global HTN Practice Guidelines, BP measurement was done (7). The device used was a validated electronic (oscillometric) upper-arm cuff. BP was measured in a sitting position with arm resting on a table with mid-arm at heart level, back supported on a chair, legs uncrossed, and feet flat on the floor, neither patient nor staff talking before, during, and between measurements. The participants were instructed to avoid smoking and caffeine and exercise for 30 minutes before the procedure. Then they were relaxed for 35 minutes. Implementation of cuffs was according to device instructions for electronic devices. This was done in a single visit with three measurements with one minute between them. The average of the last two measurements was calculated. Suppose the BP of the first reading was <130/85 mmHg; there was no further requirement for BP measurement. The recorded BP of participants provides their specific BP numbers and the BP goal.

Classification of the participants based on 2020 ISH HTN guidelines is

• Normotensive (<130/<85 mmHg),
• High normal BP (130-139/85-89 mmHg),
• Hypertensive (≥140/≥90 mmHg) individuals.

The present study excludes normotensive and hypertensive individuals (7). The numbers of participants recruited are 95 healthy adult males.

Electrocardiographic measurement and interpretation: A trained laboratory technician, blinded to the research subject, measured ECG at a paper speed of 25 mm/sec, at a 10 mm/mV gain. The device used for measuring ECG record was An ECG device Model: SE1200 antielectroshock type class I of EDAN Medical India Private Ltd. The participants underwent standard supine 12-lead ECG after a minimum 5-minute rest at the baseline examination for the diagnosis of LVH based on the ECG-LVH criterion. The ECG-LVH standards applied are Sokolow-Lyon voltage and Cornell Product for diagnosing LVH. The present study measured ECG parameters, The Sokolow-Lyon (SL) voltage (S in V1+R in V5/V6) and Cornell voltage (CV: S in V3+R in a VL) on three consecutive heartbeats. The present study measured the QRS duration on three consecutive heartbeats from lead II (or lead I, III, or a VF if the measurement of QRS duration is difficult from lead II). The SL-LVH of each participant from the measured value of relevant ECG, defined as ≥35 mm (3.5 mV) was calculated. Similarly, The Cornell voltage Product (CP) from each recording of individual ECG as the CV (+0.8 mV in men) ×QRS duration, defined as 2440 mm×ms (≥244 mV×ms) [16,17] was calculated. Interpretations were evaluated based on SL-LVH and CP-LVH criteria.

Twelve lead ECG report LVH values of 98 recruited participants were calculated based on Sokolow-Lyon (SL-LVH) and Cornell Product (CP-LVH) ECG-diagnosed LVH criteria. As per SL-LVH criteria, 10 participants’ ECG reports came LVH (+), and none of the individuals came LVH (+) as per CP-LVH criteria. There were no other abnormalities in the 12 lead ECG reports. Two participants refused to consent to do an Echocardiogram (ECHO). The ECHO of the remaining LVH (+) 8 participants has done in the Department of Cardiology, AIIMS Raipur, to rule out the differential diagnosis of LVH. Exclusion of one participant was done based on the diagnosis of Inter-Ventricular Septal (IVS) Thickness, based on the ECHO report from the study. Three individuals out of 10 LVH (+) subjects were not involved in the study as two refused to give consent to do ECHO, and one was diagnosed with IVS hypertrophy which comes under the exclusion criteria of this study. Out of 98 individuals, three were eliminated, 7 were LVH (+), and 88 were LVH (-). Thus, the final sample size is 95 {LVH (+), n=7 and LVH (-), n=88}.

Statistical Analysis

For the comparison of continuous data (age, height, weight, BP), a test used was an unpaired t-test. For comparison of the categorical data (BMI, SES Class, use of substances), a test used was the Chi-square test. To determine the strength of the relationship, a test used was regression analysis between one dependent variable and a series of independent variables. A p-value <0.05 was considered statistically significant. The statistics software STATA/SE 12.0 was used to perform statistical analyses.

Results

(Table/Fig 1) shows the final sample size is 95 {LVH (+), n=7 and LVH (-), n=88}. (Table/Fig 2) shows the frequency distribution with the percentage of demographic factors and personal lifestyle characteristics of all participants (n=95). The parameters assessed to check were demographic factors, educational level, marital status, occupation, and personal lifestyle characteristics physical activity and diet. Participants with higher educational levels are 83 (%), married 76 (%), and last 12 months participation minimum of 30 minutes of physical exercise {3-4 times per week 40 (%) and not at all 42 (%)}.

The comparison of HNBP (SBP and DBP) within each personal lifestyle characteristic was insignificant. The comparison of SBP within each variable, i.e., Educational level (p-value-0.237), marital status (p-value-0.641), occupation {(employed/ unemployed) n (%) 94 (98.9)/1 (1.05) was not adequate to determine p value}, physical activity (p-value-0.479), and diet (p-value-0.501) and DBP with Educational level (p-value-0.535), marital status (p-value-0.866), occupation 94 (98.9)/1 (1.05) was not adequate to determine p-value], physical activity (p-value-0.058), and diet (p-value-0.237), snack in between meals (p-value-0.135)}.

(Table/Fig 3) shows the linear regression of demographic factors with SL-LVH. age Group-I (20-24 years) was taken as the reference variable. Indicator variables age Group-II (25-29 years) and Group-IV (35-39 years) had a positive relation with SL-LVH. Group-IV (35-39 years) (std. coef. 0.4621059, 95% CI 0.0385065 to 0.4686115; p-value=0.021) and Group-II (25-29 years) (std. coef. 0.4422758, 95% CI 0.0501719 to 0.4566986; p-value=0.015) had a positive relation. Higher education level was taken as a reference variable. Primary educational level (std. coef.-0.2473403, 95% CI-0.8019454 to-0.0982954; p-value=0.013) had a negative relation with SL-LVH (p<0.05).

(Table/Fig 4) shows the relation between lifestyle factors and Sokolow-Lyon LVH using linear regression analysis. There is no relation found within personal lifestyle characteristics parameters and SL-LVH {Physical activity (30 minutes daily walk (last 12 months participation)), (1 to 2 times per week and 3 to 4 times per week (p-value=0.521), 1 to 2 times per month and 3 to 4 times per week (p-value=0.562), Not at all and 3 to 4 times per week (p-value=0.689), diet (inadequate and adequate intake of fruits and vegetables) (p-value=0.532), eating breakfast and no breakfast (p-value=0.281), taking snack in between meals and no snack in between meals) (p-value=0.919)}.

(Table/Fig 5) shows characteristics of factors like age, height, weight, BMI, HNBP, SES class related to SL-LVH, and use of substances (alcohol, smoking, tobacco, gutkha), used daily (once/twice), monthly (once/twice) or >3 months were affecting ECG findings specifying SL-LVH. There were no significant differences in age (p-value=0.358), height (p-value 0.670), weight (p-value 0.193), BMI (p-value=0.199), HNBP {SBP (p-value=0.324) and DBP (p-value=0.705)}, or use of substances (p-value=0.986), except daily use of substances (p-value=0.005), expressed in terms of mean±SD and n (%) between SL-LVH (+) and (-) groups. The study population with normal BMI is 60 (63.2%) and overweight is 35 (36.8%), out of which 6 (6.3%) and 1 (1.05%) are LVH (+), respectively. SES classes have a significant p-value <0.05 (0.003). All LVH (+) individuals are from the lower middle III SES class {7 (7.4%)}. LVH (-) individuals of upper I, upper middle II, lower middle III, upper lower IV and lower V are 7 (7.4%), 31 (32.6%), 23 (24.2%), 25 (26.3%) and 2 (2.1%), respectively. Daily use of substances has a significant p-value <0.05 (0.005). Out of 7 LVH (+), participants using alcohol, smoking, tobacco, or gutkha are 5 (5.3%), and no use of any substances is 2 (2.1%).

Discussion

The present study shows that daily use of substances (alcohol, smoking, tobacco, gutkha) among personal lifestyle characteristics related to ECG-diagnosed LVH. SES, specifically lower middle III class, age Group-IV (35-39 years), and higher educational level among demographic factors, are related to ECG-diagnosed LVH.

There is no relation found within personal lifestyle characteristics parameters and SL-LVH {physical activity (30 minutes daily walk (Last 12 months participation), (1-2 times per week and 3-4 times per week, 1-2 times per month and 3-4 times per week, not at all and 3-4 times per week), diet (inadequate and adequate intake of fruits and vegetables), eating breakfast and no breakfast, taking snack in between meals and no snack in between meals)}, and demographic factors {marital status (single/married), occupation (unemployed and employed)} and SL-LVH.

There was no relationship found between HNBP (SBP and DBP) within each personal lifestyle characteristic. Also, there was no relation between age, height, weight, BMI, HNBP (SBP and DBP), and use of substances except for daily use of substances seen between SL-LVH (+) and (-) groups. Electrocardiographic assessment of LVH remains the first choice technique and represents an easy-to-perform, widely available, specific, repeatable, established prognostic value, and cost-effective method to assess the presence of LVH in the setting of clinical practice of HTN [1,6]. ECHO is much more sensitive than ECG to detect LVH, although ECG-LVH is a highly specific indicator for the condition [1,4].

There is a well-known fact that lifestyle characteristics are associated with HTN. There is also a strong relationship between HTN and ECG-diagnosed LVH. Still, there are very few studies on the relationship between HNBP and lifestyle characteristics and the impact of HNBP on ECG-diagnosed LVH, a decisive and independent risk factor for CVE [3,9].

Takase H et al., concluded that both SokolowLyon voltage and Cornell product are novel predictors of the future development of HTN in the general population (2). The risk of HTN increases even below the SokolowLyon voltage threshold and Cornell product defined for LVH. Findings in this study suggest that the amplitude of voltage in ECG is closely associated with future BP and is an important marker for managing BP (Table/Fig 4). Univariate Cox proportional hazard regression analyses for future development of HTN {Sokolow-Lyon voltage, mV (Hazard Ratio (95% CI) 1.64 (1.52-1.77) (p-value <0.0001), Cornell product, mm.ms/100 (Hazard Ratio (95% CI) 1.04 (1.03-1.05) (p-value <0.0001) (2). Ueda H et al., concluded that even highnormal BP was significantly related to the presence of new-onset ECGdiagnosed LVH (9).

Based on the above-supporting studies (1),(2),(4),(6) in the present study, ECG-diagnosed LVH criteria was taken as the principal marker of LVH caused by HNBP. The Echocardiography (ECHO) was done on ECG-diagnosed LVH (+) participants according to ECG-diagnosed LVH criteria to rule out any other diagnosis of LVH other than HNBP.

Owiredu EW et al., concluded that the prevalence of pre HTN is high among apparently healthy Ghanaian adults (49.0%) (8). Lower educational levels, a sedentary lifestyle, and alcohol consumption are the predominant risk factors for pre HTN in Kumasi (8). In the present study, daily use of substances is the factor that can prioritise lifestyle modification to minimise the HNBP in relation to LVH. Avoidance of using substances may prevent the early onset of LVH. The demographic factors which can predict LVH are age Group-IV (35-39 years), higher educational level, and SES, specifically in the Lower middle III class.

Personal lifestyle characteristics like physical activity (30 minutes daily walk for last 12 months), use of substances except for daily use of substances and diet (adequate use of fruits and vegetables, breakfast, snack in between meals) were not related to HNBP and ECG diagnosed LVH. Demographic factors such as height, weight, BMI, marital status, and occupation are unrelated to ECG-diagnosed LVH.

In the present study, the relationship of demographic factors age Group-IV (35-39 years), higher educational level, SES Lower middle III class according to Modified Kuppuswamy’s Classification (15), and lifestyle characteristics, Daily use of substances such as alcohol, smoking, tobacco, and gutkha with HNBP in relation to ECG diagnosed LVH was present. The present study can be used in the future for clinical assessment of demographic and lifestyle characteristics related to HNBP in relation to the absence or presence of ECG diagnosed LVH.

Further future studies can be carried out on the demographic and lifestyle characteristics related to HNBP in relation to the absence and presence of ECG-diagnosed LVH so that lifestyle modification can prevent CVE caused by LVH related to HNBP.

Limitation(s)

There is a comparison between a limited range of systolic and diastolic HNBP and not between normotensive and HNBP individuals. In the present study, seven subjects were LVH (+) according to the Sokolow-Lyon criteria, but none were LVH (+) with the Cornell product criteria.

Conclusion

The present study concluded that there was a significant relationship present between SES (Lower middle III class) and daily use of substance in relation to the absence and presence of the ECG-diagnosed LVH. Age Group-IV (35-39 years) and Group-II (25-29 years) had a positive relationship with the ECG diagnosed LVH when compared to Group-I (20-24 years). Primary educational level had a negative relation with the ECG-diagnosed LVH compared to higher educational level.

Acknowledgement

The authors carried out the study under the supervision of the Department of Physiology AIIMS Raipur (C.G.). The authors are grateful to all participants, Mr. Pushpendra Kumar Gautam and Mr. Jagannath Nishad, for their help in data collection.

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DOI and Others

DOI: 10.7860/JCDR/2023/58405.18014

Date of Submission: Jun 12, 2022
Date of Peer Review: Sep 17, 2022
Date of Acceptance: Jan 24, 2023
Date of Publishing: Jun 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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