Santosh University Journal of Health Sciences

ORIGINAL ARTICLE
Year
: 2021  |  Volume : 7  |  Issue : 2  |  Page : 20--25

Study of the lipid and lipoprotein activity in various grades of untreated hypertension


Shivani Bansal1, Ashok Kumar1, Tanzeel Wani1, Tanuraj Tyagi2,  
1 Department of Medicine, Santosh Medical College, Ghaziabad, Uttar Pradesh, India
2 Department of Medicine, Safdarjung Hospital, Delhi, India

Correspondence Address:
Shivani Bansal
Department of Medicine, Santosh Medical College, Ghaziabad, Uttar Pradesh
India

Abstract

Introduction: Hypertension is an important medical and public health problem both in developed and developing countries. Abnormalities in serum lipid levels (dyslipidemia) are recognized as a major risk factor for cardiovascular disease (CVD) and essential hypertension. Lipid profile is earliest marker for coronary heart disease and includes total cholesterol (TC), high-density lipoprotein-cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglycerides (TG), and very LDL (VLDL). The role of lipoprotein (a) (Lp[a]) as an independent biomarker of vascular disease risk has been investigated for more than 20 years, but recently the European Atherosclerosis Society has issued a new consensus statement endorsing routine measurement of Lp(a) among patients with moderate-to-high-risk CVD. The aim of the study is to find out lipid profile and lipoprotein activity in various grades of untreated hypertension. Materials and Methods: This was a cross-sectional study conducted at a tertiary care setting in Ghaziabad. The study was conducted from February 2017 to February 2018 and 125 subjects were included after the detailed history, physical examination, and inclusion and exclusion criteria. All patients were evaluated for their lipid profile along with Lp(a) and other routine investigations. Results: There was a statistically significant rising level on TC, TG, LDL, VLDL, and Lp(a) (P ≤ 0.0001) excluding HDL statistically not significant (P = 0.343). This study showed that lipid and lipoprotein cholesterol abnormalities exist and even worsen with severity of hypertension. It is important that investigations in patients with hypertension should include lipid profile and lipoprotein. Conclusion: Serum lipid profile can serve as an important marker for screening hypertensive patients for CVD and their early detection can reduce cardiovascular morbidity and mortality. In this study, TC, LDL-C, TG, VLDC-C, Lp(a), and body mass index were found to be abnormal in hypertensive patients, but HDL-C did not show any significant variation with hypertension.



How to cite this article:
Bansal S, Kumar A, Wani T, Tyagi T. Study of the lipid and lipoprotein activity in various grades of untreated hypertension.Santosh Univ J Health Sci 2021;7:20-25


How to cite this URL:
Bansal S, Kumar A, Wani T, Tyagi T. Study of the lipid and lipoprotein activity in various grades of untreated hypertension. Santosh Univ J Health Sci [serial online] 2021 [cited 2022 Aug 11 ];7:20-25
Available from: http://www.sujhs.org/text.asp?2021/7/2/20/331798


Full Text



 Introduction



Hypertension is an important health problem in both developing and developed countries and a major risk factor for developing cardiovascular diseases (CVD), stroke, and chronic renal disease. It has been deemed the biggest single risk factor for deaths and causing around 7 million deaths each year. With the current rates of this disease, India is projected to have largest number of patients with hypertension in the world and the potential to become the “Hypertension capital of world.”[1] Essential hypertension has been appropriately called as a silent killer because it is usually asymptomatic and untreated. Hypertension is classified as either primary/essential hypertension or secondary hypertension. Primary/essential hypertension is the form of hypertension that by definition has no underlying cause.[2] It is the most common cause of hypertension affecting 90%–95% of total hypertensive patients. It is mostly familial in origin. Secondary hypertension is caused by an identifiable underlying cause. Essential hypertension remains a major modifiable risk factor for CVD despite important advances in our understanding of its pathology and the availability of effective treatment strategies. High blood pressure increases the risk of CVD for millions of people worldwide. Several prospective studies have identified the major risk for hypertension such as obesity, smoking, and alcohol consumption and dyslipidemia apart from dietary patterns.[3][INLINE:1][INLINE:2][INLINE:3][INLINE:4]

Several risk factors (modifiable and nonmodifiable) play a role in progression of hypertension.[4] Various factors such as age, sex, hyperlipidemia, diabetes, high body mass index (BMI), obesity, alcohol drinking, high sodium intake, and other were found to be associated with hypertension.[5] Abnormalities in serum lipid levels (dyslipidemia) are recognized as a major risk factor for CVD and essential hypertension.[6] Lipid profile is the earliest marker for coronary heart disease and includes total cholesterol (TC), high-density lipoprotein-cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglycerides (TG), and very LDL (VLDL). Approximately 10% of the global population is affected by dyslipidemia. Various cross-sectional and prospective epidemiological studies have shown that hypertension increases significantly with higher BMI and waist circumference.[7] The Framingham heart study data on the hypertensive population reported that more than 80% had at least one additional CVD risk factor and that predominantly these risk factors were atherogenic in nature.[8] Dyslipedemic hypertension constitutes the important components of the metabolic syndrome as defined by National Cholesterol Education Program guidelines (adult treatment panel III).[9] The risk of CVD associated with hypertension coexisting with dyslipidemia is more multiplicative than the sum of individual risk factors.[6],[10],[11],[12],[13] Many prospective epidemiological studies have reported positive associations of baseline Lp(a) concentration with coronary heart disease risk,[14] but very limited case–control studies studied the association between elevated Lp(a) and essential hypertension.[15] The physiological function of this lipoprotein is still unknown, but the importance is attributed to it has increased considerably in the light of the evidence that high plasma concentrations of Lp(a) are not only associated with an increased risk of vascular diseases such as CHD and restenosis of coronary bypass but are also considered as an independent risk factor. Lp(a) acts as a competitive inhibitor of tissue type plasminogen activator and thereby helps in modulating the fibrinolytic system consistent with an atherogenic role.[16],[17] Dyslipedemia is more common in untreated hypertensives than normotensives, and lipid levels increase as BP increases. Various studies have explored the association of hypertension and dyslipidemia, but the definite pattern or changes with regard to the severity of hypertension is still largely lacking in reports.[18],[19],[20] Moreover, since lipid and lipoprotein indices were common complications of hypertension and/or its treatment,[20],[21],[22] adequate investigations form the bed-rock of effective patient management.[23],[24][INLINE:5][INLINE:6][INLINE:7]

The aim of the study is to evaluate the abnormality of lipid profile (TC, TG, HDL, and VLDL) and lipoprotein activity in various grades of untreated hypertension and also to know the prevalence and type of hyperlipidemia in hypertensive subject.

Aims and objectives

The aim of the present study is to evaluate the abnormality of lipid profile (TC, TG, HDL, and VLDL) and lipoprotein activity in various grades of untreated hypertensionTo know the prevalence and type of hyperlipidemia in hypertensive subject.

 Materials and Methods



This was a cross-sectional study conducted at a tertiary care setting during the period of February 2017 to February 2018. One hundred and twenty-five subjects aged between 30 and 65 years were taken. Hundred cases of untreated hypertension and 25 nonhypertensive as control were taken.

The subjects were evaluated and selected by detailed medical history, physical examination, systemic examination, and routine investigations to rule out any underlying disease.[INLINE:8]

Inclusion criteria

Patients with essential hypertension whether previously diagnosed or recently diagnosed without complication of hypertension are included in this study. In the study, systolic blood pressure ≥140 mmHg and diastolic ≥90 mmHg based on average of two readings or one in case of hypertensive and the grades of hypertension are as follows:

Grade 1 = 140–159/90–99 mmHgGrade 2 = 160–179/100–109 mmHgGrade 3= >180/>110 mmHg

Exclusion criteria

Secondary hypertensive patients are excluded from this studyPatients with diabetes mellitus, hypothyroidism, nephritic/nephrotic disease, and chronic liver disease and patient on steroid therapy are excluded from this studyThose receiving lipid altering drugs or antihypertensive medication which affect lipid metabolism are excludedChronic smoker and alcoholics.

The study comprises two groups:

Group 1 – Untreated hypertensive cases (n-100)Group 2 – Normotensive control (n-25).

The patient in the study is subjected to:

A complete general medical and physical examinationLaboratory investigations which included

Complete blood countFasting blood sugarBlood urea and serum creatinineUrine routine and microscopyLipid profile which includes:TGVLDL-CLDL-CHDL-CTotal serum cholesterol.

ECGLipoprotein A (Lp[a]).

Statistical analysis

Data sets were stored in Microsoft Excel and analyzed through Statistical Package for the Social Sciences, version 23 (SPSS Inc., Chicago, IL, USA). Results for continuous variables are presented as mean ± standard deviation, whereas results for categorical variables are presented as number (percentage). The possible association was found out using Chi-square test or Student's t-test. The level P < 0.05 was considered as the cutoff value or significance.

 Observation and Results



There is a statistically significant effect of groups BMI at the P = 0.0095 level for all four groups.

There is a statistically significant effect of groups' total cholesterol at the P ≤ 0.0001 level for all four groups.

There is a statistically nonsignificant effect of groups HDL at the P = 0.342 level for all four groups.

There is a statistically significant effect of groups LDL at the P ≤ 0.0001 level for all four groups.

There is a statistically significant effect of groups VLDL at the P = 0.0001 level for all four groups.

There is a statistically significant effect of groups' Lp(a) at the P = 0.0001 level for all groups.

TC was high in 60% of hypertensive patients. It was low in 4.76% only and normal in 37.24% of hypertensive patients. HDL was low in 31.43% and normal in 68.57% of hypertensive patients. LDL was high in 44.67% of hypertensive patients. It was low in 18.1% and normal in 37.14% of patients. VLDL was high in 7.62% of hypertensive patients. It was low in 5.71% and normal in 86.67% of hypertensive patients. TG was found high in 93.33% and normal in 6.67% of hypertensive patients.

 Discussion



The burden of CVD is increasing worldwide, and it continues to be the most common disease treated by physicians.

The present study was conducted to evaluate the abnormality of lipid profile (TC, TG, HDL, LDL, and VLDL) and lipoprotein activity in various grades of untreated hypertension and to know the prevalence and types of hyperlipidemia in hypertensive subjects.

It is a cross-sectional study with a number of untreated hypertensive cases 100 and controls 25.

Patients were evaluated with detailed history, meticulous examination (blood pressure measurement), and laboratory investigations. Laboratory investigations included lipid profile (TC, TG, HDL, LDL, and VLDL) and Lp(a). Blood sugar fasting, blood urea, serum creatinine ECG, and chest Xray were done to rule out secondary hypertension.

In our study, there was a positive correlation seen in TC and various grades of hypertensive and normotensive subjects. This was a statistically significant P ≤ 0.0001 level for all four groupsThe correlation between HDL cholesterol and various grades of hypertension was statistically nonsignificant P = 0.342 level for all four groupsIn this study, there was a statistically significant effects of groups LDL at the P ≤ 0.0001 level for all four groups. The difference progressively increased with increasing grades of hypertension. Intergroup difference in LDL was significant for hypertension Grade 3 and control (P = 0.0001) and hypertension Grade 3 and hypertension Grade 2 (P = 0.015) onlyThe correlation between VLDL and various grades of hypertension was statistically significant P = 0.0001 level for all groups. Intergroup difference in VLDL was significant for all grades of hypertensionThe correlation between TG and various grades of hypertension was statistically significant P = 0.0001 level for all four groups. The difference progressively increased with increasing grades of hypertensionThe positive correlation between Lp(a) and various grades of hypertension was statistically significant P = 0.0001 level for all four groups. Difference was progressively increased with the increasing grades of hypertension. Intergroup difference was significant for various grades of hypertension P = 0.001 except hypertension Grade 3 and hypertension Grade 1 (P = 0.002) onlyThe positive correlation between BMI and various grades of hypertension was statistically significant P = 0.0095 level for all groups. Difference was progressively increased with increasing grades of hypertension.

Thus, our study shows that dyslipidemia is more common among hypertensive patients, and among the parameters, TC, LDL-C, VLDL, and Lp(a) were found significantly higher in all grades of hypertension as compared to control, while there was no significant difference in HDL-C in both groups.

In the study, it was seen that serum lipid profile of hypertensive patients was deranged significantly compared to normotensive patients.

There was a statistically significant rising level on TC, TG, LDL, very LDL, and Lp(a) (P ≤ 0.0001) excluding HDL statistically not significant (P = 0.343).

This study showed that lipid and lipoprotein cholesterol abnormalities exist and even worsen with severity of hypertension. It is important that investigations in patients with hypertension should include a lipid profile and lipoprotein.

 Conclusion



The serum lipid profile of the hypertensive patients was deranged significantly compared to normotensive patients. The most consistent elevation was seen in levels of TG, DL, and VLDL.

There was a statistically significant positive correlation in all grades of hypertension with increasing level of Lp(a).

The study showed that patients with hypertension had a higher lipid and Lp(a) levels than controls and the values became more significant with increasing severity of hypertension. The difference was statistically significant for TG, LDL-C, and VLDL-C. It is important that investigations in patients of hypertension should include lipid profile and Lp(a).

Thus, it was concluded that serum lipid profile can serve as an important marker for screening hypertensive patients for CVD and their early detection can reduce cardiovascular morbidity and mortality. More so, in the study, TC, LDL-C, TGs, and VLDL-C and BMI were found to be abnormal in hypertensive patients, but HDL-C did not show any variation with hypertension.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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