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Table of Contents
ORIGINAL ARTICLE
Year : 2020  |  Volume : 10  |  Issue : 1  |  Page : 6-9

Association between anthropometric measurements and lipid profile in newly detected hypertensive patients at a tertiary hospital in Bangladesh


Department of Medicine, Chattagram Maa-O-Shishu Hospital Medical College, Chittagong, Bangladesh

Date of Submission26-Dec-2019
Date of Acceptance03-Feb-2020
Date of Web Publication20-Apr-2020

Correspondence Address:
Dr. Jishu Deb Nath
Department of Medicine, Chattagram Maa.O.Shishu Hospital Medical College, Chittagong
Bangladesh
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JICC.JICC_54_19

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  Abstract 


Introduction: Hypertension (HTN) is an important public health problem worldwide and causing global disease burden contributing as cardiovascular diseases, cerebrovascular disease (stroke), and end-stage renal disease and marked disability. Objectives: The objective was to investigate the correlation between anthropometric indices and dyslipidemia relating to newly diagnosed HTN and compare with normotensive individuals. Materials and Methods: A cross-sectional comparative study of 131 patients splitting two groups comprising 65 hypertensive patients as case and 66 normotensive patients as control underwent in a tertiary hospital. Different anthropometric indices and fasting lipid profile were evaluated between two groups with the help of SPSS software. Results: Among 131 patients, the mean ± standard deviation (SD) of systolic blood pressure (SBP) was 155.9 ± 9.18 in case group and 124.6 ± 22.06 in control group (P < 0.5) and diastolic pressure was 96.70 ± 6.10 in case group and 78.45 ± 6.98 in control group (P < 0.05). The mean ± SD body mass index was 24.23 ± 3.3 in case group and 22.13 ± 2.92 in control group (P < 0.05). Serum triglyceride was 251.13 ± 85.9 in case group and 256.5 ± 73.5 in control group (P < 0.05). Total cholesterol (TC) and low-density lipoprotein (LDL) were 230.2 ± 44.53 and 150.78 ± 32.9 in case group and 166.27 ± 30.45 and 98.9 ± 20.15 in control group (P < 0.05). Strong-positive correlation was found between high SBP and LDL (r = 0.517), high diastolic blood pressure (DBP) and LDL (r = 0.560), and high DBP and TC (r = 0.514). Conclusion: Anthropometric measures and lipid profile are the important tools should be emphasized early to diagnose HTN.

Keywords: Arm circumference, diastolic blood pressure, systolic blood pressure, waist hip ratio


How to cite this article:
Nath JD, Roy Biswas RS. Association between anthropometric measurements and lipid profile in newly detected hypertensive patients at a tertiary hospital in Bangladesh. J Indian coll cardiol 2020;10:6-9

How to cite this URL:
Nath JD, Roy Biswas RS. Association between anthropometric measurements and lipid profile in newly detected hypertensive patients at a tertiary hospital in Bangladesh. J Indian coll cardiol [serial online] 2020 [cited 2020 Sep 23];10:6-9. Available from: http://www.joicc.org/text.asp?2020/10/1/6/282978




  Introduction Top


Hypertension (HTN) is an important public health problem worldwide. It is responsible for increased global disease burden like cardiovascular diseases (CVD), cerebrovascular disease (stroke), and end stage renal disease and marked disability.[1] Worldwide, prevalence estimates for HTN may be as much as one billion individuals per year, and approximately 7.1 million deaths per year are attributable to it.[2]

Worldwide, two-third of deaths from stroke and half of the deaths from coronary artery diseases are also attributed to HTN.[3] Obesity is an established and independent risk factor for the development and complication of HTN.[4] In 2016, more than 1.9 billion adults aged 18 years and older were overweight. Of these, over 650 million adults were obese. Overall, about 13% of the world's adult population (11% of men and 15% of women) were obese in 2016 and worldwide prevalence of obesity nearly tripled between 1975 and 2016.[5]

CVD is the leading cause of disability and death worldwide, and a great majority of CVDs are associated with dyslipidemia. Worldwide, there is broad variation in serum lipid profile levels among different population groups. Increased serum levels of total cholesterol (TC), triglyceride (TG), low-density lipoprotein (LDL), and decreased high-density lipoprotein (HDL) are known to be associated with major risk factors for CVD.

The overall prevalence of HTN in Bangladesh was 26.4%, and the prevalence was higher in women (32.4%) than men (20.3%).[6]

Various measures of obesity including body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), and waist-to-height ratio have been used to diagnose obesity-related cardiovascular risk. WHR and waist-to-height ratio are also simple anthropometric parameters and are sometimes used as markers for abdominal adiposity.[7]

Globalization, increasing urbanization, changing lifestyles, and a more mechanized and stressful workplace directly affect dietary and physical activity patterns and ultimately increase the risk of such diseases. BMI is positively associated with both systolic blood pressure (SBP) and diastolic blood pressure (DBP). Weight loss significantly reduces blood pressure (BP), suggesting that BMI is not only a marker but also etiology associated with high BP.


  Materials and Methods Top


The study was conducted in the Department of Medicine, Maa-Shishu-O-General Hospital, Agrabad, Chattagram, from April 2018 to April 2019. A total of 131 patients were selected, 65 of them were newly diagnosed hypertensive patients and 66 participants with normal BP (normotensives) attending with other comorbidities. Patients with major comorbidities such as features of any cardiac, renal, or hepatic complications or major medical problems were excluded. Furthermore, those on lipid-lowering and antihypertensive medications taking for dyslipidemia and HTN were also excluded. After obtaining oral and written informed consent, data were collected, and anthropometric measurement and blood tests for serum lipid profile were sent to our biochemistry laboratory.

In this study, BP measurements were performed by specially trained doctors placed in outdoor. Sitting BP was measured after 10 min of rest with a standard adult sphygmomanometer at the mid of interview and again at the end. The mean BP value was used for the analysis. HTN was defined on the basis of the Joint National Committee-7 cutoff point of 140 mmHg and above for SBP and/or 90 mmHg and above for DBP.[8] All anthropometric measurements were taken by trained doctors with allowing only light clothes. A digital portable scale was used to measure body weight to the round figure as kilogram. The scale was calibrated to the zero after few intervals. Height was measured as centimeter with a stadiometer.

BMI (kg/m2) was calculated by weight in kilograms divided by the square of height in meters. Adults were classified according to their BMI into three groups: normal weight (BMI: 18.5–24.9 kg/m2), overweight (BMI: 25.0–29.0 kg/m2), and obese (BMI more than 30 kg/m2).[9] WC was measured above the iliac crest and below the lowest rib margin at minimum respiration. Hip circumference (HC) was measured at the widest part of the hip at the level of the greater trochanter to the nearest half centimeter.[10] The waist and HCs were measured with a flexible tape. Abdominal obesity was measured according to the WHO criteria as a WHR above 0.90 for males and above 0.85 for females. Lipids levels were classified according to the classification recommended by the National Cholesterol Education Program and Adult Treatment Panel III guidelines.[11] The desirable level of TC was <200 mg/dl, borderline high was between 200 and 239 mg/dl, and high TC was considered when the level was >240 mg/dl. LDL was defined as optimal level when it was <100 mg/dl, near-optimal level between 100 and 129 mg/dl, borderline high between 130 and 159 mg/dl, high between 160 and 189 mg/dl, and very high when it was >190 mg/dl. TG level was considered as normal when it was <150 mg/dl, borderline high between 150 and 199 mg/dl, high between 200 and 499 mg/dl, and very high when it was >500 mg/dl. Desirable HDL was considered when it was >40 mg/dl and low when it was <40 mg/dl.


  Results Top


About half of the patients (49.6%, n = 66) came from the age group of 31 to 40 years. Majority of the patients (62.6%, n = 82) were male. Most of the patients belonged from middle socioeconomic condition. The mean age, BP, anthropometric measurements, and fasting serum lipid levels of participants are shown in [Table 1]. The mean age, height, weight, and BMI were 34.3 ± 6.82, 158.1 ± 6.87, 60.3 ± 6.83, and 23.1 ± 3.28 accordingly. Statistically significant differences were found in BP recordings (P > 0.05). The mean SBP was 155.9 ± 9.18 in case group and 124.6 ± 22.06 in control group. The mean diastolic pressure was 96.70 ± 6.10 in case group and 78.45 ± 6.98 in control group. The BMI was 24.23 ± 3.3 in case group and 22.13 ± 2.92 in control group. Serum TG was 251.13 ± 85.9 in case group and 256.5 ± 73.5 in control group. TC and LDL were 230.2 ± 44.53 and 150.78 ± 32.9 in case group and 166.27 ± 30.45 and 98.9 ± 20.15 in control group accordingly [Table 2].
Table 1: Frequency table showing demographic profiles

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Table 2: Anthropometric variables and lipid profiles of case and control (n=131)

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Strong, positive correlation was found between high SBP and LDL (r = 0.517), high DBP and LDL (r = 0.560), and high DBP and TC (r = 0.514). Moderate, positive correlation was found between high SBP and TC (r = 0.479), high DBP and AC (r = 0.471), and high SBP and AC (r = 0.373). Weak, positive correlation was found between high SBP and WHR (r = 0.249), high DBP and WHR (r = 0.193), high SBP and BMI (r = 0.265), and high DBP and BMI (r = 0.297). Negative correlation was found between high DBP and TG (r = −0.061) [Table 3].
Table 3: Correlation of BP between different anthropometric indices

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  Discussion Top


The Framingham Heart Study, a famous study for 44 years, estimated that excess body weight (including overweight and obesity) accounted for approximately 26% of cases of HTN in men and 28% in women,[12] In our study, it relates to 24.5% of male and 38.7% of women accounts or overweight and obesity.

According to a survey in the Bangladeshi population, the prevalence of HTN is 17.9% in general, 18.5% in men and 17.3% in women. HTN is probably more common in the elderly population.[13]

In a Western study[14], for every 1 kg/m2 increase in BMI, 1.4-mmHg increase for men and a 1.2-mmHg increase for women were noted. In a Chinese study, for every 1 kg/m2 increase in BMI, a 1.7-mmHg increase for men and a 1.4-mmHg increase for women were noted.[15] Similarly, our analysis shows that high SBP and DBP is positively correlated with BMI.

The incidence of metabolic syndrome is higher in hypertensive patients when compared to the general population; in a study conducted in Bangladesh, among the hypertensive patients, 38.7% high WC, 68.8% low HDL-cholesterol (HDL-C), and 55.3% high TGs were noted.[16] In our study, a significant number of patients had low HDL (55.72%), 41.98% of patients had high LDL and 41.98% had high TG level in hypertensive patients.

Another study in Bangladesh showed that serum TC, TG, and LDL-cholesterol (LDL-C) were markedly raised (P > 0.001), whereas HDL-C was significantly lower (P > 0.001) in hypertensive as compared to controls in a study investigating serum lipid profile in hypertensive patients[17] that was similar or concordant to our study results.

In a recently published study, 19.5% of older persons in the rural area of Bangladesh, 20.8% of women, and 18% of men had metabolic syndrome.[18] The prevalence was higher in women and half of the metabolic syndrome patients were hypertensive in another study.

There is evidence of a relationship between serum lipids and BP. Furthermore, a combination of hyperlipidemia and HTN increased the risk of CVD.

Research has shown that low HDL-C, high LDL-C, and high TG levels are positively associated with an increase in BMI. Xu et al.[19] indicated that there was a significant upward trend for BP, TG, TC, and LDL-C to increase, whereas HDL-C decreases, with increasing BMI and WC adjustment for age. In this study, we observed that hypertensive overweight and obese patients had lower HDL-C levels than normal weight hypertensive people, but no statistical significance among BMI classes was noted. In the regression analysis model, LDL-C was found to associate with SBP in male and DBP in female positively, and HDL-C was found to associate with SBP in males negatively (P < 0.05). Similarly, in our study, high SBP and high DBP were strongly positively correlated with rising lactate dehydrogenase. High SBP was moderate positively correlated to TC, and high DBP was strong with TC. Very weak-positive correlation was found in hyper TG and high SBP whereas negative correlation was found in high DBP.


  Conclusion Top


HTN is one of the silent killers as it might be undiagnosed or many years until detected after developing various complications. As anthropometric study and lipid profiles are directly correlated with early detected HTN, early responsibilities should rely on primary physicians for curbing mortality and morbidities related to HTN.

Limitations

The study was done in single center based, and the sample size was 131, so the result may not directly reflect according to whole nations.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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Abu Siddique M, Sultan MA, Haque KM, Zaman MM, Ahmed CM, Rahim MA, et al. Clustering of metabolic factors among the patients with essential hypertension. Bangladesh Med Res Counc Bull 2008;34:71-5.  Back to cited text no. 13
    
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Chen Z, Smith M, Du H, Guo Y, Clarke R, Bian Z, et al. Blood pressure in relation to general and central adiposity among 500,000 adult Chinese men and women. Int J Epidemiol 2015;44:1305-19.  Back to cited text no. 15
    
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Saha MS, Sana NK, Shaha RK. Serum lipid profile of hypertensive patients in the Northern region of Bangladesh. J Bio Sci 2006;14:93-8.  Back to cited text no. 16
    
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Khanam MA, Qiu C, Lindeboom W, Streatfield PK, Kabir ZN, Wahlin Š. The metabolic syndrome: Prevalence, associated factors, and impact on survival among older persons in rural Bangladesh. PLoS One 2011;6:e20259.  Back to cited text no. 17
    
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Rahima MA, Khan AK, Sayeed MA. Metabolic syndrome in rural Bangladesh: Comparison of newly proposed IDF, modified ATP III and WHO criteria and their agreements. Diabetes Metabolic Syndrome Clin Res Rev 2007;1:251-2.  Back to cited text no. 18
    
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    Tables

  [Table 1], [Table 2], [Table 3]



 

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