Oxidative stress and inflammation in patients presenting with hypertension and type 2 diabetes at the Shai-Osudoku District Hospital, Dodowa

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July, 2015
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Increasing evidence has highlighted the roles of oxidative stress and inflammation in the promotion of hypertensive and type 2 diabetic complications. Inflammation which can lead to overproduction of reactive oxygen species triggers oxidative stress in patients presenting with hypertension and type 2 diabetes (T2DM). The purpose of this study was to evaluate oxidative stress and inflammatory markers in patients presenting with hypertension (HPTN) and T2DM. The study was conducted from October 2013 to July 2015 at the Diabetic/hypertensive clinic and Laboratory Unit of the Shai-Osudoku District Hospital, in the Shai-Osudoku District of the Greater Accra Region of Ghana. The study population consisted of 250 participants: 100 controls and 150 patients with T2DM, HPTN and HPTN/T2DM as “case groups”. Based on clinical and laboratory criteria, the participants were classified into four (4) groups: normal participants (control=100), normotensive patients with T2DM (T2DM, n=50), patients with hypertension (HPTN, n=49) and hypertensive patients with T2DM (HPTN + T2DM, n=51.Serum Total Antioxidant Capacity was significantly decreased among case participants as compared to the controls (p=0.033). This decrease was more prominent (p-value < 0.01) in participants presenting with both chronic conditions (T2DM and HPTN) with mean value of 1.07±0.43Mm. Of all the inflammatory markers compared, case participants had higher levels, with significant differences in Erythrocyte Sedimentation Rate, (p < 0.0001) and the high-sensitivity C-reactive protein, (p=0.0011) but not Tumour necrosis factor-alpha, (P=0.883) and White blood cell, (p=0.1536). High-sensitivity C-reactive protein was significantly increased in T2DM (p < 0.01) and hypertensive participants (p < 0.01). The high levels were marked (p < 0.001) in participants presenting with T2DM/HPTN. The prevalence of metabolic v syndrome among the case participants was significantly higher than the control participants (21.3% vs. 2%) using National Cholesterol Education Programme, (NCEP ATP III) criteria. Intra-group metabolic syndrome (MetS) differences was observed among the cases, with the proportion of MetS increasing from those presenting with HPTN (8.2%) and with T2DM (25.5%) to a maximum among the participants presenting with T2DM/HPTN (30%). Lipid indices except high density lipoprotein cholesterol were found to be higher among the case participants than the control participants (p < 0.0001 each). Patients with the two associated diseases have a more active inflammatory and oxidative stress. MetS has been demonstrated to be significantly associated with inflammation in patients with HPTN and T2DM. Both T2DM and HPTN are strongly associated with hyperlipidaemia and obesity, besides being powerful risk factors for cardiovascular disease. Since inflammation is known to affect T2DM and HPTN in pathways that implicate endothelial dysfunction, hence endothelial markers of vascular integrity such as VCAM-1, Oxidized LDL and Nitric Oxide in the various disease groups can be investigated.
A thesis submitted to the Department of Molecular Medicine, School of Medical Sciences, Kwame Nkrumah University of Science and Technology in partial fulfillment of the requirement for the Degree of Master of Philosophy,