Review for 10.1186/s12876-022-02149-5 (2022)

Reviewer’s report
Title: 
The Association Between Hypertension and The Risk Of Gallstone
disease: A Cross-sectional Study
Version: 
0 
Date: 
04 Jun 2021
Reviewer: 
Srikanth Gopi
Reviewer's report:
The article explored the epidemiological association between the gall stone
disease and hypertension by analyzing the data collected from all the subjects
attending a large tertiary care center for physical examination. They observed
that the prevalence of gall stone disease was 8.6% and the hypertension was
significantly associated with gall stone disease risk with a significant dose-
response association. The authors must be commended for the large sample size. 
My comments are:
1. The most important determinant in the management of gall stone disease is
symptoms due to gall stones. This was not assessed in the patients with gall
stones although we may assume that post cholecystectomy patients were
symptomatic earlier. 
2. The definition of hypertension was based on the blood pressure reading during
the hospital visit and hence there was a risk of missing the hypertensive patients,
whose blood pressure had been controlled by anti-hypertensive drugs, the details
of which were not available in the study. 
Gall stones once formed are less likely
to be dissolved by themselves. Analysis including hypertensive patients on drugs
with well controlled blood pressure may be more informative to evaluate
hypertension as a risk factor of gall stone disease.
3. The previous co-morbidities of the subjects like diabetes, dyslipidemia was
not mentioned as fasting blood sugar and lipid profile alone would not be
sufficient to diagnose these disorders in patients on treatment. 
4. In the article, my understanding is that hypertensive subjects were cases, and
the rest were controls. In table 2, OR for gall stone disease was higher for
controls than cases. The confusion must be clarified. 
5. The provided data established only an association between hypertension and
gall stone disease but not a causal relationship. Hence, a recommendation of
early screening and different prevention strategies in hypertension cannot be
done as done by the authors in the conclusion section. 
6. In results section on prevalence of gall stones in males and females (page 9,
lines 6-9 and page 14, lines 54-57), the wording and prevalence rates can be
rewritten so as to easily understand it. The prevalence of gall stone disease in
males and females was 7.1% and 10.4% as per the demographic data. 
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