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Research Article Palliative Medicine & Care: Open Access Open Access A Comparative Observational Study of Blood Pressure Levels among Different Groups of Hypertensive Patients On The Basis Of Gender and Age Ali1, Syed M Ali2, Syed Muhammad ZHN3, Aileeya F4, Adnan A5, Zarghoona W6, Neeta M7*, Sana N8, Syeda H Fatima9, Abdulwaasey M10

1MBBS, DHQ Teaching Hospital, Gujranwala,

2Medical Student, Hamdard College of Medicine and Dentistry, Pakistan

3MBBS, MSBE Assistant Professor, Department of Community Medicine, , , Pakistan

4MBBS, House Officer, Abbasi Shaheed Hospital, Karachi, Pakistan

5MBBS, Senior Lecturer, Department of Physiology, Altibri Medical College Karachi, Karachi, Pakistan

6MBBS, M. Assistant, Musavvir Stem cell clinic and pathology laboratory

7Manager Medical Affairs and Clinical Research, Hilton Pharma Pvt ltd, Pakistan

8MBBS, MPH, Assistant Professor, Department of Community Medicine, , Lahore, Pakistan

9MBBS, House officer, Abassi Shaheed Hospital, Karachi, Pakistan

10MBBS, Resident Memon Hospital, Karachi, Pakistan

Received: October 19, 2017; Accepted: October 27, 2017; Published: November 16, 2017

*Corresponding author: Neeta Maheshwary, Manager Medical Affairs and Clinical Research, Hilton Pharma Pvt ltd, Pakistan,

E-mail: [email protected]

Abstract Background: Although literature suggests that the risk of cardiovascular mortality associated with mixed hypertension and isolated systolic

factorshypertension affecting is significantly the levels of highersystolic than and normotension, diastolic blood it pressures is not the in case such with patients. isolated diastolic hypertension. This difference in the effects of mixed hypertension, isolated systolic hypertension and isolated diastolic hypertension on the well-being of the patients stimulates interest in the potential Objective: or isolated diastolic hypertension. To assess the effect of gender and age on the blood pressure levels in patients with mixed hypertension isolated systolic hypertension Material and Methods:

After taking ethical approval from Urban Hospital, Karachi campus, a cross-sectional multicenter study was carried out among 174 patients aged 18 years or above with self-reported history of hypertension. After taking a brief medical history with the help of a structured questionnaire, the blood pressure of the patients was measured by using sphygmomanometer with stethoscope to assess hypertension level.Results: The duration of study was 6 months. mean systolic blood pressure than those with mixed hypertension (p=0.047) while among females patients those with isolated diastolic hypertension The study results revealed that among male patients those with isolated systolic hypertension had a statistically significantly lower systolic hypertension had lower mean systolic blood pressure than those with mixed hypertension whereas among >40 years old patients those with isolatedhad lower systolic mean or diastolic diastolic blood hypertension pressure hadthan lower those mean with systolic mixed hypertension.and diastolic blood Furthermore, pressures among respectively ≤40 years than oldthose patients with mixed those hypertension. with isolated

Conclusion: systolic blood pressure than those with mixed hypertension. Further evaluation of the role of gender and age in the control of blood pressure levels in above mentionedThe groups study of results hypertensive revealed patients that male is recommended. patients with isolated systolic hypertension had a statistically significantly lower mean

Keywords: Blood Pressure Level; Mixed Hypertension; Isolated Systolic Hypertension; Isolated Diastolic Hypertension; Gender; Age

Symbiosis Group *Corresponding author email: [email protected] A Comparative Observational Study of Blood Pressure Levels among Different Copyright: Groups of Hypertensive Patients On The Basis Of Gender and Age © 2017 Ali, et al.

Introduction et al.,After in 2001 taking and aMidha brief Tmedical et al., in 2012.[8,9]history with the help of a world adult population in the year 2000 and this percentage is Hypertension has been reported to affect 26.4% of the was measured by using sphygmomanometer with stethoscope tostructured assess hypertension questionnaire, level. the Patients blood pressure with history of the of patientscardiac inprojected economically to increase developing by the year countries.[1]According 2025 to 29.2% and out to of aWorld total of 972 million adults affected in the year 2000, 639 million were events, neurological disorders, cluster headache, diabetes, Health Organization estimates, hypertension affects about 40% gastrointestinal disease, visual problems, epistaxis and morbid itof increases adults above the risk 25 yearsof various of age medical and causes conditions 7.5 million such as deaths heart study.obesity were excluded from the study. Those patients who were annually, representing more than 12% of all deaths globally and not on anti-hypertensive medication were also excluded from the

Asattack, per the stroke, latest kidney guidelines failure of andthe Joint blindness National but Committee despite being for SPSS version 20 was used to code, enter and analyze the a serious health problem, it is preventable and treatable.[2] collected data. After checking for normality, inferential analysis was performed using Kruskal Wallis test. The significance level guidelineshypertension suggest management initiation (JNC of a 8), pharmacologic both lifestyle modificationstreatment when as wasResults set at 0.05.The duration of study was 6 months. well as blood lowering medications are recommended.[3]These

found to have normal levels of both systolic and diastolic blood [4]blood pressure is 140/90 mmHg or higher in adults younger than Out of total 174 patients included in the study, 22 were 60 years, or 150/90 mm Hg or higher in adults 60 years and older. pressures and thus were excluded from final analysis, leaving a isolatedThough diastolic mixed hypertension hypertension has not. andWhile literature isolated suggests systolic total of 152 patients. hypertension have been frequently defined as separate entities, that the risk of cardiovascular mortality associated with mixed isolatedThe systolic stratified hypertension analysis on and the isolated basis of diastolic gender hypertension to compare revealedblood pressure that among among male patients patients with there mixed was a hypertension, statistically hypertension and isolated systolic hypertension is significantly higher than normotension, it is not the case with isolated of those with isolated systolic hypertension and those with mixed hypertensionsignificant difference where thebetween former the had mean lower systolic mean blood systolic pressure blood isolateddiastolic systolic hypertension. hypertension [5]It also as comparedreports that to thoseall-cause with mortality isolated rates in males aged above 50 years were highest in those with pressure than the later (142.86±7.55 mm hg vs. 151.97±10.04 diastolic hypertension and normal blood pressure. [6] patients or mean systolic and diastolic blood pressures among systolic hypertension and isolated diastolic hypertension on the mm hg, p=0.047). The mean diastolic blood pressure among male This difference in the effects of mixed hypertension, isolated between those with mixed hypertension and those with isolated factors affecting the levels of systolic and diastolic blood systolicfemale patientsor diastolic were hypertension. not statistically Among significantly females patients different the well-being of the patients stimulates interest in the potential mean diastolic blood pressure of those with isolated diastolic with the objective of assessing the effect of gender and age on hypertension was found to be lower than mean diastolic blood pressures in such patients. This study was therefore conducted pressure of those with mixed hypertension but the difference was isolated systolic hypertension or isolated diastolic hypertension. the blood pressure levels in patients with mixed hypertension, Patients and Methods statistically non-significant (p=0.429) [Table 1].

systolicThe stratifiedhypertension analysis and on theisolated basis ofdiastolic age to comparehypertension blood revealedpressure that among the patientsmean systolic with and mixed diastolic hypertension, blood pressures isolated After taking ethical approval from urban hospital, Karachi campus, a cross-sectional multicenter study was carried out among patients with self-reported history of hypertension. By aged 18 years or above were included in the study. Patients were hypertensionamong both ≤40and yearsthose and with >40 isolated years oldsystolic patients or werediastolic not using convenient sampling technique, a total of 174 patients statistically significantly different between those with mixed blood pressure of those with isolated systolic hypertension was divided in three groups according to their blood pressure levels, foundhypertension. to be lower Among than ≤40 mean years systolic old patients blood pressure the mean of systolic those those with mixed hypertension, those with isolated systolic with mixed hypertension but the difference was statistically seventhhypertension, report andof the those Joint with National isolated Committee diastolic (JNC hypertension. 7) though Mixed hypertension was defined as per the guidelines of the patients with both stage I and stage II hypertension were mean systolic and diastolic blood pressures of those with isolated considered to have mixed hypertension. [ 7] Isolated systolic systolicnon-significant or diastolic (p=0.37). hypertension Among >40 respectively years old werepatients found both to the be lower than mean systolic and diastolic blood pressures of those with mixed hypertension but the differences were statistically (systolichypertension blood (systolic pressure blood <140 pressure mmHg and ≥140 diastolic mmHg blood and pressurediastolic blood pressure <90 mmHg) and isolated diastolic hypertension non-significant (p=0.305 and p=0.541 respectively) [Table 2]. ≥90 mmHg) were defined as per the criteria used by Franklin SS Citation: et al. (2017) A Comparative Observational Study of Blood Pressure Levels among Different Groups of Hypertensive Page 2 of 4

Ali, Ali SM, Patients On The Basis Of Gender and Age. Palliat Med Care 4(4): 1-4. DOI: http://dx.doi.org/10.15226/2374-8362/4/4/00145 A Comparative Observational Study of Blood Pressure Levels among Different Copyright: Groups of Hypertensive Patients On The Basis Of Gender and Age © 2017 Ali, et al.

Table 1:

Blood Pressure Comparison among Patients with Mixed Hypertension, Isolated Systolic Hypertension and Isolated Diastolic Hypertension: Gender wise Stratified Analysis Males Variables Mean±S.D p* Mixed Hypertension1 Systolic Blood Pressure (mm Hg) 0.047 2 Isolated Hypertension 151.97±10.04 1 Mixed Hypertension 142.86±7.55 Diastolic Blood Pressure (mm Hg) Isolated Hypertension 95.43±5.49 3 >0.999 Females 97.50±15.00 Variables Mean±S.D p* Mixed Hypertension4 Systolic Blood Pressure (mm Hg) Isolated Hypertension 152.26±13.18 3 4 >0.999 Mixed Hypertension 152.50±15.00 Diastolic Blood Pressure (mm Hg) Isolated Hypertension 95.05±4.51 5 0.429 90.00±0.00 1 *Kruskaln=70 Wallis Test 2n=7 n=4 3 4

n=65n=2 5

Table 2:

Blood Pressure Comparison among Patients with Mixed Hypertension, Isolated Systolic Hypertension and Isolated Diastolic Hypertension: Age wise Stratified Analysis ≤40 Years Variables Mean±S.D p*

Mixed Hypertension1 Systolic Blood Pressure (mm Hg) Isolated Hypertension2 150.06±12.43 0.37 Mixed Hypertension1 140.00±0.00 Diastolic Blood Pressure (mm Hg) … Isolated Hypertension 94.00±3.36… 3 >40 Years Variables Mean±S.D p*

Mixed Hypertension4 Systolic Blood Pressure (mm Hg) Isolated Hypertension 154.19±10.40 5 0.305 Mixed Hypertension4 147.00±11.59 Diastolic Blood Pressure (mm Hg) Isolated Hypertension 96.51±6.05 6 0.541 95.00±12.24 1 *Kruskal Wallis Test 2 n=68n=1 n=0 3 4

n=67n=10 5

6 n=6

Citation: et al. (2017) A Comparative Observational Study of Blood Pressure Levels among Different Groups of Hypertensive Page of 4

Ali, Ali SM, 3 Patients On The Basis Of Gender and Age. Palliat Med Care 4(4): 1-4. DOI: http://dx.doi.org/10.15226/2374-8362/4/4/00145 A Comparative Observational Study of Blood Pressure Levels among Different Copyright: Groups of Hypertensive Patients On The Basis Of Gender and Age © 2017 Ali, et al.

Discussion Conclusion

those with isolated systolic hypertension had a statistically lowerThe mean study systolic results revealedblood pressure that among than malethose patients with mixed those The study results revealed that among male patients hypertensionwith isolated systolic while among hypertension females had patients a statistically those with significantly isolated diastolic hypertension had lower mean diastolic blood pressure andsignificantly diastolic lower blood mean pressures systolic were blood observed pressure in than patients those with than those with mixed hypertension though the difference was mixed hypertension. No significant differences between systolic diastolic hypertension among females or with respect to their ages.mixed Further hypertension, evaluation isolated of the systolic role hypertensionof gender and and age isolated in the statistically non-significant. control of blood pressure levels in above mentioned groups of patients those with isolated systolic hypertension had lower hypertensive patients is recommended. meanThe systolic study bloodresults pressure further thanrevealed those that with among mixed ≤40 hypertension years old Conflicts of Interest among >40 years old patients those with isolated systolic or All authors have none to declare. diastolicthough the hypertension difference washad statisticallylower mean non-significant systolic and whereasdiastolic blood pressures respectively than those with mixed hypertension References 1.

though the differences were again statistically non-significant. Kearney PM, Whelton M, Reynolds K, Muntner P, Whelton PK and He J. conclusion that the blood pressure levels are poised to be lower Global burden of hypertension: analysis of worldwide data. The lancet. if anyThe of studythe systolic results or clearlydiastolic point blood out pressure towards is within one expected normal 2. 2005;365(9455):217-223. Doi:10.1016/S0140-6736(05)17741-1 WorldNC 8 Hypertension Health Day 2013. Guideline WHO.2013. Algorithm. Joint National Committee.2014. limits after taking anti-hypertensive medication than if none of 3.4. AJ rmstrong C. Joint National Committee. JNC8 guidelines for the management of hypertension in adults. American family physician. boththem systolicis within and normal diastolic limits. blood This ispressures because ifand an antihypertensivenot for only one ofmedication them. is effectively lowering blood pressure, it will do so for 2014;90(7):503-504. of isolated systolic and isolated diastolic hypertension as assessed 5. Hozawa A, Ohkubo T, Nagai K, Kikuya M, Matsubara M, Tsuji I, et al. Prognosis pronounced among males with isolated systolic hypertension. Moreover, and unexpectedly, this trend was found to be more by self-measurement of blood pressure at home: the Ohasama study. that females have a higher prevalence of blood pressure than Archives of internal medicine. 2000;160(21):3301-3306. Doi:10.1001/ This warrants further evaluation as though it has been shown archinte.160.21.3301 Smith WM. Mortality associated with diastolic hypertension and isolated 6. systolicRutan GH, hypertension Kuller LH, among Neaton men JD, screened Wentworth for the DN, Multiple McDonald Risk RH Factor and whichmales, theymay arelead not to knownless effective to have bloodhigher pressure blood pressure control levels than than males, either with or without anti-hypertensive medication, 7. Intervention Trial. Circulation. 1988;77(3):504-514.

males. [10] Literature rather reports contrary findings, as a study Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, by Ong KL et al., in 2008 showed that blood pressure control in et al. The seventh report of the Joint National Committee on prevention, females was not significantly inferior as compared with males. detection, evaluation, and treatment of high blood pressure. National High [11] A study by Wiinberg N et al., in 1995 also showed males to Blood Pressure Education Program. JAMA. 2003;289(19):2560-2572. [12] A review article by Reckelhoff JF in 2001 also found males to 8. Doi:10.1001/jama.289.19.2560 have significantly higher systolic blood pressure than females. Franklin SS, Jacobs MJ, Wong ND, Gilbert JL, Lapuerta P. Predominance of isolated systolic hypertension among middle-aged and elderly US have higher blood pressure levels than females. [13] hypertensives. Hypertension. 2001;37(3):869-874. hypertensionWith regard tend to to thehad studylower findingmean blood that pressure in any oflevels the than two 9. Midha T, Lalchandani A, Nath B, Kumari R, Pandey U. Prevalence of isolated age groups i.e. ≤40 years or >40 years patients with isolated diastolic hypertension and associated risk factors among adults in Kanpur, India. indian heart journal. 2012 Aug 31;64(4):374-379. DOI:10.1016/j. as search did not reveal any relevant published literature. 10. patients with mixed hypertension, no comparison could be made ihj.2012.06.007 Limitation and Recommendation Kokiwar PR, Gupta SS, Durge PM. Prevalence of hypertension in a rural 11. community of central India. J Assoc Physicians India. 2012 ;60(6):26-29. control and cardiovascular risk factors in Americans with diagnosed a moderate sample size but it is acknowledged that the use of Ong KL, Tso AW, Lam KS, Cheung BM. Gender difference in blood pressure a largerDue tosample resource size constraint,would have this resulted study in was more conducted precise withand hypertension. Hypertension. 2008 Apr 1;51(4):1142-1148. Doi:10.1161/ illuminating estimates of the associations evaluated by this study. 12. HYPERTENSIONAHA.107.105205

gender and age in the control of blood pressure levels in different Wiinberg N, Høegholm A, Christensen HR, Bang LE, Mikkelsen KL, Nielsen In light of the study findings, it is recommended that the role of PE, et al. 24-h ambulatory blood pressure in 352 normal Danish subjects, groups of hypertensive patients warrants further examination related to age and gender. AmJ Hypertens.1995;8(10Pt1):978-986. ReckelhoffDoi:10.1016/0895-7061(95)00216-2 JF. Gender differences in the regulation of blood pressure. management of hypertension in such patients. as it can have significant implication on the approach towards 13. Hypertension. 2001;37(5):1199-1208. Citation: et al. (2017) A Comparative Observational Study of Blood Pressure Levels among Different Groups of Hypertensive Page 4 of 4

Ali, Ali SM, Patients On The Basis Of Gender and Age. Palliat Med Care 4(4): 1-4. DOI: http://dx.doi.org/10.15226/2374-8362/4/4/00145