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Study of Essential Hypertension with Special Reference to End Organ Damage in Adults

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Study of Essential Hypertension with Special Reference to End Organ Damage in Adults International Journal of Advances in Medicine Rukmini RM et al. Int J Adv Med. 2018 Oct;5(5):1227-1233 http://www.ijmedicine.com pISSN 2349-3925 | eISSN 2349-3933 DOI: http://dx.doi.org/10.18203/2349-3933.ijam20183899 Original Research Article Study of essential hypertension with special reference to end organ damage in adults Rukmini Ramya M.*, Rajya Lakshmi M. Department of General Medicine, Rangaraya Medical College, Kakinada, Andhra Pradesh, India Received: 30 June 2018 Revised: 10 July 2018 Accepted: 27 July 2018 *Correspondence: Dr. Rajya Lakshmi M., E-mail: [email protected] Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. ABSTRACT Background: Hypertension, a major public health concern, affecting 20-25% of the adult population. It is the major risk factor for diseases involving Cardio Vascular (CV) and renal system. The World Health Organization (WHO) has estimated that high Blood Pressure (BP) causes 1 in every 8 deaths, making hypertension the third leading killer in the world. The recent emerging trend in the treatment of hypertension is not only based on the pragmatic need to lower BP levels, but also on lowering the CV risk profile, which is largely linked to the presence of the end organ damage. Methods: One hundred patients with hypertension are recruited in this study. The ethics committee of Rangaraya Medical College, Kakinada approved this study and all the participants provided informed consent for all the procedures in the study protocol. Results: Majority of the patients (40%) with EOD have hypertension of >10 years duration. The relative frequency of various end organ damages (CVS: 34%, CNS: 17%, kidney: 12% and eye: 10%) is also high in patients with hypertension of >10 years duration. Conclusions: A significant proportion of hypertensive subjects had documented associated EOD, with LVH being the most prevalent EOD. The above findings emphasize the important role of the primary care clinicians to the early detection, treatment and control of high blood pressure that might help to reducing overall cardiovascular risk. Keywords: Essential hypertension, End organ damage, Risk factors INTRODUCTION modified lifestyle (such as smoking, high fat diet, stress and physical inactivity), the prevalence of hypertension Hypertension, a major public health concern, affecting has become more prominent. Various studies have shown 20-25% of the adult population.1 It is the major risk factor a significant and continuous relationship between high for diseases involving Cardio Vascular (CV) and renal BP levels and increased risk of end organ damage in system.2 The World Health Organization (WHO) has terms of CV mortality, Myocardial Infarction (MI), 1 estimated that high Blood Pressure (BP) causes 1 in every stroke and vascular disease. Elevated Systolic Blood 8 deaths, making hypertension the third leading killer in Pressure (SBP) and Diastolic Blood Pressure (DBP) are the world. Globally, there are one billion hypertensive associated with number of risks including the mortality patients and 4 million people die annually as a direct risk, which is doubled for every 20/10 mmHg increase in 2 result of hypertension.1 The number of adult hypertensive SBP/DBP level from the level of 115/75mmHg. There is patients are predicted to increase from 972 million in year strong evidence that patients with End Organ Damage 2000 to 1.56 billion in year 2025.2 With increase in (EOD) associated with hypertension have a higher International Journal of Advances in Medicine | September-October 2018 | Vol 5 | Issue 5 Page 1227 Rukmini RM et al. Int J Adv Med. 2018 Oct;5(5):1227-1233 morbidity and mortality, which can be reduced by 99mmHg and stage 2 if SBP is >160mmHg or DBP is accurate evaluation and management of hypertension.3 >100mmHg. The recent emerging trend in the treatment of hypertension is not only based on the pragmatic need to Hemoglobin (Hb), fasting blood sugar (FBS), lipid lower BP levels, but also on lowering the CV risk profile, profile, blood urea nitrogen (BUN), serum creatinine (S which is largely linked to the presence of the end organ Cr), complete urine examination, 24hr urinary proteins, damage.1 chest x-ray (CXR) electrocardiogram (ECG), USG abdomen, and fundoscopy are done for all the patients. Hence this study is intended to study prevalence of Echocardiography and CT Brain are done in necessary various patient characteristics like age, sex, Body Mass patients. Index (BMI), smoking, alcoholism, stage and duration of hypertension and their relation to the end organ damage All the patients are evaluated with CXR to detect profile in local population. cardiomegaly. ECG is taken to detect Left Ventricular Hypertrophy (LVH) according to Sokolow-Lyon voltage METHODS criteria (SV1+RV5> 3.5mV, R aVL> 1.1mV) and Cornell voltage criteria ( SV3 + R aVL ≥ 2.8mV (for Present study is descriptive cross-sectional study men), SV3 + R aVL>2.0mV (for women)), ischemic conducted in the department of Medicine, Government heart disease (IHD) with Q waves and ST-T changes, General Hospital, Kakinada from November 2015 to atrial fibrillation (AF) with varying R-R interval and August 2017. absence of p waves. Those having abnormal ECG are further evaluated with 2D-Echocardiography. Inclusion criteria Patients presenting with symptoms of raised intracranial • Patients above the age of 40 years with hypertension tension and focal neurological deficits are evaluated with as per JNC 7 attending outpatient and inpatient CT (computed tomography) brain to detect infarcts, intra facilities in department of Medicine are eligible for cerebral hemorrhage (ICH), sub-arachnoid hemorrhage enrolment (SAH) and hypertensive encephalopathy. • Only the patients with essential hypertension are enrolled. Chronic kidney diseases are defined as persistent proteinuria in the absence of urinary tract infection or Exclusion criteria impaired glomerular filtration rate (60 ml/min/1.73m2) according to Cockcroft-Gault equation. • Patients younger than 40 years • Patients with secondary hypertension. Creatinine Clearance [Cr Cl] (ml/min) = One hundred patients with hypertension are recruited in (140- age) X body weight (kg) this study. The ethics committee of Rangaraya Medical College, Kakinada approved this study and all the 72 X plasma creatinine (mg/dl) participants provided informed consent for all the procedures in the study protocol. Detailed history is (multiply with 0.85 for women) taken, and thorough clinical examination is done for all patients recruited to the study. Fundus is examined using direct ophtholmoscope and retinopathy is classified into 4 grades according Keith Measurement of blood pressure (BP) Wegener and Barker classification. Grade 3 and 4 retinopathy are used as evidence of EOD in the eyes. BP measurement of right upper arm is done with standard mercury sphygmomanometer with appropriate cuff sizes End organ damage (EOD) is studied in relation to age, i.e. width of the bladder of the cuff is equal to at least sex, life style pattern, smoking, alcoholism, high salt diet, 40% of arm circumference and the length of the cuff BMI, stage and duration of hypertension and compliance bladder is enough to encircle at least 80% of the arm to treatment and significance of their association with circumference. After the patient has rested for five EOD is analyzed. minutes and ensuring that he/she had not smoked or taken coffee within 30 minutes of measuring the BP, SBP is Statistical analysis taken as the first of at least two regular tapping Korotkoff sounds and DBP as the point at which last regular All statistical analyses are performed using the SPSS 19.0 Korotkoff sounds is heard. Two BP readings are taken at for Windows platform. Data is summarized using intervals of 2 minutes and the average reading is descriptive statistics. Chi square test is used to analyze calculated. According to JNC 7, hypertension is classified group difference. For all statistical tests of significance, into stage 1 if SBP is 140-159mmHg or DBP is 90- the values are two tailed and unless. International Journal of Advances in Medicine | September-October 2018 | Vol 5 | Issue 5 Page 1228 Rukmini RM et al. Int J Adv Med. 2018 Oct;5(5):1227-1233 RESULTS patients is 161.8 (±23.3) mmHg and DBP is 98 (±10.4) mmHg. Hypertension is graded as stage 1 (SBP is 140- In present study of 100 hypertensive patients 63 are men 159mmHg or DBP is 90-99mmHg) and stage 2 (SBP is and 37 are women. In the present study majority of the >160mmHg or DBP is >100mmHg) as per the guidelines patients (34%) are in the age group of 60-69 years. Fifty of JNC 7. In the present study 56% patients belong to eight percent of the patients are above the age of 60 stage 1 hypertension and 44% of the patients belong to years. Mean age of the patients studied is 61.9 (±8.7). Out stage 2 hypertension. of 100 patients 52 (47 men and 5 women) have active life style and 48 (16 men and 32 women) have sedentary life Out of 100 patients 49 patients (31 men and 18 women) style. are compliant to treatment and 51 (32 men and 19 women) are non-compliant. Out of 100 patients studied Table 1: Baseline character of the patients. 67 (44 men and 23 women) patients are having end organ damage due to hypertension. Thirty three patients (19 Variables Groups Male Female Total (%) men and 14 women) do not have any end organ damage. 40-49 yrs 10 6 16 (16%) 50-59 yrs 18 8 26 (26%) Table 3: Prevalence of risk factors. Age (yrs) 60-69 yrs 23 11 34 (34%) ≥70 yrs 12 12 24 (24%) Risk Factors Men Women Total (%) Family H/O Total 63 37 100 25 14 39 (39%) Active 47 5 52 (52%) hypertension Life style Sedentary 16 32 48 (48%) Smoking 34 4 38 (38%) Normal 40 17 57 (57%) Alcoholism 28 0 28 (28%) Over High salt diet 25 14 39 (39%) 17 12 29 (29%) BMI weight Diabetes mellitus 11 5 16 (16%) Obese 6 8 14 (14%) Dyslipidemia 11 12 23 (23%) 0-5 yrs 12 10 22 (22%) 6-10 yrs 26 10 36 (36%) Out of 100 patients 38 patients are asymptomatic.
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