End Organ Damage In Hypertensive Geriatric Age Group: A Cross ...

Advertisement IR: 12.51 Archives Vol 1 No 3 (2017) 10-16 Original Article End Organ Damage in Hypertensive Geriatric Age Group: A Cross Sectional Study

• Prakashkumar Kyada

Prakashkumar Kyada

×  Department of General Medicine, MGM Medical College, Navi Mumbai, India.

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• Kunal Jadhav

Kunal Jadhav

×  Department of General Medicine, MGM Medical College, Navi Mumbai, India.

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• T. K. Biswas

T. K. Biswas

×  Department of Geriatric Department, MGM Medical College, Navi Mumbai, India.

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• Varshil Mehta 

Varshil Mehta

×  MGM Medical College, Navi Mumbai, India. http://orcid.org/0000-0001-5804-9948 [email protected]

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• Sojib Bin Zaman

Sojib Bin Zaman

×  Department of Development Studies, University of Dhaka, Bangladesh. http://orcid.org/0000-0002-3043-7954

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Abstract

Objective: Hypertension is one of the common risk factors for cardiovascular and cerebrovascular diseases/disorders A developing country like India faces the double burden of communicable and non-communicable diseases; of the which, hypertension is the most important treatable cause of mortality and morbidity with loss of functional capacity and decline in the quality of life. Aim: To study the prevalence of end organ damage in the hypertensive geriatric age group. Method: The present study was a cross sectional study, conducted in 150 elderly patients admitted in MGM Hospital, Navi Mumbai, India with the diagnosis of stage I or II hypertension from 2011 to 2013. Results: Data analysis of the present study showed that 68% of elderly population aged between 60 to 69 years were suffering from hypertension. Compared to males, females had a higher rate of target organ damage. This study found that out of all patients with total end organ damage, 54.6 % had CVS complications, 15.7 % had hypertensive retinopathy, 25.9 % and 18.51 had raised creatinine and proteinuria respectively. 19.4 % had cerebrovascular accident (CVA) complications. Among Cardiovascular related complications Coronary artery disease (CAD) was found in 21 patients, out of them 7 had Congestive cardiac Failure (CCF). Left Ventricular Hypertrophy (LVH) was the most common complication and seen in 38 patients. 13.8 % patients had Regional Wall Motion Abnormality (RWMA) Conclusion: The present study concluded that Isolated Systolic Hypertension (ISH) is the commonest type of hypertension in geriatric age group. This study concluded that the most common risk factors of HTN in the elderly are sedentary life style, dyslipidemia and extra salt intake while the most common end organ damage was observed to be Left Ventricular Hypertrophy followed by renal dysfunction.

Keywords: Hypertension Isolated Systolic Hypertension Dyslipidemia

Introduction

High blood pressure is one of the most common risk factors for developing both the cardiovascular and cerebrovascular diseases. During the period of epidemiological transition, developing countries might face the double burden of communicable and non-communicable diseases. Of the non-communicable causes, hypertension is one of the most important treatable causes which is responsible to contribute high f mortality and morbidity around the world. Study found that, systolic blood pressure (SBP) continues to rise until 70-80 years of age while diastolic blood pressure shows the increased trend up to 50-60 years for a normal person [1].

High blood pressure among the elderly age group confers almost three to four fold increase in risk for the development of cardiovascular disease, as compared to the younger. Research suggested that hypertension affects more than half of the people who are aged 65 or older, and the prevalence of hypertension and its related complication continues to rise with age [2].

Hypertension often leads to complications involving the systems like that of cardiovascular, nervous system kidneys, retina etc. Several trials have demonstrated significant rise of blood pressure leading to target organ damage

The aim of the study is to find out the frequency of end organ damage among the hypertensive geriatric patients.

Methods & Materials

The present study was a cross sectional analytic study which was conducted among the 150 elderly patients whose age was above 60 years at MGM Hospital, Kamothe, Navi Mumbai.

Target Organ Damage Definition

End organ damage usually refers to damage occurring in major organs fed by the circulatory system (heart, kidneys, brain, eyes) which can sustain damage due to uncontrolled hypertension, hypotension, or hypovolemia. The present study used the following reference points to conclude the presence of the end organ damage.

For heart: evidence on electrocardiogram screening of the heart muscle thickening up (but may also be seen on chest X-ray) suggesting left ventricular hypertrophy) or by echocardiography of less efficient function (left ventricular failure) [3].

For Kidneys: the presence of leakage of protein into the urine (albuminuria or proteinuria), or reduced renal function [3].

Inclusion & Exclusion Criteria

The participants were selected purposively from 2011 to 2013. Geriatric patients who were hypertensive as per the criteria of Joint National Committee 7 (JNC-7) were included [4]. The patients were later classified according to the target organ complication/s. All other patients below the age of 60 years was excluded.

Data Collection

Clinical evaluation was done by using a structured questionnaire which was prepared following the medical condition. Other information collected was as follows: past or present history of angina pectoris, myocardial infarction, transient ischemic attacks, cerebrovascular disease, hypertensive encephalopathy, renal failure and left ventricular failure based on history or medical records. This was followed by a complete physical examination and necessary investigations like Electrocardiogram, Echocardiographic correlations and end organ complications of cardiovascular, cerebrovascular and renal system. Descriptive statistics were used to present the study findings. The participants were further classified in stage I or stage II as per the JNC-7 criteria. Stage I includes the patients whose blood pressure was between 140-159 mmHg. Stage II included patients having blood pressure above 160 mmHg. All the data management, and data analysis was conducted by IBM SPSS software (Version 20.0).

Ethics

The study proposal was approved by the MGM Medical College’s Ethics Review Committee.

Results

150 elderly patients having stage I or stage II hypertension were studied. 49% patients had systolic blood pressure (SBP) between 140-159 mmHg (Stage I) and 51% patients had SBP > 160 mmHg (Stage II). Out of total patients, 56 (37%) were female and 94 (62%) were male. About 74 patients had stage I HTN while 74 had stage II HTN. Among them 108 (72%) patients developed target organ damage (table 1).

Table 1. . Distribution according to gender and stage of HTN

Category	Frequency	Percentage
Gender
Females	56	37.3
Males	94	62.7
Hypertension Stage
Stage 1	74	49.3
Stage 2	76	50.7
Target organ damage
Present	108	72.0
Absent	42	28.0

Table 2. . Descriptive statistics for patient’s characteristics *BMI: Body Mass Index; W/H: Weight by height; SBP: Systolic Blood Pressure; DBP: Diastolic Blood Pressure.

Category	Mean	Standard Deviation (SD)
Age (Years)	67.06	6.35
Height (cm)	161.24	11.85
Weight (kg)	62.58	10.15
BMI	24.36	5.04
W/H Ratio	0.91	0.18
SBP	161.53	12.73
DBP	84.97	4.47

We found significant correlation between SBP (Stage I and II) and end organ complications. 68% of patients with Stage I Isolated Systolic Hypertension (ISH) suffered target organ damage. 78% of patients with Stage II ISH suffered target organ damage. Hence earlier diagnosis and treatment of ISH would reduce target organ damage. Most common clinical presentation was headache (35%), and dyslipidemia (31%) among the study participants. 24% were smokers and 24% alcoholics and 34% patients were taking extra salt diet. We also found significant correlation (pGoogle Scholar

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