ECHOCARDIOGRAPHIC ASSESSMENT OF HYPERTENSIVE CHANGES IN ELDERLY PATIENTS OF ISOLATED SYSTOLIC HYPERTENSION WITH SPECIAL REFERENCE TO CARDIOVASCULAR COMPLICATIONS
Objective: The objective of the study was to assess the echocardiographic changes and cardiovascular complications in patients with isolated systolic hypertension (ISH).
Methods: This was an observational cross-sectional study done in the Departments of General Medicine, Cardiology, and Radiodiagnosis of MKCG Medical College and Hospital, Berhampur, Odisha, India. Seventy patients above the age of 65 years with systolic blood pressure (BP) ≥140 mm Hg and diastolic BP <90 mm Hg, without any secondary causes of hypertension and antihypertensive drug therapy were selected for this study. Echocardiography and electrocardiography studies were implemented for demonstrating the development of cardiovascular complications.
Results: Of 70 cases (41 males and 29 females), 64.3% were asymptomatic and 35.7% were symptomatic, with palpitation being the major symptom, 40% (28 cases) developed retinopathy, 45.71% developed increased left ventricular mass index (p=0.04), 18.57% had increased in LV volume (>90 ml/m2), 30% cases had regional wall motion abnormalities, 27.1% had reduced ejection fraction (<56%), and 52.66% showed LA enlargement in this study (p=0.048). Doppler measurements of diastolic filling were significant in patients with ISH with higher peak atrial velocity (A wave) of 79.71±11.79 cm/s and a lower ratio of peak early to atrial velocity of 0.82±0.29.
Conclusion: This study demonstrates that elderly patients with ISH had a prevalence of concentric left ventricular hypertrophy (LVH) which was found to be more in female patients than in male patients followed by left atrial enlargement.
2. Bavishi C, Goel S, Messerli FH. Isolated systolic hypertension: An update after SPRINT. Am J Med 2016;129:1251-8.
3. Manicia G, Fagard R, Narkiewicz K, Redon J, Zanchetti A, Böhm M, et al. 2013 ESH/ESC guidelines for the management of arterial hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J 2013;34:2159-219.
4. Wilking SV, Belanger A, Kannel WB, D’Agostino RB, Steel K.Determinants of isolated systolic hypertension. JAMA 1988; 260:3451-5.
5. Lewington S, Clarke R, Qizilbash N, Peto R, Collins R. Age-specific relevance of usual blood pressure to vascular mortality: A meta-analysis of individual data for one million adults in 61 prospective studies Lancet 2002;360:1903-13.
6. Izzo JL, Levy D, Black HR. Importance of systolic blood pressure in older Americans. Hypertension 2000;35:1021-4.
7. Conen D, Bamberg F. Noninvasive 24-h ambulatory blood pressure and cardiovascular disease: A systematic review and meta-analysis. J Hypertens 2008;26:1290-9.
8. Franklin SS, Khan SA, Wong ND, Larson MG, Levy D. Is pulse pressure useful in predicting risk for coronary heart disease? The Framingham heart study. Circulation 1999;100:354-60.
9. London GM, Guerin AP. Influence of arterial pulse and reflected waves on blood pressure and cardiac function. Am Heart J 1999;138:220-4.
10. Boutioukos M, Schinkel AF, Bax JJ, Lampropoulos S, Poldermans D. The impact of hypertension on systolic and diastolic left ventricular function. A tissue Doppler echocardiographic study. Am Heart J 2006;151:1323.
11. Heesen WF, Beltman FW, May JF, Smit AJ, de Graeff PA, Havinga TK, et al. High prevalence of concentric remodeling in elderly individuals with isolated systolic hypertension from a population survey. Hypertension 1997;29:539-43.
12. Sumimoto T, Murakami E, Iwata T, Dazai Y, Hiwada K. Left ventricular cardiac structure and diastolic function in isolated systolic hypertension in the elderly. J Hum Hypertens 1993;7:3-6.
13. Asmar R, Rudnichi A, Blacher J, London GM, Safar ME. Pulse pressure and aortic pulse wave are markers of cardiovascular risk in hypertensive populations. Am J Hypertens 2001;14:91-7.
14. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL, et al. Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension 2003;42:1206-52.
15. Yambe M, Tomiyama H, Yamada J, Koji Y, Motobe K, Shiina K, et al. Arterial stiffness and progression to hypertension in Japanese male subjects with high normal blood pressure. J Hypertens 2007;25:87-93.
16. Zieman SJ, Melenovsky V, Kass DA. Mechanisms, pathophysiology, and therapy of arterial stiffness. Arterioscler Thromb Vasc Biol 2005;25:932-43.
17. Lind L. Systolic and diastolic hypertension impair endothelial vasodilatory function in different types of vessels in the elderly: The Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS) study. J Hypertens 2006;24:1319-27.
18. Prevention of stroke by antihypertensive drug treatment in older persons with isolated systolic hypertension. Final results of the Systolic Hypertension in the Elderly Program (SHEP). SHEP Cooperative Research Group. JAMA 1991;265:3255-64.
19. Kannel WB, Castelli WP, McNamara PM, McKee PA, Feinleib M. Role of blood pressure in the development of congestive heart failure. The Framingham study. N Engl J Med 1972;287:781-7.
20. Dwivedi S, Singh G, Agarwal MP. Profile of hypertension in elderly subjects. J Assoc Physicians India 2000;48:1047-9.
21. Colandrea MA, Gary D Systolic hypertension in the elderly. An epidemiologic assessment of circulation. Am J Med 1991;90:145-205.
22. Bharucha NE, Kuruvilla T. Hypertension in the Parsi community of Bombay: A study on prevalence, awareness and compliance to treatment. BMC Public Health 2003;3;1.
23. Messerli FH. Hypertension in special populations. Med Clin North Am 1997;81:1335-45.
24. Rocha E, Mello e Silva A. Isolated systolic hypertension--epidemiology and impact in clinical practice. Rev Port Cardiol 2003;22:7-23.
25. Kulkarni V, Bhagwat N, Hakim A, Kamath S, Soneji SL. Hypertension in the elderly. J Assoc Physicians India 2001;49:873-6.
26. Wong TY, Klein R, Sharrett AR, Manolio TA, Hubbard LD, Marino EK, et al. The prevalence and risk factors of retinal microvascular abnormalities in older persons: The Cardiovascular Health Study. Ophthalmology 2003;110:658-66.
27. Boon D. ST segment depression criteria and the prevalence of silent cardiac ischemia in hypertensives. Hypertension 2003;4:476-81.
28. Savage DD, Drayer JI, Henry WL, Mathews EC, Ware JH, Gardin JM, et al. Echocardiographic assessment of cardiac anatomy and function in hypertensive subjects. Circulation 1979;59:623-32.
29. Chatterjee S, Roy AN, Majumdar BB, Ghosh S, Bala B, Bhowmick K, et al. Changes in cardiac status due to isolated systolic hypertension by non-invasive studies. J Evol Med Dent Sci 2014;3:347-55.
30. Schlant RC, Gilbert CA, Nutter DO. Echocardiographic study of cardiac dimensions and function in the endurance-trained athlete. Am J Cardiol 1977;40:528-33.
31. Dunn FG, Chandraratna P, De Caralho JG, Basta LL, Frohlich ED. Sudden cardiac death, ventricular arrhythmias and hypertensive left ventricular hypertrophy. J Hypertens 1993;11:1003-10.
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