A clinical and echocardiographic study in elderly hypertensive patients
Authors: Sharan Badiger*
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Introduction: Isolated systolic hypertension is the commonest cause of raised blood pressure in the older population. As the age progresses more and more persons will be hypertensive. It is a disease, which is definitely the most prevalent, remediable risk factor for cardiovascular diseases and cerebrovascular diseases.
Objective: To study the clinical profile of hypertension in elderly, to find out associated risk factors, especially on cardiac through echocardiography.
Materials and Methods: A total number of sixty elderly hypertensive patients of ?60 years with systolic blood pressure ? 140 and diastolic blood pressure ? 90 mm of Hg were included in this study. A detailed history with general and systemic examination with fundus examination was carried out. Complete blood count, urine analysis, blood sugar, renal profile, lipid profile, chest x-ray, electrocardiogram, and echocardiogram were done in all patients.
Results: Sixty patients were evaluated, and the mean age was 67.72±7.004 years of which 35 (58.33%) were males and 25 (41.67%) females and the common age group was 60-65 years. Chest pain in 45% and breathlessness in 38.33% were commonest clinical presentation. Family history, smoking history and total cholesterol were associated risk factors of hypertension. Hypertensive retinopathy was observed in 38.33% patients. Ischemic changes in 31.67% followed by left ventricular hypertrophy in 20% were most common electrocardiographic findings. The echocardiographic evaluation showed left ventricular dysfunction in 63.33% was common entity in the form of left ventricular hypertrophy in 30%, left ventricular dilatation in 15% and left ventricular diastolic dysfunction in 48.33%. Ischemic heart disease was diagnosed in 55% patients. Out of these 18 (54.55%) had anterior, 4 (12.12%) lateral, 3 (9.09%) inferior and 4 (12.12%) septal infarcts. One patient had global hypokinesia, and three patients had more than one segment involvement. There was strong co relation between left ventricular hypertrophy, ischemia and systolic blood pressure.
Conclusion: The elderly hypertensive patients tend to have isolated systolic hypertension. Smoking history, family history and dyslipidemia are important determinants of hypertension. Left ventricular hypertrophy and other associated risk factors are responsible for coronary artery disease.