Lakshmi, Thampy (2009) A study on the prevalence of increased left ventricular mass and Proteinuria in newly diagnosed hypertensive patients. Masters thesis, Kilpauk Medical College, Chennai.
|
Text
200100409lakshmi_thampy.pdf Download (913kB) | Preview |
Abstract
INTRODUCTION : Hypertension is defined as any one of the following: Systolic blood pressure > 140mmHg, Diastolic blood pressure > 90mmHg, Taking any anti hypertensive Medication. Hypertension is a major cause of morbidity and mortality. The heart, arterial vessels, brain, kidney and retinal vasculature are major target organs adversely affected by high blood pressure. In adults there is a continuous incremental risk of target organ damage across levels of both systolic and diastolic blood pressure. The multiple risk factor intervention trial (MRFIT) which included >3.5 lakh male participants, demonstrated a continuous and graded influence of both systolic and diastolic blood pressure on CHD mortality extending down to systolic blood pressure of 120mmHg. Cardio vascular disease risk doubles for every 20-mmHg systolic and 10-mm Hg diastolic rise in blood pressure. AIM : 1. To study different cardiac geometry in newly diagnosed hypertensives. 2. To correlate proteinuria and LV mass in hypertensives. METHODOLOGY : Study Method : Cross - Sectional Study. Subjects and Methods : Fifty newly registered patients at hypertension clinic in Government Royapettah Hospital between February 2008 - July 2008 formed the material of the study. Inclusion Criteria : 1. Newly detected patient with systolic BP > 140 mm hg and/or diastolic BP > 90 mmhg in atleast 2 visits. 2. Age more than 40 years. 3. No clinical or lab evidence of heart failure, renal failure, coronary artery disease, valvular heart disease, secondary hypertension, hyperlipidemia, overt proteinuria, urinary tract infection. In all these patients, history of substance abuse, comprehensive clinical examination and appropriate imaging and bio-chemical evaluation done. DISCUSSION : Study was conducted in 50 newly detected hypertensives in the age group of 40-70-years of age with 60% females and 40% male. Most of the patients were in 40-50 years of age group. Among 30 males, 14 were smokers (46%). Out of 50 patients, 27 (54%) were having a body mass index consistent with overweight (23-30), 23(46%) were having normal BMI. As per JNC-7 staging of hypertension, 24 (48%) of patients were in stage I and 26 (52%) were in stage - II Out of 50 patients, 26 (52%) had unfavourable cardiac geometry. Among patients with unfavourable cardiac geometry, 11 patients (22%) had concentric remodelling, 8 (16%) had eccentric hypertrophy and 7 (14%) had concentric hypertrophy. The urine protein creatinine ratio was in microalbuminuria range in 18 (36%) patients of which 15 (83%) had abnormal cardiac geometry, 3 (17%) had normal cardiac geometry; showing a significant association between proteinuria and left ventricular hypertrophy in patients with essential hypertension. Among 14 (48%) patients with smoking habit out of 30 males in the study, 9 (64%) had proteinuria. A significant association was seen between proteinuria and smoking. A significant association was seen between widened pulse pressure and abnormal cardiac geometry. Incidence of LVH was more in patients with widened pulse pressure. 11(73%) out of 15(30%) of patients with pulse pressure in the range of 51-60 and 5(62.5%) of 8(16%) with pulse pressure >60 had LVH respectively while LVH was seen in 2 patients (29%) and 8 patients (40%) in patients with pulse pressure range of <40 and 41-50 respectively. Majority of patients in the pulse pressure range of < 40 and 41-50 had normal geometry. Among 26 patient with stage II hypertension, 20 (77%) had LVH while 6 (25%) of patients with stage I hypertension had LVH. In patients with proteinuria, 12 (80%) of LVH was in stage II; in patients without proteinuria, 8 (72%) of LVH was in stage II hypertension. Among 27 overweight patients, (70%) 19 had LVH. out of 18 patients with proteinuria, 14 (78%) were overweight. Among 24 patients with stage I hypertension, 18 (75%) had normal cardiac geometry and only 5 (21%) had microproteinuria. Among 26 patients with stage II hypertension, 19 (73%) had LVH of which 13 (68%) had microproteinuria. CONCLUSION : Among the fifty patients with newly diagnosed hypertension in the age group of 40-70 years majority were in fifth decade. Among the fifty patients, 26 had left ventricular hypertrophy and 24 had normal cardiac geometry. In patients with LVH, majority had concentric remodelling, while eccentric hypertrophy and concentric hypertrophy occurred with almost equal incidence. Among 18 patients with microproteinuria, 15 had left ventricular hypertrophy showing significant association between proteinuria and left ventricular hypertrophy. Smoking showed significant association with proteinuria. A significant association was seen between widened pulse pressure and LVH Majority of patients with pulse pressure above 50 had LVH. While most of the patients with pulse pressure < 50 had normal geometry. Majority of patients (70%) with proteinuria and LVH were in stage-II hypertension.
| Item Type: | Thesis (Masters) |
|---|---|
| Uncontrolled Keywords: | left ventricular mass, Proteinuria, newly diagnosed, hypertensive patients. |
| Subjects: | MEDICAL > General Medicine |
| Depositing User: | Pushparaj A |
| Date Deposited: | 13 Jul 2017 11:14 |
| Last Modified: | 03 Feb 2018 08:24 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/1539 |
Actions (login required)
 |
View Item |
