Damodaran, D (2010) A Hospital Based Cross-sectional study on the Incidence of Micro-albuminurea and Left Ventricular Hypertrophy among Hypertensive Patients. Masters thesis, Chengalpattu Medical College, Chengalpattu.
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Abstract
INTRODUCTION : Hypertension provides both despair and hope. Despair because it is quantitatively the largest risk factor for cardiovascular diseases, is growing in prevalence, and is poorly controlled virtually everywhere. Hope because prevention is possible and because treatment can control hypertension in all most all patients with consequent marked reduction in stroke and heart attack. It should be noted that cardiovascular diseases are the leading cause of death worldwide, not only in economically developed countries but also in the developing world. In turn, hypertension is overall the major contributor to the risks for cardiovascular diseases. The over all world wide prevalence of hypertension is approximately 26% of the adult population, with marked differences between countries. The increasing prevalence of hypertension is primarily a consequence of the population becoming older and obese. Despite overwhelming evidence that effective treatment of hypertension is associated with a significant reduction of cardiovascular events, the number of patients who are aware of their condition and who achieve adequate BP control remains unacceptably low. Albumin excretion and microalbuminuria are currently drawing a great deal of attention in the medical literature. Much of this attention derives from the fact that albumin excretion is a risk factor for kidney failure, stroke, and cardiovascular and all cause mortality, particularly for persons with diabetes and/or hypertension. Based on the data from the Heart Outcomes Prevention and Evaluation Study (HOPE STUDY), it is clear that the presence of microalbuminuria is an signal from kidney that cardiovascular risk is increased and that vascular responses are altered. Microalbuminuria is a highly specific predictor of the simultaneous occurrence of both cardiac and vascular abnormalities. Data from the LIFE study show that the ECG strain pattern of ST-segment depression and T-wave inversion in the lateral precordial leads is a predictor of heart failure. This strain pattern has been associated with increased left ventricular mass and depressed left ventricular function. This study focuses on the incidence of microalbuminuria and left ventricular hypertrophy among hypertensive patients along with demographic analysis. AIMS AND OBJECTIVES : To find out the incidence of Micro-albuminuria and Left Ventricular Hypertrophy among hypertensive patients without associated conditions like Diabetes Mellitus, Stroke, Ischaemic Heart Disease and Renal Diseases. MATERIAL AND METHODS : A hospital based cross-sectional study was conducted among hypertensive patients who attend the out-patient department of cardiology in Chengalpattu Medical College Hospital, Chengalpattu from march 2009 to December 2009 to find out the incidence of microalbuminuria and left ventricular hypertrophy Among hypertensive patients. All patients between the age of 35 and 65 who attend the hypertensive clinic were screened for the following diseases and excluded from the study. 1. Diabetes mellitus. 2. Cerebro-vascular accident. 3. Coronary artery disease. 4. Kidney diseases (creatinine above 2 mg/dl). 5. Urinary tract infection. Diabetes mellitus was ruled out by fasting and post prandial blood sugar. Coronary artery disease and stroke was ruled out by history, physical examination and appropriate investigation. Urinary tract infection was ruled out by urine culture and kidney diseases by blood urea and serum creatinine. Patients who were on ACE/ARB drugs were excluded from the study. Study subjects who were anemic and who had fever were excluded from the study. Only patients with raised blood pressure without the above conditions were the study subjects. BLOOD PRESSURE MEASUREMENT : Once the patient was selected by the above criteria the BP has been recorded in the following manner. Several steps have been taken to minimize the variability. 1. Having the subjects rest silently and comfortably (with back and arm support if seated) for about 5min before measurement. 2. Abstaining from drinking caffeine or alcohol containing beverages or tobacco use within 30 min before a BP measurement. 3. Questioning the subject regarding the most recent meal or evacuation of bowl or bladder. 4. Centering the bladder of cuff over the brachial artery with its lower edge within 2.5 cm of the antecubital fossa. 5. Assuring that the arm was supported at the level of the heart. 6. Listening over the brachial artery by using the bell of stethoscope with minimal pressure exerted over the skin. 7. BP measurements, the cuff typically should be inflated 20mm hg higher than the pressure at which the palpable pulse at the radial artery disappears. 8. Attempting to avoid “terminal digit preference,” there should be an equal number of readings ending in 0,2,4,6, or 8 mmhg. 9. Measurement of BP in both arm typically are obtained at the initial visit, and the arm with higher BP was used thereafter if the difference was greater than 10/5 mmhg. 10.On each occasion at least two readings were taken with as much as time as it was practicable separateable. If reading more than 5mmhg additional readings were taken until they where close. 11.For diagnosis at least three sets of readings at one week apart. CONCLUSION : In our study 22.7 % of the study subjects had microalbuminuria and 20.6 % had left ventricular hypertrophy. There was a strong statistical association between microalbuminuria and age, sex and diastolic blood pressure. Similarly the statistical association between left ventricular hypertrophy and diastolic blood pressure was strong. Both microalbuminuria and left ventricular hypertrophy were not statistically associated with body mass index and systolic blood pressure.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Micro-albuminurea ; Left Ventricular Hypertrophy ; Hypertensive Patients ; Hospital Based Cross-sectional study. |
| Subjects: | MEDICAL > General Medicine |
| Depositing User: | Subramani R |
| Date Deposited: | 05 Mar 2018 13:24 |
| Last Modified: | 05 Mar 2018 13:24 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/6005 |
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