Sharmila, M (2008) A Study on the Clinical Profile and Determinants of Isolated Systolic Hypertension. Masters thesis, Kilpauk Medical College, Chennai.
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Abstract
INTRODUCTION Until the mid 20th century, clinicians' concern was directed mainly to the systolic component of blood pressure. Later, however, when systolic blood pressure was found to be elevated with advancing age and decreased compliance of the arterial wall, it began to be considered an inevitable consequence of aging. However, there is now compelling evidence from cross sectional, longitudinal, and randomized controlled trials that show that isolated systolic hypertension confers a substantial cardiovascular risk. Despite this, it remains under diagnosed and largely untreated. The roots of this lie in a century of over reliance on the importance of diastolic pressure and largely unjustified concerns about the potential adverse consequences of treating systolic pressure. After the mercury sphygmomanometer was introduced, convention dictated that diastolic pressure was a better determinant of cardiovascular risk than systolic pressure. Systolic pressure was thought to vary considerably throughout the day, and a high pressure was believed to reflect a “strong” left ventricle. This view was perpetuated by the reliance of life assurance companies on diastolic pressure and the use of diastolic pressure in the early studies of lowering blood pressure. The use of diastolic pressure was further supported by the discovery that essential hypertension is characterized by increased peripheral vascular resistance and therefore raised mean arterial pressure, which more closely correlates with diastolic than systolic pressure. Evidence that systolic pressure is equally, if not more, important than diastolic, particularly in people over 50, was largely ignored. The latest World Health Organization and International Society of Hypertension guidelines for the management of hypertension emphasize the importance of arterial stiffness and pulse pressure as predictors of cardiovascular risk and call for further investigation of the prognostic relevance of other indices of arterial stiffness. The enemy today is no longer arterial pressure taken in isolation, but a collection of factors, of which age and doctors' conservatism are among the most important. It is high time that we recognize Isolated Systolic Hypertension as an important clinical condition and update our practicing guidelines accordingly. AIM OF THE STUDY: 1. To study the clinical profile of Hypertensives with Isolated Systolic Hypertension in terms of Symptomatology, History, Clinical features and Laboratory data. 2. To study the determinants of Isolated Systolic Hypertension. MATERIALS AND METHODS: Materials–Patients with Isolated Systolic Hypertension who attended Hypertension OP under institution of Kilpauk Medical College and Govt. Hospital were taken up. Study population included patients belonging to low socioeconomic urban or semi urban city of Chennai. Isolated Systolic Hypertension was defined as per JNC-7 guidelines. The study group included 1. Newly detected hypertensives with Isolated Systolic Hypertension. 2. Control group with essential hypertension (Systolic and Diastolic Hypertension). Following group were excluded from the study. 1. Patients with secondary form of hypertension. 2. Patients with Pre hypertension. Detailed evaluation of patients in terms of symptomatology, History, Clinical examination, and Laboratory data were carried out. The proforma used for the same is attached. Once diagnosed, they were put on appropriate management. The treatment and outcome is not included in the study. RESULTS: 115 patients with isolated systolic hypertension were diagnosed among patients attending hypertension clinic and were included in study group during the period Aug 2006 - Jul 2007. 50 patients with essential hypertension group were attending hypertension clinic were included in the study to compare and analyze the determinants of isolated systolic hypertension. CONCLUSION: 1. Isolated Systolic Hypertension is not an inevitable consequence of aging; rather it is the endpoint of several contributing factors. 2. Increasing Age and Female Preponderance are the most significant variables in the evolution of Isolated Systolic Hypertension. 3. The Blood Pressure components namely Systolic and Diastolic Blood Pressure, Pulse Pressure and Mean Arterial pressure influence the occurrence of Isolated Systolic Hypertension. 4. Baseline cholesterol and Baseline Blood glucose were not predictive of Isolated Systolic Hypertension incidence but may influence and contribute in due course. 5. Similarly Smoking and BMI were also not predictive of Isolated Systolic Hypertension incidence. 6. Since Isolated Systolic Hypertension is a definite clinical entity, it is important to study the determinants and pay more attention to the diagnosis and treatment of the same. Limitations of the study. • Small Sample Size, • Baseline Parameters were only used to assess the determinants of Isolated Systolic Hypertension.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Isolated Systolic Hypertension ; Determinants ; Clinical Profile. |
| Subjects: | MEDICAL > General Medicine |
| Depositing User: | Subramani R |
| Date Deposited: | 10 Mar 2018 12:18 |
| Last Modified: | 10 Mar 2018 12:18 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/6123 |
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