Clinical Profile of Hypertension and Diabetes Mellitus in Elderly: A Study of 75 Patients

Anitha, R (2009) Clinical Profile of Hypertension and Diabetes Mellitus in Elderly: A Study of 75 Patients. Masters thesis, Stanley Medical College, Chennai.

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Abstract

INTRODUCTION: Advances in medical science and improved social conditions during the past few decades have increased the life expectancy of humans. This phenomenon of population ageing has placed the developing nation, India, too amidst the demographic transition towards ageing trend. Further, graying of population is faster in India than many European and developed countries. This has changed the emphasis from communicable to non-communicable diseases. The prevalence of diabetes and hypertension increases with age and they form the major risk factors for increased morbidity and mortality rates among the elderly. The clinical presentation of diabetes and hypertension in this subgroup is somewhat different from the younger group of patients and calls for studies on the unusual future. Geriatric hospital admission rates not only depend on the increased prevalence of non communicable risk factors but also on their nutritional status and socio-demographic profile. In-depth epidemiological studies on old people are the need of the day to understand and reflect on the necessities of the geriatric population. Hence this study is undertaken to have a detailed analyses of the hypertensive and diabetic elderly patients admitted to medical wards. AIMS OF THE STUDY: 1. To study the clinico-laboratory and complication profile of elderly diabetics and hypertensives. 2. To study the other associated cardiovascular risk factors and co morbid illness in them. 3. To study the frequency and reason for admissions to medical wards in these people. PATIENTS AND METHODS: Patients aged 60 years and above, admitted to the medical wards of Government Stanley Medical College Hospital with either hypertension or diabetes mellitus or both were taken up for the study. These patients were evaluated for the presence of cardiovascular risk factors and target organ damage. The period of the study was from February 2007 to May 2008. Ethical Committee approval was obtained for the study. Exclusion Criteria: 1. Patients aged less than 60 years. 2. Patients aged 60 years and above with no hypertension or diabetes were excluded from the study. The following data were collected and analysed. 1. Age, Sex, IP No. 2. Details of Hypertension and Diabetes mellitus. If the patients were already known to have hypertension or diabetes, the details of its duration, drugs taken, drug compliance, hypertension and diabetes control achieved were noted. RESULTS: A total of 75 patients aged 60 years and above admitted to the medical wards of Government Stanley Medical College Hospital with either hypertension or diabetes mellitus or both were analyzed. 50% of the patients belonged to the age group of 60 – 75 years. Mean age was 68 years and the age range 60 – 88 years. There were 45 males and 30 females with a male to female ratio of 1.5:1. SUMMARY: 1. 75 elderly inpatients with hypertension or diabetes or both were analysed. (Males- 45, Females-30 and mean age was 68 years). 2. Out of the 75 patients, 41.3% had hypertension alone, 16% had diabetes alone and 42.6% had both. 3. Only 4.8% of the hypertensive patients had Isolated Systolic Hypertension (ISH). 4. 11.3% of the diabetics were obese (BMI >30) and 77.2% of the diabetics were centrally obese ( defined by WHR). 5. There is no statistically significant association between BMI and diabetes or central obesity and diabetes. 6. 20.5% of the known hypertensives and 34.3% of the known diabetics were not on therapy currently. Rest of the patients who were on drugs too had poor drug compliance and poor hypertension and diabetes control. 7. 54% and 35% of the patients were found to have hypertension and diabetes only after target organ damage. 8. 28% of the patients were with the BMI above the range of overweight. More females (43.3%) compared to males (17.7%) were overweight and obese. 9. 64.4% of males and 86.7% of females were centrally obese (defined by WHR). 26.7% of males and 63.3% of females were centrally obese when defined by waist circumference (IDF criteria for South-East Asians). BMI and central obesity have statistically significant association. 10. 64% had cardiac complications, 30.6% had cerebrovascular complications, 8% had peripheral vascular disease, 20% had peripheral neuropathy and 89.3% had chronic kidney disease. 11. Of the 31 patients with MI, almost half of the patients (15) had clinically unrecognized MI (silent MI) diagnosed by routine electrocardiogram and echocardiographic screening showing regional wall motion abnormality. 12. Of the 41 cardiac failure patients, 70.7% had left ventricular dysfunction and 29.3% had normal LV function. 13. Only 5.3% of the patients had degenerative valvular heart disease. 14. Of the 18 cerebrovascular events, 78.3% were ischemic strokes and 21.7% were hemorrhagic strokes. 15. 89.3% of the patients were found to have chronic kidney disease (GFR<90ml/min). 29.3%, 45.3%, 12% and 2.6% of the patients were in stage 2, 3,4 and 5 chronic kidney disease. 16. Serum creatinine of >1.5 mg/dl has a sensitivity of 16.4% and specificity of 100% to diagnose renal failure (GFR< 90ml/min). To diagnose severe renal failure (GFR< 30ml/min), it has a sensitivity of 90.1% and specificity of 98.4%. 17. On an average the hospital admission rate is 0.5 per year in the study population. Major causes of hospital admissions are heart failure (33.5), acute coronary syndrome (19.2%), stroke and its sequelae (19.2%), COPD (4.2%) and renal failure (3.5%). 18. 76% of the patients had to be supported by their children with their average monthly income of Rs.2200. 19. Only 20% received either widow pension or elderly pension from government. 20. 93.3% of the patients are manual laborers by occupation. CONCLUSION: 1. This study shows that isolated systolic hypertension is less prevalent in Indians. 2. There is no significant association between BMI and diabetes or central obesity and diabetes in elderly Indians. 3. Awareness among the elderly Indians on the need for early detection and regular treatment for hypertension and diabetes is poor. This calls for community wide education on these non-communicable diseases. 4. These elderly Indians are centrally obese but normal weight individuals. 5. Cardiac complication is the most common macrovascular complication noted and renal disease is the most common microvascular complication. But cardiac complications are the major cause for morbidity and hospital admissions. 6. Search for and recognition of silent MI and heart failure with preserved ejection fraction is important in these group of patients. 7. Serum creatinine is not a good screening test for identifying renal disease in these patients. Calculation of GFR with the simple Cockcroft-Gault formula is advisable. 8. Heart failure is the most important cause for morbidity and hospitalization in these patients. 9. These observations need to be confirmed by further larger epidemiological studies for our own data in elderly population. 10. It is important to realize the impact of a rapidly ageing population on our health care system. And we need to gear up for the future challenges posed by this ailing demographics. The various governmental and nongovernmental agencies must act in stride and take the required measures for the betterment of senior citizens.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Clinical Profile ; Hypertension ; Diabetes Mellitus ; Elderly ; 75 Patients Study.
Subjects: MEDICAL > General Medicine
Depositing User: Subramani R
Date Deposited: 23 Mar 2018 16:18
Last Modified: 24 Mar 2018 08:27
URI: http://repository-tnmgrmu.ac.in/id/eprint/6505

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