Related Experiment Videos
Hypertension in the elderly
V Kulkarni1, N Bhagwat, A Hakim
1Department of Medicine, TN Medical College and BYL Nair Hospital, Mumbai.
Insights
Elderly patients with hypertension often have isolated systolic hypertension (ISH). Uncontrolled blood pressure, ISH, and other risk factors contribute to cardiovascular and cerebrovascular complications in older adults.
Area of Science:
- Gerontology
- Cardiology
- Nephrology
Background:
- Hypertension is a significant health concern in the elderly population.
- End-organ damage is a common complication of hypertension in older adults.
- Understanding the interplay of risk factors is crucial for managing hypertension in the elderly.
Purpose of the Study:
- To elucidate the clinical characteristics of hypertension in elderly individuals.
- To investigate the development of end-organ complications associated with hypertension.
- To assess the combined effect of hypertension and other risk factors on complication development.
Main Methods:
- A cohort of 136 elderly patients from a Hypertension Clinic was studied.
- Data collection included detailed medical history, physical examination (including waist-to-hip ratio and fundoscopy), and laboratory tests (RFT, LFT, blood sugar, lipid profile).
- Investigations comprised chest X-ray, ECG, 2-D echocardiography, abdominal ultrasound, and CT head scans when indicated.
Main Results:
- Headache was the most frequent symptom (77.9%), though 24 patients were asymptomatic.
- Obesity, diabetes, alcohol use, dyslipidemia, and family history were key determinants of hypertension.
- Isolated systolic hypertension (ISH) affected 56.6% of patients, with Grade II hypertensive retinopathy in 29.4% and Left Ventricular Hypertrophy (LVH) in 36.8% (ECG) and 46.4% (2-D echo).
- Uncontrolled hypertension and ISH correlated with increased cardiovascular and cerebrovascular complications.
Conclusions:
- Elderly hypertensive patients frequently exhibit Isolated Systolic Hypertension (ISH).
- A family history of hypertension is a significant determinant.
- Uncontrolled hypertension, ISH, Left Ventricular Hypertrophy (LVH), and co-existing risk factors are major contributors to cardiovascular and cerebrovascular morbidity.
Objectives:
To study the clinical profile of hypertension in the elderly, development of end organ complications and the effect of hypertension with other risk factors in producing these complications.
Methods:
One hundred and thirty six elderly patients attending the Hypertension Clinic were included in the study. A detailed history was taken that included presenting illness, family history of hypertension, diabetes, coronary artery disease, dyslipidaemia and history of addictions. Physical examination included systemic examination with measurement of waist to hip ratio and fundoscopy for retinopathy. Renal and liver function tests (RFT, LFT), blood sugar, lipid profile, X-ray chest, electrocardiography (ECG), 2-D echocardiography, abdominal ultrasound and computed tomography (CT) scan head (if indicated) were other important investigations done.
Results:
Seventy-nine patients were in the age group of 60-65 years, of which 42 (30.9%) were males. Headache was the commonest chief complaint in 77.9% patients; whereas 24 patients were asymptomatic. Obesity, diabetes, alcohol, dyslipidaemia and family history were important determinants of hypertension. Lipid profile was abnormal in 55.9% patients. Isolated systolic hypertension (ISH) was found in 56.6% patients. Grade II hypertensive retinopathy was observed in 29.4% patients with uncontrolled blood pressure. Left ventricular hypertrophy (LVH) was the commonest ECG manifestation seen in 36.8% patients of which 26.5% had uncontrolled blood pressure. LVH could be diagnosed in 46.4% patients by 2-D echo. Patients with uncontrolled blood pressure and ISH had increased incidence of cardiovascular and cerebrovascular complications. Cardiovascular complications were seen in 19.1% patients having dyslipidaemia and hypertension. Cerebrovascular complications were seen in 15.4% patients having hypertension with LVH. Treatment included calcium channel blockers and/or other drugs.
Conclusions:
The elderly hypertensive patients tend to have ISH. Family history of hypertension is an important determinant of hypertension. Uncontrolled hypertension, ISH, LVH and other associated risk factors are responsible for cardiovascular and cerebrovascular morbidity.