Cardiac changes in isolated systolic hypertension in elderly with special reference to electrocardiography and echocardiography study

Abstract

Background&Objectives:Isolated systolic hypertension is a raised systolic blood pressure with normal diastolic blood pressure. As age progresses, more persons will be hypertensive, a disease which is definitely most prevalent remediable risk factor for cardiovascular diseases. Isolated systolic hypertension is the commonest variant of increased blood pressure in the elderly.At the same time, awareness of hypertension, its risk factors, and complications is very poor. Most of these elderly patients are asymptomatic, and hence remain undiagnosed for a very long time and finally present with irreversible end-organ complications. Most common organ to be involved is heart. Hence the present study is undertaken to study the cardiac status and associated risk factors of elderly patients with isolated systolic hypertension. Methods: An observational (cross-sectional) study undertaken on patients attending the outpatient department and inpatients of C.R.G.H hospital attached to R.D.Gardi Medical College , Ujjain, during the period of one and half year between November 2017 and May 2019.Patients more than 60 years of age with isolated systolic hypertension were included in the study. Detailed evaluation of patients comprising of detailed clinical history, thorough physical examination with relevant basic investigations was done.Standing blood pressure was recorded and at least 2 measurements on each of 2 or more visits and mean of the three recordings were taken.Routine investigations like Complete blood count (CBC), Urine-albumin, Fasting and post-prandial blood sugars (FBS, PPBS), Glycosylated haemoglobin, Blood urea, Serum creatinine, Lipid profile were done. ECG and 2-D guided M-mode echocardiography was done and analysed for LVH and LVMI respectively. The statistical software namely SPSS 11.0 and systat8.0 were used for the analysis of the data. Chi square and fisher exact test were used to find the significance of proportions of risk factors between increased LVMI and normal LVMI.Results: A total of 120 patients, aged more than or equal to 60 years (elderly) who were newly diagnosed with isolated systolic hypertension (SBP >140,DBP < 90) were selected.The mean age of all the patients was 73.31+/-6.62. 64.2% of the study group were males, while 35.8%were females.The commonest ECG finding was left ventricular hypertrophy. 35% were positive by Sokolw-Lyon criteria and 26.7% were positive as per Romhilt- Estees criteria.   Increased LVMI (>131 gm/m2 in males and >100gm/m2 in females) in 48.4%. Increased LV volume (>90ml/m2) in 17.5% of patients. Regional wall motion abnormality in 25.8% of the patients and Reduced ejection fraction in 40.0% of the patients.Interpretation and Conclusion: Hypertension in the elderly population is emerging as a major public health problem in our country. ISH contributes to significant morbidity and mortality as it is associated with complication and target organ damage.Increased BMI, waist-hip ratio, dyslipidemia and diabetes mellitus are most common risk factors associated with isolated systolic hypertension.ISH associated with risk factors has definite effect on heart in terms of Left ventricular hypertrophy and increased LVMI.