Kulkarni V, Bhagwat N, Hakim A, Kamath S, Soneji S L
Department of Medicine, TN Medical College and BYL Nair Hospital, Mumbai.
J Assoc Physicians India. 2001 Sep;49:873-6.
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.
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.
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.
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.
研究老年高血压的临床特征、终末器官并发症的发生情况以及高血压与其他危险因素在引发这些并发症中的作用。
本研究纳入了136名前往高血压门诊就诊的老年患者。详细记录病史，包括现病史、高血压、糖尿病、冠状动脉疾病、血脂异常家族史以及成瘾史。体格检查包括全身检查，测量腰臀比，并进行眼底镜检查以评估视网膜病变。还进行了其他重要检查，包括肾功能和肝功能检查（RFT、LFT）、血糖、血脂谱、胸部X线、心电图（ECG）、二维超声心动图、腹部超声以及头颅计算机断层扫描（CT）（如有必要）。
79名患者年龄在60 - 65岁之间，其中42名（30.9%）为男性。头痛是77.9%患者最常见的主要症状；而24名患者无症状。肥胖、糖尿病、饮酒、血脂异常和家族史是高血压的重要决定因素。55.9%患者的血脂谱异常。56.6%患者为单纯收缩期高血压（ISH）。血压未控制的患者中，29.4%出现II级高血压性视网膜病变。左心室肥厚（LVH）是最常见的心电图表现，在36.8%的患者中出现，其中26.5%血压未控制。通过二维超声心动图可在46.4%的患者中诊断出LVH。血压未控制和ISH的患者心血管和脑血管并发症的发生率增加。19.1%血脂异常和高血压患者出现心血管并发症。15.4%高血压伴LVH患者出现脑血管并发症。治疗包括使用钙通道阻滞剂和/或其他药物。
老年高血压患者倾向于患有ISH。高血压家族史是高血压的重要决定因素。血压未控制、ISH、LVH和其他相关危险因素是心血管和脑血管发病的原因。
