English

Abstract

AIM: It was thought previously that morbidity and mortality are directly related to both Systolic and Diastolic blood pressure. However evidences from different studies suggest that systolic hypertension deserves more importance especially due to its profound effect on cardiovascular disease progression. Isolated systolic hypertension (ISH) has now increased amongst the elderly population due to increased longevity. METHOD: Total 240 patients of 65 - 89 years age group were taken as study group at the out-patient and in-door department of CNMC Kolkata and NBMC, Siliguri. All patients were divided into three groups based on systolic blood pressure: Gr A=SBP-140—159 mmHg, Gr B=SBP-160-179 mmHg & Gr C=SBP>180 mmHg with each group having age and sex matched 100 healthy normotensive control subjects. History, Clinical examination, ECG and Echocardiographic studies were done in the selected patients. Sophisticated tests were not done due to nonavailability. RESULTS: Major Electrocardiogram changes are left atrial enlargement, left ventricular hypertrophy with systolic strain, Inferior wall ischemia, both bundle branch blocks, bifascicular block, left axis deviation. Other minor changes were: antero- septal ischemia, septal wall ischemia, lateral wallischemia, right axis deviation, arrhythmia, and low voltage were also noted. Echocardiography in 2-D and M-ModeandEcho-Doppler assessment showed increased Intraventricular septal thickness (IVST), Left ventricular posterior wall Thickness (LVPWT) and Left ventricular mass index were the major changes. Left ventricular functional abnormality like diastolic dysfunction was another significant abnormality. CONCLUSION: Different anatomical & functional changes in ISH are more prevalent in higher SBP group, and strong risk factor for future catastrophic cardiac events. It is an independent risk factor for CVS morbidity and mortality. Early therapeutic intervention along with life style modification therefore can prevent long term CVS complications. INTRODUCTION: Isolated systolic hypertension (ISH) is a common form of hypertension in elderly person of both sex and it affects 2/3 rd of all individuals of hypertension between the ages of 65-89 years 1 . During the recent decades the importance of perceiving ISH has changed from a relatively benign condition to major cardiovascular risk factor and more recent data from Framingham study reinforces the prognostic significance of raised SBP and wide pulse pressure as independent risk factor2. According to JNC 7th report in person older than 50years, systolic BP>140 is much more important CVS risk factor than diastolic BP. ISH is also a common antecedent of heart failure, kidney damage, blindness and other conditions. Heart failure may be due to LVH with resulting diastolic dysfunction with or without concomitant systolic dysfunction or myocardial infarction4. Though it was thought previously that morbidity and mortality from hypertension are directly related to both SBP and DBP, it is now