Echocardiographic assessment of hypertensive changes in elderly patients with isolated systolic hypertension and its correlation with pulse pressure

Context: Isolated systolic hypertension (ISH) is increasingly recognized as a cardiovascular risk factor. Increase in pulse pressure is a powerful independent predictor of cardiovascular events. Aims: To study the hypertensive changes by 2D echocardiography in elderly patients with ISH and to compare the hypertensive effects in patients with pulse pressure between 50-70 mmHg and >70 mmHg. Settings and Design: This observational case series study was conducted over a period of 2 years (2009-2011) at a tertiary care hospital in Pune. Materials and Methods: Seventy-six newly diagnosed cases of ISH among the geriatric population over 60 years of age who attended the medicine and geriatric outpatient departments (OPDs) were studied for the hypertensive changes on 2D echocardiography and Doppler. Inclusion criteria were patients ≥ 60 years of age having systolic blood pressure (SBP) >140 mmHg and diastolic blood pressure (DBP) ͳ90 mmHg. The patients were divided into two groups according to pulse pressure (50-70 mmHg and >70 mmHg). Left ventricular hypertrophy (LVH), diastolic dysfunction, and systolic dysfunction were evaluated on 2D echocardiography and correlated with the pulse pressure. Statistical Analysis Used: Chi-square, Odds Ratio (OR) with 95% Confidence Intervals (CI) were done using SPSS. Results: Out of 76 patients, 48 patients (63.1%) had diastolic dysfunction, 46 patients (60.5%) had LVH, and 36 patients (47.4%) had systolic dysfunction on 2D echo. Patients with pulse pressure >70 mmHg showed increased incidence of LVH (75.6%) than those with pulse pressure 50-70 mmHg and (46.2%) respectively. There was no significant change in incidence of systolic dysfunction in the two groups. Conclusions: Incidence of LVH and diastolic dysfunction was more in ISH. Incidence of LVH and diastolic dysfunction was found to be more in patients with wide pulse pressure