Ankle brachial pressure index to assess atherosclerotic risk in hypertensive subjects

Background: This research was planned to study correlation of ankle brachial pressure index (ABPI) with clinical features, laboratory investigations and anthropometric measurements in patients of essential hypertension and to establish association of atherosclerosis risk in hypertensive subject.Methods: This prospective observational year-long study was conducted after the institutional ethics committee approval in outpatient department of a tertiary care hospital. 153 adult non-pregnant patients were enrolled after written informed consent. Out of these, 51 patients each were of stage I hypertension, stage II hypertension and normal blood pressure. The ABPI were measured in the posterior tibial arteries using a Doppler ultrasound probe. The detailed demographic and anthropometric data was entered in proforma and data statistically analyzed.Results: In our study 28 (55%) out of 51 patients in stage II Hypertension had low ABPI as compared to 23 (45%) out of 51 patients in stage I Hypertension. No patients with normal blood pressure had low ABPI. There is significant correlation of stage of hypertension and ABPI (p <0.001). Mean ABPI (0.9102) in stage II hypertensive was low as compared to stage I hypertensive (0.9124) and normotensive subjects (1.0263). ABPI was inversely correlated with lipid profile. The hypertensive subjects with duration of hypertension for more than 5 years, the mean ABPI was significantly lower (0.8773) than those hypertensive subjects who had duration of hypertension less than 5 years (0.9526) (p 0.001).Conclusions: ABPI proves to be a non-invasive, bed side modality to assess the atherosclerotic risk in hypertensive patients.

Study of hypertensive subjects with diabetes as co-morbidity

Background: Combined presence of diabetes and hypertension increases the chances of various complications manifold than individually. Together, they accelerate the development of left ventricular hypertrophy, coronary artery disease, renal dysfunction, diabetic retinopathy and cerebrovascular diseases.Methods: After ethical considerations this observational study was carried out to identify the clinical, laboratory and end-organ profile of Hypertensive subjects who also had Diabetes; this cohort was also compared with subjects who had hypertension only.Results: The prevalence of hypertensive subjects with diabetes as co-morbidity was 10.26%. 26.4% subjects had family history of diabetes and 20.4% had family history of hypertension. The mean diastolic blood pressure (83.66±12.0) was significantly higher in hypertensive diabetes group, than the subjects with hypertension only (76.98±6.46) and the difference was statistically significant (p <0.0001). 51.9% of hypertensive females with diabetes had significantly higher (p 0.0003) central obesity. Macrovascular damage was slightly more common in females and microvascular damage was common in male hypertensive diabetic subjects. Out of 102 patients having end organ damage 37.25% had single organ involvement and 62.75% had multiple organ involvement. Retinopathy (33.2%) was commonest followed by renal (27.6%), cardiovascular (16.2%) and cerebrovascular (14.8%). Hypertensive diabetic patients had higher occurrence of end organ damage reflecting the impact of diabetes-hypertension co-morbidity on target organs.Conclusions: Given the increasing rates of coronary artery disease among Indians, especially at a younger age, 5understanding and successfully managing this deadly duo may hold the key to reducing cardiovascular mortality in India