Research Article
Open Access
An Assessment of Difference in Manifestations
of Mixed and Isolated Hypertension In Terms
Of Their Signs and Symptoms in Hypertensive
Patients
Meh Jabeen1, Adnan A2*, Summaiya I3, Maham R4, Zarghoona W5, Sheema S6, Syed Muhammad ZHN7, Sumrina M8, Fatima T9, Fahar SI10
1MBBS, M. Phil, Professor, Department of Physiology, Hamdard College of Medicine and dentistry
2MBBS, Senior Lecturer, Department of Physiology, Altibri Medical College Karachi
3MBBS, Hamdard College of Medicine and Dentistry
4MBBS.Senior Medical Officer, Community Health services, National TB Program
5MBBS, M. Assistant, Musavvir Stem cell clinic and pathology laboratory
6MBBS, Postgraduate trainee, Department of Medicine, Patel Hospital
7MBBS, MSBE, Assistant professor, Department of Community Medicine, Baqai Medical University
8Msc, Physiology, Karachi University
9MBBS, Final year, Medical student, Jinnah Sindh Medical University
10MBBS, Final year, Medical Student, Jinnah Sindh Medical University
2MBBS, Senior Lecturer, Department of Physiology, Altibri Medical College Karachi
3MBBS, Hamdard College of Medicine and Dentistry
4MBBS.Senior Medical Officer, Community Health services, National TB Program
5MBBS, M. Assistant, Musavvir Stem cell clinic and pathology laboratory
6MBBS, Postgraduate trainee, Department of Medicine, Patel Hospital
7MBBS, MSBE, Assistant professor, Department of Community Medicine, Baqai Medical University
8Msc, Physiology, Karachi University
9MBBS, Final year, Medical student, Jinnah Sindh Medical University
10MBBS, Final year, Medical Student, Jinnah Sindh Medical University
*Corresponding author: Dr. Adnan Anwar MBBS, Senior Lecturer, Department of Physiology, Altibri Medical College Karachi, E-mail:
@
Received: December 26, 2017; Accepted: January 02, 2018; Published: January 12, 2018
Citation: Jabeen M,Adnan A, Summaiya I, Maham R, et al. (2018) An Assessment of Difference in Manifestations of Mixed and Isolated Hypertension In Terms Of Their Signs and Symptoms in Hypertensive Patients. Palliat Med Care 5(1): 1-6. DOI: 10.15226/2374-8362/5/1/00150
AbstractTop
Background: It is not an uncommon practice to report the prevalence and effects of mixed hypertension and isolated hypertension on that of a patient’s well-being separately. Though such outcomes have been reported to be dissimilar by a number of studies, literature do not shed any light on whether the two types of hypertension i.e. Mixed and isolated differ from each other in their manifestations.
Objective: To determine the difference in manifestations of mixed and isolated hypertension in terms of their signs and symptoms in
hypertensive patients.
Methods: After taking ethical approval, a cross-sectional study was carried out among 152 conveniently sampled patients, aged 18 years or above, with self-reported history of hypertension who were taking anti-hypertensive medication. According to their blood pressure levels, patients were divided into two groups, those with mixed hypertension and those with isolated hypertension. A structured questionnaire was used to take a brief medical history whereas sphygmomanometer with stethoscope was used to measure the blood pressure of the patients.
Results: The study results revealed that among the signs and symptoms of hypertension only nausea was found to have a statistically significant association with type of hypertension (p=0.014). Furthermore, both history of headache and severity of chest pain were found to have only marginally insignificant associations with type of hypertension (p=0.063 and p=0.054 respectively). None of the other signs and symptoms of hypertension were associated with type of hypertension.
Conclusion: The study results revealed that only nausea had a statistically significant association with type of hypertension though both history of headache and severity of chest pain had only marginally insignificant associations with type of hypertension. Special focus on these symptoms by health care professionals during hypertension screening is recommended.
Keywords: Manifestations; Mixed Hypertension; Isolated Hypertension; Signs and Symptoms; Hypertensive Patients;
Methods: After taking ethical approval, a cross-sectional study was carried out among 152 conveniently sampled patients, aged 18 years or above, with self-reported history of hypertension who were taking anti-hypertensive medication. According to their blood pressure levels, patients were divided into two groups, those with mixed hypertension and those with isolated hypertension. A structured questionnaire was used to take a brief medical history whereas sphygmomanometer with stethoscope was used to measure the blood pressure of the patients.
Results: The study results revealed that among the signs and symptoms of hypertension only nausea was found to have a statistically significant association with type of hypertension (p=0.014). Furthermore, both history of headache and severity of chest pain were found to have only marginally insignificant associations with type of hypertension (p=0.063 and p=0.054 respectively). None of the other signs and symptoms of hypertension were associated with type of hypertension.
Conclusion: The study results revealed that only nausea had a statistically significant association with type of hypertension though both history of headache and severity of chest pain had only marginally insignificant associations with type of hypertension. Special focus on these symptoms by health care professionals during hypertension screening is recommended.
Keywords: Manifestations; Mixed Hypertension; Isolated Hypertension; Signs and Symptoms; Hypertensive Patients;
Introduction
In the year 2000, 26.4% of the world adult population has
been reported to suffer from hypertension, two thirds of which
belonged to developing countries.[1]A meta-analysis reported
the prevalence of hypertension in Pakistan to be 17% based on
data gathered prior to 2004.[2] More recently, World Health
Organization reported that25.2% of the Pakistani population
suffered from raised blood pressure in 2014.[3] Between 2000
and 2025, the prevalence of hypertension is projected to increase
by 9% in men and 13% in women.[1]
A meta-analysis found that throughout middle and old age, blood pressure is strongly related to vascular mortality down to at least 115/75 mmHg.[4] Hypertension has been reported to result in 7.5 million deaths annually but despite being a serious health problem, is preventable and treatable.[5] Both lifestyle modifications such as smoking cessation, moderate alcohol consumption, reduced sodium intake and increased physical activity as well as blood lowering medications such as ACE inhibitors, Angiotensin receptor blockers, Thiazide diuretics and calcium channel blockers have been recommended for its management.[6]
As literature search revealed, it is not an uncommon practice to report the prevalence and effects of mixed hypertension and isolated hypertension on that of a patient’s well-being separately, and though such outcomes have been reported to be dissimilar as well by a number of studies, literature do not shed any light on whether the two types of hypertension i.e. Mixed and isolated differ from each other in their manifestations.[7-9] In light of the evidence cited above, it is not unrealistic to suspect and therefore investigate the existence of such a difference.
This study, believed to be first of its kind, was thus carried out with the objective of determining the difference in manifestations of mixed and isolated hypertension in terms of their signs and symptoms in hypertensive patients.
A meta-analysis found that throughout middle and old age, blood pressure is strongly related to vascular mortality down to at least 115/75 mmHg.[4] Hypertension has been reported to result in 7.5 million deaths annually but despite being a serious health problem, is preventable and treatable.[5] Both lifestyle modifications such as smoking cessation, moderate alcohol consumption, reduced sodium intake and increased physical activity as well as blood lowering medications such as ACE inhibitors, Angiotensin receptor blockers, Thiazide diuretics and calcium channel blockers have been recommended for its management.[6]
As literature search revealed, it is not an uncommon practice to report the prevalence and effects of mixed hypertension and isolated hypertension on that of a patient’s well-being separately, and though such outcomes have been reported to be dissimilar as well by a number of studies, literature do not shed any light on whether the two types of hypertension i.e. Mixed and isolated differ from each other in their manifestations.[7-9] In light of the evidence cited above, it is not unrealistic to suspect and therefore investigate the existence of such a difference.
This study, believed to be first of its kind, was thus carried out with the objective of determining the difference in manifestations of mixed and isolated hypertension in terms of their signs and symptoms in hypertensive patients.
Patients and Methods
A cross-sectional study was carried out among patients
with self-reported history of hypertension who were taking
anti-hypertensive medication. After taking ethical approval,
a total of 152 conveniently sampled patients, aged 18 years or
above, were included in the analysis who met inclusion criteria.
Patients were divided into two groups according to their blood
pressure levels, those with mixed hypertension and those with
isolated hypertension. The guidelines of the seventh report of
the Joint National Committee (JNC 7) were used to define mixed
hypertension though patients with both stage I and stage II
hypertension were considered to have mixed hypertension. [10]
The criteria used by Franklin SS et al., in 2001 and Midha T et al.,
in 2012 was used to define isolated hypertension (systolic blood
pressure ≥140 mmHg and diastolic blood pressure < 90 mmHg or
systolic blood pressure < 140 mmHg and diastolic blood pressure
≥90 mmHg).[11, 12]
A structured questionnaire was used to take a brief medical history whereas sphygmomanometer with stethoscope was used to measure the blood pressure of the patients. History of cardiac events, neurological disorders, cluster headache, diabetes, gastrointestinal disease, visual problems, epistaxis and morbid obesity constituted the exclusion criteria.
The collected data were coded, entered and analyzed on SPSS version 20. Descriptive analysis was performed by calculating frequencies and percentages whereas inferential analysis was performed by applying chi-square test. The significance level was set at 0.05. The duration of study was six months.
A structured questionnaire was used to take a brief medical history whereas sphygmomanometer with stethoscope was used to measure the blood pressure of the patients. History of cardiac events, neurological disorders, cluster headache, diabetes, gastrointestinal disease, visual problems, epistaxis and morbid obesity constituted the exclusion criteria.
The collected data were coded, entered and analyzed on SPSS version 20. Descriptive analysis was performed by calculating frequencies and percentages whereas inferential analysis was performed by applying chi-square test. The significance level was set at 0.05. The duration of study was six months.
Results
The study results revealed that 54.6% of the study
participants were >40 years old, 53.3% of them were males
whereas only 12.5% of them were smokers. 50.7% gave a
positive history of headache and out of them 35.1% reported it
to be severe. 36.8% gave a positive history of vertigo and out of
them only 5.4% reported it to be severe. 24.3% had edema and in
64.9% of those it was present bilaterally whereas in 29.7% it was
found to be of severe grade. 26.3% gave a positive history of chest
pain and out of them 85.0% reported it to subside either with
rest or by taking a medication. 40.8% gave a positive history of
vision problems, 42.8% reported to suffer from dyspnea and out
of them 36.9% reported it to be severe. 21.1% reported to suffer
from nausea, 41.4% from sleep apnea, 34.9% from irregular
heartbeat/palpitation, 60.5% from fatigue and 48.0% from
confusion [Table 1].
The study results further revealed that among the signs and symptoms of hypertension tested for association with type of hypertension i.e. Mixed or isolated, only nausea was found to have a statistically significant association (p=0.014) where only those with mixed hypertension were likely to suffer from it (23.7% vs. Nil).Moreover, both history of headache and severity of chest pain were found to have only marginally insignificant associations with type of hypertension (p=0.063 and p=0.054 respectively) where those with a positive history of headache and chest pain that improves with rest or medication were more likely to have mixed type of hypertension (53.3% vs. 29.4% and 89.2% vs. 33.3% respectively). None of the other signs and symptoms of hypertension were found to be associated with type of hypertension [Table 2].
The study results further revealed that among the signs and symptoms of hypertension tested for association with type of hypertension i.e. Mixed or isolated, only nausea was found to have a statistically significant association (p=0.014) where only those with mixed hypertension were likely to suffer from it (23.7% vs. Nil).Moreover, both history of headache and severity of chest pain were found to have only marginally insignificant associations with type of hypertension (p=0.063 and p=0.054 respectively) where those with a positive history of headache and chest pain that improves with rest or medication were more likely to have mixed type of hypertension (53.3% vs. 29.4% and 89.2% vs. 33.3% respectively). None of the other signs and symptoms of hypertension were found to be associated with type of hypertension [Table 2].
Discussion
The study results revealed that among the signs and
symptoms of hypertension, only nausea was found to have a
statistically significant association with type of hypertension.
Moreover, both history of headache and severity of chest pain
were found to have only marginally insignificant associations
with type of hypertension.
Interestingly, the study findings revealed nausea to be significantly associated with mixed hypertension. A thorough search of the published literature did not reveal any evidence of such an association in patients on anti-hypertensive therapy. Though it is expected that all the study participants did not take similar anti-hypertensive therapy, but even without that consideration there is no prior evidence of persistence of nausea only in patients with mixed hypertension.
Interestingly, the study findings revealed nausea to be significantly associated with mixed hypertension. A thorough search of the published literature did not reveal any evidence of such an association in patients on anti-hypertensive therapy. Though it is expected that all the study participants did not take similar anti-hypertensive therapy, but even without that consideration there is no prior evidence of persistence of nausea only in patients with mixed hypertension.
Table 1:Descriptive Analysis
Variables (n=152) |
Frequency (%) |
|
Age |
≤40 Years |
69(45.4) |
>40 Years |
83(54.6) |
|
Gender |
Male |
81(53.3) |
Female |
71(46.7) |
|
Smoking |
Yes |
19(12.5) |
No |
133(87.5) |
|
History of Headache |
Yes |
77(50.7) |
No |
75(49.3) |
|
Severity of Headache1 |
Mild/Moderate |
50(64.9) |
Severe |
27(35.1) |
|
History of Vertigo |
Yes |
56(36.8) |
No |
96(63.2) |
|
Severity of Vertigo2 |
Mild/Moderate |
53(94.6) |
Severe |
3(5.4) |
|
Edema |
Yes |
37(24.3) |
No |
115(75.7) |
|
Laterality of Edema3 |
Bilateral |
24(64.9) |
Unilateral |
13(35.1) |
|
Grading of Bilateral Edema3 |
Mild/Moderate |
26(70.3) |
Severe |
11(29.7) |
|
Chest Pain |
Yes |
40(26.3) |
No |
112(73.7) |
|
Severity of Chest Pain4 |
Improves with rest or medication |
34(85.0) |
Requires hospital visit |
6(15.0) |
|
Vision Problems |
Yes |
62(40.8) |
No |
90(59.2) |
|
Dyspnea |
Yes |
65(42.8) |
No |
87(57.2) |
|
Dyspnea Severity5 |
Mild/Moderate |
41(63.1) |
Severe |
24(36.9) |
|
Nausea |
Yes |
32(21.1) |
No |
120(78.9) |
|
Sleep Apnea |
Yes |
63(41.4) |
No |
89(58.6) |
|
Irregular Heartbeat/Palpitation |
Yes |
53(34.9) |
No |
99(65.1) |
|
Fatigue |
Yes |
92(60.5) |
No |
60(39.5) |
|
Confusion |
Yes |
73(48.0) |
No |
79(52.0) |
|
1n=77
2n=56
3n=37
4n=40
5n=65
2n=56
3n=37
4n=40
5n=65
Table 2:Relationship between Type and Signs and Symptoms of Hypertension
Variables |
Mixed Hypertension (n=135) |
Isolated Hypertension (n=17) |
|
Frequency (%) |
Frequency (%) |
||
Smoking |
Yes |
15(11.1) |
4(23.5) |
No |
120(88.9) |
13(76.5) |
|
P |
0.142* |
||
History of Headache |
Yes |
72(53.3) |
5(29.4) |
No |
63(46.7) |
12(70.6) |
|
P |
0.063 |
||
Severity of Headache1 |
Mild/Moderate |
45(62.5) |
5(100) |
Severe |
27(37.5) |
Nil |
|
P |
0.107* |
||
History of Vertigo |
Yes |
49(36.3) |
7(41.2) |
No |
86(63.7) |
10(58.8) |
|
P |
0.694 |
||
Severity of Vertigo2 |
Mild/Moderate |
46(93.9) |
7(100) |
Severe |
3(6.1) |
Nil |
|
P |
0.665* |
||
Edema |
Yes |
35(25.9) |
2(11.8) |
No |
100(74.1) |
15(88.2) |
|
P |
0.163* |
||
Laterality of Edema3 |
Unilateral |
22(62.9) |
2(100) |
Bilateral |
13(37.1) |
Nil |
|
P |
0.414* |
||
Grading of Bilateral Edema3 |
Mild/Moderate |
24(68.6) |
2(100) |
Severe |
11(31.4) |
Nil |
|
P |
0.488* |
||
Chest Pain |
Yes |
37(27.4) |
3(17.6) |
No |
98(72.6) |
14(82.4) |
|
P |
0.294* |
||
Severity of Chest Pain4 |
Improves with rest or medication |
33(89.2) |
1(33.3) |
Requires hospital visit |
4(10.8) |
2(66.7) |
|
P |
0.054* |
||
Vision Problems |
Yes |
58(43.0) |
4(23.5) |
No |
77(57.0) |
13(76.5) |
|
P |
0.124 |
||
Dyspnea |
Yes |
57(42.2) |
8(47.1) |
No |
78(57.8) |
9(52.9) |
|
P |
0.704 |
||
Severity of Dyspnea5 |
Mild/Moderate |
35(61.4) |
6(75.0) |
Severe |
22(38.6) |
2(25.0) |
|
P |
0.372* |
||
Nausea |
Yes |
32(23.7) |
Nil |
No |
103(76.3) |
17(100) |
|
P |
0.014* |
||
Sleep Apnea |
Yes |
59(43.7) |
4(23.5) |
No |
76(56.3) |
13(76.5) |
|
P |
0.112 |
||
Irregular Heartbeat/Palpitation |
Yes |
50(37.0) |
3(17.6) |
No |
85(63.0) |
14(82.4) |
|
P |
0.114 |
||
Fatigue |
Yes |
79(58.5) |
13(76.5) |
No |
56(41.5) |
4(23.5) |
|
P |
0.154 |
||
Confusion |
Yes |
63(46.7) |
10(58.8) |
No |
72(53.3) |
7(41.2) |
|
P |
0.344 |
||
*Fisher's Exact Test |
|||
1n=72 and 5 for mixed and isolated hypertension respectively
2n=49 and 7 for mixed and isolated hypertension respectively
3n=35 and 2 for mixed and isolated hypertension respectively
4n=36 and 3 for mixed and isolated hypertension respectively
5n=57 and 8 for mixed and isolated hypertension respectively
2n=49 and 7 for mixed and isolated hypertension respectively
3n=35 and 2 for mixed and isolated hypertension respectively
4n=36 and 3 for mixed and isolated hypertension respectively
5n=57 and 8 for mixed and isolated hypertension respectively
Furthermore, a positive history of headache as well as chest
pain that improves with rest or medication rather than requiring
a hospital visit was found to be marginally associated with mixed
hypertension. As was the case with nausea, literature was not
found to have reported similar associations earlier in patients on
anti-hypertensive therapy.
As it has been shown that hypertensive patients who have uncontrolled blood pressure due to poor adherence to antihypertensive medication continue to be at risk of serious morbidity and mortality, and as adherence to anti-hypertensive therapy was not evaluated in the study participants, the presence of the above reported associations due to selective non-adherence only by patients with mixed hypertension cannot be ruled out, but as the group of participants with mixed hypertension was quite large as compared to those with isolated hypertension, such a conclusion appears highly improbable.[13]
As it has been shown that hypertensive patients who have uncontrolled blood pressure due to poor adherence to antihypertensive medication continue to be at risk of serious morbidity and mortality, and as adherence to anti-hypertensive therapy was not evaluated in the study participants, the presence of the above reported associations due to selective non-adherence only by patients with mixed hypertension cannot be ruled out, but as the group of participants with mixed hypertension was quite large as compared to those with isolated hypertension, such a conclusion appears highly improbable.[13]
Limitation and Recommendation
Having a moderate sample size and using convenient
sampling technique because of financial and time constraints
were the prime limitations of this study. In light of the study
findings it is recommended that the symptoms identified in this
study to be associated with type of hypertension, if present, need
special attention of health care professionals during hypertension
screening as they may be suggestive of the type of hypertension
a patient has.
Conclusion
The study results revealed that only nausea was found to have
a statistically significant association with type of hypertension
though both history of headache and severity of chest pain were
found to have only marginally insignificant associations with
type of hypertension. None of the other signs and symptoms
of hypertension were found to be associated with type of
hypertension. Special focus on these symptoms by health care
professionals during hypertension screening is recommended.
Conflicts of Interest
All authors have none to declare.
km2, 95% of which is equatorial forest. The official population is 229,000, but there are approximately 40,000 illegal immigrants.
km2, 95% of which is equatorial forest. The official population is 229,000, but there are approximately 40,000 illegal immigrants.
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