Isolated systolic hypertension

‘Effect of anti-hypertensive drugs and other modifiable factors
on systolic blood pressure (SBP) in elderly population: a study
from a tertiary care hospital in Delhi’
CO-SUPERVISOR
Razi Ahmad
MD,DCH
Associate Professor Pharmacology
Supervisor of HAH Centenary
Hospital Pharmacy, Jamia
Hamdard, New Delhi
PRESENTED BY:
NIKHIL SINGH
M.PHARM
PHARMACY PRACTICE
NIPER-H
SUPERVISOR
Dr. Shridhar Dwivedi
MD, PhD (Cardiology), FAMS,
FRCP (London), FIACS,
Dean and Principal of HIMSR & HAH
Centenary Hospital
Jamia Hamdard, New Delhi

Flow of Seminar
• Introduction
• Complications of Hypertension
• Aim & Objective
• Methodology
• Inclusion Criteria & Exclusion Criteria
• Results
• Conclusion

INTRODUCTION
• Hypertension (HTN) or high blood pressure, sometimes called arterial hypertension, is
a chronic medical condition in which the blood pressure in the arteries is elevated.
• In elderly population, systolic hypertension is the commonest form of hypertension
and it is a better predictor of cardiovascular events, end-stage renal disease , as
compared to diastolic blood pressure.
• Isolated systolic hypertension is more often seen in the elderly than in the young.
• Population older than 50 years, systolic blood pressure (SBP) over 140 mm Hg is an
important risk factor for stroke and heart disease.
• Most cases of uncontrolled hypertension in the United States are due to systolic
hypertension among elder.
• Therefore, prevention and treatment of systolic hypertension (SBP) may be helpful in
the growing epidemic of kidney & heart dysfunction among elderly persons.

AIM & OBJECTIVES
AIM:
The overall aim is to evaluate the effect of anti-hypertensive drugs on systolic blood
pressure (SBP) in elderly population. More specifically, the following objectives will be
achieved:
Objectives:
1) To study the effect of antihypertensive drugs on systolic blood pressure (SBP) in
elderly patients (≥50 years men and in ≥45 years females, menopausal).
2) To find out relation between various factors (smoking/red meat/junk food) and systolic
blood pressure (SBP) in elderly population.
3) To analyze the effect of Visceral Adiposity Index on systolic blood pressure (SBP) in
elderly patients.

Methodology
 Type: It is the prospective study of the elderly patients with hypertension.
 Site: The study was conducted at Hakeem Abdul Hameed Centenary
Hospital, Jamia Hamdard , New Delhi – 110062, India.
 Study population: 220 patients with their follow-up
 Duration of study: 11 months
 Source of data: Patients registered in OPD/IPD & ICU
 Follow up have taken after every 1 to 2 month

Inclusion Criteria
 Elderly patients (male ≥50 yr. and female ≥ 45yr. , Post
Menopausal)
 Patients with > 140/90 mm of Hg
 All menopausal female with BP > 140/90 mm of Hg
 Systolic blood pressure >140 mm of Hg

Exclusion Criteria
 Patient with age of Male < 50 yrs. and female < 45yrs
(or non-menopausal)
 Patients with ≤ 140/90 mm of Hg
 Patients with other chronic diseases ( Except T2DM)

Results
• Out of total 230 patients enrolled, 220 (96%) were
followed and completed study (9 were left and 1
died).
Gender wise Distribution of Patients
Gender Frequency Percentage (%)
MALE 108 49%
FEMALE 112 51%
TOTAL 220 100%

MALE, 108,
49%
FEMALE,
112, 51%
The study includes more female patients as compared to male patients. A total of 51%
patients were female while 49% patients were male. There is significant correlation
between gender and SBP (P˂0.05).
Gender wise distribution of patients

45-55, 73
55-65, 98
65-75, 37
75-85, 12
85-95, 1
0
20
40
60
80
100
120
(Years) 45-55 55-65 65-75 75-85 85-95
Age wise distribution of patients
There is significant correlation between age and SBP (P<0.05)

Socioeconomic Status (modified kuppuswamy scale 2014)
56%
30%
14%
0
20
40
60
80
100
120
140
IV III II
The study reveals that 123 (56%) patients belongs to IV socioeconomic status patients
followed by 66 (30%) to III socioeconomic status patients. There is negative correlation
between Socioeconomic Status and SBP (P<0.05).

Religion wise distribution
HINDU ,
157, 72%
MUSLIM ,
60, 27%
CHRISTIAN ,
2, 0.09%
0
20
40
60
80
100
120
140
160
180
HINDU MUSLIM CHRISTIAN
The maximum number of patients belongs to Hindu group, 157 patients (72%) of total
population followed by Muslim group, 60 patients (27%) of total population. There is
negative correlation between religion and SBP (P<0.05).

Education
This study reveals that illiterate patients are more hypertensive as compare literate
patients. There is negative correlation between SBP and education (P<0.05)
Illiterates 10th 12th
Graduate &
above
Total
Frequency 85 36 67 29 220
85
36
67
29
220
0
50
100
150
200
250
PATIENTS
LITRACY

OBESITY
The study depicts that obese patients (134) were more hypertensive as compared
to non-obese patients (86). Among the 134 obese patients female patients were
88(65.67%) and male patients were 46 (34.32%) There is significant relation
between obesity and SBP (P<0.05).
Male Female Total
Obese Patients 46 88 134
Non-obese Patients 62 24 86
46
88
134
62
24
86
0
20
40
60
80
100
120
140
160
PATIENTS
GENDER
Obese Patients Non-obese Patients Linear (Obese Patients )

Tobacco user
The study documented that among the 220, hypertensive patients, 40.90% (90) patients
were tobacco. The habits of tobacco were seeing more in male patients (31.36%) as
compared to female patients (9.54%). There is positive correlation between tobacco
and SBP (P<0.05).
Smokers user (%) Non-smoker
Male 69 39
Female 21 91
Total 90 130
69
39
21
9190
130
0
20
40
60
80
100
120
140
NO.OFPATIENTS
GENDER
Male Female Total

Non-vegetarians
Male Female Total
Non-veg eater (n=152) Non-
red meat (n1)
14 10 24
Non-veg eater (n=152) Red
meat (n2)
72 56 128
14 10
24
72
56
128
0
20
40
60
80
100
120
140
AxisTitle
Axis Title
Non-veg eater (n=152) Non-red meat (n1) Non-veg eater (n=152) Red meat (n2)
In this study 152 (69.09%) patients were non-veg eater out of 220 elevated systolic
blood pressure patients and among the non-veg eater 128 (58.18%) were red meat eater
while only 24 (10.90%) non-red meat eater. The occurrence of male patients (39.09%)
was found comparatively higher than female patients (30%). There is significant
correlation was found between non-veg eater and SBP (P<0.05).

Junk Food Eater
Male Female Total
Total no 108 112 220
Junk food 100 90 190
Non-junk food eater 8 22 30
108 112
220
100 90
190
8 22 30
0
50
100
150
200
250
PATIENTS
GENDER
Total no Junk food Non-junk food eater
The study leads to conclude that out of 220 hypertensive patients, 190 (86.36%)
patients were junk food eater and 30 (13.63%) patients were non-junk food eater. The
habit of junk food eating was more in male patients 100(45 %%) as compared to
female patients, 90 (40.90%). There is positive correlation between junk food eater
and SBP (P<0.05).

Type-II Diabetes Mellitus
Male Female Total
T2DM 25 41 66
Non- T2DM 36 58 94
25
41
66
36
58
94
0
20
40
60
80
100
AxisTitle
Axis Title
T2DM Non- T2DM
This study leads the conclusion that only 66 (30%) patients were having T2DM out of 220
hypertensive patients and among the T2DM patients female patients were more
41(18.63%) as compared to male patients 25(11.36%)There is no significant correlation
between T2DM and SBP (P> 0.05).

MONO DRUG THERAPY
TELMI
SARTA
N
(40Mg)
RAMIP
RIL(5M
g)
AMLO
DIPINE
(5Mg)
METOP
ROLOL
(50Mg)
CARVE
DILOL(
3.125M
g)
CHLOR
THALI
DONE
(12.5
Mg)
INDAP
AMIDE
( 2.5
Mg)
SPIRO
NLACT
ONE
(50Mg)
ATENO
LOL
(50Mg)
% REDUCTION IN SBP 21.61% 19.37% 17.15% 15.01% 12.50% 11.76% 6.66% 2.75% 0.09%
21.61%
19.37%
17.15%
15.01%
12.50% 11.76%
6.66%
2.75%
0.09%
0.00%
5.00%
10.00%
15.00%
20.00%
25.00%
REDUCTIONINSBP
DRUGS
This study reveals that among the single drug therapy telmisartan (40mg) shows 21.61%
reduction in systolic blood pressure followed by ramipril (5mg) shows 19.3% reduction,
amlodipine (5mg) shows 17.15% reduction, metoprolol (50mg) shows 15.01% reduction &
carvedilol (3.125mg) shows 12.5% reduction.

TWO DRUG THERAPY
α1 & β1
BLOCK
ER +
THIAZI
DE
CCB+
DIURET
ICS
CCB+ β1
BLOCK
ER
ARBS +
CCB
THIAZI
DE +
ARBS
% REDUCTION IN SBP 27.21% 26.70% 24.57% 19.03% 18.72%
27.21% 26.70%
24.57%
19.03% 18.72%
0.00%
5.00%
10.00%
15.00%
20.00%
25.00%
30.00%
REDUCTIONINSBP
DRUGS
This study reveals that among the dual drug therapy α1 & β1 blocker + diuretic shows
27.21% reduction in systolic blood pressure followed by CCB+ diuretics shows 26.7%
reduction, CCB+ β1 blocker shows 24.57%reduction, ARBS + CCB shows 19.03%
reduction & thiazide + ARBS shows 18.72%reduction.

TRIPLE DRUG THERAPIES
CCB+β1
BLOCKE
R +
ARBs
CCB+
ACE +
DIURETI
C
ARBs +
DIURETI
C + CCB
DIURETI
C+DIUR
ETIC+α1
&β1BLO
CKER
CCB+α2a
gonist+DI
URETIC
REDUCTION IN SBP (%) 23.91% 21.60% 14.44% 13.88% 2.85%
23.91%
21.60%
14.44% 13.88%
2.85%
0.00%
5.00%
10.00%
15.00%
20.00%
25.00%
30.00%
%REDUCTIONINSBP
DRUGS
This study depicted that among the triple drug therapy CCB+ β1 blocker + ARBs
shows 23.91% reduction in systolic blood pressure followed by CCB+ ACEI+ diuretic
shows 21.60%reduction, ARBs + Diuretic + CCB shows 14.44% reduction and
diuretic +diuretic + α1 & β1 blocker shows 13.88%reduction

FOUR DRUGS THERAPY
% REDUCTION IN SBP
ACEI+ CCB+DIURETICS +
β1 BLOCKER
11.54%
11.54%
0.00%
2.00%
4.00%
6.00%
8.00%
10.00%
12.00%
14.00%
%REDUCTIONINSBP
DRUGS
This study reveals that the four drugs therapy ACEI+ CCB+ diuretics + β1 blocker
shows 11.54% reduction in systolic blood pressure.

Descriptive Statistics of Lab Investigations by
Multiple Regression (IBM SPSS 2.0)
Recorded values Mean±SD Reference values P value ˂ 0.05,
significant
SBP(mmHg) 172 16±16.76 ≤ 140 1
Creatinine (mg/dl) 1.22±0.52 0.5-1.4 0.352
Urea (mg/dl) 34.04 ± 14.89 15-45 0.501
GFR (mL/min/1.73 m2) 64.47±26.65 ≥60 (≥ 50 years) -0.538
K+ (meq/l) 4.08±0.72 3.5-5.4 -0.09
Na+(meq) 139.59±3.78 136-149 0.03
Cl- (meq/l) 105.63±4.66 98-108 0.09
SGOT (IU/L) 28.41±5.51 5-40 0.191
LDL (mg/dl) 86.34±20.74 150-190 0.04
HDL (mg/dl) 53.06±20.74 30-70 -0.128
The study reveals that K+ is negatively correlated with SBP (P= -0.090), Cl- is not correlated with
SBP (P=0.09), Na+ is positively correlated with SBP (0.03),SGOT is not correlated with SBP
(0.191).HDL is negatively correlated with SBP (P=-0.128),LDL is positively correlated with SBP
(P=0.04) , Creatinine & Urea did not show significant correlation, GFR is negatively correlated
with SBP, C-RP is positively correlated with SBP.

CONCLUSION
• This study concluded that prevalence of elevated SBP is highest in the age group of 55-65
years among elderly patients.
• This study also reveals that age, obesity, non-veg eater and junk food eaters are positively
correlated with elevated SBP, while socioeconomic status and education are negatively
correlated with SBP.
• Tobacco showed significant correlation with elevated SBP and this habit was seen more in
male patients as compared to female patients
• Waist circumference is positively correlated with elevated SBP although visceral adiposity
index has no significant correlation with SBP.
• In pharmacological treatment of telmisartan as single drug therapy provides good control
of SBP followed by ramipril and amlodipine but combination of two drugs carvedilol with
thiazide diuretic or CCB with diuretics provides better control of systolic hypertension as
compared to monotherapy in elderly population.
• Carvedilol did not show good control in elevated SBP as a single drug therapy but with
diuretics (combination) showed better control in elevated SBP. In this study combination
of carvedilol with thiazide were given to very few patients so further study on this
combination needed. According to available evidence it is clearly depicted that carvedilol
could be a valuable tool for the management of hypertension.
• In addition some previous studies are supporting our results whereas some are not, so
considering the findings; this study opens the door for further research in this regard.

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