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Medication used by hypertensive patients in Isfahan, Najaf-Abad and Arak
Tavasooli AA, Khosravi AR, Mohamadifard N, Shahrokhi SH
Objectives:
High blood pressure is the most prevalent chronic disease which doctors
come in contact with. It’s prevalence in Isfahan city has been reported to be
18%. Appropriate application of drugs have useful effects on morbidity and
mortality. The aim of this study is to identify the complex of drugs used in
three districts of Isfahan, Najafabad and Arak.
Methods and Materials: This is a descriptive cross- sectional study, which was conducted in
Isfahan, Najafabad and Arak districts during 2000-2001. Random cluster
sampling was used and 10674 subjects were selected from rural and urban
areas of three above-mentioned districts. Blood pressure measurement
was carried out by was carried out by trained personal According to world
Health organization (who) standardized criteria .The mean valve obtained
from three readings was used in the analysis. Hypertension was defend as
SB 140 mmg and/or DBP 90 and/or the use of antihypertensive
medication. Data were entered in EPI 5 software and analyzed by using
T.Test and Chi- Square test in SPSS software.
Results:
About 2015 individuals (18.9%) had high blood pressure. The knowledge,
treatment and blood pressure control rates were 47%, 23% and 9%
respectedly. Of 670 patients undergone therapy 527 used single drug, 113
used two drugs with 35 different combinations and 30 used three drugs
with 25 different combinations.
Among the single- drug users B- blockers were the most prevalent primary
selection (23%). after that Methydopa were the second drugs (28%).
Frequency of diuretics consumption was 0.9% which is not completely
consistent with the suggested proper regimen. Among the complex
regimen of two or three drugs, inappropriate combinations like using
Atenolol with properonol (9 patients) and ACE inhibitor with potassium
sparing diuretics (0/5%), direct vasodilator (such as hydralazin) without BBlocker or ca- antagonist (except nifedipine) were seen.
Conclusion:
In our study, primary selection in one drug users was in order B- Blocker
58/8% (Atenolol 51/4%- propranolol 7/4%), Methyldopa 25/6%, nifedipine
4/9% and triamtren-H 4% which had no exact similarity to those
recommended by WHO, and diuretics (in particular Thiazids) were used
very little. Considering the useful effects of Thiazids this view should be
changed. Taking direct vasodilators (such as hydralayzin) alone in our
patients will increase reflex tachycardia and lowers patients’ tolerance
against medication. In our study, unsuitable complexes in complex drug
regimen reduce patients’ compliance and hypertension control and will
increase drug side – effects. The need exists to plan correctly for their
modification.
Keywords:
High blood pressure, Drug used- reduce blood pressure, complex regimen.
The frequency of systolic versus diastolic heart failure in an Egyptian cohort
Bassem S. Ibrahim
National Heart Institute, Cairo, Egypt
Background:
Aims:
Methods:
Results:
Conclusion:
All factors predisposing for congestive heart failure (CHF), such as coronary
artery disease (CAD), hypertension and diabetes are increasing in
prevalence in Egypt. Despite this, no data about CHF in our country are
available.
To study the relative contribution of systolic vs. diastolic heart failure in
Egyptians and the prevalence of risk factors in this population, as well as
their prognosis.
This was a retrospective study of patients with a diagnosis of CHF over a
3.5-year period in a general cardiology clinic. Demographic, ECG and
echocardiographic data for left ventricular systolic and diastolic function
were collected. The differential effect of systolic vs. diastolic CHF was
analyzed regarding hospitalization and mortality.
After exclusion of valvular diseases, we found 155 patients diagnosed with
heart failure, 102 patients (66%) had systolic heart failure, and 53 (34%) had
diastolic heart failure. Mean age was 60"10 and 63"11 years, respectively
(Ps0.13). Systolic CHF patients had significantly more CAD, while those with
diastolic failure were mostly hypertensives (P-0.01) for both. There was no
significant difference in the incidence of diabetes mellitus, cerebrovascular
accidents or atrial fibrillation between the two groups. Patients with systolic
failure required more hospitalization, P-0.05, and had a mortality rate of
17.6% vs. 11.3% for patients with diastolic heart failure (Ps 0.3).
Diastolic heart failure is present in one-third of cases of CHF in Egyptians.
Hypertension is very common in this group. These patients require less
hospitalization but have a similar mortality rate.
The effectiveness of community–based programs on hypertension prevention and
control
Nizal Sarraf-zadegan M.D
Isfahan Cardiovascular Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
The rapid rise of non-communicable diseases (NCD) threatens economic and social
developments as well as the lives and health of millions of people. In 1998, NCD contributed to almost
60% of deaths in developing countries.
New lifestyle changes result in higher rates of NCD such as cardiovascular (CVD), cancers,
hypertension, diabetes and chronic obstructive pulmonary diseases.
Although a considerable body of evidence suggests that programs for hypertension and
associated risk factors prevention and control beside low cost case-management, offer feasible, cost
effective ways to reduce hypertension mortality and morbidity, however, in most developing countries,
implementation of these programs is lacking probably due to the lack of awareness in this regard.
Educating people on lifestyle changes in an integrated manner, namely to eat a healthy diet, to
keep physically active, to avoid smoking and cop with stresses, will be the main emphasis of any
effective community- based initiative directed at the primary prevention of high blood pressure.
Successful interventional strategies should focus on health services, public education, community
organization and regulations.
Blood Pressure In Children Of Hypertensive And Normotensive Parents
Feiz J MD, Kelishadi R MD, Bashardoost N PhD
Isfahan Cardiovascular Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
Objectives:
To compare the blood pressure (BP) of children of hypertensive and
normotensive parents in order to identify at -risk children.
Subjects and Methods: This case-control study was performed on 746 children and adolescents
(aged between 6 to 18 years) with hypertensive parents as the case group,
and 2238 children and adolescents in the same age group with
normotensive parents as controls . BP, weight, body mass index were
measured and physical examination was performed. Data have been
analyzed by SPSS/win using the student t, multiple linear - and logistic
regression tests.
Results:
The mean systolic BP (SBP) and diastolic BP (DBP) in children of
hypertensive mothers was significantly higher than controls (108.8+ 14.2 vs.
104.3+15.2,95%CI=98.2-107.4, P<0.05 and 72.4+11.4 vs.67.6+11.2,
95%CI=64.2-70.1, P<0.05 respectively). Regarding fathers, this difference
was significant only for SBP (107.1+15.4vs.104.4+15.1,95%CI=99.1105.7,P<0.05). The mother/children correlation of SBP and DBP and also
the father/children correlation was significant for DBP (P<0.05). Using
multiple regression analysis, SBP and DBP more than 95th centile of children
were significantly associated with mean parental BMI (P<0.05).
Conclusion:
The results confirm the importance of the primary prevention of essential
hypertension especially in children of hypertensive parents.
Keywords:
essential hypertension, parent, children, prevention.
Cardiovascular Disease in Iran: Mortality, Prevalence and risk factors over 15 years
Khami A., Sarraf-Zadegan N., Boshtm M., Bashardoost N., Malekafzali H., Rafie M., Tafazoli F.
Isfahan Cardiovascular Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
Until the 1960s, the trend in mortality from coronary heart disease (CHD) was generally upward in the
industrialized countries. This peak was followed by a downward trend in many of these countries.
Several population based studies have been done to determine the prevalence of Ischemic heart
diseases using WHO (Rose) questionnaire as well as the prevalence of CHD risk factors using Monica
questionnaire in different countries around the world.
Similar studies have been done in Iran as well. Death certificates were used in one of our studies to
obtain the data about cardiovascular disease (CVD) mortality which were stratified according sex and
different age groups (30-75 years old) for the years 1981–1995 ICD-9 revision and the population
distribution of men and women in 1986 as the standard population were used, then death rates were
standardized for age by the direct method.
Age adjusted CVD mortality rates per 100000 for the years 1981, 1986, 1991 and 1995 were 2099.8,
1324.8, 1305.9 and 1093.7 respectively. Sex-adjusted and age-sex-adjusted CVD mortality rates also
have been obtained. Another cross-sectional study have been done in 1995-1996 on 5187 men and
women aged 40-70 years who were selected from 40 clusters by random cluster sampling using WHO
(Rose) questionnaire (RQ) and Minnesota code classification (MC) for 12 lead ECG which was done
to determine the prevalence of CHD. The prevalence of definite angina pectoris (AP) according to RQ
was 7.6% and possible myocardial infarction (MI) was 3.3%, but according to MC the prevalence of
definite MI was 4.4% and possible MI was 3.2%, respectively. Few studies have been done in Iran
showing an increasing trend in the prevalence and incidence of CHD especially among younger
people. The large geographical variations in the prevalence of major risk factor have been widely
accepted.
Another cross sectional study that have been done by Isfahan Cardiovascular Research Center in
1995 on 2200 men and women aged 20-70 years using the questionnaire derived from the WHO
manual (MONICA) showed that 45% of the people had hypertriglyceridemia, 33%
hypercholesterolemia, 6% diabetes mellitus, 12% were current smokers and 18% were hypertensives.
These data were obtained according to sex and different age groups also. Although the general food
pattern of the population fails within the accepted ranges recently, but the trend in the last 20 years
reveals a significant rise in fat intake such that 21% of the energy is coming from fat compared to the
previous figure of 13%.
The results obtained from above studies revealed increasing prevalence and incidence of CHD and its
risk factors although mortality from CVD was decreasing due to new treatment strategies. These
results may be due to the effects of urbanization and western life style.
Effect of Cigarette Smoking on Electrocardiographic performance for the Identification
of Left Ventricular Hypertrophy in Arterial Hypertension
Mahmoud K. Farrag MD, Lobna F. EL-Toney MD, Fathia K. Ibraheem MD
Department of Internal Medicine, Assiut University Hospitals
Background:
Objectives:
Methods:
Results:
Conclusions:
Keywords:
Cigarette smoking is one of the major risk factors in the development of
cardiovascular diseases (CVD). Left ventricular mass (LVM) is associated
with an increase in the risk of morbidity and mortality of CVD in hypertensive
patients.
To investigate the effect of cigarette smoking on the prevalence of left
ventricular hypertrophy (LVH) and to assess the influence of smoking on the
diagnostic criteria of electrocardiography (ECG) for LVH in recently
diagnosed untreated hypertension using Echocardiographic LVM as a
reference.
137 recently discovered untreated hypertensive patients were evaluated; 52
patients were excluded while 82 patients remained (37 smokers and 45 non
smokers) and had ECG and M-mode Echocardiography.
Smokers did not significantly differ from non smokers in age, gender, height,
weight, body surface area (BSA), body mass index (BMI), and systolic and
diastolic blood pressures. LVH was detected in smokers more than non
smokers (43.2% vs 20%, p<0.05 by Echocardiography, and 24.3% vs
11.1%, p<0.05 by ECG). Sensitivity of ECG criteria for detection of
echocardiographically-determined LVH was lower in smokers than non
smokers (10% vs 36.6%,p<0.05 respectively) and lower in heavy smokers
than in moderate smokers (50% vs 76.6%,p<0.01 respectively) when using
Sokolow-Lyon voltage (chest leads) . In contrast, sensitivity of ECG criteria
for detection of LVH did not differ either between smokers and non smokers
or between heavy and moderate smokers when LVH identification was
based on other ECG criteria as limb leads (Gubner-Ungerleider), both limb
and chest leads (Minnesota code 3-1, Framingham criterion, and Cornell
voltage) and different leads (Perugia score and Romhilt-Estes score ≥5
point). Specificity of ECG was not affected by smoking status.
Cigarette smoking is an independent risk factor for development of LVH in
recently diagnosed untreated hypertensive patients. Sensitivity of ECG for
identification of echocardiographically-determined LVH is lower in smokers
and is inversely correlated with severity of smoking when LVH is defined
according to Sokolow - Lyon voltage. So, for LVH identification in
hypertensive smokers, Sokolow-Lyon voltage (chest leads) should be
avoided and replaced by other ECG criteria (limb leads, combined limb and
chest leads and different leads) which are not affected by smoking.
Smoking;
Electrocardiography;
Echocardiography;
Left
ventricular
hypertrophy; hypertension.
The Heritabilty of Haemodynamic Variables Contributing to Blood Pressure in a Large
Omani Pedigree: First Report of The Nizwa Blood Pressure Study
M. O. Hassan, A. Jaffer, S. Albarwani, S. Al Yahyaee, S. Al Haddabi, J. Al Lawati and R.A.
Bayoum
College of Medicine, Sultan Qaboos University and the Ministry of Health, Sultanate of Oman
Objectives:
Methods:
Results:
Conclusions:
The aim of this project is to examine the genetic influence on hemodynamic and
other related variables contributing to blood pressure in 5 generations of a large
Omani pedigree.
In 177 members of one semi-rural Omani family, aged 16-90 years, R-R interval
(heart rate (HR), systolic (SBP), diastolic (DBP) mean blood pressure (MABP),
stroke volume (SV) and total peripheral resistance(TPR)were measured noninvasively using the Task Force Monitor which provides continuous beat-to-beat
blood pressure and cardiac parameters. Other relevant variables were 24 hour
ambulatory blood pressure (ABPM, Schiller), body mass index (BMI) and waist
circumference (WC).
Hemodynamic variables were measured after 10 minutes of rest and during 3
minutes of mental stress using the Stroop color test and 3 minutes of foot ice
immersion. Differences between the hemodynamic variables during the stress tests
and the respective resting periods were taken as the reactivity for that variable.
Genetic parameters were estimated using variance decomposition methods
implemented in the SOLAR software package.
Based on a simple analysis model with age, sex and blood pressure status as
covariates more than half the traits show significant heritability. Variables showing
the strongest additive genetic heritability (h2) were resting SV, (h2 = 0.3, SE ± 0.13,
P<0.0009), ice TPR (h2 = 0.40, SE ± 0.15, P<0.0005) ice SV (h2 =0.24, SE ± 0.14,
P<0.009), Color TPR reactivity (h2 = 0.25, SE ± 0.14, P<0.003) and ice DBP (h2
=0.37, SE ± 2.0, P <0.002). ABPM showed a strong heritability only for DBP during
daytime activity (h2= 0.27, SE ± 0.14 P< 0.0071). The heritability of BMI and WC
were similarly very strong (P<0.00001 and P<0.00085 respectively)
These preliminary results show that, of the hemodynamic variables, SV and TPR,
the main components of blood pressure, are under a significant genetic influence in
this population.
Value of Blood Pressure Monitoring In Predicting Left Atrial Size in Hypertensive
Patients
Mohamed Lotfy, Mona Rayan MD, Sameh Emil MD, Sayed A. Elhafiz MD, Ali Ramzy MD
Objectives:
Methods:
Results:
Conclusions:
To examine blood pressure profile and its relation to left atrial size and to evaluate
the relationship between left atrial size and left ventricular mass.
Left atrial size was measured in 50 patients with mild to moderate hypertension
with ambulatory blood pressure monitoring for day, night and 24 blood pressures
mean values and measuring LVM.
There was significant relationship between LA size and 24 and night systolic blood
pressure (p < 0.05) and high significant relation between LA and day systolic blood
pressure (p <0.0001). Dippers were 77% in patients with LA enlargment also there
was significant relation between LA size, LVM (p<0.05) and duration of
hypertension also there was highly significant relation between LA size and age
(p<0.0001).
High systolic blood pressure, LVM, age, non dipping pattern of blood pressure and
long duration of hypertension are strong predictors of LA enlargement in
hypertensive patients.
Ambulatory Blood Pressure Monitoring In Normotensive and Hypertensive Type 2
Diabetics
Mary Fekry Tawfik, MS, Ihab Mohamed Attia MD, Nabil Mahmoud Farag MD, Alaa Hataba MD,
Sayed Abdel Hafez Moharam MD, Sameh Emil Sadek MD
Background:
Ambulatory blood pressure monitoring has demonstrated the presence of a
blood pressure circadian rhythm in both normotensive and hypertensive
subjects.
Aim:
To assess the prevalence of abnormal blood pressure rhythm in both
normotensive and hypertensive type 2 diabetics and to show that patients
with lack of nocturnal blood pressure fall might be at risk of left ventricular
hypertrophy.
Patients and Results: Ambulatory blood pressure monitoring was performed to 40 patients with type
2 diabetics (20 normotensives and 20 hypertensives) and 20 control subjects
(10 normotensives and 10 hypertensives). Nocturnal diastolic blood pressure
and especially nocturnal systolic blood pressure were significantly less
marked in both normotensive and hypertensive diabetics. % systolic and
diastolic blood pressure change in the normotensive non diabetics vs
normotensive diabetics for the systolic BP. : -8.58  3.9 % vs – 4.29  7.87 %
( p< 0.05 ) and -7.093.53% vs –5.973.53% (p<0.05) for the diastolic BP. %
systolic and diastolic blood pressure change in the hypertensive non diabetics
vs hypertensive diabetics: -10.08 4.43% vs –3.697.47% (p<0.01) for
systolic BP and -8.294.79% vs –3.299.71% (p<0.05) for diastolic BP. No
statistical significance was found in day-night systolic and diastolic blood
pressure changes between the normotensive and hypertensive non
diabetics:– 8.58  3.9% vs – 10.08  2.43% (p>0.05) for systolic BP and 7.09 3.53% vs –8.294.79% (p>0.05) for diastolic BP. The contribution of
impaired diurnal blood pressure rhythm to target organ damage showed that
left ventricular mass index correlated significantly with the night-time systolic
and diastolic blood pressure in the hypertensive diabetics: 130.55 67.17 and
-3.69 7.47%(p<0.001) and 130.55 67.17 and -3.299.71% (p<0.001) and
with the night-time diastolic blood pressure only in the normotensive diabetics:
111.4238.02 and -4.297.87% (p>0.05) and 111.42 38.02 and -5.97 4.46
% (p<0.05). No significant correlation was found between left ventricular mass
index and blood pressure circadian rhythm in the control subjects.
Conclusion:
The results obtained showed that the decrease in the nocturnal fall of blood
pressure is prevalent in type 2 diabetics and that it contributes to the severe
end organ damage (left ventricular hypertrophy). Thus ambulatory blood
pressure monitoring is of clinical importance in the treatment of diabetic
subjects as a restoration of a more physiological circadian blood pressure
pattern is an important goal.
Blood Pressure Variability and Occurrence of Dysrhythmias In Patients On
Hemodialysis
Ahmed Sabry, MS, Ramzy Hamed MD, Sayed Abdel Hafiz MD, Sameh Emil MD, Azza El Fiky MD
Introduction:
Aim:
Methods:
Results:
Conclusion:
Hypertension is one of the most important manifestations of CVS diseases
encountered in hemodialysis patients. There is variability in BP due to
variability in extra cellular volume. PVCs are prevalent in hemodialyzed
patients. Concentric LVH conferring higher risk than does eccentric one.
To study the relationship between BP variability and occurrence of PVCs.
30 male patients on regular hemodialysis with mean age of 46.6±1.7. All
patients were monitored by Holter monitor and ambulatory BP monitoring
(ABPM) including the dialysis period. Lab investigations included: CBC,
serum creatinine, blood urea, electrolytes, and echocardiography.
The study is divided into: predialysis, dialysis and postdialysis. The
prevalence of PVCs was 60% (lown G I and II). Most significant correlation
was between: the prevalence of PVCs and increased LVM, LVMI and LA
enlargement. Impaired diastolic functions significantly affect genesis of
PVCs in post-dialysis period. BP variability and chemical profile showed no
significant correlation.
This group of stable, low risk hemodialysed patients had higher prevalence
of PVCs. It was influenced by increased LVM and LVMI and LA
enlargement. So, older hypertensive population should be subjected to
routine echocardiography to detect LVM, LVMI and LA enlargement as a
predictor for PVCs.
The Predictive Value of Loss of Blood Pressure Circadian Rhythm in Patients with
Acute Myocardial Infarction
Noha Mahmoud A Hamid, Mona Mostafa Rayan MD, Sameh Emil Sadek MD, Said A Hafiz
Khaled MD
Aim:
To evaluate the incidence of major adverse cardiac events (MACEs) in
dippers and non–dippers hypertensive patients with acute myocardial
infarction.
Material and methods: Twenty four hours non invasive ambulatory blood pressure monitoring was
performed two days after admission for sixty patients admitted to coronary
care unit with the diagnosis of hypertension and acute myocardial infarction.
All patients under went a full clinical evaluation, ECG and echocardiography
one week after admission to calculate left ventricular mass. MACEs (death,
reinfarction, heart failure, stroke and recurrent ischemia) were reported
during three to six months follow up.
Results:
Twenty seven patients (45%) of the study group showed ≥10% night drop of
both systolic and diastolic blood pressure [dippers], whereas thirty three
patients (55%) showed either no such drop or no drop at all [non dippers].
The last group showed longer duration of hypertension, higher left
ventricular mass index >134 gm/m 2 (normal cut point), larger left atrial size
and higher systolic blood pressure (max, mean and night). Also, they had
higher incidence of MACEs 48% vs 37% in dippers from all patients
developing MACEs, in the form of 63% (reinfarction), 38% (angina) and 0%
(stroke).
Conclusion:
Therefore, the loss of blood pressure circadian rhythm in hypertensive
patients with acute myocardial infarction adds a predictive value in the
assessment of these patients and ambulatory blood pressure monitoring has
to be considered as an important tool in the prognostic stratification of these
patients.
Pattern of Cerebral Atherosclerosis in Egyptian patients with cerebral ischemia
Zaki H1, El-Etribi M1, Dwedar A1, Abdulghani M1, Hassan A2 Saleh M3
1Neurology Department, 2Radiology Department, 3Cardiology Department; Ain Shams University
Background:
Patients and Methods:
Results:
Conclusions:
Key words:
The prevalence of atherosclerosis varies with the population selected,
for instances, in orientals carotid atherosclerosis is unusual, but in the
United States it is epidemic. Aim: To clarify the distribution of
atherosclerosis in the cerebral circulation in the Egyptian patients with
cerebral ischemia.
100 Egyptian patients with ischemic stroke or transient ischemic attacks
underwent full neurologic and laboratory assessment as well as MRI or
CT-brain and both transthoracic and Transesophageal echocardiography. Intracranial vascular assessment was done using MRA or digital
subtraction cerebral Angiography while extracranial vascular
assessment was done using carotid Duplex and MRA or digital
subtraction Angiography.
Significant extracranial carotid stenosis was present in only 13% of
patients while significant stenosis of the intracranial carotid system
(including intracranial internal carotid artery, middle cerebral and anterior
cerebral arteries) was present in 48% of patients and significant
intracranial vertebrobasilar stenosis was present in 32% of patients. By
multivariate analysis, only a past history of ischemic heart disease was
significantly correlated with extracranial carotid stenosis while only
insulin dependant diabetes correlated with the intracranial carotid
stenosis.
In Egyptian patients with cerebral ischemia atherosclerosis of the
intracranial carotid and vertebrobasilar systems is more prevalent than
the extracranial carotid system. Moreover 60% of patients who have
extracranial stenosis have a tandem intracranial lesion.
Cerebral atherosclerosis, TIA, stroke.
Hypertnsion and Autonomic Nervous System Function "HANS" study
Abdel Moneim M. Mashaal, MD
National Heart Institute
Aim:
The aim of this work is to study the Autonomic Nervous System function in
early, pre-hypertension "Pre.H." and in established hypertension "E.H."
stages.
Patients and Methods: This study included 300 subjects with elevated B.P and 80 normotensive
subjects for comparison. Each subject was exposed to the following
physiologic tests: change in posture, Valsalva maneuver, mental stress, cold
pressor, hyperventilation tests. The pharmacological tests included:
Isoprinaline infusion, propranolol infusion, atropine sulphate infusion and
isosorbid dinitrite sublingually.
Results:
The low pressure sensitive baroreoptors function was intact in Pre. H.
stages I & I1 and the high pressure sensitive receptors function, is intact in
Pre. H. stage I. and is attenuated in pre H. stage II. Both functions were
greatly impaired in E.H. also it revealed significant increase in the activity of
the cerebral cardio-vascular autonomic centers "CVAC" at cortical, subcortical and medullary levels in the 3 tages.
Beta1 and alph2 adrenergic receptors sensitivity increased significantlly in
Pre H. stage II, while they were attenuated in "E.H." The parasympathetic
receptors function was intact, and the resting parasympathetic outflow was
normal in Pre. H. stage I and it increased in Pre. H. stage II & E.H. The
resting vascular tonicity increased significantly in the three stages.
The Echo-Doppler study revealed significant increase in left ventricular
(L.V.) systolic function (F.S) mainly in Pre. H. stages I & II, due to
exaggerated contractility of the septal wall (S.W) and Posterior wall (P.W),
(P.W > S.W) the diastolic dysfunction of L.V. appeared in Pre. H. stage II &
E.H. (Reversed E/A ratio and significantly increase in I.V.R.T.). The
structural changes included significant increase in S.W & P.W thickness of
L.V (S.W > P.W) and a significant decrease in right ventricular volume in
E.H. A significant +ve correlation between the increased cerebral CVAC
activities and the increased contractility of S.W & P.W. of the L.V and also
with its diastolic dysfunction.
Conclusion:
This study confirmed the important role of ANS in genesis and aggravation
of essential hypertensions. Also it revealed the value of utilizing the
baroreflex function for determining the early stages of hypertention. Further
more it demonstrated the cardiac functional and structural changes in
various stages of hypertention which may be used as a diagnostic tool for
assessing hypertension severity. In addition it may provide a rational
approach for management of hypertension by the centrally acting
antihypertention drugs and the simultaneous use of alpha and betaadrenergic blocking agent or agents.
Blood Pressure Pattern And Prevalence Of Hypertension Among Egyptian Primary
Shcool Children, Abbassia District, Cairo Governorate
Marzouk DA, Abou-Alfotouh A, El-Setouhy M and Sabour SM
Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Ain
Shams University
Background:
Hypertension is the most prevalent risk factor for coronary heart disease
(CHD) and stroke. Risk factors for hypertension may originate early in life
and develop throughout life from childhood into eventual onset of the
disease in adulthood.
Objective:
The present study was carried out to investigate the pattern (distribution)
and determinants) of blood pressure in Egyptian primary school children in
Abassia district, Cairo governorate and to determine the prevalence of
hypertension and its correlation with anthropometric measures.
Methods:
A multistage stratified random sample of primary schools was drawn from
two primary schools. The students of first to fifth primary grades were
included. The age ranges from 6-13 years, 279 (50.7%) males and 271
(49.3%) females.
Results:
The study revealed that 6.5% & 5% of the students had systolic and diastolic
hypertension respectively and 1.3% had both pressures elevated. Girls had
higher diastolic blood pressure than males. Children having systolic
hypertension tended to be significantly heavier, have higher BMI, greater
midarm circumference, triceps and suprascapular skin fold thickness, waist
and hip circumferences than children having systolic blood pressure < 95th
percentile. Only subscapular skin fold thickness is greater in children having
diastolic hypertension than children having diastolic blood pressure < 95th
percentile. Both systolic and diastolic blood pressures are positively
correlated with age. The prevalence of obesity is 6.5%. Girls are significantly
more obese than males. The present study revealed that obesity is
significantly associated with SBP but not DBP. Stepwise regression analysis
revealed that age, midarm circumference, diastolic blood pressure had
significant effect on SBP while weight and systolic blood pressure had
significant effect on DBP.
Conclusion:
The prevalence of systolic and diastolic hypertension is quiet high in primary
school children in Abassia district, Cairo. It is strongly associated with
obesity. The identification of hypertension in children is recommended as it
is an important contribution to the prevention of cardiovascular disease in
adulthood. Interventions to obese children are in urgent need.
Original Contributions
Verdi Hall (10:00 – 11:30)
Wednesday April 9th, 2003-04-09
Chairmen:
Abdallah Abo Hashem - Adel Abdel Aziz - Helmy Bakr
10:00 - 10:15
Pattern of Cerebral Atherosclerosis in Egyptian patients with
cerebral ischemia
Zaki H1, El-Etribi M1, Dwedar A1, Abdulghani M1, Hassan A2
Saleh M3
1Neurology Department, 2Radiology Department, 3Cardiology
Department; Ain Shams University
10:15 – 10:30
The Predictive Value of Loss of Blood Pressure Circadian
Rhythm in Patients with Acute Myocardial Infarction
Noha Mahmoud A Hamid, Mona Mostafa Rayan MD, Sameh Emil
Sadek MD, Said A Hafiz Khaled MD
10:30 – 10:45
Blood Pressure In Children Of Hypertensive And
Normotensive Parents
Feiz J MD, Kelishadi R MD, Bashardoost N PhD
Isfahan Cardiovascular Research Center, Isfahan University of
Medical Sciences, Isfahan, Iran
10:45 – 11:00
Blood Pressure Variability and Occurrence of Dysrhythmias
In Patients On Hemodialysis
Ahmed Sabry, MS, Ramzy Hamed MD, Sayed Abdel Hafiz MD,
Sameh Emil MD, Azza El Fiky MD
11:00 - 11:15
Value of Blood Pressure Monitoring In Predicting Left Atrial
Size in Hypertensive Patients
Mohamed Lotfy, Mona Rayan MD, Sameh Emil MD, Sayed A.
Elhafiz MD, Ali Ramzy MD
11:15 – 11:30
Marzouk DA, Abou-Alfotouh A, El-Setouhy M and Sabour SM
Department of Community, Environmental and Occupational
Medicine, Faculty of Medicine, Ain Shams University
Original Contributions
Verdi Hall (10:00 – 11:30)
Friday April 11th, 2003-04-09
Chairmen:
Samir Rafla - Hassan Khaled - Naser Taha
10:00 - 10:15
The Heritabilty of Haemodynamic Variables Contributing to
Blood Pressure in a Large Omani Pedigree: First Report of
The Nizwa Blood Pressure Study
M. O. Hassan, A. Jaffer, S. Albarwani, S. Al Yahyaee, S. Al
Haddabi, J. Al Lawati and R.A. Bayoum
College of Medicine, Sultan Qaboos University and the Ministry of
Health, Sultanate of Oman
10:15 – 10:30
The frequency of systolic versus diastolic heart failure in an
Egyptian cohort
Bassem S. Ibrahim
National Heart Institute, Cairo, Egypt
10:30 – 10:45
Medication used by hypertensive patients in Isfahan, NajafAbad and Arak
Tavasooli AA, Khosravi AR, Mohamadifard N, Shahrokhi SH
10:45 – 11:00
Effect of Cigarette Smoking on Electrocardiographic
performance for the Identification of Left Ventricular
Hypertrophy in Arterial Hypertension
Mahmoud K. Farrag MD, Lobna F. EL-Toney MD, Fathia K.
Ibraheem MD
Department of Internal Medicine, Assiut University Hospitals
11:00 - 11:15
Ambulatory Blood Pressure Monitoring In Normotensive and
Hypertensive Type 2 Diabetics
Mary Fekry Tawfik, MS, Ihab Mohamed Attia MD, Nabil
Mahmoud Farag MD, Alaa Hataba MD, Sayed Abdel Hafez
Moharam MD, Sameh Emil Sadek MD
11:15 – 11:30
Hypertnsion and Autonomic Nervous System Function
"HANS" study
Abdel Moneim M. Mashaal, MD
National Heart Institute