Abstract
Amaç: Hipertansiyon (HT) inme, miyokard enfarktüsü, konjestif kalp yetmezliği, periferik vasküler hastalık ve son dönem böbrek hastalığı için en yaygın görülen değiştirilebilen risk faktörüdür. Hipertansiyon prevalansı, sayısız epidemiyolojik çalışmada tutarlı bir şekilde bildirilmiştir. Çoğu sanayileşmiş ülkede yetişkin nüfus örneklerinde % 25-55 olarak tespit edilmiştir. İç Hastalıkları polikliniğimizde yaptığımız çalışmada polikliniğimize başvuran hastalarda hipertansiyon prevalansının ve uç organ hasarı oranlarının saptanması amaçlanmıştır.
Yöntem: Ege Üniversitesi Tıp Fakültesi Hastanesi İç Hastalıkları Polikliniğine Ağustos 2018-Mart 2019 tarihleri arasında başvuran hastaların biyokimyasal testleri ve konsültasyon notları retrospektif olarak Elektronik Hasta Dosyası üzerinden incelendi. Yaş, cinsiyet, sigara kullanımı, yaşadığı şehir, kullandığı antihipertasif ilaçlar, ek hastalıkları, biyokimyasal verileri, spot idrar ve tam idrar tetkiki, EKG, fundoskopik bakı gibi hipertansiyon ilişkili uç organ hasarı ile ilişkili verileri incelendi. İstatistiksel analiz için SPSS 25.0 programı kullanıldı.
Bulgular: Çalışmaya bu tarihler arasında polikliniğimize başvuran toplam 1267 hasta dahil edildi. Bunlardan 332 kişinin hipertansif 935 kişinin normotansif olduğu belirlendi ve iki grup oluşturuldu. Hipertansiyon prevalansı % 26.2, altı aylık hipertansiyon insidansı %12.5 saptandı. Hastaların %65 inin kadın olduğu ve yaş ortalaması 57±14 saptandı. Olguların % 40 ı poliklinikte kan basıncı ölçümü sırasında tanı alan hastalardı. Hipertansiyon ilişkili uç organ hasarı ile ilgili olarak bakılan EKG lerde Sokolow Lyon kriterlerine göre hastaların %12.3 ünde sol ventrikül hipertrofisi mevcuttu. Spot idrar verilerine göre proteinüri oranı %23 bulundu. Hipertansif retinopati oranı % 32.85 olarak bulundu. Hipertansif retinopati ile serebrovasküler olay sıklığı arasında yakın korelasyon gösteren bir ilişki saptandı. Serum total kolesterol düzeyi yüksek olan hipertansif hastalarda belirgin oranda hipertansif retinopati sıklığının arttığı saptandı.
Sonuç: Hipertansif retinopati ve SVO sıklığı arasında pozitif korelasyon gösteren bir ilişki saptadık. Hipertansiyon ilişkili LVH ile hipertansif retinopati arasında pozitif korelasyon gösteren bir ilişki saptadık. Fundoskopik bakı, 12 derivasyonlu EKG, spot idrar protein/kreatinin oranı tetkiklerinin tüm hipertansif hastalarda düzenli olarak yapılması gerektiğini düşünüyoruz. Bu sayede hipertansiyonun doğuracağı sekonder hastalıklar önlenebilir. Serum total kolesterol yüksekliği ile retinopati gelişimi arasında yakın bir ilişki saptadık. Tüm hipertansif hastaların lipid düzeylerinin görülerek gerekli tedaviye erken dönemde başlanması retinopati gelişmini engelleyebilir.
Keywords
Project Number
1
Thanks
İç Hastalıkları asistanlık eğitimim süresince bana her zaman desteklerini sunan İç Hastalıkları Anabilim Dalı başkanı Sn. Prof. Dr. S. Fehmi Akçiçek’e Asistanlık eğitimim ve tezimin hazırlanması süresince engin bilgi birikimi ve bilimsel deneyimiyle bana her daim yol gösterici olan, bilimsel araştırmalara olan ilgimin artmasını sağlayan tez danışmanım Sn. Prof. Dr. Soner Duman’a teşekkürü borç bilirim.
References
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- Aydoğdu S, Güler K, Bayram F, Altun B, Derici Ü, Abacı A, et al. Türk hipertansiyon uzlaşı raporu 2019. Turk Kardiyol Dern Ars. 2019;47(6):535-46.
- Seyahi N, Ateş K, Süleymanlar G. Current status of renal replacement therapy in Turkey: A summary of the Turkish society of nephrology registry report. Current Status of Renal Replacement Therapy in Turkey. 2020.
- Bergler-Klein J. What’s new in the ESC 2018 guidelines for arterial hypertension: The ten most important messages. Wiener Klinische Wochenschrift. 2019;131(7-8):180-5.
- Rakotovao-Ravahatra ZD, Randriatsarafara FM, Razafimanantsoa F, Rabetokotany FR, Rakotovao AL. Blood count results from hypertensive patients seen in laboratory of CHU-HJRB Antananarivo in 2013. The Pan African Medical Journal. 2016;23:49-.
- Bozduman F, Yildirim E, Cicek G. Biomarkers of nondipper hypertension in prehypertensive and hypertensive patients. Biomarkers in Medicine. 2019;13(05):371-8.
- Cetin N, Tufan AK. Platelet activation and inflammation in hypertensive children with non-dipper and dipper status. Iranian journal of kidney diseases. 2019;13(2):105.
- Erdogan D, Icli A, Aksoy F, Akcay S, Ozaydin M, Ersoy I, et al. Relationships of different blood pressure categories to indices of inflammation and platelet activity in sustained hypertensive patients with uncontrolled office blood pressure. Chronobiology International. 2013;30(8):973-80.
- Sunbul M, Gerin F, Durmus E, Kivrak T, Sari I, Tigen K, et al. Neutrophil to lymphocyte and platelet to lymphocyte ratio in patients with dipper versus non-dipper hypertension. Clinical and Experimental Hypertension. 2014;36(4):217-21.
- Sun X, Luo L, Zhao X, Ye P, Du R. The neutrophil-to-lymphocyte ratio on admission is a good predictor for all-cause mortality in hypertensive patients over 80 years of age. BMC Cardiovascular Disorders. 2017;17:1-9.
- Thilly N, Boini S, Kessler M, Briançon S, Frimat L. Management and control of hypertension and proteinuria in patients with advanced chronic kidney disease under nephrologist care or not: data from the AVENIR study (AVantagE de la Néphroprotection dans l′ Insuffisance Rénale). Nephrology Dialysis Transplantation. 2009;24(3):934-9.
- Galassi A, Brancaccio D, Cozzolino M, Bellinghieri G, Buoncristiani U, Cavatorta F, et al. Awareness of hypertension and proteinuria in randomly selected patients in 11 Italian cities. A 2005 report of the National Kidney Foundation of Italy. The Journal of Clinical Hypertension. 2009;11(3):138-43.
- Erden S, Bicakci E. Hypertensive retinopathy: incidence, risk factors, and comorbidities. Clinical and Experimental Hypertension. 2012;34(6):397-401.
- Del Brutto OH, Mera RM, Viteri EM, Pólit J, Ledesma EA, Cano JA, et al. Hypertensive retinopathy and cerebral small vessel disease in Amerindians living in rural Ecuador: The Atahualpa Project. International Journal of Cardiology. 2016;218:65-8.
- de la Sierra A, Segura J, Banegas JR, Gorostidi M, de la Cruz JJ, Armario P, et al. Clinical features of 8295 patients with resistant hypertension classified on the basis of ambulatory blood pressure monitoring. Hypertension. 2011;57(5):898-902.
- Wang A, Dai L, Su Z, Chen S, Li J, Wu S, et al. Proteinuria and risk of stroke in patients with hypertension: the Kailuan cohort study. The Journal of Clinical Hypertension. 2018;20(4):765-74.
- Shirafkan A, Motahari M, Mojerlou M, Rezghi Z, Behnampour N, Gholamrezanezhad A. Association between left ventricular hypertrophy with retinopathy and renal dysfunction in patients with essential hypertension. Singapore Med J. 2009;50(12):1177-83.
- Hicks PM, Melendez SAC, Vitale A, Self W, Hartnett ME, Bernstein P, et al. Genetic epidemiologic analysis of hypertensive retinopathy in an underrepresented and rare federally recognized native American population of the intermountain west. Journal of community medicine & public health. 2019;3(1).
- Gupta RP, Gupta S, Gahlot A, Sukharamwala D, Vashi J. Evaluation of hypertensive retinopathy in patients of essential hypertension with high serum lipids. Medical Journal of Dr DY Patil University. 2013;6(2):165-9.
Abstract
Objective: Hypertension (HT) is the most commonly altered risk factor for stroke, myocardial infarction, congestive heart failure, peripheral vascular disease and end-stage kidney disease. The prevalence of hypertension has been consistently reported in numerous epidemiological studies. It has been determined as 25-55% in adult population samples in most industrialized countries. In our study in our Internal Diseases outpatient clinic, we aimed to determine the prevalence of hypertension and the rates of end organ damage in patients who applied to our outpatient clinic. Methods: Biochemical tests and consultation notes of patients who applied to the Ege University Medical Faculty Hospital Internal Diseases Policlinic between August 2018 and March 2019 were analyzed retrospectively through the Electronic Patient File. Data related to hypertension related end organ damage such as age, gender, smoking, city of residence, antihypertensive drugs used, additional diseases, biochemical data, spot urine and full urine examination, ECG, fundoscopic examination were examined. SPSS 25.0 program was used for statistical analysis. Results: A total of 1267 patients who applied to our outpatient clinic between these dates were included in the study. Of these, 332 people were hypertensive, 935 were normotensive, and two groups were formed. The prevalence of hypertension was 26.2%, and the incidence of six months hypertension was 12.5%. 65% of the patients were female and the mean age was 57 ± 14. 40% of the cases were patients diagnosed in the outpatient clinic during blood pressure measurement. According to Sokolow Lyon criteria, 12.3% of patients had left ventricular hypertrophy in the ECG s that was examined regarding hypertension related end organ injury. Proteinuria rate was 23% according to spot urine data. The rate of hypertensive retinopathy was 32.85%. A close correlation was found between hypertensive retinopathy and the frequency of cerebrovascular events. It was found that the frequency of hypertensive retinopathy increased significantly in hypertensive patients with high serum total cholesterol level. Conclusions: We found a positive correlation between hypertensive retinopathy and SVO frequency. We found a positive correlation between hypertension-associated LVH and hypertensive retinopathy. We think that fundoscopic examination, 12-lead ECG, spot urine protein / creatinine ratio tests should be performed regularly in all hypertensive patients. In this way, secondary diseases caused by hypertension can be prevented. We found a close relationship between serum total cholesterol elevationand the development of retinopathy. Starting the necessary treatment early by monitoring the lipid levels of all hypertensive patients may prevent the development of retinopathy.
Project Number
1
References
- Sengul S, Akpolat T, Erdem Y, Derici U, Arici M, Sindel S, et al. Changes in hypertension prevalence, awareness, treatment, and control rates in Turkey from 2003 to 2012. Journal of hypertension. 2016;34(6):1208-17.
- Aydoğdu S, Güler K, Bayram F, Altun B, Derici Ü, Abacı A, et al. Türk hipertansiyon uzlaşı raporu 2019. Turk Kardiyol Dern Ars. 2019;47(6):535-46.
- Seyahi N, Ateş K, Süleymanlar G. Current status of renal replacement therapy in Turkey: A summary of the Turkish society of nephrology registry report. Current Status of Renal Replacement Therapy in Turkey. 2020.
- Bergler-Klein J. What’s new in the ESC 2018 guidelines for arterial hypertension: The ten most important messages. Wiener Klinische Wochenschrift. 2019;131(7-8):180-5.
- Rakotovao-Ravahatra ZD, Randriatsarafara FM, Razafimanantsoa F, Rabetokotany FR, Rakotovao AL. Blood count results from hypertensive patients seen in laboratory of CHU-HJRB Antananarivo in 2013. The Pan African Medical Journal. 2016;23:49-.
- Bozduman F, Yildirim E, Cicek G. Biomarkers of nondipper hypertension in prehypertensive and hypertensive patients. Biomarkers in Medicine. 2019;13(05):371-8.
- Cetin N, Tufan AK. Platelet activation and inflammation in hypertensive children with non-dipper and dipper status. Iranian journal of kidney diseases. 2019;13(2):105.
- Erdogan D, Icli A, Aksoy F, Akcay S, Ozaydin M, Ersoy I, et al. Relationships of different blood pressure categories to indices of inflammation and platelet activity in sustained hypertensive patients with uncontrolled office blood pressure. Chronobiology International. 2013;30(8):973-80.
- Sunbul M, Gerin F, Durmus E, Kivrak T, Sari I, Tigen K, et al. Neutrophil to lymphocyte and platelet to lymphocyte ratio in patients with dipper versus non-dipper hypertension. Clinical and Experimental Hypertension. 2014;36(4):217-21.
- Sun X, Luo L, Zhao X, Ye P, Du R. The neutrophil-to-lymphocyte ratio on admission is a good predictor for all-cause mortality in hypertensive patients over 80 years of age. BMC Cardiovascular Disorders. 2017;17:1-9.
- Thilly N, Boini S, Kessler M, Briançon S, Frimat L. Management and control of hypertension and proteinuria in patients with advanced chronic kidney disease under nephrologist care or not: data from the AVENIR study (AVantagE de la Néphroprotection dans l′ Insuffisance Rénale). Nephrology Dialysis Transplantation. 2009;24(3):934-9.
- Galassi A, Brancaccio D, Cozzolino M, Bellinghieri G, Buoncristiani U, Cavatorta F, et al. Awareness of hypertension and proteinuria in randomly selected patients in 11 Italian cities. A 2005 report of the National Kidney Foundation of Italy. The Journal of Clinical Hypertension. 2009;11(3):138-43.
- Erden S, Bicakci E. Hypertensive retinopathy: incidence, risk factors, and comorbidities. Clinical and Experimental Hypertension. 2012;34(6):397-401.
- Del Brutto OH, Mera RM, Viteri EM, Pólit J, Ledesma EA, Cano JA, et al. Hypertensive retinopathy and cerebral small vessel disease in Amerindians living in rural Ecuador: The Atahualpa Project. International Journal of Cardiology. 2016;218:65-8.
- de la Sierra A, Segura J, Banegas JR, Gorostidi M, de la Cruz JJ, Armario P, et al. Clinical features of 8295 patients with resistant hypertension classified on the basis of ambulatory blood pressure monitoring. Hypertension. 2011;57(5):898-902.
- Wang A, Dai L, Su Z, Chen S, Li J, Wu S, et al. Proteinuria and risk of stroke in patients with hypertension: the Kailuan cohort study. The Journal of Clinical Hypertension. 2018;20(4):765-74.
- Shirafkan A, Motahari M, Mojerlou M, Rezghi Z, Behnampour N, Gholamrezanezhad A. Association between left ventricular hypertrophy with retinopathy and renal dysfunction in patients with essential hypertension. Singapore Med J. 2009;50(12):1177-83.
- Hicks PM, Melendez SAC, Vitale A, Self W, Hartnett ME, Bernstein P, et al. Genetic epidemiologic analysis of hypertensive retinopathy in an underrepresented and rare federally recognized native American population of the intermountain west. Journal of community medicine & public health. 2019;3(1).
- Gupta RP, Gupta S, Gahlot A, Sukharamwala D, Vashi J. Evaluation of hypertensive retinopathy in patients of essential hypertension with high serum lipids. Medical Journal of Dr DY Patil University. 2013;6(2):165-9.
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Internal Diseases |
| Journal Section | Research Articles |
| Authors | |
| Project Number | 1 |
| Publication Date | December 9, 2024 |
| Submission Date | November 17, 2023 |
| Acceptance Date | August 14, 2024 |
| Published in Issue | Year 2024 |