European Journal of Cardiovascular Medicine

Hypertension is a chronic, non-communicable condition that affects individuals across all socio-economic strata and age groups. Globally, the burden of hypertension has been rising significantly, particularly among young and middle-aged adults. It now represents one of the leading contributors to morbidity and mortality, driven in part by changing lifestyles, increasing urbanization, and the growing prevalence of metabolic diseases. In developing countries like India, these trends are further exacerbated by socio-economic transitions that have shifted disease burdens from communicable to non-communicable disorders such as hypertension.

The “rule of halves” remains relevant in many low and middle income countries: half of the individuals with hypertension remain undiagnosed, half of those diagnosed are untreated, and only half of those treated achieve adequate blood pressure (BP) control. Despite the availability of effective, well-tolerated, and affordable antihypertensive therapies, less than 14% of adults with hypertension achieve optimal control, defined as systolic BP <140 mmHg and diastolic BP <90 mmHg.

Severe global practice guidelines, including those by the Joint National Committee (JNC-8), prioritize a multidimensional approach to the management of hypertension. This involves pharmacological interventions and lifestyle modification in the form of lowered sodium intake, more physical activity, weight loss, cessation of smoking, and limiting alcohol intake. Likewise, the National Institute for Health and Care Excellence (NICE) also suggests dietary enhancement, salt limitation, and frequent aerobic exercise, especially in overweight patients with raised BP. The 2019 NICE blood pressure staging and the 2021 WHO guidelines on pharmacological treatment further intensify approaches to diagnosis and management across the healthcare environment.

In India, hypertension management is confounded by low patient awareness, poor accessibility of medications, cost of treatment, and poor compliance. Shortfalls in healthcare delivery, particularly in rural settings, and deficit in long-term physician–patient communication aggravate these issues. Intensive evidence indicates that multifaceted approaches—ranging from counseling and community interventions to pharmacist-based programs are stronger in encouraging compliance.

Hypertension is often accompanied by lipid metabolism disorder, such as increased triglycerides and reduced high-density lipoprotein (HDL), which together form dyslipidemia. The presence of these metabolic disturbances markedly increases cardiovascular risk and aggravates outcomes. This interaction is particularly provocative in the setting of metabolic syndrome (MetS), a cluster of risk factors that encompasses central obesity, hyperglycemia, dyslipidemia, and increased BP. Both insulin resistance and central obesity have been regarded as key pathophysiological mechanisms underpinning MetS. Insulin resistance causes impairment in glucose use, results in compensatory hyperinsulinemia, and ultimately leads to β-cell failure and hyperglycemia. Central obesity, quantifiable by waist circumference or waist-hip ratio, accelerates this process and is also closely associated with hypertension and diabetes.

Notwithstanding established advantages of lifestyle intervention and early diagnosis, a high percentage of hypertensive patients are not aware of their metabolic status at the time of diagnosis. With the rising burden of hypertension and its metabolic associations, early integrated screening approaches are needed. This research was conducted to assess clinical and metabolic profiles of recently screened hypertensive patients in a tertiary facility, with the aim of establishing associated risk patterns and guiding timely intervention.

Aims and Objectives

Aim

To evaluate the clinical characteristics and metabolic profile of newly screened hypertensive patients presenting to a tertiary care teaching hospital.

Objectives

1. To identify patients with elevated blood pressure through systematic screening.
2. To diagnose hypertension based on the Joint National Committee 8 (JNC-8) guidelines.
3. To assess the clinical presentation and symptomatology at the time of diagnosis.
4. To investigate relevant laboratory parameters, including metabolic and biochemical markers.
5. To evaluate cardiac involvement through electrocardiography (ECG) and two-dimensional echocardiography (2D Echo).

his prospective observational study was conducted in the Department of Family Medicine at Dr. D.Y. Patil Medical College, Hospital and Research Centre, Nerul, Navi Mumbai, during the period 2023–2024. The study aimed to evaluate the clinical and metabolic profile of newly screened hypertensive patients attending the outpatient department (OPD).

Study Design: Prospective Observational Study

Study Site: Dr. D.Y. Patil Hospital, Nerul, Navi Mumbai

Study Duration: January 2023 to December 2024

Sample Size: A total of 100 patients were enrolled in the study. The sample size was calculated using the formula: n = z² × p × q / d²

Where:

·         z = 1.96 (for 95% confidence interval)

·         p = 25% (estimated prevalence)

·         q = 100 − p = 75%

·         d = 9% (absolute precision)

Thus,

n = (1.96)² × 25 × 75 / 9² = 89, which was rounded up to 100 for convenience.

Eligibility Criteria

Inclusion Criteria

·         All adult patients (>18 years) presenting to the OPD with newly diagnosed hypertension based on JNC-8 guidelines (Systolic BP >140 mmHg and/or Diastolic BP >90 mmHg).

·         Patients providing informed consent.

Exclusion Criteria

·         Pregnant women

·         Patients with known comorbidities such as diabetes mellitus, ischemic heart disease, cerebrovascular accident, or chronic kidney disease (CKD)

·         Patients receiving medications or hormonal therapy affecting blood pressure

·         Patients presenting with hypertensive emergencies (evidence of end-organ damage)

Study Procedure:

Eligible patients attending the OPD were screened and recruited after obtaining written informed consent (available in English, Hindi, and Marathi). Demographic and clinical data were collected using a pre-designed, semi-structured questionnaire. Clinical examination was conducted along with relevant laboratory investigations, including metabolic and biochemical parameters. Cardiac assessment was done using electrocardiography (ECG) and two-dimensional echocardiography (2D Echo). Patients were followed through the course of their outpatient evaluation to assess baseline profiles.

Approval for the study was obtained from the Institutional Ethics Committee of D.Y. Patil Medical College, Navi Mumbai, prior to commencement.

Table 16: Renal Artery Doppler Findings among Male and Female Patients

Table 16 shows the results of renal artery Doppler examination in the study population. Most patients had normal findings—90.9% of males and 82.6% of females. Abnormal Doppler findings suggestive of renal artery involvement were observed in 9.1% of males and 17.4% of females.

Table 17: Cardiac Involvement among Male and Female Patients

Table 17 presents the echocardiographic findings related to cardiac involvement among the hypertensive patients. Concentric left ventricular hypertrophy (Conc. LVH) was more common in males (53.2%) compared to females (21.7%). Conversely, regional wall motion abnormality (RWMA) was seen more frequently in females (56.5%) than in males (24.7%). Overall, 22% of patients showed no significant cardiac abnormalities. The association between gender and cardiac findings was statistically significant (χ² = 9.4126, p = 0.0022).

Table 1 revealed a male predominance (77%) in the study population, which was statistically significant. Table 2 showed that the most common age groups affected were 50–59 years and 60 years and above, with no significant gender difference in age distribution. Table 3 described the distribution of hypertension stages across age groups, with most patients in stage I, particularly in the 50–59 year age group. Table 4 demonstrated that both males and females predominantly had stage I hypertension, though females had a slightly higher proportion. Table 5 presented clinical symptoms, with headache and giddiness being the most frequent complaints, while a small proportion of males were asymptomatic. Table 6 showed that overweight and obesity were prevalent, especially among females, and the gender difference in BMI was statistically significant. Table 7 indicated that most participants had no addiction history; smoking and alcohol use were only reported in males. Table 8 described hemoglobin levels, with most values between 10–12 g/dL and no significant gender difference. Table 9 presented thyroid hormone levels (T3, T4, TSH), showing no significant differences between genders. Table 10 showed normal mean serum sodium, potassium, and chloride levels, with no significant gender-based variation. Table 11 revealed that 71% had elevated serum cholesterol, with females having significantly higher mean levels. Table 12 demonstrated that the majority had low HDL levels, with females having significantly lower HDL than males. Table 13 showed elevated triglyceride levels in nearly one-third of patients, with significantly higher levels in females. Table 14 presented comparable mean random blood sugar levels among both sexes, with no significant difference. Table 15 summarized ECG abnormalities, with LVS being the most common finding, followed by LVH and ST changes. Table 16 showed normal renal artery Doppler in 89% of patients, with mild abnormalities in the remaining. Table 17 highlighted significant gender differences in cardiac involvement, with RWMA more common in females and concentric LVH more frequent in males.

In the current study involving 100 newly diagnosed hypertensive patients, there was a clear predominance of males, accounting for 77% of the population. This male predominance may be explained by a combination of biological and socio-behavioral factors, including differences in hormonal influence, lifestyle habits, and healthcare-seeking behavior. Males tend to develop hypertension earlier in life compared to females, who are believed to be relatively protected by estrogen before menopause.

The age distribution revealed that the largest proportion of patients were in the 60 years and above category, followed closely by those aged 50–59 years. The average age was comparable across genders, highlighting that middle-aged and elderly individuals form the bulk of the newly diagnosed hypertensive population. This trend underscores the cumulative effect of age-related vascular changes and lifestyle patterns that contribute to elevated blood pressure over time.

Regarding the stage of hypertension, 70% of the participants were classified as having stage I hypertension, with the highest frequency noted in the 50–59 age group. Gender-wise, a higher percentage of females presented with stage I hypertension compared to males. However, a greater proportion of stage II cases were found among males. These findings emphasize the importance of early screening across all age groups, especially in males who may present with more severe disease.

The clinical symptomatology showed that headache and giddiness were the most frequently reported symptoms. A notable proportion of patients were asymptomatic, particularly among males. This reinforces the concept of hypertension as a silent killer, often remaining undiagnosed until complications arise. Other symptoms like chest pain, palpitation, and visual disturbances were also documented, reflecting the varying spectrum of clinical presentation.

Analysis of body mass index revealed that a majority of the patients were either overweight or obese, with females having a higher mean BMI compared to males. This finding highlights the strong association between central obesity and hypertension, particularly in the context of metabolic syndrome. Weight management should therefore be an integral part of hypertension control strategies.

Addiction history in the study showed that the majority of patients did not consume tobacco, alcohol, or other substances, with usage being more prevalent among males. Though overall prevalence was low, even mild to moderate exposure to these risk factors may have contributed to early onset or progression of hypertension, particularly when coupled with sedentary lifestyle and poor dietary habits.

The fasting blood sugar levels were within the normal range for most participants, with minimal gender differences. Although diabetes was an exclusion criterion, elevated blood sugar levels in some cases may suggest early glucose intolerance or prediabetic states, which necessitate closer monitoring.

Electrocardiographic findings showed that the most common abnormalities were left ventricular strain and hypertrophy, with a small percentage showing ischemic changes or T wave abnormalities. These findings indicate that cardiac remodeling begins early in the course of hypertension and may precede clinical symptoms. On 2D echocardiography, concentric left ventricular hypertrophy was the most prevalent structural change among males, while regional wall motion abnormalities were more common in females. This gender-specific variation in cardiac involvement is clinically significant and warrants further evaluation in future studies.

Overall, the study emphasizes the complex interplay between demographic, clinical, metabolic, and cardiovascular parameters in newly diagnosed hypertension. The findings highlight the necessity for early screening, lifestyle modification, and a comprehensive cardiovascular risk assessment to prevent long-term complications associated with uncontrolled blood pressure.

Hypertension continues to be a major public health concern in India, with low levels of awareness and inadequate control contributing significantly to cardiovascular and renal morbidity. Reliable data on the clinical and metabolic profile of newly diagnosed hypertensive individuals are crucial for shaping effective preventive and therapeutic strategies. The current study highlights the relevance of early detection, risk factor assessment, and comprehensive evaluation in newly screened hypertensive patients.

Emphasis on education and targeted interventions focusing on modifiable risk factors—such as dietary control, weight reduction, salt limitation, and other lifestyle modifications—can serve as cost-effective, population-based strategies. Incorporating such measures into the broader public health framework can enhance hypertension control and reduce the burden of cardiovascular and renal diseases. The findings from this study provide meaningful insights into the clinical characteristics and metabolic alterations associated with newly diagnosed hypertension and can support more informed decision-making in primary care settings.

Limitations

The study was cross-sectional in nature; hence, long-term follow-up and outcome assessment were not possible. Additionally, the relatively small sample size limits the generalizability of the findings. Future research involving larger, multicentric cohorts is recommended to validate these results and expand their applicability to broader populations.

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