Notesale: Turn your study into money

Document Preview

Extracts from the notes are below, to see the PDF you'll receive please use the links above

---

CODEN: IJCMPR
Available online at www
...
com

International Journal of Current Medical and Pharmaceutical Research
Journal homepage: http://journalcmpr
...
N
...
Singh

ARTICLE INFO

ABSTRACT

Article History:

Aim: The aim of the present study was to perform the set of standard autonomic function
tests in children with a family history of hypertension and compare the results with
children of normotensive parents
...
Hypertension can be especially hard to manage when combined with other
disorders, such as diabetes or obesity
...

Results: The study included 60 young and healthy children
...
Thesubjects were selected based on exclusion-inclusion
criteria
...
Results showed that children with a family history of
hypertension have abnormal values on autonomicfunction testing, when compared with
children of normotensive parents
...

Conclusion: This study stated that the children with family history of hypertension
experienced mild to moderate autonomic fluctuations in early age which may make them
more susceptible to hypertension in their future life

Received10th, February, 2015
Received in revised form24th,
February, 2015 Accepted16th, March,
2015 Published online 28th,
March,2015
Key words:

Hypertension, Autonomic function
tests, Sympathetic activity,
Normotension

Copyright © 2015 Chiranjeevi kumar Endukuru et al
...


INTRODUCTION

around your arm
...
Many cardiovascular disease have been
shown to be characterized by a marked increase in
sympathetic drive to the heart and peripheral vascular
resistance which forms the main reason for essential
hypertension and other cardiovascular disorders like heart
failure, circulatory failure etc
...


The autonomic nervous system is a part of the peripheral
nervous system and plays a central role in maintaining
cardiovascular homeostasis
...
Autonomic function testing is designed to
determine the mechanisms involved in the regulation of
blood pressure and heart rate and some other
functions
...
Chiranjeevi kumar Endukuru
Department of Physiology, Narayana Medical College, Nellore, AP, India

INTERNATIONAL JOURNAL OF CURRENT MEDICAL AND PHARMACEUTICAL RESEARCH(2015)35–39

Hypertension is the chronic elevation of blood pressure and
an important human health problem
...

One of the important causes of primary hypertension is
genetic susceptibility
...
Family members share genetic
factors, activities, habits and attitude that can determine the
health and their risk for disease
...
Genetic factors likely
to play some role in hypertension, cardiovascular diseases
and other related conditions
...
The risk for high blood pressure can
increase even more when heredity combines with
Unhealthy diet, alcohol consumption and smoking
...

It was also reported by some studies that the excess activity
of the sympathetic nervous system increases blood pressure
and contributes to hypertension
...
It has been
found that children with a family history of hypertension
presented some abnormal features like weight gain, raised
blood pressure and increased Blood pressure response to
sympathetic function tests like cold pressor and isometric
hand grip tests
...

From the current study, we attempted to conduct both
sympathetic and parasympathetic function tests in children
with family history of hypertension and children of
normotensive parents by measuring the blood pressure
response to standing, blood pressure response to isometric
handgrip, deep breathing test, valsalva ratio and cold
pressor test and signifying that an assessment of cardiac
autonomic functions may be of prognostic value in such
individuals
...
The approval of
Medical ethics committee of Narayana Medical College,
Nellore was taken for this “An Evidence based Study of
Autonomic dysfunction in Children with a family history
of Hypertension”
...
The procedure
was explained and written consent was obtained from the

subjects
...
The subject selection was based on the
predetermined exclusion-inclusion criteria
...
The participants were
distributed into two groups
...
All participants
completed a questionnaire regarding family history of
hypertension
...
Positivefamily history of hypertension was
defined ashaving at least one member in the group
including the father, mother and siblings with
hypertension
...

All the subjects were thoroughly examined clinically to
rule out any illness which might impact the autonomic
activity
...

Cardiovascular Autonomic function tests were carried out
in the morning in the department between 10 AM to 12 Pm
after 2 hours of light breakfast, after intimate testing
procedures with the subjects
...
Blood pressure
was recorded under basal conditions
...
Subject was asked to submerge one of his
upper limbs in cold water for 60 seconds
...
Submersion of the limb in ice cold water increases
systolic blood pressure by about 10-20 mm of Hg and
diastolic blood pressure by about 10 mm of Hg
...
The blood pressure rise is due to increased
sympathetic activity and heart rate rise is due to decreased
parasympathetic activity
...
ECG electrodes were connected
for lead II recording of ECG and sphygmomanometer for
blood pressure measurement
...
Subject was asked to maintain a
pressure of 30% of the maximum activity in the hand grip
dynamometer for about 5 minutes
...

Blood pressure response to standing
Patient is again allowed to assume a supine position, and a
recording of blood pressure is done in the supine position
...
The Autonomic
function tests which were performed to assess the
cardiovascular parasympathetic functional status:
Deep breathing test
This test is used to assess the parasympathetic activity
...

ECG electrodes were connected for recording Lead II
ECG
...
Expiration to
inspiration ratio was determined by using the formula
...
Subject was made to lie down in a
semi recumbent or sitting position
...
Mouth piece was put into the mouth of the
subject and the Mercury manometer was connected to the
mouth piece
...
Subject was asked to exhale
forcefully into the mercury manometer and asked to
maintain the expiratory pressure at 40 mm of Hg for 10 –
15 seconds
...

Valsalva ratio were calculated by using the formula
...
This
response is detected by recording ECG in supine and
standing postures
...
ECG electrodes were connected from the subject
to the cardiowin system
...
Basal

heart rate was recorded by using cardiowin system
...
Heart
rate response to standing was determined by using the
formula heart rate in standing position – heart rate in
supine position
...
These
results were analyzed by ANOVA with SPSS version 17
...
The results of the above tests
were compared between Study group and control group
Table 1: Shows that there were no significant findings
between anthropological variables like age and BMI
...
)
Height (cm)
Weight (Kg)
BMI (Kg/m2

Control group
(n = 30)
18
...
76
164
...
26
57
...
73
21
...
61

Study group
(n = 30)
20
...
68
166
...
93
57
...
11
21
...
2

P value
0
...
07
0
...
55

Table 2: Shows that the physiological findings like basal
heart rate, SBP and DBP values were found to be higher in
subjects of study group as compared with control group but
this difference was statistically insignificant (p>0
...

Table 2 Physiological Considerations
Control group
(n = 30)
Basal Heart rate BPM
84
...
95
Resting SBP (mm of Hg) 115
...
92
Resting DBP (mm of Hg) 76
...
02
Resting-RR (breath/min) 13
...
26
Variables

Study group
P value
(n = 30)
86
...
11 0
...
52 ± 6
...
06
81
...
69 0
...
68 ± 4
...
74

Table 3: Shows that all the parasympathetic autonomic
function tests like heart rate response to standing i
...
30:15
ratio, heart rate response to deep breathing i
...
E: I and
valsalva ratios in the children of study group were almost
similar to control group
...
05)
...

Table 3 Statistical analysis of Parasympathetic
function tests in Study group and control group
Variables
Heart rate response to
standing 30:15 Ratio
Valsalva ratio
Heart rate response to
deep breathing E: I Ratio

Control group Study group
P value
(n = 30)
(n = 30)
1
...
05

1
...
04

0
...
25 ± 0
...
26 ± 0
...
26

1
...
02

1
...
05

0
...
These
findings were statistically significant (p< 0
...
05)
...


INTERNATIONAL JOURNAL OF CURRENT MEDICAL AND PHARMACEUTICAL RESEARCH(2015)35–39

Table 4 Statistical analysis of Sympathetic function
tests in Study group and control group
Variables
Isometric Handgrip SBP
Isometric Handgrip DBP
Cold Pressor Test SBP
Cold Pressor Test DBP
Bp Response to standing
SBP change
Bp Response to standing
DBP change

Control group
(n = 30)
14
...
20
19
...
05
8
...
4
12
...
56

Study group
(n = 30)
19
...
86
26
...
93
14
...
6
18
...
56

P value
<0
...
001**
<0
...
001**

4
...
38

6
...
41 <0
...
20±0
...
43±0
...
001**

Figure 1 Parasympathetic Function tests

Figure 2 Sympathetic Function tests

DISCUSSION
In the present study, we demonstrated that young
children with a family history of hypertension have
increased risk of developing hypertension
...
Inour study it was clear
that children with family history of hypertension
expressed
statistically
significant
exaggerated
cardiovascular and sympathetic reactivity when
compared to children of normotensive parents
...
This increased blood pressure and heart
rate observed in this study in the children of
hypertensive parents indicated the importance of genetic
influence on hypertension in children
...
e
...
e
...
These results were statistically not
significant (p>0
...
It indicates that the parasympathetic
reactivity tests are similar in both the groups
...
It
was also indicated that sympathetic autonomic function
tests cold pressor test, isometric handgrip test, blood
pressure response to standing have both prognostic and
diagnostic importance to determine sympathetic reactivity
...
Blood
pressure responds to standing values also slightly higher in
test group when compared to control and these values also
statistically significant
...
Persons with a family history of
hypertension manifest augmented vasoconstrictor and
sympathetic responses to laboratory stressors, such as cold
pressor test and isometric handgrip test that may predispose
them to hypertension
...
This
study support the concept of inherited vascular reactivity as
an indicator of sympathetic hyperactivity which forms the
basis for the development of hypertension in the children
with a family history of hypertension in their future life
...
The parasympathetic nervous systems remains
unchanged in both test and control groups
...

Regular supervision of autonomic activity may prove to be
a useful tool in predicting the future hypertension
...
It
is also important to screen these children to identify
markers to assist in prediction of development of essential
hypertension in adulthood
...


Competing interests
4
...

Authors Contributions

5
...
K
...
Maruthy have made substantial contributions to
concept and study design
...
Dr
...
Singh was
involved in acquisition of data, analysis and interpretation
of data
...
Chiranjeevi Kumar Endukuru have done spell
check, proof read, sequence alignment and statistical
analysis
...
All authors read and approved the
final manuscript
...


6
...

8
...


Authors' information
10
...
Sc
...
Sc
...

Currently working as a Tutor/Demonstrator in the
Department of physiology, AIIMS Bhopal
...


Acknowledgment

12
...
K
...
Maruthy and Dr
...
Singh for his kind support and Concept
...


13
...

2
...
c “Text book of medical physiology”
11th edition 2006
B
...
C
...


15
...

Chadha SL et al, “An epidemiological study of blood
pressure in school children 5-14 year in Delhi” Indian
Heart Journal
...

Chunfang Qiu et al, “Family History of Hypertension
and Type 2 Diabetes in Relation to Preeclampsia
Risk" Hypertension 2003;41:408-413
...
K
...

Gupta AK et al, “Influence of family history of
morbid cardiovascular events on blood pressure
levels in school children” Indian Pediatrics
...

Harrison’s principles of internal medicine vol-2
Jin Shang Wu et al, “Epidemiological study on the
effect of Prehypertension and family history of
hypertension on cardiac autonomic function” J
American College Cardiology
...

Marianne A
...
van der Sande et al, “Family history:
an opportunity for early interventions and improved
control of hypertension, obesity and diabetes”
Bulletin of the World Health Organization, 2001,
79(4)
...
23 issue
...
229-304
...
Joyner et al, “Sympathetic Nervous
System and Blood Pressure in Humans Individualized
Patterns of Regulation and Their Implications”
Hypertension 2000;56: 233-237
...

Okoh BAN et al, “Childhood hypertension and
family history of hypertension in primary school
children in Port Harcourt” Niger J Paed 2013; 40 (2):
184 –188
Taizan Shirakawa et al, “Differential Impact of
Family History on Age-Associated Increase in the
Prevalence of Hypertension and Diabetes in Male
Japanese Workers” Hypertens Res vol
...
2
(2006)
...


How to cite this article:
Chiranjeevi kumar Endukuru et al
...
International Journal of Current Medical and Pharmaceutical Research, 1, (2),
35-39
...
journalcmpr

---