RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCE, BANGALORE,

KARNATAKA

ANNEXURE-II

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1 Name of the candidate and DR. ELDHO JOSEPH

address
POST GRADUATE STUDENT, DEPARTMENT OF
GENERAL MEDICINE,
NAVODAYA MEDICAL COLLEGE HOSPITAL AND
RESEARCH CENTRE,
MANTRALAYAM ROAD,
RAICHUR-584103.

2 Name of the institution NAVODAYA MEDICAL COLLEGE HOSPITAL AND

RESEARCH CENTRE,
MANTRALAYAM ROAD,
RAICHUR-584103.

3 Course of study and M.D, GENERAL MEDICINE (3YEARS)

subject

4 Date of admission to 1th JUNE 2012

course

Title of the topic

5
A CLINICAL STUDY OF HYPERTENSIVE EMERGENCIES AT

NAVODAYA MEDICAL COLLEGE HOSPITAL AND

RESEARCH CENTRE RAICHUR

6 BRIEF RESUME OF INTENDED WORK:

6.1 Need for the study:

Hypertensive emergency is defined as the association of extremely elevated

blood pressure with physical or laboratory findings that indicate acute or
ongoing target organ damage1
Hypertensive emergencies are characterized by severe elevations in BP
(>180/120 mmHg) complicated by evidence of impending or progressive target
organ dysfunction2. Hypertensive emergency account for significant number of
medical emergencies. Hypertensive emergency can be an end result of chronic
hypertension, non compliance of drugs, or new presentation of unrecognized
essential hypertension.

Target organ damage resulting from hypertension includes the brain, heart,
kidneys and the eyes2, a number of cardiovascular, pulmonary and neurological
symptoms are found to be associated with patients in hypertensive emergency
with target organ involvement.

Patients in hypertension related acute target organ damage usually present

with focal neurological deficits, dyspnoea, chest pain, and visual disturbances4
The physician should perform an extensive evaluation in a patient who presents
with any of these symptoms and with an elevated blood pressure to exclude a
hypertensive emergency.

Due to various cerebral, cardiac and renal complications, there is an urgent

need to reduce the morbidity and mortality of hypertensive emergencies in the
society.

As only few studies on the clinical profile of patients with hypertensive

emergencies are done in our country, there is a need for a better evaluation of
the clinical profile in these patients

This study aims to find out the clinical profile of hypertensive emergencies in
our hospital
6.2 Review Of Literature

Zampglione et al in their study on prevalence and clinical presentation of

hypertensive urgencies and emergencies noticed that hypertensive crises
account for 27% of all medical emergencies in an emergency department, out
of which 24% fall in the category of hypertensive emergencies. 4

Martin j et al in their study- hypertensive crises profile prevalence and clinical

presentations, differed in their finding in that they found the prevalence of
hypertensive crises to be 1.7% of all clinical emergencies out of which 39.6%
being hypertensive emergencies. 5

Sobrino j et al studied prevalence, forms of clinical presentation and treatment

of arterial hypertension noted that 19.5% of the patients studied by them
presented with a hypertensive emergency d by spontaneous bleeding in 37%.6

Bennet et al in their study on hypertensive emergencies found that 93% of

patients presenting in hypertensive emergencies had previously been diagnosed
as having chronic hypertension, and concluded that improved management of
pre-existing known hypertension could lower the incidence of hypertensive
emergencies7

M E K Ahmed et al studied clinical features and survival rates of 200 patients

with malignant and accelerated hypertension and concluded that by clinical
features and by survival rates malignant and accelerated hypertension are one
and the same disease8

Nadar et al studied echocardiographic changes in patients with malignant phase

hypertension. They noticed that patients with malignant hypertension have
significant cardiac hypertrophy, in association with systolic dysfunction and
dilated left atria, irrespective of the duration of known hypertension9

Lip G.Y, Beevers D.G investigated the factors affecting the survival in patients
presenting with malignant hypertension. The most common causes of
death were renal failure, stroke which was followed by myocardial infarction
and heart failure10
 6.3 Objective of the study:

The aim of the present study is to evaluate the modes of presentations, clinical
profile and spectrum of target organ damage in patients with hypertensive
emergencies

7 7.1 Material and Methods:

The present study is done in patients admitted to Navodaya Medical College
Hospital and Research centre over a period of one year

Study design:

Prospective study

Study Period:

One year from January 2013 to December 2013.

Sample Size: 50 cases

7.2 Methodology:
A detailed history will be taken which includes presenting symptomatology,
hypertension related history with emphasis on drug compliance. The
information thus obtained will be recorded in the proforma

Blood pressure will be recorded in these patients at the time of admission, after
one hour, after 24 hours and at the time of discharge

Detailed clinical examination will be done in these patients with examination

of respiratory system, cardiovascular system, gastro intestinal system and
central nervous system. Fundoscopic examination of all the patients will be
done. Blood samples of these patients will be evaluated for biochemical
abnormalities.

Appropriate statistical methods will be used in the evaluation of patient data

 Inclusion criteria :

Patients above 18 years of age.

Severe elevations in Blood Pressure (>180/120 mmHg) as per The
Seventh Report of the Joint National Committee on Prevention,
Detection, Evaluation, and Treatment of High Blood Pressure2

Evidence of target organ damage, either clinically or on laboratory
findings.

Exclusion criteria :

Chronic renal failure, valvular heart diseases

7.3 Does the study require any investigation or intervention to be conducted

on patients or other humans or animals?

Yes, the study requires the following investigations:

BLOOD : Haemoglobin, Total count, Differential count, Erythrocyte

sedimentation rate, Random blood sugar, Serum Protein, Platelet count,
serum total cholesterol, serum triglycerides, high density lipoprotein, low
density lipoprotein, microalbuminuria , blood urea, serum creatinine and
urine analysis
special investigation as indicated by the clinical presentation like
ECG,2D-ECHO,CT scan, chest x ray, USG
7.4 Has ethical clearance been obtained from your institution in case of 7.3?

Yes ethical clearance has been obtained

8 List of References:

1. Singh WG, Aslam N, Hypertensive emergencies Hypertension an

international monogragph 2001; 350. IJPC.

2. Joint national committee on prevention detection and treatment of high blood

pressure. The seventh report of Joint national committee on prevention
detection, and treatment of high blood pressure. JAMA 2003; 289: 2560-2572.

3. Treatment of Hypertension in the Prevention and Management of Ischemic

Heart Disease: A Scientific Statement From the American Heart Association
Council for High Blood Pressure Research and the Councils on Clinical
Cardiology and Epidemiology and Prevention Circulation. 2007;115:2761-
2788,

4. Zamapaglione et al. Hypertensive urgencies and emergencies.

Hypertension1996; 27: 144-147

5. . Martin J et al: Arquivos Brasileiros de Cardiologia - Volume 83, No 2,

August 2004.

6. Sobrino J et al. prevalence, forms of clinical presentation and treatment of

arterial hypertension at an emergency unit. Rev Cli Esp; 187 (2):56-60 June.

7. . Bennett NM; Shea S. Hypertensive emergency. American journal of public

health 1998. 78:636-640

8. . MEK Ahmed et al. Lack of difference between malignant and accelerated

HTN; bmj 1986; 292: 235-237.

9. . Nadar et al. Echo cardiographic changes in patients with malignant phase

hypertension: J HumHypertens. 2005.

10. Lip GY et al. Complication and Survival of 354 patients with malignant
phase hypertension. J Hypertens Aug: 13(8) 915-24.

11. Elliot WJ. Hypertensive emergencies. In Critical Care Clinics Vol 17.
Number 2 April 2001 W.B.Saunders company.
12. Vasan RS, et al. Assessment of frequency of progression to hypertension in
1. Joint National Committee on prevention detection, and treatment of high
blood pressure. The nonhypertensive participants in the Framinham heart study.
Lancet. 2001; 358:1682-1686.

13. Cameron JS, Hicks J. Frederick Akbar Mahomed and his role in the
description of hypertension at Guy's Hospital. Kidney Int. 1996; 49:1488-1506.

14. Mancia G. Scipione Riva-Rocci. Clin Cardiol. 1997;20:503-504.

15. George A, William H. Comprehension management of hypertensive

emergencies and urgencies: Heart Dis (4 8): 358-371 2002. Lippincott Williams
and Wilkins.
 9 Signature of the candidate

10 Remarks of the Guide

11 11.1 Name and Designation of Dr.S.S.ANTIN

Guide (In block letters) PROFESSOR AND HEAD OF DEPARTMENT ,

DEPARTMENT OF GENERAL MEDICINE ,
NAVODAYA MEDICAL COLLEGE AND
RESEARCH CENTRE,
RAICHUR.

11.2 Signature

11.3 Co-guide ( if any)

11.4 Signature
 11.5 Head of the Department
Dr.S.S.ANTIN
PROFESSOR AND HEAD OF DEPARTMENT ,
DEPARTMENT OF GENERAL MEDICINE ,
NAVODAYA MEDICAL COLLEGE AND
RESEARCH CENTRE,
RAICHUR.

11.4 Signature

12.1 Remarks of Chairman and

12
Principal

12.2 Signature