Study Of Serum Testosterone Levels In Male Hypertensives- A One Year Hospital Based Study

Abstract

BACKGROUND & OBJECTIVES Hypertension has reached epidemic proportions worldwide and is responsible for one half of the global health burden. Hypertension is an independent modifiable risk factor for major cardiovascular and cerebrovascular adverse events like ischemic heart disease and stroke which are the leading causes of mortality accounting for 14.6 million deaths worldwide. Testosterone is the predominant male sex hormone and low serum testosterone levels are usually associated with decreased libido, erectile dysfunction, and decreased muscle mass, however it is also known to be associated with conditions like hypertension, diabetes mellitus, obesity, dyslipidaemia. Testosterone is known to augment vasodilatation and adequate levels may prevent the development or attenuate the progression of hypertension and its related complications. METHODOLOGY A one year hospital based observational study was conducted among 100 adult male patients of age > 18 years, who visited the medicine department of a tertiary care hospital in North Karnataka.. Study participants were either known cases of hypertension or newly diagnosed hypertensives according to JNC 8 guidelines. With their consent blood samples were drawn with all aseptic precautions & the levels of serum testosterone were estimated using Centaur XP analyser by chemiluminescent immunoassay technique and its association with hypertension and its complications were studied. Categorical outcomes are summarized by rates, ratios & chi square test. RESULTS: In our study of 100 hypertensive male patients, age of the patients ranged from 25-69 years. Maximum number of cases i.e. 51 (51%) were in the age group of 51-60 years. 79% of the patients had low for age testosterone levels. 65 out of 78 (83.33%) patients with SBP >140mmHg & 44 of 48 (91.66%) patients with DBP >90mmHg had low for age serum testosterone levels which was statistically significant with p value of 0.045 & 0.003 respectively. We also observed that out of the 67 patients with duration of HTN > 10 years 58 (86.56%) patients had low for age testosterone levels which was statistically significant with p=0.001. Out of total 100 patients ,47 ( 47%) patients had cerebrovascular complications & 45 (95.74%) of them had low for age testosterone levels. 34 ( 34%) patients had cardiovascular complications & all 34 (100%) of them had low for age testosterone levels. This was statistically significant with p=<0.001. Out of 100, 34 patients consumed alcohol and among them 26 patients(76.47%) had low for age testosterone levels which was statistically significant with p=<0.01. Low for age testosterone levels was associated with level of physical activity.47( 85.45%) out of 55 patients with sedentary work, 27 out of 38 (71.05%) patients with moderate work & 5 out of 7 ( 71.42%) patients with heavy work had low for age testosterone levels which was statistically significant with p=0.001. 61% of the patients also had microvascular complications of HTN in the form of hypertensive retinopathy. Among them 56 (91%) patients had low for age testosterone levels which was statistically significant with p value<0.001. Hence low for age testosterone levels can predict both micro & macrovascular complications of HTN. 65(86.66%) among the 79 hypertensive males with low for age testosterone levels had normal lipid profile. CONCLUSION In our study, maximum number of cases were in the age group of 51-60 years. 79% of the patients had low for age serum testosterone levels. Low for age testosterone levels was observed in majority of patients with SBP >140mmHg , DBP >90mmHg. Low for age serum testosterone levels showed significant association with longer duration of HTN, cerebrovascular & cardiovascular complications of HTN, hypertensive retinopathy, alcohol consumption & sedentary lifestyle. Lifestyle modifications like increase in physical activity ,decrease in alcohol consumption can improve the testosterone levels. Early estimation of serum testosterone levels can predict both micro & macrovascular complications of HTN. But this observation needs to be confirmed in a larger cohort study.