Hypertension Month Special: Could Palms be the Future Tool to Screen High BP?

Just earlier this month, we celebrated World Hypertension Day and we would have witnessed several campaigns being run for screening healthy individuals for high blood pressure, facilitating early detection so as ensure effective blood pressure control and improving long term outcomes.

Amidst rising emphasis on Ambulatory Blood Pressure Monitoring (ABPM) and Single-Pill Combination (SPC) for optimizing hypertension care, we have a fascinating screening tool emerging ahead of us in the light of this unique evidence published in an eminent Indian Journal.

Palms (Epidermal Ridge Patterns) could possibly help in screening for hypertension. The results of this study indicate that certain specific patterns are consistently present more frequently in individuals with high blood pressure. Also, certain epidermal ridge patterns stand out distinctly by their presence in normotensive individuals.

Recent Study Indicates Palms Could Predict Hypertension

The results of this study compared and analyzed the palmar epidermal ridge patterns of 500 patients (250 hypertensive and 250 normotensives) to find an interesting association of specific patterns consistently emerging out more often in hypertensive patients compared to those that did not have hypertension.

Results – Radial Loops and Whorls Consistent with High Blood Pressure

• The study found that mean “atd” angle was higher in hypertensive patients group as compared to a normotensive group, and there was a statistically significant association of mean “atd” angle in the former compared to the latter

• It was noted the radial loop epidermal ridge pattern was more common in the hypertensive group, whereas the ulnar loop was more often traced normotensive group.

• It was also observed that the pattern characterizing whorls were more constant in the hypertensive group, thus suggesting that the presence of whorls may be associated with an increased probability of having raised blood pressure

Dermatoglyphics – Brief Overview Professor Harold Cummins, an American anatomist, is considered to be the founder of Dermatoglyphics; which refers to analysis of epidermal ridge patterns of skin on the volar aspect of fingers, palms, toes, and soles. These epidermal patterns generally start to develop during sixth and seventh weeks of intrauterine life and are well formed by the end of second trimester Basic Terminologies and Patterns in Dermatoglyphics There are specific patterns of epidermal ridges as briefed in general as follows: Loop:ridges which start on one side, rise toward center, andreturn back to the side they started from; ulnar loop has the open end towards the ulnar side, and radial loop has the open end towards the radial side Whorls: ridges are circular Arches: ridges enter from one side, make a rise in the center, and exit through the opposite side Composite: ridges comprising ofboth loop and whorls together Palm Angle (“atd” triangle) Palm Angle also known as “atd” triangle is formed by intersection of three triradii in palm. Triradii “a” is at the base of the index finger, triradii “d” is at the base of the little finger, and “t” is the axial triradius located further below. Thus, “atd” angle is formed at “t” triradius

Findings Consistent with Earlier Studies

This is not the first study of this kind. But what is interesting is the finding of this study seems to quite corroborate with similar such modest-sized studies conducted in other parts of India and abroad.

Dermatoglyphics as a Screening Tool – An Opportunity Knocking Doors

Though this data emerges as a potential promise, in the ambition of being further nurtured from various elements involved in healthcare before it makes it to the clinician’s kit

Firstly, we need large and long term studies to further substantiate and establish Dermatoglyphics as a screening tool. Having said that, it may not be practically feasible for busy practitioners to have magnifying lenses as a part of their clinical armamentarium.

This opens doors of opportunity to develop tools which can identify patterns of palmar epidermal ridges, collate them with other components of basic demographic profile and established cardiovascular risk factors, and thereby quantify the risk of developing hypertension in an individual; thus serving of research and diagnostic value for screening hypertension in general population

With success stories from Continuous Glucose Monitoring Systems (CGMS), Ambulatory Blood Pressure Monitoring (ABPM) devices and various tools for opportunistic screening of Atrial Fibrillation in elderly to reduce the risk of stroke, the day patients’ palms could be routinely scanned to predict hypertension does not seem too far-fetched.

And yes, it may just become yet another success story etched on the path of personalized medicine. Only time will tell…!!

References:

Adapted from

1. Ganesh Chakravathy et al, A Handy tool for hypertension prediction: Dermatoglyphics, Indian Heart Journal 2018;70:S116eS119


2. Mohd. Bhat et al, Dermatoglyphics: in health and disease - a review, International Journal of Research in Medical Sciences Bhat GM et al. Int J Res Med Sci. 2014 Feb;2(1):31-37