International Journal of Current Research and Review
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IJCRR - vol 06 issue 07, April, 2014

Pages: 39-45

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HYPERTENSION - PREVALENCE AND RISK FACTORS AMONG URBAN POPULATION IN NORTH KARNATAKA

Author: Madhumitha M.1 , Naraintran S. Manohar C. , Revathi S. , Mallikarjun K. Biradar, R.S. Patil

Category: Healthcare

Abstract:Background: Hypertension, a major public health problem, is directly responsible for 57% of all stroke deaths and 24% of coronary heart disease related deaths in India. The prevalence of hypertension is increasing rapidly in developing countries more in urban areas due to changing life style and increasing longevity. Objectives: 1.To estimate the prevalence of hypertension and associated risk factors among urban population (18 years and above) of Raichur district of North Karnataka Materials and Methods: Prevalence of hypertension among adults from the previous studies was found to be 35%. Sample size of 713 was calculated using the formula 4pq/L2 with 10% allowable error. Systematic random sampling was used and after taking informed consent, participants were interviewed using a pre tested questionnaire based on WHO STEPS approach for chronic disease risk factor surveillance and examined. Diagnostic criteria were based on JNC VII guidelines, SBP ?140mmHg and/or DBP ?90mmHg. Data was analysed using Epi-info and SPSS version 17. proportions and chi square test were used. Results: Prevalence of hypertension was found to be 37.6%; significantly associated with smoking, fruits and vegetables intake, salt intake, junk foods, family history of hypertension and obesity. There is no significant association with type of diet (vegetarian or non vegetarian) alcohol and physical activity. Conclusion: prevalence of hypertension among urban population is high. Life style factors are significantly associated with hypertension. So there is an urgent need for life style modification among urban especially among those with positive family history

Keywords: Hypertension, Prevalence, risk factors, family history, urban

Full Text:

INTRODUCTION

Hypertension is the commonest cardiovascular disorder affecting at least 20% of adult population in several countries. It is one of the important risk factors for cardio-vascular mortality accounting for 20-30% of all deaths1 . It became evident in the early 1970s itself that only about half of the hypertensive subjects in the general population of most developed countries were aware of the condition, only about half of those aware of the problem were being treated. If this is the situation with highly developed medical services, the proportion treated in developing countries would naturally be far less1. It is an interesting as well as a dangerous disease entity. It remains silent without any symptoms but causes continuous damage to person’s cardio vascular system. For the same reason WHO has given the name “SILENT KILLER” as the disease does not cause any harm by itself but predisposes to other cardiovascular diseases like stroke, myocardial infarction etc. It is a major risk factor for cardiovascular disease, chronic renal disease and stroke2 Every year, 17th May is dedicated to World Hypertension Day (WHD). This is an initiative of the World Hypertension League, an affiliated section of the International society of Hypertension(ISH). The WHD was first inaugurated in May 2005 and has become an annual event ever since. The purpose of the WHD is to promote public awareness of hypertension and to encourage citizens of all countries to prevent and control this silent killer, the modern epidemic3 . Hypertension is an iceberg disease. The CUPS study revealed that the RULE OF HALVES is still valid in the south Indian population4 . So it is important to detect hypertension and treat promptly to avoid further life threatening complications. Since no other study has been conducted so far in this area, this study aims to estimate the prevalence of hypertension and its associated risk factors.

AIMS AND OBJECTIVES:

1. To estimate the prevalence of hypertension among subjects aged 18 and above. 2. To study the association between the hypertension and its risk factors.

MATERIALS AND METHODS

Study Design: Community based cross sectional study. Duration of study: August 2010 – September 2012. Study Population: people aged 18 years and above residing in the urban field practice area of Navodaya Medical College and Hospital, Raichur Diagnostic criteria: Based on JNC VII criteria, a person was considered hypertensive if- 1. SBP ≥140 and/or DBP ≥90 mmHg 2. Persons with history of hypertension and on anti-hypertensives. Sample Size calculation Prevalence of hypertension among adults from the previous studies was found to be 35% Sample size of 713 was calculated using the formula 4pq/L2 w i t h 1 0 % a l l o w a b l e e r r o r Sampling method: Systematic random sampling. House was taken as the sampling unit. Step -1: sampling interval, m= total number of houses/sample size=3625/713 = 3.73≈ 4 Step 2: k, random number should be less than or equal to sampling interval i.e., m Random number was selected as 3 by using lottery method and so 3rd house was taken as the first house and from then on every 4 th house was be visited to find the eligible person. If there were more than one eligible person at the time of visit, the subject to be interviewed was selected by lottery method. If the inhabitants were not at home at the time of visit, the next house was visited. Step-3: 3, 3+4, 7+4, 11+4...... After taking informed consent, the participants were interviewed and examined. Collection of data: Data was collected by interviewing the study subjects using a pre-tested Madhumitha M. et. al. HYPERTENSION – PREVALENCE AND RISK FACTORS AMONG URBAN POPU questionnaire based on WHO STEPS approach for chronic disease risk factor surveillance. Measurement of blood pressure: The study participants were made to sit comfortably for 5 minutes before BP was measured. Blood pressure was measured using the auscultatory method with a standardized calibrated mercury column type sphygmomanometer and an appropriate sized cuff encircling at least 80% of the arm in the seated posture, with feet on the floor and arm supported at heart level. The first blood pressure measurement was recorded after obtaining sociodemographic information from the study subject, while the second was recorded after a brief clinical examination. The reading at which korotkoff sound is first heard will be considered as systolic blood pressure and at which the korotkoff sound disappears will be taken as diastolic blood pressure. We used the average of two readings of SBP and DBP to describe the blood pressure of the participant. In cases where the two readings differed by over 10 mm of Hg, a third reading was taken and average of the three measurements was taken.

STATISTICAL ANALYSIS:

STATISTICAL ANALYSIS: Data was analysed using Epi info and SPSS version-17.0. Proportions, was used to find out the Prevalence and Chi–square test was used to find the association between categorical variables.

RESULTS

Prevalence The prevalence of hypertension was found to be 37.6%; 30.2% were in stage I HTN 7.4% of the subjects were in stage II hypertension. Among them 53.7% of hypertensives were already diagnosed to have HTN while 46.3% were newly detected hypertensives; this proves that hypertension is an iceberg disease. 40.4% were found to be pre hypertensives. This shows that more than 3/4th of the population is suffering from high BP. Association with Risk factors This study revealed that hypertension was significantly associated with body mass index, maximum in obese patients when compared to normal and underweight;(p 6 grams/day and family history of hypertension were found to be significantly associated with hypertension. (p=0.009; p=0.003 respectively). \

DISCUSSION

Prevalence of hypertension was found to be 37.6%. 30.2% were in stage I and 7.4% in stage 11 HTN (SBP 140-159 mmHg and/or DBP 90-99 mm Hg and SBP >160 mmHg and/or DBP > 100 mm Hg) respectively; 50.7% of hypertensives were already diagnosed to have HTN while 49.3% were newly detected hypertensives. This shows the submerged portion of the iceberg. Findings of our study are similar to Gupta, R in Jaipur, in urban adults in 2002 which showed prevalence of hypertension as 36% in men and 37% in women5 and a study conducted by Avadaiammal6 et.al in Trivandrum city, Kerala, south India in 2006 which showed the prevalence as 47% In our study 40.4% were having pre hypertension. This was high when compared to a Study carried out by M.M.H,V.K Desai7 et al,2011 in urban area of south Gujarat region which showed the overall prevalence of prehypertensives as 34.5%But a study conducted by Chaudhry K et al in 2012 in Wardha, in young females 18-25 years showed that 58% were prehypertensives8 Our study revealed a positive correlation with family history of hypertension similar to studies conducted by Patnaik N9 et al in Orissa S.S.Reddy1 in Tirupati in 2005, Haresh Chandwani10 in Gujarat in 2010. Significant association of hypertension was found with smoking. studies done by PatnaikN9 ,S.S.Reddy1 et al in Tirupati(2005), S.Yadav11 et al(2008) ,HareshChandwani10 et al in Gujarat in 2010 also showed similar results. A recent case-control study from Bangalore also showed that smoking was an independent risk factor for hypertension12 (odds ratio 2.25, p=0.014). Our study showed a significant association between HTN and alcohol consumption (p=0.013).A study done by NC Hazarika13 et al in Assam in 2003 in elderly population found that Alcohol consumption increased the risk of hypertension in the study population. S.S.Reddy1 in Tirupati in 2005, Patnaik N9 in Orissa in 2005, Haresh Chandwani10 et al in Gujarat in 2005 also revealed higher prevalence of hypertension among those who consume alcohol. Study conducted by M.M.H, V.K.Desai7 et al in Surat found that prevalence of hypertension was higher (40.1%) among alcohol consumer than non- drinker (27.2%). Study by Saunders 14et al. found a significant positive association between hypertension and alcohol consumption. In their study, in most cases the BP level fell to normal levels after abstinence and remained so in those who continued to abstain but returned to the hypertensive state in those who resumed consumption of alcohol, thus indicating that alcohol is an important risk factor for hypertension. The Chennai urban population study in 2003 showed BMI was more in hypertensives compared to non hypertensive individuals15. A multi-centric study conducted by Hypertension study group in 2001 among the elderly in Bangladesh and India found that High body mass index was an important correlate of hypertension16. Studies done by Zachariah17 et al, S.S.Reddy in Tirupati 1 et al (2005), Patnaik N9 in Orissa (2005), S.Yadav11 et al (2008) and Haresh Chandwani10 et al in Gujarat also revealed the similar findings. There is significant association with increased waist hip ratio similar to Chennai Urban Population Study (CUPS) 15 in 2003.Studies by Mehan M B18.in urban Indian population showed similar findings. This study also found a positive correlation with salt intake, fruits and vegetable intake similar to studies done by Haresh Chandwani10 in Gujarat and Avadaiammal Vimala6 in urban population of Kerala. Our study can be compared to study by Mehan M Bet al which revealed that hypertension was found in all subjects who consume < 500 gm of vegetables and fruits per day.18. The INTERHEART STUDY in 2003 by Salim Yusuf 19 et al found that low consumption of fruits, vegetables constitute a major risk for myocardial infarction worldwide in both sexes and at all ages in all regions In our study, there is no significant association between Hypertension and physical activity. (p=0.586).Our study can be compared to a study done by L. Patnaik etal9 in Orissa in 2005 where there is no statistical significance between HTN and physical activity. (p>0.05 ).But studies conducted by S.S.Reddy in Tirupati1 and Shantirani15 et al. in Chennai (Chennai Urban Population Study) found significant association with hypertension and physical activity in contrast to our study. Our results can be compared with a study done by Avadaiammal Vimala6 which showed that the prevalence of hypertension among subjects on vegetarian diet vs. mixed diet was 41% vs. 49%, respectively but the difference was not statistically significant. (p= 0.09). A study done by Gilberts E C 20 et al in a south Indian population also did not find significant association between diet and hypertension.

CONCLUSION

Prevalence of hypertension was found to be 37.6%. pre hypertension is also high with 40.4%.There is significant association of hypertension with smoking , alcohol, fruits and vegetable consumption , junk foods, salt intake and positive family history. Body mass index and waist hip ratio also showed significant association. How ever, there is no association with physical activity and type of diet. So, life style factors certainly influence the occurrence of hypertension especially among urban population. Almost half the hypertensives were newly detected during the course of the study. So screening of the population for BP is the only effective method for to diagnose this silent killer and treat adequately for prevention of further complications like stroke, coronary artery disease and renal failure. IEC activities has to be undertaken at the community level which should focus on weight reduction, cessation of smoking and alcohol, increased physical activity and restriction of dietary salt intake. Schools must provide opportunities for promotion of healthy life style in children and the youth. Mental relaxation techniques like yoga and meditation has to be promoted. Public education has to be the cornerstone for successful national campaign to detect, evaluate and treat high BP.

ACKNOWLEDGEMENTS

Authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to authors / editors / publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed.

 

 

References:

REFERENCES

1. Reddy SS, Prabhu GR. 2005 “ Prevalence of hypertension and its risk factors among adults aged 20-60 years residing in an urban slum area of Channa Reddy Colony (Urban slum area) in Tirupati town” Indian Journal of community Medicine Vol: 30(3);84-86.

2. International Society of Hypertension. World hypertension day 17th may, 2005. Available at http://www.ishworld.com/default.aspx?World Hypertension Day accessed on 10.06.2012.

3. World Health Organization, Heart Beat: The rhythm of health report on World Health Day. 7 th April 1991.geneva: WHO 1992.

4. Deepa R, Shanthirani CS, Pradeepa R, Mohan V. “Is the Rule of Halves” in Hypertension still valid? Evidence from Chennai Urban Population study. J Association physicians India.2003; 51:153-7

5. R Gupta, Trends in hypertension epidemiology in India Journal of Human Hypertension (2004) 18, 73–78.

6. Avadaiammal Vimala, Suja Ann Ranji, Mattummal Thodi Jyosna et al,2009” prevalence, risk factors and awareness of hypertension in urban population” Saudi journal of renal disease and transplantation. Vol 2094):685-689

7. M.M. H, V.K. Desai, A. Kavishwar: A Study On Effect Of Life Style Risk Factors On Prevalence Of Hypertension Among White Collar Job People Of Surat. The Internet Journal of Occupational Health. 2011 Vol 1; Number 1

8. Chaudhry K, Diwan SK, Mahajan SN Prehypertension in young females, where do they stand? Indian heart J 2012 MayJun;64(3):280-3

9. L. Patnaik, N. C. Sahani, T.Sahu et al 2005. A Study on Hypertension in Urban Slum of Brahmapur, Orissa,journal of community medicine, Indian association of preventive and social medicine Orissa chapter 10.

10. Chandwani H, Pandor J, Jivarajani P, Jivarajani H. 2010 “Prevalence and correlates of hypertension among adults in the urban area of Jamnagar, Gujarat” Electronic Physician; Vol 2: 52-59.

11. Yadav S, Boddula R, Genitta G, Bhatia V, Bansal B, Kongara S, et al 2008. “Prevalence and risk factors of pre-hypertension and hypertension in an affluent north Indian population” Indian Journal of Medical Research: 712-720.

12. WHO. Integrated Management of Cardiovascular Risk. Report of a WHO Meeting. Geneva; July 2002

13. NC Hazarika, D Biswas, J Mahanta Hypertension in the Elderly Population of Assam JAPI • VOL. 51 • JUNE 2003

14. Saunders J.B, Beevers D.G and Paten A. Alcohol induced hypertension. Lancet1961; 2: 653-656.

15. CS Shanthirani et al. Prevalence and Risk Factors of Hypertension in a Selected South Indian Population - The Chennai Urban Population Study (J. Assoc Physicians India 2003; 51:20-27).

16. Iftekhar Quasem, Mrunal S.Shetye, Shiney C. Alex, et al Hypertension study group. 10. Prevalence, awareness, treatment and control of hypertension among the elderly in Bangladesh and India: a multicentric study, Bulletin of the World Health Organization 2001,79:490-500

17. Zachariah M G, Thankappan K R, Alex S C. Prevalence, correlates, awareness, treatment, and control of hypertension in a middle-aged urban population in Kerala. Indian Heart J. 2003 May-Jun; 55(3):245-51

18. Mehan MB, Srivastava N, Pandya H. Profile of non communicable disease risk factor in an industrial setting. J Post grad Med September 2006 Vol 52(3) 167-73.

19. Salim Yusuf, Steven Howken, Stephanie Ounpuu et al. “Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries” THE INTER HEART STUDY: case-control study The Lancet, Volume 364, Issue 9438, Pages 937 - 952, 11 September 2004

20. Ericus C A M Gilberts, Marinus J C W J Arnold, Diederick E Grobbee. Hypertension and determinants of blood pressure with special reference to socio economic status in a rural south Indian community. Journal of epidemiology

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One article from every issue is selected for the ‘Best Article Award’. Authors of selected ‘Best Article’ are rewarded with a certificate. IJCRR Editorial Board members select one ‘Best Article’ from the published issue based on originality, novelty, social usefulness of the work. The corresponding author of selected ‘Best Article Award’ is communicated and information of award is displayed on IJCRR’s website. Drop a mail to editor@ijcrr.com for more details.

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A Study by Bhat Asifa et al. entitled "Efficacy of Modified Carbapenem Inactivation Method for Carbapenemase Detection and Comparative Evaluation with Polymerase Chain Reaction for the Identification of Carbapenemase Producing Klebsiella pneumonia Isolates" is awarded Best Article for Vol 13 issue 17
A Study by Gupta R. et al. entitled "A Clinical Study of Paediatric Tracheostomy: Our Experience in a Tertiary Care Hospital in North India" is awarded Best Article for Vol 13 issue 16
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A Study by Sindhu Priya E S et al. entitled "Neuroprotective activity of Pyrazolone Derivatives Against Paraquat-induced Oxidative Stress and Locomotor Impairment in Drosophila melanogaster" is awarded Best Article for Vol 12 issue 23
A Study by Habiba Suhail et al. entitled "Effect of Majoon Murmakki in Dysmenorrhoea (Usre Tams): A Standard Controlled Clinical Study" is awarded Best Article for Vol 12 issue 22
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A Study by Avijit Singh"Comparison of Post Operative Clinical Outcomes Between “Made in India” TTK Chitra Mechanical Heart Valve Versus St Jude Mechanical Heart Valve in Valve Replacement Surgery" is awarded Best Article for Vol 12 issue 19
A Study by Sonali Banerjee and Mary Mathews N. entitled "Exploring Quality of Life and Perceived Experiences Among Couples Undergoing Fertility Treatment in Western India: A Mixed Methodology" is awarded Best Article for Vol 12 issue 18
A Study by Jabbar Desai et al. entitled "Prevalence of Obstructive Airway Disease in Patients with Ischemic Heart Disease and Hypertension" is awarded Best Article for Vol 12 issue 17
A Study by Juna Byun et al. entitled "Study on Difference in Coronavirus-19 Related Anxiety between Face-to-face and Non-face-to-face Classes among University Students in South Korea" is awarded Best Article for Vol 12 issue 16
A Study by Sudha Ramachandra & Vinay Chavan entitled "Enhanced-Hybrid-Age Layered Population Structure (E-Hybrid-ALPS): A Genetic Algorithm with Adaptive Crossover for Molecular Docking Studies of Drug Discovery Process" is awarded Best article for Vol 12 issue 15
A Study by Varsha M. Shindhe et al. entitled "A Study on Effect of Smokeless Tobacco on Pulmonary Function Tests in Class IV Workers of USM-KLE (Universiti Sains Malaysia-Karnataka Lingayat Education Society) International Medical Programme, Belagavi" is awarded Best article of Vol 12 issue 14, July 2020
A study by Amruta Choudhary et al. entitled "Family Planning Knowledge, Attitude and Practice Among Women of Reproductive Age from Rural Area of Central India" is awarded Best Article for special issue "Modern Therapeutics Applications"
A study by Raunak Das entitled "Study of Cardiovascular Dysfunctions in Interstitial Lung Diseas epatients by Correlating the Levels of Serum NT PRO BNP and Microalbuminuria (Biomarkers of Cardiovascular Dysfunction) with Echocardiographic, Bronchoscopic and HighResolution Computed Tomography Findings of These ILD Patients" is awarded Best Article of Vol 12 issue 13 
A Study by Kannamani Ramasamy et al. entitled "COVID-19 Situation at Chennai City – Forecasting for the Better Pandemic Management" is awarded best article for  Vol 12 issue 12
A Study by Muhammet Lutfi SELCUK and Fatma entitled "Distinction of Gray and White Matter for Some Histological Staining Methods in New Zealand Rabbit's Brain" is awarded best article for  Vol 12 issue 11
A Study by Anamul Haq et al. entitled "Etiology of Abnormal Uterine Bleeding in Adolescents – Emphasis Upon Polycystic Ovarian Syndrome" is awarded best article for  Vol 12 issue 10
A Study by entitled "Estimation of Reference Interval of Serum Progesterone During Three Trimesters of Normal Pregnancy in a Tertiary Care Hospital of Kolkata" is awarded best article for  Vol 12 issue 09
A Study by Ilona Gracie De Souza & Pavan Kumar G. entitled "Effect of Releasing Myofascial Chain in Patients with Patellofemoral Pain Syndrome - A Randomized Clinical Trial" is awarded best article for  Vol 12 issue 08
A Study by Virendra Atam et. al. entitled "Clinical Profile and Short - Term Mortality Predictors in Acute Stroke with Emphasis on Stress Hyperglycemia and THRIVE Score : An Observational Study" is awarded best article for  Vol 12 issue 07
A Study by K. Krupashree et. al. entitled "Protective Effects of Picrorhizakurroa Against Fumonisin B1 Induced Hepatotoxicity in Mice" is awarded best article for issue Vol 10 issue 20
A study by Mithun K.P. et al "Larvicidal Activity of Crude Solanum Nigrum Leaf and Berries Extract Against Dengue Vector-Aedesaegypti" is awarded Best Article for Vol 10 issue 14 of IJCRR
A study by Asha Menon "Women in Child Care and Early Education: Truly Nontraditional Work" is awarded Best Article for Vol 10 issue 13
A study by Deep J. M. "Prevalence of Molar-Incisor Hypomineralization in 7-13 Years Old Children of Biratnagar, Nepal: A Cross Sectional Study" is awarded Best Article for Vol 10 issue 11 of IJCRR
A review by Chitra et al to analyse relation between Obesity and Type 2 diabetes is awarded 'Best Article' for Vol 10 issue 10 by IJCRR. 
A study by Karanpreet et al "Pregnancy Induced Hypertension: A Study on Its Multisystem Involvement" is given Best Paper Award for Vol 10 issue 09

List of Awardees

A Study by Ese Anibor et al. "Evaluation of Temporomandibular Joint Disorders Among Delta State University Students in Abraka, Nigeria" from Vol 13 issue 16 received Emerging Researcher Award


A Study by Alkhansa Mahmoud et al. entitled "mRNA Expression of Somatostatin Receptors (1-5) in MCF7 and MDA-MB231 Breast Cancer Cells" from Vol 13 issue 06 received Emerging Researcher Award


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Disclaimer: International Journal of Current Research and Review (IJCRR) provides platform for researchers to publish and discuss their original research and review work. IJCRR can not be held responsible for views, opinions and written statements of researchers published in this journal.



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International Journal of Current Research and Review (IJCRR) provides platform for researchers to publish and discuss their original research and review work. IJCRR can not be held responsible for views, opinions and written statements of researchers published in this journal

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