|
JOURNAL OF COMMUNITY MEDICINE |
|
INDIAN ASSOCIATION OF PREVENTIVE AND SOCIAL MEDICINE ORISSA CHAPTER |
|
*Asst. surgeon, **Asst. Professor, ***Professor and Head ****P.G. Student
Department of Community Medicine, M.K.C.G. Medical College, Brahmapur |
|
L. Patnaik, N. C. Sahani, T.Sahu S. Sethi |
|
Abstract
Research question: What is the prevalence of hypertension and associated risk factors in adult population residing in urban slum of Brahmapur, Orissa? Objectives: 1. To study the prevalence of hypertension. 2. To identify the risk factors 3. To assess their awareness on hypertension. Methods: -Study design: Cross- sectional study. Setting: Urban slum area Ankoli of Brahmapur Participants: 336 persons above 18 years of age Study period: June 2005 - August 2005 Study variables: Age, Sex, Family H/O hypertension, Addiction, Body mass index BMI. Statistical analysis: Proportion, Chi-square test, Relative risk Results: The overall prevalence of hypertension was found to be 10.7 per cent. Higher prevalence of Hypertension was highly prevalent among people with family H/O hypertension (26.9%), Hypertension was significantly higher in persons of age more than 40 years, with family H/O hypertension, alcohol intake, BMI>25 (P<0.001), Diabetes Mellitus (P<0.01) and smoking (P<0.01). Out of 36 hypertensives, 83.3% were aware of their disease and among them 86.7% were taking regular medicines, and 66.7% had satisfactory control. Among the hypertensives, 44.4% were having no restriction of salt and diet, 83.3% were not doing regular exercises, 66.7% were not aware of complications and 27.7% were not aware about the do’nts of hypertension. Conclusion: Routine screening of people above 40 year and counseling of diagnosed cases were suggested for behavioral change. Key words: Diabetes, smoking, Body mass index, exercise.
Introduction Hypertension is the commonest cardiovascular disorder, posing a major public health challenge to population in socioeconomic and epidemiological transition. It is one of the major risk factor for cardiovascular mortality, which accounts for 20-50% of all deaths.1 Hypertension is fast emerging as a modern epidemic in the world. Developed countries are considering it as a leading cause of death but even developing countries do not lag behind in being affected by it.2 In a meta-analysis of 34 epidemiological studies from rural and urban populations of India, it was observed that hypertension is emerging as a major public health problem in India and is more prevalent among urban people compared to those of rural area.3 In early stages of high blood pressure, there are no symptoms. Many who are afflicted feel no discomfort until a medical crisis – a heart attack, the rupture of a blood vessel in the brain or a stroke - strikes. As a consequence, high blood pressure is often called the “Silent Killer.”2
Lack of knowledge about the morbidity, complications and the method of control of hypertension contributes to a large percentage of undetected and untreated hypertensive subjects in the community.4 Till date prevalence study of Hypertension in slum areas was very minimal. So an attempt was undertaken with the objectives of assessing the prevalence of hypertension and to identify the risk factors and to assess their knowledge and practice on hypertension. Material and Methods
It was a community based cross sectional study conducted during June - August 2005 in urban slum area of Ankoli, Brahmapur, which is the field practice area of Department of Community Medicine. As per Anganwadi registers, total no. of slum households in 4 anganwadi areas present in Ankoli named Ankoli Bauri sahi-I, II, Pankellapalli, Panda colony was 884. Total population of 4 areas was 5098 as per registers and the population above 15 years was 3320. The sample size was determined by taking 10% of the total population i.e. 332. On verification of registers, it was found that average of 2-3 people of 18 years and above was residing in each family. So the no. of families to be visited were 110 (332/3). 110 households from 884 households were selected with interval of 8 (884/110). Starting at random every 8th household was visited and all the members > 18 years were included in the study in the selected family. Locked houses were excluded and the next household was selected for the study. In the process, data were collected in respect of 336 people in 110 households.
The study subjects were interviewed by predesigned and pretested questionnaire. Data in respect of age, sex, family history of hypertension, dietary habits, addictions, history of diabetes etc. were collected. Their height in cm. was measured using standardized measuring tape and weight (kg.) was recorded by digital weighing machine. Blood pressure was recorded by using standardized mercury sphygmomanometer in left upper arm in sitting position. Phase I and phase V recordings were considered as systolic and diastolic pressures respectively. In case of newly diagnosed cases, 3 recordings were taken in a gap of 5-7 days. A person was labeled as hypertensive if the systolic BP ≥ 140 mmHg and/or diastolic BP ≥ 90 mmHg.5. Already diagnosed cases taking anti-hypertensive were also considered for prevalence study. Absentees were covered by revisiting the house. Knowledge and practice were assessed in patients of hypertension.
Results Out of 336 people, 49.4% were male. Proportion of people in different age groups of 15-20, 20-30, 30-40, 40 -50, 50 -60 and >60 years were 14.9%, 26.8%, 18.4%, 20.2%, 14.9% and 4.8% respectively.
The overall prevalence of hypertension was found to be 10.7%. It was 13.25% in males and 8.23% in females. Early onset of hypertension was observed from 20-30 years onwards in females compared to males. In both sex Maximum prevalence was found in persons above 60 years. Fig. 1: Age and Hypertension
The line diagram shows that Hypertension is increasing with age starting from 20 years onwards and maximum prevalence is found in persons above 60 years. Tab. II: Hypertension and risk factors
Higher prevalence of hypertension was found in persons with diabetes mellitus (30%), family history of hypertension (26.9%), age more than 40 years (23.9%), smoking (23.3%), BMI >25 (19.23%), alcohol intake (16.6%), male sex (13.25%), irregular exercise (13.13%), non-vegetarian diet (11.3%). Hypertension was significantly higher in persons of more than 40 years age, with family H/O hypertension, alcohol intake, BMI>25 (P<0.001) as well as in persons with Diabetes Mellitus and smoking (P<0.01). Relative risk of hypertension due to all enumerated risk factors were more than 1, highest in >40 years (12.05) followed by family H/O hypertension (7.8). Tab. III: Knowledge and Practice of Hypertensive people
All cases of hypertension, both new and old were assessed for their Knowledge and Practice as it is a chronic problem that needs constant monitoring and life style modification. Out of 36 hypertensives, 83.3% were aware of their disease; but only 86.7% were taking regular medicines and 66.7% had satisfactory control of hypertension. 66.7% of them were not aware of complications and 27.7% were not aware about the do’nts of hypertension. Among the previously diagnosed cases, 40% were having no restrictions of salt and fat in diet, 83.3% were not doing regular exercises. Discussion The overall prevalence of hypertension found to be 10.7per cent. The prevalence of hypertension was 13.25% in males and 8.23% in females. Gaurav R.B et al in a community based study in urban area found the prevalence of hypertension to be 13.9%.4 In a study conducted in an urban slum Reddy SS and Prabhu GR, found that prevalence of hypertension in population 20 - 60 years was 8.6% out of which prevalence in males was 9.6% and 7.6% in males and females respectively.6 Higher proportion of hypertension in the present study could be due to inclusion of people above 60 years of age. Highest prevalence was found in the age group of 60 years and above but affected above 20% after the age of 40 years with an increasing trend with age. Sharma RB and Singh B in their study observed a consistent rise in prevalence rate from 1.4% to 31.93% with the increase in age group from 20-25 years to 55-60 years in both sexes.7 Such changes of blood pressure with age might be due to changes in vascular system. Hypertension was significantly higher in persons of more than 40 years age (P<0.05), family H/O hypertension (P<0.05), alcohol intake (P<0.05), BMI more than 25 (P<0.001) and Diabetes Mellitus (P<0.01), smoking (P<0.01). Relative risk of hypertension due to each of enumerated risk factors was more than 1; it was notably high in age group above 40 years and those with family history of hypertension. In a study by Deswal BS et al, hypertension was significantly higher in groups consuming alcohol (23.9%, P<0.05) and relative risk was 3.75 times more among them. Although the relative risk was found to be 1.8 in smokers, the association was not found significant. Family history of hypertension in first degree relatives was significantly higher (P< 0.001) and relative risk was 4.86 times more.8 Sandeep TK et al found 70% of persons having BMI > 25 to be hypertensive.9 Among the hypertensive subjects, 83.3% were aware of their disease, as they were already diagnosed. 86.7% of them were taking antihypertensives regularly and 66.7% had satisfactory control of their hypertension. In the study by Khadilkar HA et al, 15.48% were aware of their hypertensive status. Of those 76.95 were taking treatment and 70% of them could take treatment regularly.10 Only few of the hypertensives had gone for dietary modifications and regular exercise. Conclusion: The overall prevalence of hypertension was 10.7% and it was more in males. Risk of hypertension increased with age, particularly beyond 40 years. Early onset of hypertension was seen in females in 20-40 years. Family H/O hypertension, alcohol intake, BMI>25, DM and smoking were significantly associated Early detection of hypertension can be facilitated by periodic screening of the people regularly above the age of 40 years. Counseling of the hypertensives on lifestyle modification and its role in controlling hypertension should be emphasized. Reference 1. 1. K.Park, Text Book of P.S.M., M/s Banarsidas Bhanot Publishers, 18th edition, 2005. 2. Kulkarni AT. Hypertension- A silent killer. Indian Medical gazette, 1998; 32 (3): 73-77. 3. Gupta R. Meta-analysis of prevalence of hypertension in India. Indian Heart Journal, 1997; 49: 43-48. 4. Gaurav RB, Samel DR, kartikeyan S. Community based study on hypertension in an urban area. Antiseptic, 2002; 99 (6): 216-219. 5. Technical report series, No. 862, World Health Organization, 1996. 6. Reddy SS and Prabhu GR. Prevalence of risk factors of Hypertension in adults in an urban slum, Tirupati, A.P. IJCM, 2005; 30 (3): 84-86. 7. Sharma RB and Singh B. A study of hypertension in adult population (20-60 years) of a rural area of J & K state. IJCM, 1997; 22 (4): 155-159. 8. Deswal BS, satyamoorthy TS, Dutta PK, Ganguly SS. An epidemiological study of hypertension among residents in Pune. IJCM, 1991; 16 (1): 21-28. 9. Sandeep TK, Baghel PK, Jain MK. Study of prevalence of complications in a symptomatic obese patients. Indian Practitioner, 2003; 56 (12): 219-225. 10. Khadilkar HA, Ghattargi CH, Thite GH. Profile of awareness in hypertensive cases regarding treatment. Indian Practitioner, 2004; 57(6): 376-378. |
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
A Study on Hypertension in Urban Slum of Brahmapur, Orissa |
