Prevalence of hypertension and its risk factors among adults in urban field practice area NMC, Raichur, Karnataka, India

INTRODUCTION

It is the commonest cardiovascular disorder, posting a major public health problem of the world and especially to population in socio-economic and epidemiological transition.¹ It is one of the major and independent risk factors for non-communicable diseases like cerebrovascular disease, coronary heart diseases, and cardiac and renal failure.² The recent WHO report states that considering the prevalence of any diseases, hypertension ranks fourth in the world.³ As it is hidden beneath an outwardly asymptomatic appearance, the disease does immense harm to the body in the form of ‘Target organ’ damage hence the WHO is named it the “silent killer”.⁴ Hypertension affects approximately 1 billion people worldwide. Raised blood pressure is estimated to cause about 7 million premature deaths throughout the world, and 4.5% of the disease burden (64 million disability-adjusted life years (DALYs). The estimated number of Indians with hypertension was 120 million in year 2000, which is likely to expend to 200 million by 2025, with equal numbers among men and women.²

The World Health Day theme 2010 focuses on Urbanization and Health – addressing health issues of the rapidly increasing urban population. Over half of the world’s population lives in cities. By 2050, seven out of every 10 people will be city dwellers. India is a part of this global trend. Nearly 28 percent of India’s population lives in cities and this is expected to increase to 41 percent by the year 2020. The rapid increase in urban population worldwide is among the important global health issues of the 21^st century.

Definition

Systemic arterial hypertension is defined as a state of chronically elevated arterial blood pressure, as compared to what is normally expected, as per the defined level given in JNC-VII.⁵

Objectives

• To estimate the prevalence of hypertension among adults in urban population.

• To estimate the risk factors associated.

METHODS

Study area: The study was undertaken in the urban field practice area of the Department of Community Medicine, Navodaya Medical College, Ashapur, Raichur.

Study population: The study population comprised of people aged 18-65 years residing in the urban-field practice area of Navodaya Medical College & Hospital, Raichur.

Study design: It is community based cross sectional study.

Statistical analysis

Analyzed statistically using the SPSS statistical package (SPSS version 17.0 for windows 2009).Chi Square test was used and P value less than 0.05 will be considered significant.

Duration of study: January 2013 – December 2013.

Inclusion criteria

People aged 18-65 years who are the permanent residents in the urban field practice area of Navodaya medical College.

Exclusion criteria

• Individuals below 18 years and above 65 years

• Individuals who did not give consent

Sample size calculation

Using statistical formula

n= Z²pq

d²

Prevalence of NCD in urban area, p= 5%; n = 1900 (150 among these were not responding, so the sample size came to be 1751).

Sampling method: Systematic random sampling. House was taken as the sampling unit.

RESULTS

In our study, 23.9% were having normal BP. 42.5% were having pre hypertension (SBP 120-139 and/or DBP 80-89 mmHg). 29.2% were having stage I HTN (SBP 140-159 mmHg and/or DBP 90-99 mm Hg). 4.4% of the subjects were having stage II HTN (SBP >160 mmHg and/or DBP >100 mm Hg) giving a prevalence of 33.6% (29.2% stage I HTN +4.4% Stage II HTN) (Table 3).

Males have shown higher prevalence of HTN (37.3%) compared to female (28.9 %). There is highly significant association between HTN and sex (p<0.0001) (Table 4).

As age increases, BP increases, highest prevalence is seen. In 60-65 years followed by 40-49 years whereas in age group 20-29 years prevalence of HTN was less (11.8%). There is highly significant association between HTN and age (p<0.0001) (Table 5).

Table 6 shows that 53.7% of hypertensives were already diagnosed to have HTN while 46.3% were newly diagnosed hypertensives.

Table 7 depictS that, 36.9% of hypertensives had family history of HTN and 63.09% hypertensives did not have family history of HTN. There is significant association between HTN and family history of HTN (p=0.003).

The Table 8 shows that 2.21% of hypertensives were taking <6 grams salt per day while 97.78% of hypertensives were taking >6 grams salt per day. There is significant association between HTN and salt intake (p=0.009).

Table 9 depict that 30.27% of the hypertensives were physically active and 69.72% were physically inactive. There is no significant association between HTN and physical activity (p=0.586).

Occurrence of HTN was more in past smokers (79.79%) followed by current smokers (46.9%) when compared to non-smokers (24.25%). There is highly significant association between HTN and smoking (p=0.0001) (Table 10).

Table 11 depict that 56.11% of the hypertensives were consuming alcohol and 32.1% of hypertensives were not consuming alcohol. There is significant association between HTN and alcohol consumption (p=0.013).

χ2 =6.112, df=1, p=0.013.

Table 12 depict that, 33.3% of hypertensives had stress while 66.6% of hypertensives did not have any stress. There is highly significant association between HTN and stress (p<0.0001).

DISCUSSION

The present study was undertaken in the urban field practice area of Navodaya Medical College, Raichur. The objective of this community based cross sectional study was to find the prevalence of hypertension and the risk factors associated with it among adults.

Prevalence of hypertension

In our study, 588 were found to have hypertension giving a prevalence of 33.6%. Among them 53.7% of hypertensives were already diagnosed to have HTN while 46.3% were newly detected hypertensives. This shows the submerged portion of the iceberg. A simliar study conducted by Gupta R in Jaipur, in urban adults in 2002 showed prevalence of hypertension as 36% in men and 37% in women.⁶ Our prevalence was less when compared to a study conducted by Avadaiammal et al in Trivandrum city, Kerala, south India in 2006 which showed the prevalence as 47% (SBP 120-139 and/or DBP 80-89 mmHg).⁷

Prevalence of HTN with age

Highest prevalence is seen in 60-65 years (56%) followed by 40-49 years (41.27%). A study conducted by Patnaik N et al in 2005,in an urban slum of Orissa found that Hypertension was significantly higher in persons of more than 40 years age.⁸ A study conducted by Zachariah M G et al. in a middle-aged urban population in Kerala in 2003 also found that prevalence of hypertension was more in older age.⁹

Prevalence of HTN with sex

Males have shown higher prevalence of HTN (37.3%) compared to female (28.9%). Studies done by Gupta R⁽¹⁰⁾ in Rajasthan and Mohan V in Chennai also showed that the prevalence in males was found to be more than females.¹¹

Prevalence of hypertension with family history

36.9% of hypertensives had family history of HTN and 63.09% hypertensives did not have family history of HTN. A study conducted by Patnaik N et al in 2005 in an urban slum of Orissa found that hypertension was significantly higher in persons who have a family history of hypertension.⁸

Prevalence of hypertension with quantity of salt intake

97.78% of hypertensives consumed more than 6 grams of salth per day. A study done by Chandwani Het al in Gujarat in 2010 showed a higher prevalence of hypertension among people who consumed excess salt.¹²

Prevalence of hypertension with smoking

In our study occurrence of HTN was more in past smokers (82.4%) followed by current smokers (51.5%) when compared to non-smokers (27.6%). There is significant association between HTN and smoking (p=0.0001).

Our study can be compared with studies done by Sahani PNC et al, Sahu T et al in Orissa found that Hypertension was significantly higher in Smokers.¹³

Prevalence of hypertension with alcohol

14.11% of hypertensives were consuming alcohol and 85.88% of hypertensives were not consuming alcohol. A study done by Hazarika NC et al in Assam in 2003 in elderly population found that Alcohol consumption increased the risk of hypertension in the study population.¹⁴

Prevalence of hypertension with physical activity

In our study 30.27% of the hypertensives were physically active and 69.72% were physically inactive. A study conducted by S.S.Reddy in Tirupati in 2005 showed higher prevalence of hypertension with lack of physical activity.¹⁵ A study done by Shantirani et al in Chennai (Chennai Urban Population Study) also found significant association with hypertension and physical activity (p=0.0001).¹⁶

Prevalence of hypertension with stress

In our study 66.66% of hypertensives had stress while 33.3% of hypertensives did not have any stress. There is significant association between HTN and Stress. (p<0.0001). A study done by Deswal BS among the residents of Pune showed that the relative risk of developing hypertension in those who had stress and anxiety was 2.5 and 2.43 times respectively.¹⁷

CONCLUSION

The prevalence of hypertension in the study subjects was 33.6% . 50.7% of hypertensives were already diagnosed to have HTN while 49.3% were newly detected hypertensives. This represents the submerged portion of the iceberg. As age increases BP increases. Males have shown higher prevalence of HTN when compared to females. Family history of hypertension was present in 36.9% of the hypertensive. There is significant association between HTN and salt intake. Hypertension is more in those who are physically inactive. Occurrence of HTN was more in people who smoked. Occurrence of HTN was more in people who had stress.

Recommendations

• A nationwide initiative to create awareness among the people of the community regarding the harmful effects of tobacco, alcohol with main focus on children, adolescents and adults, so as to deter early initiation of smoking and alcohol .

• Effective implementation of COTPA (Cigarette Other Tobacco Product Act), to prevent the advertisement of tobacco products and to prevent use of cigarette in public places.

• Routine screening for risk factors and NCDs in the health services for all individuals.

• Emphasis on comprehensive approach that encompasses preventive, promotive, curative and rehabilitative aspects in medical and nursing curriculum rather emphasizing only on curative care.

• Integration of all NCDs related national programme by creating separate division/department for NCDs and renaming the programme as integrated National NCDs Control Programme keeping the scope open for entry of more diseases in future.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: The study was approved by the Institutional Ethics Committee

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