Retrospective Analysis of Epidemiological Profile of Hypertensive Patients

John Masih¹*, Bansal A.², Thakur Amit K.¹and Painkara U.S.³

¹Assistant Professor, Medicine, Govt. Medical College, Jagdalpur

²Associate Professor, O.B.G., Govt. Medical College, Jagdalpur ³Professor &H.O.D., Medicine, Govt. Medical College, Jagdalpur

ABSTRACT:

Back Ground :Countless actors have hammed death by clutching their heart in imagined pain before collapsing ,yet this Bollywood over kill has had no effect on most Indians, who remain oblivious to the threat of cardiovascular disease (heart attack and stroke)till it comes knocking on their doors.

Material and method: The study is retrospective in nature and was conducted in a tertiary care hospital. The data was collected in a pre drawn and pre tested proforma between May 2003 and May 2004.

Variables: Age, gender, Nature of diet, Obesity, Family history, Smoking, Alcoholism etc.

Observations and Discussion: More than fifty percent patients were either normotensive or in pre hypertensive stage.18 % and 29 % were in hypertension stage-I, II and III. There were only five patients who gave history of hypertension running in their families.45 % were hypertensive obese out of these 67.85 % were suffering from Diabetes. 52.72 % smokers were found hypertensive.

Conclusion and Recommendations: Modifiable factors played an important role in causing hypertension along with some biological factors like obesity, diabetes etc. The impact of these factors can be minimized by changing their life style like spend at least 30 minutes in exercise every day, reduce their body weight etc.

KEY-WORDS: Life style, Waistlines

INTRODUCTION:

Indian Heart Watch data (1-2) reveals that one in two Indian smoker's don’t know that their tobacco addiction causes stroke while 385-more than one in three- don’t knows it causes heart disease. While people in smaller cities smoked and ate more fatty food and less fresh fruits and vegetables, metro-residents tend to be less active. Obesity, high blood pressure and high cholesterol were uniformly high, with people doing little to lower their risk. The data further reveals that even among literate middle-class urban Indians, awareness and control rates of risk factors was low, for example, roughly one in three people surveyed had hypertension ,of which only 575knew they had high blood pressure. Among those with diagnosed hypertension, 40% were on medicine to lower it but 25%had it under control. In comparison ,high income countries ,60 % people with diagnosed high blood pressure have it controlled, reported researchers at the World Congress of Cardiology. Roughly half of all heart attacks and strokes come out of the blue in people with no diagnosed heart disease, so identifying risk factors early in healthy people is a must to delay disease and prevent death. By keeping in mind the above facts and as per recommendations of the World Health Organization (W.H.O.) study group in 1957, that in order to get a comprehensive picture of a disease, more and more such studies have to be carried out, Garg Narendra K.(3) and Garg Narendra K. and Sharma A.B.(4), the authors have under taken this study with the objective to study the epidemiological profile of Hypertensive patients retrospectively.

MATERIAL AND METHODS:

The study is retrospective in nature and was conducted in a tertiary care hospital, Raipur (C.G.).The data was collected in a pre drawn and pre tested Performa between May 2003 and May 2004.Variables used were Age, gender, Nature of diet, Obesity, Family history, Smoking, Alcoholism etc.

Hypertension: Hypertension is defined as sustained increase in systolic BP of 140mm Hg or more and diastolic BP 90mmHg or more.

Classification of Blood Pressure for adults , JNC -VII guide line post graduate Medicine , 2004(5).

JNC7BP categories	JNC6BP categories	SBP mm of Hg	And /or	DBP mm of Hg
Normal	--	<120	And	<80
Pre Hypertension	Optimal	120 – 139	Or	80-89
	Normal	<130	And	<85
	High Normal	130-139	Or	85-89
Hypertension	Hypertension	--	----	----
Stage -I	Stage –I	140-159	Or	90-99
Stage –II	--	> 160	Or	> 100
--	Stage –II	160-179	Or	100-109
--	Stage –III	> 180	Or	> 110

OBSERVATIONS AND DISCUSSION:

On analysis of the collected data it was noted that as age advances B.P.goes up in both sexes except in 71 +years of age group. Highest number of patients were in pre-hypertensive stage (Table-I). It was further observed that number of males were more in each stage of hypertension. In the present study there were only 11 % patients were vegetarian rest 89 %non vegetarian (Table-II).Highest number of patients were in pre hypertensive stage. It has been further noted that in both vegetarian and non vegetarian, in each stage number of males were more than their counterparts females.

Higher number of obese patients without diabetes were in normotensive stage in comparison to their counterparts obese with diabetes while in pre-hypertensive and stage-I, almost equal number of patients were found both in obese with diabetes or without diabetes (Table-III).In stage –II&III there were higher number of obese patients were found with diabetes in comparison to nine diabetics obese. It shows that obesity plays an important role in causing hypertension. .There were higher number of males in Stage I to III of BP with Diabetes in comparison to females (Table-IV) in almost all age groups. In normotensive stage there were only seven and two diabetic male and female respectively .In prehypertensive stage there were no person was noted irrespective of gender while in age group from 41 and above years of age there were eighteen and six male and females diabetics respectively There were only one female smokers (Table-V). It was further noted that she belongs to hypertensive II&III stage. While out of two non smokers females one each in stage –I and stage-II&III of blood pressure. Seventeen and nine male smokers and non smokers respectively were in Sage –I and Stage –II &III stage of Blood Pressure. Again table further reveal that there were nineteen males smokers and non smokers fall in pre hypertensive stage of BP against three and four smoker and non smokers males respectively in normotensive stage. These higher number of hypertensives indicate that smoking has positive impact on Blood Pressure.

There is now stastical proof that urban Indian life styles are queering the pitch for the Indian heart (6) Blood pressure might be dipping across the world but in India ,it has risen. The W.H.O.says the average BP went down by 2.7mm mercury among women globally, while increasing by 2.4 mm mercury in India. In men, it decreased by 2.3 mm mercury globally in the past three decades but in India it went up by 2.2 mm mercury (6). Nearky 139 million Indians were suffering from high BP at the end of 2008-14 % of the global burden of uncontrolled hypertension.

The study by the Harvard School of Medicine found that screening an additional 25 % of the population would lead to an increase of more than 10 % in the rate of appropriate treatment of hypertension in high-risk individuals (6).High BP is the leading risk factor for cardiovascular disease mortality, causing more than 7 million deaths every year worldwide. The Havard study presented at the world congress of Cardiology in Dubai says 900 million people in developing countries have high BP but only one third are aware of their disease. Moreover, only 100 million of these people receive treatment, while only 5 % of the total are controlled. Dr. Ashok Seth, chairmen of Escorts heart I institute said,' over 50 % people in India don’t know they have high BP till incidentally found on a routine health checkup. The danger is that in many, it presents in the form severe high pressure called hypertensive crisis which lead to temporary stroke, bleeding in eyes and heart failure. Those with high risk like family history of high BP and heart disease and smokers should get their BP checked at regular intervals". Dr. Deepak Natrajan, head of interventional cardiology at Moolchan hospital told TOI," very young people are now coming to us with a full blown heart attack and one of the reasons for this is uncontrolled high BP .Youngesters today have very poor life style triggered by their extremely busy schedules".

India is seeing a massive increase in BP levels which is a huge contributor to stroke and heart attacks. Youngesters must spend at least 30 minutes excersing every day, consume a good amount of fruit and vegetables and reduce their body weight (6).

Mothers who are exclusively breastfeeding their babies for at least six months can lower their risk of developing high BP later in life by a quarter. Researchers in the university of North Carolina in the U.S. found that women who gave their babies formula or breast fed for less than three months were almost a quarter more likely to develop blood pressure problems. In the study there were 56,000 mothers with at least on child concluded that mothers who breast fed for at least six months were less likely to develop hypertension over 14 years period than those who bottle fed. The research further observed that up to 12%of high BP cases among women with children could be linked to "suboptimal" breast feeding. While the findings do not prove breastfeeding was behind healthier blood pressure ,the researchers said it added to evidence that it was good for both mothers and babies(7), published in the American J of Epidemiology.

There could soon be a cap on how much salt is put in your fries. Raising taxes on products containing salt would reduce the incidence of stroke by 4% and heart attack by 2% in India. Salt is known to cause high blood pressure or hypertension that is responsible for 57% of deaths due to stroke and 24% of mortality by heart attack in India (8). Sodium makes blood vessels less able to contract or expand and may toughen heart cells.W.H.O. says an adult should not consume more than 5gm.of salt a day. However, an Indian consume double the prescribed limiti.e.10gm a day. Dr. K Srinath Reddy, president of the world heart federation ,said" people will have to b educated on reducing salt use while cooking, beside giving up the habit of adding table salt in their foods. He further added that we also will have to be ensure that processed foods don't contain high salt levels". The Harvard study found that a salt tax would save money by reducing the number of people needing treatment for hypertension and CVD events such as heart attacks and stroke.

TABLE-I: Hypertensive as per age and gender (n=64)

HYPERTENSION	Age in years and gender										Total
	31-40		41-50		51-60		61-70		71and above		Total
	M	F	M	F	M	F	M	F	M	F
Normotensive (<120/<80)	05	01	03	01	04	02	01	01	00	01	19
Pre- Hypertensive (120-139/80-89)	04	01	03	04	12	02	06	01	05	00	38
Stage -I Hypertension (140-159/90-99)	01	00	04	01	05	03	01	01	01	00	17
Stage -II & III Hypertension (>160/>100)	01	01	04	01	06	03	03	01	04	02	26
Total	11	03	14	07	27	10	11	04	10	03	100

TABLE-II: Hypertensive as per their Diet

		Normotensive (<120/<80)		Pre- Hypertensive (120-139/80-89)		Stage -I Hypertension (140-159/90-99)		Stage -II & III Hypertension (>160/>100)		Total
Gender		M	F	M	F	M	F	M	F
Diet	Vegetarian n=11	01	01	03	00	03	00	02	01	11
Diet	Non-Vegetarian n=89	12	05	27	08	09	05	16	07	89
Total		13	06	30	08	12	05	18	08	100

TABLE-III: Hypertensive as per their obesity (n=62)

		Normotensive (<120/<80)		Pre- Hypertensive (120-139/80-89)		Stage -I Hypertension (140-159/90-99)		Stage -II & III Hypertension (>160/>100)		Total
Gender		M	F	M	F	M	F	M	F
Obese	Obese with Diabetes n=35	02	02	11	01	02	02	12	03	35
Obese	Obese with out-diabetes n=27	03	04	07	04	04	01	03	01	27
Total		05	06	18	05	06	03	15	04	62

TABLE-IV: Distribution of Diabetic Hypertensive as per their age and gender (n=50)

Stages of Blood Pressure	HYPERTENSION WITH DIABETES										Total
	31-40		41-50		51-60		61-70		71and above		Total
	M	F	M	F	M	F	M	F	M	F
Normotensive (<120/<80)	03	00	02	01	02	01	00	00	00	00
Pre- Hypertensive (120-139/80-89	00	00	03	01	07	03	06	01	02	01
Stage -I Hypertension (140-159/90-99	02	00	01	01	02	00	00	01	00	00
Stage -II & III Hypertension (>160/>100)	01	00	01	02	01	01	02	02	00	00
Total	06	00	07	05	12	05	08	04	02	01

TABLE-V: Hypertensive as per their Smoking Habit (n=55)

Smoking Habit	Normotensive (<120/<80)		Pre- Hypertensive (120-139/80-89		Stage -I Hypertension (140-159/90-99		Stage -II & III Hypertension (>160/>100)		Total
Smoking Habit	M	F	M	F	M	F	M	F
Smoker n=32	03	00	11	00	06	00	11	01	32
Non-Smoker n=23	04	00	08	00	04	01	05	01	23
Total	07	00	19	00	10	01	16	02	55