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Indian Journal of Community Medicine

Prevalence and Risk Factors of Hypertension in Adults in an Urban Slum,Tirupati, A.P.

Author(s): S.S. Reddy, G. R. Prabhu

Vol. 30, No. 3 (2005-07 - 2005-09)

Abstract

Research question: What is the prevalence of hypertension and its risk factors among adults aged 20-60 years residing years residing in an urban slum area of Tirupati town, A.P.?

Objective: To study the prevalence of hypertension and its risk factors as well as its extent of diagnosis and management among adults aged 20-60 years residing in an urban slum area of Tirupati.

Study design: Cross sectional. Study setting: Channa Reddy Colony (Urban slum area) in Tirupati town, A.P.

Study subjects: 1000 adults in the age group of 20-60 years (Males-500; Females-500) residing in an urban slum area of Tirupati town, A.P.

Study variables: Age, sex, occupation, family history of hypertension, history of cerebrovascular/cardiovascular events, diabetes mellitus, saturated fat intake, intake of excess salt, smoking, alcohol intake and regular physical exercise.

Outcome Variables: Number of hypertensives and mean blood pressure level estimations.

Statistical analysis: Proportions, Chi- square tests, .F. ratios, 't' tests, Odds ratios and 95% confidence intervals.

Results: The overall prevalence of hypertension was found to be 8.6%. Out of the 86 hypertensives, 72 (83.7%) were aware of their hypertension; all of those aware were under treatment; among the treated, only 30 (41.7%) had satisfactory control of their hypertension. Higher prevalence of hypertension was found with history of cerbrovascular/cardiovascular events (50.0%), diabetes mellitus (33.3%), family history of hypertension (23.3%), smoking (22.4%), age more than 50 years (22.2%), alcohol intake (20.0%), lack of physical exercise (15.8%), B.M.I.>25 (14.9%), male sex (9.6), non-vegetarian diet (8.8%) and saturated fat intake (8.8%). The mean systolic as well as diastolic blood pressures were found to be higher among men, higher age groups, and in business occupation of the respondents.

Conclusions: Despite treatment, most of the hypertensives had not achieved satisfactory control of blood pressure. Health education of the public is needed to control the various risk factors of hypertension.

Key words: Hypertension, Mean Blood Pressure Levels, Risk Factors for Hyprtension

Hypertension is the commonest cardiovascular disorder affecting at least 20% of adult populations in several countires. It is one of the important risk factors for cardio-vascular mortality accounting for 20-30% of all deaths. Hypertension is an iceberg disease. 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 countires would naturally be far too less. Many risk factors have been identified for hypertension. One of the important elements in the hypertension control is early diagnosis. In the light of the above, this present study on hypertension and its risk factors among adults aged 20-60 years of both sexes was conducted in a selected urban slum area in Tirupati town, A.P.

Material and Methods

A cross sectional community based study was conducted to find out the prevalence of hypertension and its various risk factors as well as the extent of diagnosis and management among adults (20-60 years) of both sexes residing in the Channa Reddy colony (urban slum area) in Tirupati, which is one of the field practice areas of the department of PSM, S.V. Medical College, Tirupati, A.P. The study was conducted during May-June, 2003. After going to the centre of the urban slum area, all the lanes and sub lanes were numbered and one lane and subsequently one sub lane were selected randomly using a currency note. Within each sub lane the number of household was roughly estimated and the first household was selected randomly using currency note. All the remaining households were visited serially following a right hand rule till the disired sample size of 1000 adults (500 male and 500 female) was reached. The outcome variables studied were number of hypertensives and mean blood pressure level estimations. A pre-designed interview schedule was used to collect the necessary information from the participants. Those individuals who were known hypertensives (with or without treatment) were also defined as hypertensives (irrespective of thier blood pressure readings).

A common weighing machine and measuring tape were used to record weight (kg) and height (cm) of all the study subjects. The statistical analysis was carried out using proportions, chi-square tests, 'F' ratios, t' tests, Odds ratio and 95% confidence intervals.

Results

Majority of the subjects were in the age group of 20-30 years (37.4%). (Table I). Overall, hypertension was found in 43 (8.6%) subjects. The proportion of hypertension was found to steadily increase with age, being highest in the 50-60 years group (38.0%). In males, the proportion of hypertension was slightly higher (9.6%) compared to that in females (7.6%) but the difference was however not statistically significant. Higher prevalence of hypertension was found in business occupation (15.2%) followed by skilled and semi-skilled (12.5%) and in professionals (11.1%) (Table II).

Table I: Age and Sex Distribution

Age Group (Years) Sex
Male (%) Female (%) Total (%)
20-30 188 (37.6) 186 (37.2) 374 (37.4)
30-40 96 (19.2) 170 (34.0) 266 (26.6)
40-50 126 (25.2) 92 (18.4) 218 (21.8)
50-60 90 (18.0) 52 (10.4) 142 (14.2)
Total 500 (100.0) 500 (100.0) 1000 (100.0)
Figures in parentheses are column percentages

Table II: Hypertension by Age, Sex and Occupation

Age Group (Years) Hypertension
Yes(%) No (%) Total (%)
20-30 0 (0.0) 374 (100.0) 374 (100.0)
30-40 6 (2.3) 260 (97.7) 266 (100.0)
40-50 26 (11.9) 192 (88.1) 218 (100.0)
50-60 54 (38.0) 88 (62.0) 142 (100.0)
Sex
Male 48 (9.6) 452 (90.4) 500 (100.0)
Female 30 (7.6) 462 (92.4) 500 (100.0)
Total 86 (8.6) 914 (91.4) 1000 (100.0)

Table III : Mean Blood Pressure Levels by Age, Sex and Occupation

Age Group (Years) Number of individuals Mean blood Pressure (mm Hg)
Systolic
(Mean + SD)
Diastolic
(Mean + SD)
20-30 374 122.5 ± 5.6 81.4 ± 4.4
30-40 266 124.3 ± 6.6 81.9±4.0
40-50 218 127.3 ± 8.6 83.7±7.7
50-60 142 131.3 ± 13.4 85.8±6.6
Sex
Male 500 1270.+8.5 83.8±5.6
Female 500 123.7±8.5 81.6±5.6
Occupation
Professional 36 126.8±10.9 82.6±5.9
Business 92 129.2±13.8 85.7±9.9
Employee 234 126.8±7.2 83.7±3.9
Skilled and Semiskilled 32 128.8±6.6 84.5±5.4
Labourer 60 125.9±5.2 82.9±4.2
Housewife 430 124.3±8.7 81.7±5.9
Student 110 121.9±4.7 81.3±3.1
Unemployed 6 124.0±8.7 82.7±2.3
Total 1000 125.3±8.7 82.7±2.3
F ratio = 19.08 P<0.001; F ratio = 19.74 P <0.001

Table IV: Prevalence of Hypertension by Various Risk Factors

Risk Factor Number of
Individuals
Number of
Hypertensives
Odds ratio
(95% CI)
More than 40 yrs. 360 80 (22.2) 30.2 (26.3-34.1)†
Male 500 48 (9.6) 1.29 (1.1-1.4)*
BMI>25 416 62 (14.9) 4.1 (3.6-4.6) †
Family history of hypertension 206 48 (23.3) 6.0 (5.1-6.9) †
History of previous events 8 4 (500.0) 11.1 (5.5-21.9) †
Diabetes mellitus 72 27 (33.3) 6.9 (5.5-8.7) †
Non-vegetarian diet 864 76 (8.8) 1.2 (1.0-1.4) *
Smoking 98 22 (22.4) 3.8 (3.1-4.6)**
Alcohol intake 90 18 (20.0) 3.1 (2.5-3.8) †
No regular exercise 152 24 (15.8) 2.4 (2.0-2.8)†
Saturated fat intake 684 60 (8.8) 1.1 (09.-1.2) *
Excess salt intake 930 50 (5.4) 0.05 (0.03-0.06) †
* P<0.05, ** p <0.01, <0.001

It was found that out of 86 hypertensives, 72 (83.7%) were aware of their hypertension; all of those aware were under treatment but among the treated, ony 30 (41.7%) had satisfactory control of thier hypertension. The mean systolic and diastolic blood pressures were found to steadily increase with age, higher in males sex and business occupation of the respondents and the differences were also statistically significant (Tables III). Significantly higher proportion of hypertension was found with many of the proven risk factors like age (more than 40 years), B.MI. more than 25, family history of hypertension, history of previous cerebrovascular or cardiovascular events, diabetes, smoking, alcohol intake and lack of physical exercise. Comparatively higher prevalence was found with male sex, non-vegetarian diet, saturated fat intake but these were however not statistically significant. Significantly lower prevalence of hypertension was found with excess salt intake (Table IV).

Discussion

The present study has found the prevalence of hypertension to be 8.6%. Comparable prevalence of 7.8% was reported in hospital patients, Mumbai (2000)2. Higher prevalence was reported in other studies3,4,5 while few studies reported course prevalence6,7. Higher prevalence in these studies may be due to higher age groups of the study.

The current study has revealed that 72 (83.7%) were aware of their hypertension, all of those aware were under treatment, among the treated, only 30 (41.7%) had satisfactory control of their hypertension. Similar findings were also reported in other studies.8

In the present study, the prevalence of hypertension was found to steadily increase with age and the mean pressure levels were also significantly higher in higher age groups. Similar observations were found in other studies4,5,8,9,10. The current study has also revealed a higher proportion of hypertension with some other risk factors like B.MI.>25, family history of hypertension, previous history of cerbrovascular/ cardiovascular events, diabetes mellitus, smoking and lack of physical exercise. It was found in East Delhi5 that 44.8% adults exercise regularly and relatively lower prevalence was found in them. In a genetically homogeneous caste population in Andhra Pradesh10 it was found that urban residence and alcohol intake in men and older age (45 years and over) and obesity in women to be important correlates of hypertension.

The current study has found significantly lower proportion of hypertension among those with excess salt intake.This could be explained by the fact that almost all hypertensives had changed their dietary practices towards low salt intake probably under medical advice.

Conclusion

Higher prevalence of hypertension was found with many of the proven risk factors studied. The study has found that 16.3% cases were hitherto undiagnosed which points out the need to devise comprehensive strategy for early identification and prompt treatment of hypertension to prevent many complications associated with high blood pressure. To achieve these objectives, it is recommended that arterial blood pressure should be measured by standard methods in every adult individual seeking health care in order to identify those who many require observation and treatment. Life style measures should be initiated especially in those with raised total cardiovascular risk as well as communities as a whole. The measures include weight reduction, restriction of smoking, alcohol intake, increased physical activity, proper treatment for diabetes mellitus, restriction of saturated fats as well as dietary sodium.

References:

  1. Hypertension Control. WHO Technical Report Series, 862, 1996.
  2. Joshi SV, Patel JC and Dhar HL. Prevalence of hypertension in Mumbai. Indian Journal of Medical Sciences 2000 54 (9), 380-383.
  3. Hazarika NC, Biswas D, Narain K, Kavita HC and Mahanta J Hypertension and its risk factors in tea garden workers of Assam. National Medical Journal of India, 2002 15 (2), 63-68.
  4. Chadha SL, Radhkirshnan S, Ramachandran V, Kaul U and Gopinath N : Prevalence, awareness and treatment status of hypertension in urban populations of Delhi. Indian Journal of Medical Research, 1990-92, 233-240.
  5. Bhasin SK, Chaturvedi S, Gupta P and Aggarwal P Status of physical exercise and its association with obesity and hypertension in two urban assembly constituencies of East Delhi: Journal of Indian Medical Association 2001, 99 911), 631-633.
  6. Malhotra P, Kumari S, Kumar R, Jain S and Sharma BK. Prevalence and determinants of hypertension in an unindustrialized rural population of North India, 1999 13, (7), 467-472.
  7. Gopinath N, Chadha SL, Sood Ak, Shekhawat S, Bindra SP and Tandon R Epidemiological study of hypertension in young (15-24 years) of Delhi urban population. Indian Journal of Medical Research 1994 99, 32-37.
  8. Kalavathy MC, Thankappan KR, sharma PS and Vasan RS : Prevalence, awareness, treatment and control of hypertension in an elderly community based sample in Kerala, India. National Medical Journal of India 2000 13(1), 9-15.
  9. Kusuma YS, Babu BV and Naidu JM. Group and sex effects of age, body composition and pulse rate on blood pressure variability in some cross cultural populations of Visakhpatnam district, South India. Journal of Cardiovascular Risk, 2001 8, (6), 337-347.
  10. Nirmala A. Age variation in blood pressure: effect of sex and urbanization in a genetically homogenous caste population of Andhra Pradesh. American Journal of Human Biology, 2001 13 (6), 744-752.
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