INTRODUCTION:
“Trust is like blood pressure. It’s silent, vital to good health, and if abused it can be deadly.”
–Frank Sonnenberg
Hypertension (HTN) is a common health problem among economically developed as well as developing nations. As per world health organization report, about 40% of people aged more than 25 years had hypertension in 2008.1 Hypertension was defined on the basis of Joint National Committee (JNC) VII criteria. If blood pressure was > 120/80, the BP was checked again after minimum of 5 minutes and only if BP was >140/90, was the person labeled as Hypertension.
Persons having systolic blood pressure (SBP) between 120-139 and/or diastolic blood pressure (DBP) “between” 80-89 were labeled to have pre-hypertension. Stage-1 hypertension was taken as systolic BP between 140-159 and/ or diastolic BP between 90-99 mmHg. Stage-2 hypertension was taken as systolic BP > 160 and/ or diastolic BP > 100mmHg.2 The prevalence and control of HTN is an essential component for reducing the burden of cardiovascular diseases. Hypertension is prevalent with increasing age among both men and women. Though the confidence intervals overlap, in those aged <50 years, men had higher prevalence of hypertension than women, and those aged > 50 years, women had a higher prevalence than men.3
Recent studies (2012) showed that for every known person with hypertension there are two persons with either undiagnosed or prehypertension. Reducing blood pressure can decrease cardiovascular risk and this can be achieved by lifestyle modification in mild cases and should be the initial approach to hypertension management in all cases. This includes dietary intervention weight reduction, tobacco cessation, and physical activity. Comprehensive hypertension management should focus not only on reducing the blood pressure, but reducing the cardiovascular risk by lifestyle measures, lipid measures, lipid management, smoking cessation, and regular exercise.4
NEED OF THE STUDY:
The world health organization has estimated that high blood pressure is the cause of one in every eight deaths, making hypertension the third leading killer disease in the world. Globally, there are one billion hypertensive people and four million people die annually as a direct result of hypertension.5
According to WHO estimates, the prevalence of raised BP in India is 32.5% (33.2% in men and 31.7% in women). Andhra Pradesh (13.3%), Odisha (9%), Chhattisgarh (8.4%) and Gujarat (6.7%) have highest prevalence while Assam and Rajasthan (1.4%), Kerala (2.4%), Bihar (2.7%), Madhya Pradesh (2.8%) and Uttar Pradesh (3.6%) are low prevalence states.6
Hypertension is directly responsible for 57% of stroke deaths and 24% of all coronary heart disease (CHD) deaths in India. Recent studies from India have shown the prevalence of Hypertension to be 25% in urban and 10% among rural population in India. In 2000, 972 million people had hypertension with a prevalence of 26.4%, 333 million in developed countries and 639 million in developing countries. From 1990 to 1999, the pooled prevalence of hypertension was 15.0%; with significant increase to 22.5% from 2000 to 2009.15 In India, 23.10% men and 22.60% women over 25 years suffer from hypertension, reports the World Health Organization’s ‘Global health statistics 2012’.7
Findings from India’s largest clinic-based survey study, called Screening India’s Twin Epidemic (SITE) show that 1 in every 5 Indian adults living in urban cities suffer not only from hypertension but also diabetes. Prevalence of hypertension in India is low as compared to world figures and India fares better than other countries in the South-East Asia Region (SEAR). On an average 25.40% in men and 24.20% in women was hypertensive in SEAR.8
By doing this study researcher wants to know the burden of hypertension in among males their local area of Punjab and various strategies adopted by such clients to reduce the burden of hypertension. Keeping in view the evidences mentioned in various articles and general life style of adults it can be described that hypertension is a disorder which is affecting men as well as women the researcher wanted to conduct the study with special emphasis among males as the men tend to be more causal and does not pay much attention to their health problems, hence the investigator wanted to study the prevalence of hypertension among males.
STATEMENT OF THE PROBLEM:
A study to assess the prevalence of hypertension among males residing in the selected community areas of Kurali.
OBJECTIVES:
· To assess the prevalence of hypertension among males.
· To determine association between prevalence of hypertension and selected socio-demographic variables.
DELIMITATIONS:
This study is limited to:
1. Males who are available at the time of data collection.
METHODOLOGY:
This chapter deals with the description of methodology adopted for the study and different steps taken for gathering and organization data for the investigation. It includes description of Research approach, Research design, Research setting, Population, Sample size, Sampling technique, Inclusion criteria, Exclusion criteria, Variables, Development of tool, Description of tool, Validity of tool, Pilot study, Reliability of the tool, Data collection procedure, Ethical consideration and Plan of data analysis and Interpretation of data.
The present study has been undertaken to assess the prevalence of hypertension among males residing in the selected community areas of Kurali.
Research Approach:
The research approach tells the researcher what data to collect and how to analyze it. It also suggests possible conclusions to be drawn from the data. In view of the nature of study, the investigator had adopted the non-experimental quantitative design, to assess the prevalence of hypertension among males residing in the selected community areas of Kurali.
Research Design:
The selection of the research design depends upon the purpose of the study, research approach and variable under study. The research design is an explicit blue print for the research activity to be carried out.
Research design is structural framework for the conduction of study and implementation, of research process. This includes selection of design, data collection methods, sampling frame work and data entry analysis plan. A descriptive survey design was used to achieve the objectives of the present study.
Research Setting:
The present study was conducted in villages of Kurali which is situated in the vicinity of Saraswati Nursing Institute. The village has been adopted by the institute as a community area setting for the clinical experience of nursing students. Kurali is 26 kilometers away from the Punjab state, capital Chandigarh situated on national highway 21. Nearby towns include Kharar, Roopnagar and Morinda on its three respective sides. Total population is 31060. Data were collected from three villages named as Chatamli, Chatamla and Dhianpura. The investigator visited the villages during morning time from 9 A.M. to 4 P.M. Punjabi is the local language for the people. Descriptive survey undertaken and data was collected by door-to-door survey. Convenient sampling done to select the sample and targeted only males who were more than 25 years or above in age from those houses. Punjabi is the local language for the people.
Population:
Population is the entire set of individuals who meet the sampling criteria. In present study it refers to people living in three villages of Kurali named as Dhianpura, Chatamli and Chatamla. In the present study target population consists of males 25 years or above residing in community areas.
Sample and Sample Size:
In the present study, sample consists of males aged 25 years or above residing in the selected community areas of Kurali.
The number of people who participated in a study against the background of cost, time, and number of available personnel, size of total population, desired precision and confidence interval and purpose of the study.
Power analysis was used to estimate in advance how big a sample is needed for the main study. Findings of the pilot study were used to calculate the sample size based on precision rate confidence interval formula for infinite population i.e total of 200 males were drawn from the from three villages named as Chatamli, Chatamla and Dhianpura based on following available information.
· Population standard deviation (roughly estimated based on pilot study) i.e., 5.04
· Stander variant (z) at given confidence level i.e., at 95% (1.96)
· Precision (acceptable error) i.e., 0.8 (conventional standard)
(1.96)2 (5.04)2
N = 
(for infinite population) N= 152
(0.8)2
In this study the sample consisted of 200 adults who were 25 years or above in age.
Sampling Technique:
Convenient Sampling technique was used to select the sample in the present study 200 males included as sample they were selected through a door-to-door survey by the investigator or the houses of village Dhianpura, Chatamla and Chatamli males’ residents who were above the age more than 25 years were conveniently selected as subjects in the present study at home.
Sampling Criteria:
a. Inclusion Criteria:
1. Males age more than 25 yrs.
2. Males those who were available at the time of data collection
b. Exclusion Criteria:
1. Males having any chronic illness.
Development of the Tool:
The tool was prepared on the basis of objectives of the study. The review of literature, expert’s opinion and personal experience of the investigator. The tools were prepared by the investigator after an extensive review of literature from books, journal on -line resources and other publications, discussion with guide and experts. Three tools were developed to attain the objectives of the study and following steps were adopted in the developmental of the tool like Review of literature, Discussion with expert, Content validity, Pilot study, Reliability.
Descriptions of the Tools:
The tools used for present study was developed specifically as per the need of the study by the investigator. males.9 A semi structured interview schedule with four research tools was developed for the study to assess the prevalence of hypertension; three tools were developed for the present study by the investigator.
Tool I: -Socio Demographic Performa:
The performa was developed by the investigator to record the socio- demographic profile of the subjects. The developed performa consists of thirteen variables. It includes Age, Marital status, Type of family, Education, Occupation, Religion, Family history of hypertension, Duration of hypertension, Smoking status, Family history of obesity, Income, Dietary pattern, Life style were recorded on this performa by the investigator.
Tool II: -Health Assessment Performa:
It was developed to record the history and health related profile of the subjects. The performa consists of eight items which includes profile of the subject, which includes Nutritional history (10 items) Hygienic habits (5 items) Health habits (4 items) Other habits (17 items) Family history (4 items) General appearance (5 items) Present medical (4 items) Any other complimentary/ alternative therapy (10 items)
Tool III: - BP Monitoring by Mercury Sphygmomanometer:
In this section Blood Pressure was taken with mercury sphygmomanometer of every subjects who were present in home by investigator. Procedure was developed and validated by the investigator same sphygmomanometer was used by the investigator for measuring BP of all the subjects to maintain the validity of the instruments.
Data Collection Procedure:
The investigator obtained the permission from Principal Saraswati Nursing Institute to conduct the final study. Ethical clearance was obtained from the ethical committee of Saraswati Nursing Institute data was collected during Jan-Feb 2019. The investigator also obtained permission from the concerned authorities to Sarpanch of the selected villages named as Dhianpura, Chatamli and Chatamla. The investigator contacted the subject at their home. The purpose of the study was explained to the subjects and they were requested to participate and cooperate for collecting the data. Informed consent was obtained on the performa and the confidentiality of the information was assured. A door-to-door survey was conducted in the village Dhianpura, Chatamli and Chatamla by the investigator and those males present at home were contacted who fulfilled the inclusion criteria as per age were included in the study.
Semi structured interview schedule include socio demographic variables were recorded on the sheet by the investigator in individual interview with its subjects. The investigator asked the required information verbally and the responses given by the subjects were noted down by the investigator herself in the socio-demographic sheet.
Health assessment Performa were fulfilled on the sheet by the investigator from every subject by interview. The investigator asked the required information verbally and the responses given by the subjects were noted down by the investigator herself in the health assessment Sheet.
BP monitoring by mercury sphygmomanometer were recorded by the investigator contacted with each subject individually. The recording was noted down on the health assessment sheet. It took 30-35 minutes to collect data from each subject. Sample conducted from various villages.
Plan for Data Analysis:
Data analysis is the systematic organization and synthesis of research data and the testing of research hypothesis using those data. The data collected by the researcher was transferred on to a master sheet prepared for each section of the tool. Analysis was done by using descriptive statistics. Descriptive statistics was used i.e., Frequency, percentage and presented in cone diagram, bar diagram and pie chart.
Analysis and Interpretation of data:
The data has been analyzed by using descriptive and inferential statistics. In descriptive statistics frequency and percentages were used for analyzing the prevalence of hypertension among males.10 Inferential Statistics i.e., chi square test was done to find out the association between hypertension with selected socio-demographic variables.
Table 1: Frequency and Percentage Distribution of Subjects according to their Socio-Demographic Variable. (N= 200)
|
Socio-demographic variables |
Category |
Frequency (f) |
Percentage (%) |
|
Age in years |
25-35 yrs |
46 |
23 |
|
36-45 yrs |
35 |
17.5 |
|
|
46-55 yrs |
44 |
22 |
|
|
56-65 yrs |
44 |
22 |
|
|
66-75 yrs and above |
31 |
15.5 |
|
|
Marital status |
Unmarried |
13 |
6.5 |
|
Married |
187 |
93.5 |
|
|
Type of family |
Joint family |
90 |
45 |
|
Nuclear family |
110 |
55 |
|
|
Education |
No formal education |
14 |
7 |
|
Primary education |
31 |
15.5 |
|
|
Secondary education |
102 |
51 |
|
|
Senior secondary education |
31 |
15.5 |
|
|
Graduate and above |
22 |
11 |
|
|
Religion |
Sikh Hindu |
179 |
89.5 |
|
21 |
10.5 |
||
|
Duration of hypertension |
>6month to <1years |
9 |
4.5 |
|
1 to 3 years |
30 |
15 |
|
|
>3 years |
14 |
7 |
|
|
Occupation |
Employed |
111 |
55.5 |
|
Unemployed |
89 |
44.5 |
|
|
Income (rs) monthly |
<5000 |
35 |
17.5 |
|
5001-10000 |
56 |
28 |
|
|
10001-15000 |
59 |
29.5 |
|
|
>15000 |
50 |
25 |
The above table-1 shows the frequency and percentage distribution of subjects as per their socio demographic variables.46 (23.0%) subjects were in the age group of 25-35 years, 44 (22.0%) subjects were in the age group of 46-65 years and 35 (17.5%) subjects were in the age group of 36-45 years while only 31 (15.5%) subjects were in the age group of > 66 years. Majority of the subjects i.e., 187 (93.5%) were married while 13 (6.5%) were unmarried. 110 (55.0%) subjects were living in nuclear family 90(45.0%) subjects were living in joint family. 102 (51%) subjects were secondary education 31 (15.0%) subjects were primary and senior secondary education, 22 (11.0%) subjects were graduate and above and 14 (7.0%) subjects were no formal education respectively. 179 (89.5%) subjects belong to Sikh religion, 21(10.5%) subjects belong to Hindu religion. 146 (73.5%) subjects were non hypertensive, 30 (15.0%) subject had history of hypertension from 1 to 3 years, whereas 14 (7.0%) subject had history of hypertension from >3 years. 9 (4.5%) subjects had history of hypertension from > 6 months to < 1 years. 111 (55.5%) subjects were employed and only 89 (44.5%) subjects were unemployed. 59 (29 %) subjects were having family income 10001-15000, 56 (28.0%) subjects were having family income 5001-10000 and 50 (25 %) subjects were having family income up >15000. 35 (17.5%) subjects were having family income up < 5000 respectively.
Table 2: Frequency and Percentage Distribution of Subjects on the Basis of Classification of Hypertension (N=200)
|
Classification of hypertension |
Frequency |
Percentage (%) |
|
Normal (<120/80 mmHg) |
147 |
73.5% |
|
Pre-Hypertensive (120-130/80-89mmHg) |
021 |
10.5% |
|
Stage-I Hypertension (140-150/90-99 mmHg) |
022 |
011% |
|
Stage-II Hypertension (≥160 -≥100mmHg) |
010 |
005% |
Table 2 depicts frequency and percentage distribution of subjects on the basis of classification of hypertension. Majority of the subjects 147 (73.5%) were non hypertensive, 22 (11.0%) subject had stage-I hypertension while 21 (10.5%) subject had pre- hypertension and only 10 (5.0%) subject had stage-II hypertension.
Figure 1: Percentage Distribution of Subjects on the Basis of Hypertension.
Table 3: Frequency and Percentage Distribution of subject as per Obesity on their Body Mass Index (N=200)
|
Classification |
Frequency |
Percentage (%) |
|
Underweight (<18.5) |
001 |
00.5% |
|
Normal Range (18.5-24.9) |
130 |
065% |
|
Overweight (25-29.9) |
069 |
34.5% |
Table 3 depicts frequency and percentage distribution of subjects as per their body mass index. Majority of the subjects’ 130 (65.0%) had normal body mass index, while 69 (34.5%) subjects were overweight and only one subjects was underweight.
Health Assessment Profile:
Table 4 (a): Frequency and Percentage Distribution of Subjects on the Basis of their Nutritional History. (N=200)
|
Subject assessment |
Frequency |
Percentage (%) |
|
|
Nutritional history |
Vegetarian |
92 |
46% |
|
Non-vegetarian |
108 |
54% |
|
|
No. of meals per days |
Two times |
29 |
14.50% |
|
Three time |
167 |
83.50% |
|
|
One time |
4 |
2% |
|
|
Habit of pickle |
Yes |
166 |
83% |
|
No |
34 |
17% |
|
|
Habit of chutney |
Yes |
168 |
84% |
|
No |
32 |
16% |
|
|
Amount of salt in meal |
½ Tea spoon |
55 |
27.50% |
|
1 Tea spoon |
109 |
54.50% |
|
|
More than 1 Tea spoon |
36 |
18% |
|
|
Number of glass of water per day |
< 2 glasses |
9 |
3% |
|
2-4 Glasses |
22 |
11% |
|
|
8 Glasses |
107 |
53.50% |
|
|
> 8 glasses |
62 |
31% |
|
|
Tea |
Yes |
154 |
77% |
|
No |
46 |
23% |
|
|
Juice |
Yes |
170 |
85% |
|
No |
30 |
15% |
|
The above table 4 (a) depicts frequency and percentage distribution of subjects on the basis of their nutritional history. Nearly half of the subjects 92 (46%) were vegetarian and 108 (54.0%) subjects were non vegetarian. Most of the subjects’ 167 (83.5%) was taking three times meals per day, 29 (14.5%) were taking two-time meals per day and 4 (2.0%) were taking food once daily. Among all the subjects 166 (83.0%) had a habit of eating pickle and 34 (17%) subjects were not eating pickle. 168 (84.0%) subjects had a habit of chutney and 32 (16%) subjects were not having habit of eating chutney. More than half of subjects109 (54.5%) were taking 1 tea spoon of salt in meal per day, only 55 (27.5%) subjects was taking ½ tea spoon of salt in meal per day and 36 (18.0%) subjects were taking more than 1 tea spoon of salt in the meal per day. Majority of the subjects i.e., 107 (53.5%) were drinking 5-8 glasses of water per day, 62 (31.0%) subjects were drinking >8 glasses of water every day, 22 (11.0%) subjects were drinking 2-4 glasses of water every day and 9 (3.0%) subjects were drinking <2 glasses of water every day. 154 (77.0%) subjects were drinking tea every day and 46 (23%) subjects were not drinking tea. 170 (85.0%) subjects were drinking juice every day and 30 (15%) were not drinking juice.
Table 4 (b): Frequency and Percentage Distribution of Subjects on the basis of their Other Habits. (N=200)
|
Other habits |
Frequency |
Percentage (%) |
|
|
Smoking |
Yes |
48 |
24% |
|
No |
152 |
76% |
|
|
Cigarette smoking duration since |
<3 months to 1 year |
4 |
2% |
|
1 year to 3 years |
3 |
1.50% |
|
|
3 years to 5 years |
3 |
1.50% |
|
|
> 5 years |
38 |
19% |
|
|
Age started at smoking |
< 5-10 years |
6 |
3% |
|
11-20 years |
6 |
3% |
|
|
21-30 years |
22 |
11% |
|
|
31-40 years |
12 |
6% |
|
|
> 40 years |
2 |
1% |
|
|
Alcohol |
Yes |
92 |
46% |
|
No |
108 |
54% |
|
|
Regular |
27 |
13.50% |
|
|
Irregular |
18 |
9% |
|
|
Occasionally |
47 |
23.50% |
|
|
Alcohol Consumption duration since |
< 5-10 years |
12 |
6% |
|
11-20 years |
20 |
10% |
|
|
21-30 years |
36 |
18% |
|
|
31-40 years |
20 |
10% |
|
|
> 40 years |
4 |
2% |
|
|
Drug Addiction |
Yes |
2 |
1% |
|
No |
198 |
99% |
|
|
Stress |
Yes |
12 |
6% |
|
No |
188 |
94% |
|
|
Family history of hypertension |
Yes |
70 |
35% |
|
No |
130 |
65% |
|
|
Duration of hypertension among family member |
6 months to 1 year |
16 |
8% |
|
1 to 3 years |
16 |
8% |
|
|
> 3 years |
38 |
19% |
|
The above table 4(b) shows the frequency and percentage distribution of subjects on the basis of their other factors. Nearly half of the subjects 152 (76.0%) were non-smoker and 48(24.0%) were smoker. Most of the subjects 38(19.0%) were taking cigarette smoking since >5 years, 3(1.5%) were taking cigarette smoking since 1years to 5 years and 4(2.0%) were taking cigarette smoking since >3 months to 1 years. Among of all subjects 22(11.0%) were started smoking at the age of 21-30 years, 12(6.0%) were started smoking at the age of 31-40 years, 6(3.0%) were started smoking at the age of <5-20 years and 2(1.0%) were started smoking at the age of>40 years. Majority of the subjects 108(54.0%) were not consuming alcohol and 92(46.0%) were consuming alcohol, 47(23.5%) were taking occasionally, 27(13.5%) were taking irregular and 18(9.0%) were taking regular alcohol. Most of the subjects 36(18.0%) were consuming alcohol from 21-30 years, 20(10.0%) were consuming alcohol from 11-20 years and 31-40 years, 12(6.0%) were consuming alcohol from<5-10 years and 4(2.0%) were consuming alcohol from >40 years. Majority of the subjects i.e., 198(99.0%) were non drug addicted and 2 (1.0%) were drug addicted. Most of the subjects 188 (94.0%) were not having any stress and 12(6.0%) were having stress. Among all the subjects 130(65.0%) were not having family history of hypertension and 70 (35.0%) were having family history of hypertension. 38 (19.0%) were have hypertension from >3 years and 16 (8.0%) were have hypertension from >6 months to 3 years.