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LEVELS OF BLOOD PRESSURE IN AN URBAN COMMUNITY

RB Gurav*, S Kartikeyan**
*Lecturer; **Associate Professor; Department of Preventive and Social Medicine, Rajiv Gandhi Medical College, Kalwa, Thane - 400 605.

A study on hypertension in an urban slum area of Mumbai revealed a prevalence rate of 13.9% in individuals aged 35 years and above. Out of 767 males, 9.52% were hypertensives and of the 665 females, 18.95% were hypertensives. In order to reduce the morbidity and mortality, hypertension must be detected at an early stage in the high risk groups so that interventional measures like health education, lifestyle modification, treatment and regular follow up can be undertaken.

INTRODUCTION

Hypertension is the most common of all the cardiovascular diseases and affects many people in developed as well as developing countries. It is recognised as an important public health problem all over the world. It is often asymptomatic and can lead to lethal complications if left untreated. [1]

Blood pressure is a continuously distributed variable in populations. There is no natural dividing line between high and normal blood pressure. [2] However WHO in its expert committee report has arbitrarily defined hypertension in adults as a systolic blood pressure equal to or greater than 160 mmHg and/or a diastolic pressure (Korotkoff phase V) equal to or greater than 95 mm Hg. [1] The epidemiological studies have demonstrated that hypertension is potentially as injurious in the young as in the old and is an important risk factor for most cardiovascular complications including congestive cardiac failure, stroke, myocardial infarction and sudden death. [3]

The reason for the origin of essential hypertension has been most frustrating. By definition, essential hypertension has no cause, but it is believed that a combination of genetic and environmental factors are responsible for the condition. [4] Social, cultural and environmental stress is probably one of the important triggering factors for blood pressure to increase either acutely or on a long term basis. [5]

Hypertension is not only one of the major risk factors for most forms of cardiovascular diseases, but that it is a condition with its own set of risk factors. The term hypertension itself implies a disorder initiated by tension or stress since stress is nowhere defined, the hypothesis cannot be tested. However, it is an accepted fact that psychological factors operate through mental processes consciously or unconsciously to produce hypertension. [2] Stress related to social and occupational factors is thought to be associated with an increased risk of cardiovascular diseases. [6] Work stress on job is thought to contribute to high blood pressure. Studies have shown that high blood pressure is especially common among telephone exchange operators and teachers. [7]

High blood pressure is the major factor contributing to strokes and is a very significant factor in heart disease and renal disease. Hypertension has been found to be highly correlated with reduced life expectancy, the higher the blood pressure, the shorter the life. The natural course of hypertension spans some 15 to 25 years starting on the average around age 35 years and often ending in premature death around the age of 50 years. [8] Most of the hypertensives are asymptomatic. So it is very important to detect such cases as early as possible. Such hypertensives should be treated before occurrence of any complications. High blood pressure is a common phenomenon all over the world and equally so in the urban life of India. So this study was conducted in an urban area, Mumbai city to find out the levels of blood pressures in the age group of 35 years and above.

MATERIAL AND METHODS

This study, which was conducted in an urban locality of Mumbai city, involved the measurement of blood pressure in a total of 1,432 subjects (767 males and 665 females) in the age group of 35 years and above. The aim of the study was explained to the subjects with the help of local opinion leaders. A detail history regarding age, sex, occupation, education was taken and was recorded in the pretested proforma.

Individuals were asked to sit comfortably and then the blood pressure was recorded in the respondent’s house. The house to house approach and the complete enumeration technique was adopted. The blood pressure was recorded with the mercury sphygmomanometer in right arm. The three readings were taken over a period of three minutes and the minimum reading was recorded. Systolic blood pressure was recorded at the appearance of the first korotkoff sound and diastolic at the phase V of korotkoff sound. The criteria for the diagnosis of hypertension were followed as per the WHO recommendations.1,15 The systolic blood pressure equal to or more than 160 mmHg and/or diastolic pressure of 95 mmHg or more was taken as hypertension, irrespective of age and sex.

Further, those individuals whose blood pressure was less than 160 mmHg and/or 95 mmHg and equal to or more than 140 mmHg and/or 90 mmHg and were considered borderline hypertensives.[12] Also, all the known cases of hypertension, irrespective of their blood pressure levels, were considered as hypertensives in this study. All the hypertensives were prescribed anti-hypertensive drugs and were advised to come for the follow up at the centre. All the borderline hypertensives were advised to come to the health centre for regular follow-up and were given health education.

OBSERVATION AND DISCUSSION

The total 1,432 subjects of both sexes in the age group of 35 years and above were examined for systolic and diastolic blood pressure. The diagnostic criteria recommended by the World Health Organization were followed for the diagnosis.1,15 Out of 767 males, 73 (9.52%) were hypertensives and of the 665 females, 126 (18.95%) were hypertensives. The prevalence of hypertension in the age group of 35 years and above was 13.90% (139 per 1,000 population).

Community surveys have shown that prevalence of hypertension in urban population above the age of 20 years is 10 to 15%.9 In hospitalised patients hypertension accounts for above 20% of all cardiovascular disorders.9 Prabhakar Rao et al [10] studied rural population with a large percentage of tribals for the prevalence of hypertension and possible contributing factors. The total prevalence was 11.98% in males and 10.75% in females aged 10 and above.

Chadha et al11 observed that the prevalence of hypertension in a Delhi based study (on individuals in the age group of 25-64 years) to be 127.5 per 1,000 (116.6 per 1,000 in males and 136.8 per 1,000 in females). Wasir et al [12] found prevalence of hypertension (BP ô 160/95 mmHg) in men and women was 3.8% and 1.45% respectively, in those aged 20 years and above. The prevalence rate observed by Mutalik in an urban community was 0.76% and that observed by Padmavati and Gupta was 2.5%. [16] The World Health Organization [16] estimated the prevalence rate of hypertension among adults to be between 10-20%.

In this study, the prevalence of hypertension increased upto 50-54 years age group i.e. 21.85% and afterwards it is reduced to 21.80% in the 55-59 years age group and again it increased to 31.43%in the 60-64 years age group. And 65 years and above age group it is decreased to 23.08% (Table 1). Out of the 199 hypertensives studied, 62.31% were housewives, 22.11% were working individuals, 8.04% were self employed and 7.54% were retired individuals. 62.81% hypertensives were illiterates in the present study. Thus the hypertension was more prevalent in illiterates in this study (p < 0.001). Baldwa et al14 observed a higher prevalence of hypertension in illiterates in a rural community of Rajasthan.

TABLE 1
Age-wise distribution
Age group in years Hypertensives Normotensives
(Per cent)		 Prevalence
35-39 41 589 6.50
40-44 34 175 16.27
45-49 43 198 17.85
50-54 26 93 21.85
55-59 29 103 21.80
60-64 11 24 31.43
>= 65 15 50 23.08
Total 199 1233 13.90

TABLE 2 :
Sex-wise distribution of blood pressure levels
Blood pressure levels Males Females Total
>= 160 and / or
95 mmHg
< 160 and/or		 73
(9.52) 		126
(18.95)		 199
(13.90)
       
95 mmHg and
>=140 and / or
90 mmHg
 19
(2.48)		 24
(3.61)		 43
(3.00)
       
< 140 and / or
90 mmHg 		675
(88.00)		 515
(77.44) 		1190
(83.10)
       
Total 767 665 1432
  (100) (100) (100)

 

Figures in parentheses indicate percentages

A survey conducted in Mumbai showed that the incidence of high blood pressure was quite high (i.e. 8.6%, 15.7% and 21%) between the ages of 36-45, 46-55 and 56-65 years respectively.13 Chadha et al11 in Delhi, observed a prevalence of 110.8, 223.5, 281.7 per 1000 in the age groups of 35-44 years, 45-54 years and 55-64 years respectively. Wasir et al12 observed that the age was directly proportional (positively correlated) with the prevalence of hypertension. In both sexes, the prevalence of hypertension was 1.93% in 25-34 years, 9% in 35-44 years, 16.1% in 45-54 years age group.

In 43 (3.00%) individuals the blood pressure was less than 160 and/or 95 mmHg and 140 and/or 90 mmHg or higher (in men 2.48% and in women 3.61%). Wasir et al [12] found that prevalence of borderline hypertension (BP more than 140/90 mmHg but less than 160/95 mmHg) in men and women was 3.6% and 1.45% respectively.

CONCLUSION

In this study prevalence of hypertension was 139 per 1000 population in an urban slum area of Mumbai in individuals aged 35 years and above. Early detection of hypertension is very important to reduce the morbidity and mortality so that interventional measures like health education, lifestyle modification, treatment and regular follow up can be undertaken.

The doctors should regularly monitor and carefully record the blood pressure of all the patients aged 35 years and above. The prevention of hypertension involves modification of the stressors and counselling the individuals at risk. Mental (psychological) factors play an important role in the causation of essential hypertension. Counselling can help in addressing issues pertaining to mental stress, anxiety and related factors.

Various non-governmental organizations (NGOs) can be involved for detection of hypertension in the community by organizing special camps for blood pressure monitoring in order to identify the hyperensives and educate them regarding lifestyle changes and treatment.

Multi-media should be utilized for imparting health education at all the levels in the community. Periodic training for all health care providers will go a long way in tackling the problem of hypertension. In a vast country such as India, the launching of a National Hypertension Control programme would be necessary to devote more resources for the screening of high risk groups.

REFERENCES

1.Report of a WHO expert committee. Arterial hypertension. TRS No. 628, World Health Organization, Geneva. 1978.

2.Park JE, Park K. Park’s text book of preventive and social medicine. 12th edition, Banarasidas Bhanot, Jabalpur, India. 232-47.

3.Gauras H, Gauras I. Hypertension in the elderly, 1983; 9-11.

4.Parmeshwara V. Editorial ‘Hypertension’. Pathogenesis of hypertension, Ramanuja DasGupta, ‘Hypertension in the elderly’. Journal of the Indian Medical Association 1987; 85 : 162-88.

5.Hegde BM. Hypertension - the other side of the coin. Journal of Association of physicians of India 1988; 36 (4).

6.Report of a WHO Expert Committee. Community prevention and control of cardiovascular diseases. 1986; TRS No. 732, pages 24-29.

7.Levi L. Stress in industry - causes, effects and prevention. Occupational safety and health series no. 51, International labour organization, Geneva. 1984; 12.

8.Green LW, Anderson CL. Text book of community health. 5th edition. Page 137.

9.Shah SJ, Paul Anand, Sainani GS, Mehta AB, Vishwanathan M. Hypertension. API Text book of medicine. 4th edition, Association of Physicians of India Mumbai. Page 461.

10.Prabhakar Rao, et al. Prevalence of hypertension in a rural community and the possible contributory factors. JAPI 1988; 36 (8).

11. Chadha et al. Prevalence, awareness and treatment studies of hypertension in an urban population of Delhi. Section-B, Biomedical research other than infectious diseases. Indian Journal of Medical Research 1990; 92 : 233-40.

12. Wasir HS, et al. Prevalence of hypertension in a closed urban community. Indian Heart Journal 1984; 36 (4).

13.Shah VV. Crusade against high blood pressure. Heart care journal of the society for prevention of heart diseases and rehabilitation. 1978; (1) : 5.

14.Baldwa VS, et al. Prevention of hypertension in a rural community of Rajasthan. JAPI 1984; 32 (12) : 1045.

15.Hypertension and coronary artery diseases, classification and control for epidemiological studies. TRS No. 168. World Health Organization, Geneva. 1959.

16.Ghosh BN, et al. A blood pressure survey in Simla Hills. Journal of the Indian Medical Association. 1983; 80 (3) : 47-52.


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