Prevalence of Prehypertension in a Rural District of Southern India
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1 Interntionl Journl of Preventive Medicine Brief Communiction Open Access Prevlence of Prehypertension in Rurl District of Southern Indi Mrinyknkopplu R. Rvi, Ngrlu C. Ashok, M. Renuk Deprtment of Community Medicine, JSS Medicl College (A Constituent College of JSS University), Mysore, Krntk, Indi Correspondence to: Dr. Mrinyknkopplu R. Rvi, Deprtment of Community Medicine, JSS Medicl College, S.S Ngr, Mysore , Krntk, Indi. E mil: drrvimr@gmil.com How to cite this rticle: Rvi MR, Ashok NC, Renuk M. Prevlence of prehypertension in rurl district of Southern Indi. Int J Prev Med 2015;6:84. ABSTRACT Bckground: Estimting the prevlence of prehypertension nd its risk fctors in popultion ecomes importnt to design preventive mesures nd hence reduce the urden of hypertension. The im of this study ws to estimte the prevlence of prehypertension nd determine the fctors ssocited with hypertension. Methods: This is cross sectionl study nd ws crried out in rurl popultion. The study included 402 prticipnts. Dt regrding sic demogrphic chrcteristics were collected long with nthropometric mesurements including height nd weight. Informtion regrding smoking lcohol intke, dietry hits were collected. Prehypertension ws defined s systolic lood pressure mm Hg nd/or distolic lood pressure mm Hg. Chi squre test ws used to find the ssocition of vrious risk fctors; t test ws used to compre the mens. Multiple liner regression nlysis ws used to know the reltionship of vrious risk fctors. Results: Prevlence of prehypertension ws estimted to e 28.8%. Fctors such s slt intke, tocco consumption, lcohol consumption, stress, fmily history of hypertension, history of dietes mellitus hd significnt ssocition with prehypertension (P < 0.05). Conclusions: The prevlence of prehypertension ws found to e high mong the rurl popultion. Erly intervention is needed to decrese the urden of hypertension nd its complictions in future. Keywords: Prehypertension, risk fctors, rurl re INTRODUCTION Hypertension is one of the estlished risk fctors for crdiovsculr diseses. [1] Vrious studies hve demonstrted Quick Response Code: Access this rticle online Wesite: DOI: / tht people with lood pressure > 120/80 ut < 140/90 hd n incresed risk of hypertension nd erly deth ecuse of crdiovsculr cuses. Met nlysis of pproximtely one million individuls from 61 long term epidemiologicl studies demonstrted tht for ech 20 mmhg increse in systolic lood pressure (SBP) or 10 mmhg increse in distolic lood pressure (DBP) over 115/75 mmhg, there ws two fold increse in mortlity ssocited with coronry rtery disese, nd stroke. [2,3] Knowing the mgnitude of prehypertension nd its risk fctors ecomes impertive to design preventive mesures. Copyright: 2015 Rvi MR. This is n open ccess rticle distriuted under the terms of the Cretive Commons Attriution License, which permits unrestricted use, distriution, nd reproduction in ny medium, provided the originl uthor nd source re credited.
2 METHODS This cross sectionl study mong rurl popultion of Mysore district ws undertken sed on the ssumption tht prevlence of prehypertension to e 50%. [4,5] With 95% confidence level nd 10% llowle error, the smple size ws clculted to e 400. A totl of 402 sujects were included in the study. Of the 23 villges coming under rurl field prctice re of Deprtment of Community Medicine, JSS Medicl College, Mysore, 5 villges were selected rndomly. Study sujects were selected sed on the popultion proportion to size of the villge. Houses tht were prenumered were selected rndomly using rndom numer tle. Adults with ge more thn 30 yers were included in the study. Severely morid sujects, pregnnt women, nd sujects not giving consent were excluded from the study. Informed consent ws otined from ll prticipnts prior to including them in the study. Informtion ws otined using prestructured questionnire. The study protocol ws pproved y Institution Ethics Committee of JSS Medicl College. Dt regrding vrious socio demogrphic chrcteristics were collected long with nthropometric mesurements such s height nd weight. Informtion regrding smoking lcohol intke, dietry hits were collected. Stnding height ws mesured in centimeters using nonexpndle mesuring tpe mounted on the wll pproximting to nerest 0.1 cm. A portle weighing mchine with clirted scle from 0 to 130 kg ws used, nd weight ws mesured to nerest 0.1 kg. Blood pressure ws recorded using mercury sphygmomnometer (Dimond co.) in sitting position in the left rm fter 5 min of rest. Averge of the two redings ws considered. Second reding ws tken fter n intervl of 10 min from the first reding. All lood pressure redings were recorded during forenoon. Cse definition According to Seventh Joint Ntionl Committee prehypertension is defined s SBP mm Hg nd/or DBP mm Hg. Sttisticl nlysis used Dt nlysis ws done using SPSS softwre version 22. (Customer id: , vlidity: Perpetul, Orgnistion: JSS university, Authoriztion code: 65dee1152f462ee) Chi squre test ws used to find the ssocition of vrious risk fctors; t test ws used to compre the mens. Multiple liner regression nlysis ws used to know the reltionship of vrious risk fctors. Sctter plot ws used to show the correltion of risk fctors with SBP nd DBP. RESULTS The study consisted of prticipnts > 30 yers of ge. The men ge of the study popultion ws 47.8 (9.65) yers. A totl of 390 (96.3%) of the study popultion were mrried. Mle popultion constituted 183 (45.2%) nd femle constituted 219 (54.1%). Prevlence of prehypertension nd hypertension ws 28.8% nd 24.6%, respectively [Tle 1]. There were no significnt differences etween the men lood pressures (systolic nd distolic) etween mle nd femle mong prehypertensives. Men ody mss index (BMI) mong the prehypertensive ws found to e (3.88) nd men slt intke in grms per dy ws found to e (1.43) [Tle 2]. Among prehypertensives, 39 (33.6%) nd 11 (9.5%) hd fmily history of hypertension nd history of dietes mellitus, respectively. Totlly, 99 (85.3%) hd the hit of dding extr tle slt. Alcohol consumption ws found to e present in 20 (17.2%) of the prehypertensive sujects [Tle 3]. Risk fctors were nlyzed with respect to the presence of normotension nd prehypertension. Vrious ehviorl risk fctors such s extr slt intke, lcohol consumption, fmily history of hypertension, history of dietes mellitus were found to hve significnt ssocition [Tle 3 nd ]. Fctors such s ge, mount of lcohol consumption, the mount of slt intke per dy hd moderte positive correltion with the SBP nd DBP [Figures 1 3]. Multiple liner regression nlysis ws pplied to vrious risk fctors. Risk fctors such s ge, mount of lcohol consumption, mount of slt intke showed significnt ssocition with the oth SBP nd DBP [Tle 4]. Tle 1: Distriution of study sujects sed on hypertensive sttus n=402 Normotensive 187 (46.4) Prehypertensive 116 (28.8) Hypertensive 99 (24.6) Tle 2: Chrcteristics of prehypertensive study sujects Men (SD) Mle (n=57) Femle (n=59) Totl (n=116) Age 46 (10.2) (8.99) 44.8 (9.65) SBP (4.86) 132 (4.60) (4.73) DBP (2.89) (2.23) (2.58) BMI (4.17) (3.5) (3.88) Slt intke/dy (1.4) (1.47) (1.436) SD=Stndrd devition, SBP=Systolic lood pressure, DBP=Distolic lood pressure, BMI=Body mss index
3 Tle 3: Distriution sed on ehviorl risk fctors Normotensive (n=187) Prehypertensive (n=116) Totl (n=303) P* Extr tle slt Asent 88 (47.1) 17 (14.7) 105 (34.7) <0.001** Present 99 (52.9) 99 (85.3) 198 (65.3) Diet Vegetle 110 (58.8) 50 (43.1) 160 (52.8) 0.008** Mixed 77 (41.2) 66 (56.9) 143 (47.2) Tocco consumption Asent 174 (93) 98 (84.5) 272 (89.8) 0.017** Present 13 (7) 18 (15.5) 31 (10.2) Alcohol consumption Asent 172 (92) 96 (82.8) 267 (88.1) 0.015** Present 15 (8) 20 (17.2) 36 (11.9) Stress Asent 131 (70.1) 30 (25.9) 161 (53.13) <0.001** Present 56 (29.9) 86 (74.1) 142 (46.86) Fmily history of hypertension Asent 177 (94.7) 77 (66.4) 254 (83.8) <0.001** Present 10 (5.3) 39 (33.6) 49 (16.2) Pst history of dietes Asent 180 (96.3) 105 (90.5) 285 (94.1) 0.04** Present 7 (3.7) 11 (9.5) 18 (5.9) *Chi-squre test, **Sttisticlly significnt. Figures in prenthesis indicte percentges Tle 3: Tle compring mens of ehviourl risk fctors DISCUSSION Normotensive Men (SD) P* Prehypertensive Grms of slt 6.29 (1.68) 8.25 (1.83) <0.001** intke/dy Numer of times 6.09 (2.7) 8.31 (2.92) smoked/dy Durtion of tocco 9.73 (3.19) 9 (3.06) consumption Numer of drinks 3.47 (0.91) 5.81 (2.22) <0.001** per week Durtion of lcohol 7.93 (4.38) (4.31) 0.003** intke BMI (2.82) (3.88) 0.98 *Independent t-test, **Sttisticlly significnt. BMI=Body mss index, SD=Stndrd devition Prevlence of prehypertension mong pprently helthy individuls of rurl community ws found to e 28.8% which is cuse for worry hs these individuls re t high risk of progressing to hypertension nd crdiovsculr diseses in the future life. The prevlence of prehypertension in our study is lower thn the prevlence in other prts of the country s demonstrted y other studies. In study done in rurl re of Andhr Prdesh [6] demonstrted the prevlence of prehypertension to e 30.1%. In study mong the Tle 4: Multiple liner regression nlysis of prehypertension with risk fctors Regression co-efficient SE P* SBP Age <0.001** Numer of lcohol drinks per dy ** Numer smoked per dy Slt intke per dy <0.001** BMI DBP Age <0.001** Numer of lcohol drinks per dy <0.001** Numer smoked per dy Slt intke per dy <0.001** BMI *Multiple liner regression, **Sttisticlly significnt. SE=Stndrd error, BMI=Body mss index, SBP=Systolic lood pressure, DBP=Distolic lood pressure urn popultion of North Indi [4] demonstrted the prevlence of hypertension to e 31%. A study in rurl popultion in Assm [7] demonstrted the prevlence to e 54%. Few other studies hve demonstrted the prevlence of prehypertension to e >40%. [4,5,8] Lower prevlence of prehypertension in our study my e due to exclusion of study sujects with h/o hypertension nd inclusion of sujects with ge >30 yers only. Nevertheless, the urden of hypertension nd prehypertension s incresed in the rurl re of Mysore in lst few yers when compred to
4 Figure 1: () Correltion of systolic lood pressure with ge. () Correltion of distolic lood pressure with ge Figure 2: () Correltion of systolic lood pressure with mount of slt intke per dy. () Correltion of distolic lood pressure with mount of slt intke per dy Figure 3: () Correltion of systolic lood pressure with mount of lcohol intke. () Correltion of distolic lood pressure with mount of lcohol intke previous studies. [9] This high urden of prehypertension is n lrm for n impending epidemic of hypertension nd its complictions if pproprite interventionl mesures re not tken. Dt from NHANES II from United Sttes reveled tht 90% of individuls with prehypertension hd one or the other crdiovsculr risk fctor. [10] Studies from Indi hve lso indicted tht incresing ge, BMI, wist hip rtio, nd impired glucose tolernce/dietes were independent risk fctors for hypertension nd prehypertension. [2,5,8] Similrly in our study most of the individuls with prehypertension hd one or the other risk fctor such s extr slt intke, overweight, lcohol consumption, nd others. Age, lcohol, mount of slt intke hd moderte positive correltion with oth SBP nd DBP. BMI showed positive correltion with DBP. The results corroorte with other study results tht ove mentioned fctors hve positive correltion with lood pressure. [11 13] The mjority of prehypertensive study sujects were indulged in hits of extr slt intke t the tle. It is well recognized tht higher slt intke is ssocited with higher lood pressure nd reduction in slt intke lowers lood pressure. Inter slt study [14] demonstrted tht the reduction in the slt
5 intke mounting to 100 mmol/dy leds to reduction in SBP in the rnge from 1 to 6 mm Hg. For distolic pressure, the estimted reduction is etween 0.03 nd 2.5 mm Hg. Vrious studies hve demonstrted the efficcy of dietry pproches lone or long with other lifestyle modifictions significntly reduce lood pressure oth in hypertensive nd prehypertensive. Dietry pproches to stop hypertension re known to decrese lood pressure significntly the effect ws more impressive with sodium restriction. [15] Limittions of the study Firstly the study does not provide ny inference regrding cusl reltionship of the vriles with prehypertension. Secondly vrious other fctors such s socioeconomic sttus, knowledge ttitude prctice regrding hypertension nd iochemicl mrkers such s triglyceride, high density lipoprotein, hyperuricemi re not evluted which re known to influence hypertensive sttus. Thirdly, extrpoltion of the prevlence of prehypertension determined from this smll smple size to entire rurl popultion remins query. CONCLUSIONS Our study highlights the incresing prevlence of prehypertension nd emphsizes tht erly intervention is needed to decrese the urden of hypertension nd its complictions in future. The study lso gives importnt informtion regrding vrious risk fctors ssocited with prehypertension. Simple lifestyle modifictions such s low intke of slt, reducing lcohol cn reduce overll lood pressure. Eduction regrding lifestyle nd dietry prctices t individul nd fmily level is needed to ring out effective chnges. Received: 16 Nov 14 Accepted: 01 My 15 Pulished: 02 Sept 15 REFERENCES 1. World Helth Orgniztion. Glol Burden of Disese: 2004 Updte. Genev: World Helth Orgniztion; Roinson SC, Brucer M. Rnge of norml lood pressure: A sttisticl nd clinicl study of 11,383 persons. Arch Intern Med 1939;64: Ntionl Nutrition Monitoring Bureu (NNMB). Diet nd nutritionl sttus of popultion nd prevlence of hypertension mong dults in rurl res, NNMB Technicl Report 24. Hyderd: NNMB; p Ydv S, Boddul R, Genitt G, Bhti V, Bnsl B, Kongr S, et l. Prevlence nd risk fctors of pre hypertension nd hypertension in n ffluent North Indin popultion. Indin J Med Res 2008;128: Deep R, Shnthirni CS, Prdeep R, Mohn V. Is the rule of hlves in hypertension still vlid? Evidence from the Chenni Urn Popultion Study. J Assoc Physicins Indi 2003;51: Srinivs S, Styvrprsd K, Rmds R, Krishn CP, Tjuddin T, Ro RP. Prevlence of prehypertension in dult popultion of rurl Andhr Prdesh. Asin J Biomed Phrm Sci 2013;3: Hzrik NC, Nrin K, Bisws D, Klit HC, Mhnt J. Hypertension in the ntive rurl popultion of Assm. Ntl Med J Indi 2004;17: Prhkrn D, Shh P, Chturvedi V, Rmkrishnn L, Mnhpr A, Reddy KS. Crdiovsculr risk fctor prevlence mong men in lrge industry of northern Indi. Ntl Med J Indi 2005;18: Mdhu B, Srinth KM, Ashok NC. Hypertension: Prevlence nd ssocited fctors in rurl South Indin popultion. Indin J Pulic Helth Res Dev 2012;3: Minous AG 3 rd, Everett CJ, Liszk H, King DE, Egn BM. Prehypertension nd mortlity in ntionlly representtive cohort. Am J Crdiol 2004;94: Zchrih MG, Thnkppn KR, Alex SC, Srm PS, Vsn RS. Prevlence, correltes, wreness, tretment, nd control of hypertension in middle ged urn popultion in Kerl. Indin Hert J 2003;55: Mdhukumr S, Gikwd V, Sudeep D. An epidemiologicl study of hypertension nd its risk fctors in rurl popultion of Bnglore rurl district. Al Ameen J Med Sci 2012;5: Mrley J, Currm J. Body mss index nd distolic lood pressure. Br Med J 1989;299: Stmler J. The INTERSALT Study: Bckground, methods, findings, nd implictions. Am J Nutr 1997;626s 42s. 15. Appel LJ, Moore TJ, Orznek E, Vollmer WM, Svetkey LP, Scks FM, et l. A clinicl tril of the effects of dietry ptterns on lood pressure. DASH Collortive Reserch Group. N Engl J Med 1997;336: Source of Support: Nil, Conflict of Interest: None declred.
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