International J. of Healthcare & Biomedical Research, Volume: 1, Issue: 3, April 2013, Pages

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1 Prevalence of hypertension in an urban and rural area of Jaipur District *KAMLESH KUMAR, * R.P. KOTHARI, *KUNAL KOTHARI, *SUMEET GARG, *MANOJ KUMAR KHANDELWAL, **RESHU GUPTA DEPTT.OF MEDICINE* & PHYSIOLOGY** MAHATMA GANDHI UNIVERSITY OF MEDICAL SCIENCES AND TECHNOLOGY, JAIPUR, RAJASTHAN, INDIA Correspondence: Dr. Kamlesh Kumar; kamal11.kk@gmail.com. ABSTRACT: Background: Hypertension, a major public health problem, is directly responsible for 57% of all stroke deaths and 24% of all coronary heart disease deaths in India. The present study was planned to analyze the prevalence of hypertension in rural and urban population. Methodology: A cross sectional comparative study was carried out over a period of one year comprising 1200 adults in both urban and rural area of jaipur district respectively. Results: In our study the overall prevalence of hypertension was found to be 24.25% in urban and 13.17% in rural area. Conclusion: Significant urban predominance over their rural was found with respect to the following socio-demographic factors: Age, sex (male), occupation (agriculture, housewives businessmen & retired personnel), education, socio-economic status (class III) and marital status (unmarried & married) Keywords: Hypertension, Urban-Rural Prevalence, Risk factors. Introduction: Hypertension (HTN) is one of the most common cardiovascular diseases with a prevalence ranging from 10 to 20% among adult population 1. Thus, it is clear that hypertension is an enormous health problem and is one of the biggest health challenges of the 21st century. The present study was carried out in the Pratap Nagar of Jaipur city and a village Sitapura in Jaipur district in Rajasthan state to analyze the prevalence of hypertension in rural and urban population. Materials and Methods: Study population comprised of persons with age 18 years & above in an urban and rural community of Jaipur district. A cross-sectional, comparative study. Criteria, a person was considered hypertensive if; 1. SBP 140 and/or DBP 90 mmhg (WHO criteria 2 ). 2. Persons already on anti-hypertensive treatment. Inclusion criteria 3 : All persons aged 18 years and above. Exclusion criteria: Persons less than 18 years, severely morbid subjects hospitalized at the time of study and persons not available at the time of study. Sample size: 1. Rural area: Sitapura, a rural field practice area in the vicinity of Mahatma Gandhi Medical College, was selected for the study adults were examined. 2. Urban area: Pratap Nagar, an urban field practice area in the vicinity of Mahatma Gandhi Medical College, was selected for the study adults were examined. Duration of the study: The study was carried out for a period of one year from December 2011 to November A pilot study was undertaken by considering 120 subjects in both urban and rural areas respectively. With minor changes in initial questionnaire (oral contraceptive use and menopausal history), final questionnaire was designed and 120

2 the study continued. All the subjects were personally contacted in their house, examined and interviewed using the pre-tested proforma. On visiting the family, baseline data of the family members was taken and persons above 18 years were screened by taking two BP readings at an interval of 3mins. Average of the two readings was considered. Mercury Sphygmomanometer. Stethoscope. Weighing machine. Measuring tape used during data collection. Following variables were observed. Age, Education, Type of Family, Socio-economic status, Occupation, Family history, Extra Salt, intake, Tobacco use, smoking 4, Alcohol consumption, Physical activity 5, Stress 6, Body Mass Index 7, Awareness, Treatment and Control 8, Blood Pressure. Chi-square has been used to test the significance of prevalence of hypertensive in association with the age, sex, religion, region, occupation, diet and habits 9, 10. The Odds ratio (OR) has been used to find the strength of relationship between prevalence of hypertensives with the various study parameters. The Statistical software namely SPSS 16.0 and Systat 8.0 were used for the analysis of the data and Microsoft word and Excel have been used to generate graphs, tables etc. Results: Table No.-1: Distribution according to age & sex of urban & rural study subject Age group (In Yrs) Urban Rural Male Female Total Male Female Total (38.37) 220 (61.62) 357 (29.75) 137 (40.77) 199 (59.23) 336 (28.00) (42.40) 144 (57.60) 250 (20.83) 104 (39.39) 160 (60.61) 264 (22.00) (45.54) 116 (54.46) 213 (17.75) 106 (46.49) 122 (53.51) 228 (19.00) (43.10) 99 (56.90) 174 (14.50) 45 (35.71) 99 (64.43) 126 (10.50) (44.35) 63 (54.78) 115 (9.58) 55 (36.42) 96 (63.58) 152 (12.67) > (38.46) 56 (61.54) 91 (7.58) 45 (47.87) 56 (52.13) 94 (7.83) Total 502 (41.83) 698 (58.17) 1200 (100.00) 492 (41.00) 708 (59.00) 1200 (100.00) 121

3 The above table shows that a majority of the study population in both urban and rural areas belonged to yr age group (29.75% in urban and % in rural). Mean age among urban study group was found to be ± 16.7 yrs, which was quite similar to the rural study group where the mean age was ± yrs.the male study group comprisedd 41.83% in urban area and 41.00% in rural area. Females comprised 58.17% in urban area and 59.00% in rural area. Table No.-2 : Prevalence of Hypertension according to age in urban & rural study population Age group (In Yrs) Urban Rural Total Subjects HTN % Total Subjects HTN % > Total As observed from the above table, the proportion of hypertension was found to steadily increase with age both in urban & rural population. In the yr age group the prevalence was 3.92% in urban area and 4.46% in rural area, which gradually increased to 57.14% and 26.59% respectively, among those aged > 70 yrs. The urban - rural difference in hypertension prevalence was found for the following age groups yrs urban hypertensive were 3.10 times more as compared to their rural yrs urban hypertensive were 1.82 times more as compared to their rural yrs - urban hypertensive were 1.60 times more when compared to their rural 70 yrs - urban hypertensive were 2.00 times more when compared to their rural. 122

4 Table No.-3 : Prevalence of Hypertension according to occupation of urban & rural study population Occupation Urban Rural Total Subjects HTN % Total Subjects HTN % Agriculture Labourer House wife Service Professional Business Retired Others Total From the above table the hypertension Housewives - The hypertension prevalence prevalence was found according to occupation among urban housewives was 2.38 times are as follows: more than their rural counterpart. Agriculture The hypertension Service class - The hypertension prevalence prevalence among rural agriculturists among urban service class was 19 times more was 3.00 times more than their urban than their rural counterpart. 123

5 Table No.-4 : Distribution of presenting complaints among Hypertensive of urban & rural study population Complaints Area Total χ 2 d.f. P- Significance Urban Rural value Headache >.05 NS (21.31) (21.52) (21.38) Palpitation >.05 NS (3.09) (4.43) (3.56) Giddiness <.001 Sig (8.25) (19.62) (12.25) None <.01 Sig (67.35) (54.43) (62.81) It could be observed from the above table that among hypertensives majority of them had no presenting complaints (urban %, rural 54.43%). In those who had complaints most common was headache % in urban & % in rural areas, followed by giddiness in urban 8.25% and in rural 19.62% and palpitation in urban was 3.09 %, and in rural was 4.43%) Among hypertensives, urban subjects not to present with any complaints were2.28 time more when compared to their rural. This was found to be statistically significant. hypertension prevalence was observed. The findings of our study compare well with other studies In US 12 the prevalence rate varied from 4% in the age group yrs to 60% in the age group yrs. Study done in Delhi and adjoining rural areas of Haryana 13. The prevalence rate of hypertension in the study population was 18.3% (95% CI, %). Prevalence of hypertension was more in males 19.1% (95% CI, %) than in females 17.5% (95% CI, %); 11.6%, 5.6%, and 1.2% of the total subjects had Grade I, Grade II, and Grade III, respectively. Only 33.8% of Discussion: them were aware of their hypertensive status. In our study the overall prevalence of hypertension was found to be 24.25% in urban and 13.17% in rural area. These results were comparable to the rates obtained by Gupta R 11 in his study titled Trends in hypertension epidemiology in India, where the prevalence of hypertension has been reported to range between 20-40% in urban adults and 12-17% among rural adults.in the present study, in both urban and rural areas the prevalence of hypertension was found to Hypertensives of 32.1% were on treatment, and 12.5% adequately controlled their BP. About 6.9% of the total hypertensives had severe hypertension 14. PURE 90 : (Prospective Urban Rural Epidemiology study) 40% of adult population worldwide has hypertension. The prevalence of hypertension was lowest in lowest-income countries (around 30%) and highest in upper-middle-income economies increase steadily with age. A sharp increase in 124

6 economies (around 50%), with high-income and lowmiddle income economies having an intermediate level (around 40%). Only 30% of the population had optimal blood pressure, with another 30% found to be in the prehypertension range. Of the 40% with hypertension, 46% of these individuals were aware of their condition, 40% were treated, but only 13% were controlled. 15 The present study did not reveal any difference in the prevalence of hypertension between males and females in both urban and rural areas (urban 24.30% and 24.21% rural 13.01% and 3.28% respectively). In the present study the mean values of SBP & DBP showed a steady increase with age in both urban and rural areas. A sharp increase in SBP was seen in the age group yrs in both urban and rural area. The rate of increase in mean values of DBP with age was less as compared to SBP and a slight decline was observed in the age group yrs of urban population. Among the subjects of nuclear families it was found that urban hypertensives were 1.80 times more and among joint families 1.87 times more, when compared to their rural. In our study, the prevalence of hypertension was found to be more among retired personnel in both urban and rural areas. In the present study, hypertension prevalence was found to be directly proportional to the socio-economic status in both urban and rural areas. It was observed from our study that a majority of hypertensive subjects (62.81%) did not have any presenting complaints. Among those who had complaints, headache was the commonest followed by giddiness and palpitation. A family history of elevated BP is one of the strongest risk factors for the future development of hypertension in individuals. It was observed from our study that > 50% of urban hypertensives had a family history of hypertension and only 8.23% had a family history of hypertension in rural area. In our study among the hypertensives 67.70% in urban and 66.46% rural area were found to consume vegetarian diet. Among the urban hypertensives 81.10% consumed >6gms of salt per day, whereas similar consumption was seen among 59.49% of rural hypertensives. Consumption of salt (>6 gms/day) was 2.54 times more in urban hypertensives when compared to their rural counterpart. However, extra salt intake was equivocal between urban and rural hypertensives. Our study shows that 88.66% urban hypertensive subjects led a sedentary life-style whereas it was 55.70% among rural hypertensive subjects. It has been seen that sedentary individuals have 20-50% increased risk of developing hypertension. In our study, smoking prevalence among hypertensives did not show a significant urban-rural difference. Smoking is by far the hardest on the heart, increasing persons resting heart rate. 16 High smoking frequency (>20 cigarettes, beedis/day) among hypertensive rural population was 1.70 times more when compared to their urban counterpart. Conclusion: In the present study, alcohol consumption among urban hypertensive subjects was 2.58 times more when compared to their rural. However, 78.95% rural hypertensive subjects and 59.18% urban hypertensive subjects consumed > 210 ml of alcohol. Duration of alcohol consumption (> 10 yrs) among urban hypertensive subjects was.3.41 times more when compared to their rural. Stress was found to be present in 10.31% of urban and 14.56% of rural hypertensive subjects. In our study, it was found that 57.79% of Urban hypertensive had a BMI of >25 kg/m 2 whereas prevalence was only 20.89% among rural hypertensive. Urban hypertensive were found to be 5.27 times more overweight (>25 kg/m 2 ) as compared to their rural. 125

7 References: 1. WHO Expert Committee. Primary prevention of essential Hypertension. WHO. Tech Rep Ser Geneva WHO Expert Committee. Hypertension control. Geneva. WHO. Tech.Rep.Ser 862. Geneva The Seventh report of the Joint National Committee on prevalence, detection, evaluation & treatment of high blood pressure. The JNC 7 Report. JAMA. 2003; 289: Covey LS, Zang EA, Wynder EL. Cigarette smoking and occupational status American journal of public health. 1992; 82: Kulkarni AP, Baride JP. Textbook of community medicine. 2 nd ed. Mumbai: Vora Medical Publication; p Fowler, Grey, Peter Anderson. Prevention in the general practice. 2 nd ed. London: p (Oxford General Practice Series). 7. Park K. Epidemiology of chronic non-communicable diseases and conditions. Textbook of preventive and social medicine. 18 th ed. Jabalpur: M/s Banarsidas Bhanot publishers; p World H e a l t h O r g a n i z a t i o n I n t e r n a t i o n a l s o c i e t y o f Hypertension. Guidelines f o r t h e management of hypertension. Guidelines subcommittee. Journal of Hypertension. 1999; 17: Bernard Rosner. Fundamentals of biostatistics. 5 th Edition. Duxbury; M. Venkataswamy Reddy. Statistics for mental health care research. NIMHANS publication. INDIA Gupta R. Trends in hypertension epidemiology in India. Journal of Human Hypertension. 2004; 18: National high blood pressure education program working group. Arch Intern Med. 1993; 153: Chadha SL, Shukla DK, Neerpal Singh. Urban rural differences in the prevalence of hypertension and its risk factors. Cardiology Today Jul-Aug; 5(4): Yuvaraj BY, Nagendra Gowda MR, Umakantha AG. Prevalence, awareness, treatment, and control of hypertension in rural areas of Davanagere. Indian J Community Med [serial online] 2010 [cited 2013 Jan 16]; 35: KK Aggarwal 2012, pure-40-of-adult-population-worldwide-has-hypertension. 16. Motilal C. Tayade, Nandkumar, B.Kulkarni, A comparative study of resting heart rate in smokers and nonsmokers, IJCRR, Vol.4 (22) ; Date of submission: 22 February 2013 Date of provisional acceptance: 03 March 2013 Date of Final acceptance: 30 March 2013 Date of Publication: 03 April 2013 Source of support: Nil; Conflict of Interest: Nil 126