Estimation of prevalence of risk factor of hypertension among population of Wardha district between age group of 35-60 years: a study protocol.

Introduction

HTN is the force of the blood exerted on the walls of arteries as a result of the left ventricle contracting against the resistance provided by the arteries and arterioles, which is necessary for the best possible functioning of the body.¹ HTN is the medical term for elevated BP. The HTN is addressed as two numbers. The Systolic pressure, which is the first number, is the blood vessel pressure produced when the heart contract or beats. The Diastolic pressure which is the second number indicates the pressure in the arteries between heartbeats.²

HTN is regarded as the third most crucial element of danger for the associated burden of illness in South Asia. In India, the impact of HTN on the cardiovascular healthcare system and health status is significant. In India, HTN is mainly accountable for more than 50% of all deaths from stroke and more than 20% of all fatalities from CDH (coronary heart disease) and according to World Health Organization (WHO), one of the main global elements of risk for early death is hypertension.³

The principal factor adding to cardiovascular mortality and morbidity is hypertension.⁴ Experts on hypertension continue to disagree on the HTN threshold that constitute abnormality, based on epidemiological and intervention research, the generally recognized criteria is systolic blood pressure (SBP) > or = 140 mmHg and/or diastolic blood pressure (DBP) > or = 90 mmHg.⁵ Adult blood pressure is divided into stages. Health and physical risks increase with each stage. These stages vary from normal, elevated (SBP 130-139 mmHg and DBP 80-89 mmHg), stage 2 Hypertension (SBP 140 mmHg and up and 90 mmHg and up), and hypertension crisis (SBP 180 mmHg and up and DBP 120 mmHg and up), a hypertension crisis is a sudden rise in blood pressure rise in blood pressure that can result in a stroke and is recorded at 180/120.⁶

HTN by age and gender also vary from; 18–39-year male (119/70 mmHg) and female (110/68 mmHg), 40-59 years male (124/77 mmHg) and female (122/74 mmHg), 60 + years male (133/69 mmHg), and female (139/68 mmHg).⁶

According to epidemiological research, in India the prevalence of HTN has been continuously rising over the past 40 years, with urban areas experiencing this trend more than rural ones.⁵ Based on The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC7) standard which was published 2003 and the American College of Cardiology/American Heart Association (ACC/AHA) guideline, Hypertension prevalence based on sex and age was 22.3% (95% CI: 20.6, 24.1) and 36.5% (31.1, 41.8), respectively.⁷

Primary hypertension & Secondary hypertension are the two main assortments of hypertension.

Essential hypertension, which is commonly called as primary hypertension, is a multifactorial form of HTN that has multiple causing factors. It is often referred to as essential or idiopathic hypertension, anything above 120/80 mmHg is normally considered to be above normal, indicating that arteries are under more pressure than they should be. You are more likely to develop essential primary hypertension if you engage in unhealthy behaviours and certain situations.⁸ Other forms of HTN have a unique root cause, including a medical condition or drug side effects. Secondary hypertension is the term used when there is a clear direct cause. Primary and secondary hypertension can coexist, and when there is an instant deterioration of BP, a new secondary cause should be considered.⁸

Secondary hypertension may frequently be cured effectively in order to minimize both the HTN & the disorder that causes it. The risk of major consequences, such as kidney failure, heart disease and stroke are decreased by effective therapy. Even if BP has risen to risky levels, secondary hypertension typically exhibits no particular symptoms, similar to primary hypertension. Secondary hypertension can result from many medical problems also secondary hypertension may be caused by a number of renal disorders, including: Polycystic kidney disease, Diabetes compilation (diabetic nephropathy), Renovascular hypertension, Glomerular disease, etc.⁹

Another type of hypertension is pregnancy-induced hypertension. Pregnancy-induced hypertension can be characterized as a disorder of conditions that happens following 20 weeks of pregnancy described by an expansion in circulatory strain to more than 140/90 mmHg regardless of proteinuria.¹⁰

A vital causal factor for stroke, long-term heart disease and coronary heart disease is high BP, unhealthy diets, use of cigarettes and alcohol, inactivity, excessive salt consumption, being overweight or obese, diet high in saturated and trans fats, are some of the modifiable risk factors that may be altered.² Non-modifiable risk factor of HTN includes being older than 64 years, having a heredity of HTN, and having other diseased condition like diabetes or renal disease; these risk factors cannot be altered.² The aim of the proposed study is to estimate the prevalence of risk factor of hypertension among population of age group 35-60-years in Wardha district.

Objective

To assess the prevalence of risk factor of hypertension

To state the risk factor of hypertension

Protocol

Method of data analysis

Statistical analysis including standard deviation, mean, proportion, frequency, and percentage and inferential statistics comprising χ² test, discriminants analysis and factor analysis will be used to analyse the data using Statistical Package for Social Sciences (SPSS)¹² and Excel.

Discussion

HTN is a notable cause of element of danger for stroke, chronic heart disease and coronary heart disease. Unhealthy diet (diets heavy in saturated and trans fats, excessive salt intake, insufficient intake of vegetables and fruits), use of tobacco and alcohol, inactivity, and being obese or overweight are some of the modifiable risk factors that can be changed. Family history of hypertension, having additional illness like diabetes or kidney disease and being over 65 years are all non-modifiable risk factors that cannot be changed.²

Cardiovascular morbidity and mortality are increased by HTN by a factor of two to four. Atherosclerosis and coronary disease are now the main risks. The degree of diastolic or systolic BP elevation in either sex, at any age, is inversely correlated with risk of hypertension. Patients with hypertension who also have an impaired glucose tolerance, high-density/high total lipoprotein (HDL) - cholesterol ratio, abnormal electrocardiographic (ECG) results, high fibrinogen levels and who smoke cigarette are at a higher chance to develop coronary heart disease.¹³

HTN is a prime element of danger for heart attack and stroke and affects almost 30% of adults. Due to hypertension, the sympathetic nervous system (SNS) and the renin-angiotensin-aldosterone system (RAAS) are affected and that are also associated with the regulation of salt-water balance and cardiovascular function.¹⁴

Hypertension a condition that can be controlled. It has been claimed that targeted reductions in the number of persons with hypertension are projected to result in significant decreases in the burden of cardiovascular disease. The acceptance of healthy lifestyle by every individual is essential for the prohibition of high BP, according to the JNC-7. Therefore, accurate estimates of hypertension are required to develop effective control strategies.¹⁵

A two-dimensional methodology is utilized for the underlying treatment of hypertension, with an emphasis on way of life changes and extra pharmacological administration. Lifestyle management, also known as non-pharmacological treatment, is essential for both individual with hypertension and individual without hypertension. Non-hypertensive individual, including those with pre-hypertension, can reduce their risk of BP-related clinical consequences and lower their blood pressure through lifestyle modifications. If the patient is able to maintain lifestyle changes, these interventions may enable drug step-down in hypertensive patients whose blood pressure is controlled by medication. The therapy is successful when a various aspects of the subject’s life are considered because essential hypertension is thought to be the result of interactions between genes and the environment. In the treatment of HTN, it is crucial to control environmental factors considering they are powerful and cause the majority of variations in BP across individuals and communities. Consumption of inactivity, psychosocial stress, alcohol, and a diet deficient in fibre and potassium are all important lifestyle or environmental factors. Obesity, particularly truncal obesity, is a strong proximate determinant of high blood pressure in Indians as well. It is well known that lifestyle factors contribute to their onset.¹⁶

All individuals with hypertension should start non-pharmacologic therapies. Changing one’s lifestyle early on can lessen the likelihood of developing other diseases and even eliminate the need for pharmaceutical treatment. However, maintaining a healthy lifestyle is insufficient or However, majority of subjects will require pharmaceutical therapies to manage their blood pressure, and leading a healthy lifestyle is inadequate or difficult to adhere to.¹⁷

The following drugs are used to treat high blood pressure¹⁸:

Diuretics (Water pills): The elimination of salt and water from the body is aided by these medications. These are frequently the 1^st medications used to treat HTN. Depending on the measurements of blood pressure and other medical conditions, such as kidney disease or heart failure, diuretics can be grouped into a number of different categories, such as potassium sparing, loop, and thiazide.

Angiotensin-converting enzyme (ACE) inhibitors: By causing the secretion of a natural chemicals that narrows the blood vessels, ACE inhibitors assist in blood vessel relaxation. Benazepril (Lotensin), lisinopril (Prinivil, Zestril), captopril, and others are examples of angiotensin-converting enzyme inhibitors.

Angiotensin II receptor blockers (ARBs): Additionally, angiotensin II receptor antagonists relax blood vessels. They prevent the natural chemical that dilates blood vessels from acting, not from developing. Losartan (Cozaar), candesartan (Atacand), and other Angiotensin II receptor blockers include.

Alpha blockers, Alpha-beta blockers, Beta Blockers, Aldosterone antagonists, Renin inhibitor, Vasodilators, and Central acting agents are other medications that can be used to treat HTN.

Ayurvedic medications have also been shown to help with conditions like hypertension and improve heart function for a long time. To ensure that the patient’s health is a primary concern, various principles and guidelines are described in Ayurvedic texts. Jatamamsi, Sarpagandha, Rason, and Arjuna are some of the therapeutic plants used to treat hypertension.¹⁹

Shamak Yoga is the type of yoga which also helps to treat hypertension. “Shamak Yoga” is a polyherbal combination of 10 Ayurvedic plants. In individuals with moderate hypertension, Shamak Yoga was shown to be statistically significant and equivalent to Atenolol for systolic and diastolic blood pressure.²⁰

This observational study will highlight the prevalence of risk factors of hypertension among population of Wardha district between age group of 35-60 years.

Based on The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC7) standard which was published 2003 and the American College of Cardiology/American Heart Association (ACC/AHA) guideline, Hypertension prevalence based on sex and age was 22.3% (95% CI: 20.6, 24.1) and 36.5% (31.1, 41.8), respectively.⁷

This study is limited to Hypertensive population of Wardha district between age group 35-60 years.

Compared to males, older women had a greater risk of developing hypertension (AOR, 4.24; 95% CI, 3.94-4.57 for men aged 50–54 and AOR, 5.58; 95% CI, 5.16–6.03 for women aged 40–49). Other than age, it has been shown that drinking alcohol, having diabetes, and not working are the main risk factors for this condition in women. In order to prevent the early onset of hypertension, teenagers and adults in India should be encouraged to adopt new lifestyle habits including eating a diet high in fruits and vegetables and getting regular blood pressure checks.²¹

19.1% of people worldwide had hypertension. Adults were 3.6 times more likely to develop hypertension if they had known diabetes mellitus. Risk factors for hypertension include a family history of HT (OR:1.82), cigarette use (OR:1.94), and alcohol use (OR:1.54 for men). With a BMI of 25 to 29.9 and below 30 correspondingly, it was shown that the risk of hypertension increased to 1.45 times and 2.27 times, respectively. Age, family history of hypertension, known history of diabetes mellitus, and body mass index were the factors of hypertension in multiple logistic regression analysis.²²

As similar study is not conducted in Wardha district the result from this study will add data to the data base related to prevalence of risk factors of hypertension.

Ethical approval

Approval by the Institutional Ethics Committee Ref. No. DMIHER (DU)/IEC/2023/594.

Datta Meghe Institute of Higher Education and Research Sawangi (M) Wardha- 442107 Maharashtra, India.