Blood pressure profile and its clinico-social determinants among attendees of urban health and training center of IQ City Medical College, Durgapur, West Bengal.

Introduction:

The world has recently observed epidemiological transition where it was being observed that death due to non-communicable disease exceeded to that of death due to communicable diseases. High blood pressure or Hypertension (HTN) was one of the leading causes of death among the existing non communicable diseases^[1] and pre-hypertension (pre-HTN) is the intervention area from where HTN can be prevented if managed judiciously or aggravates to HTN if no or inadequate intervention taken. Hypertension is characterized by Systolic ≥L40 mm of Hg or diastolic BP ≥ 90 mm of Hg^[2] and is prevalent among 10 to 30% of Indian population.^[3-6] Hypertension, pre-hypertension can lead to so many comorbidities and life threatening conditions like stroke, cardiovascular diseases, renal complications if not recognized or treated adequately or risk factors are not modified. There are several proven factors that can lead to hypertension. Sedentary lifestyle, addition, obesity and unhealthy diet are some major issue. There are also some socio-demographic determinants^[7] of hypertension like extreme high and low social class, literacy status, Race, Ethnicity^[8] etc.

Hypertension is a well-established fact for adverse Cardio vascular events (CV), renal function, retina changes etc., whereas other blood pressure profiles also creates unhealthy health conditions. Hypotension can cause dizziness, lightheadedness^[9] or in extreme it may cause shock though generally low grade hypotension is considered as healthy. Pre-HTN can lead HTN any day.

Proportion study of different BP profile along with its clinico- social determinants were very few in West Burdwan district, particularly in Durgapur, thus a study was conducted to address proportion and clinic-social determinants of different blood pressure profile and to suggest possible health fact finding and intervention.

Materials and Methods:

An institution based observational cross-sectional study was performed among attendees of Urban health and training center, Department of Community Medicine of IQ City medical college, Durgapur, West Bengal from April to August 2017 with prior approval by the institutional ethics committee of IQ City Medical College, Durgapur. Only attendees of age ≥ 18 years were interviewed and examined, whereas severely ill and disagreement for consent were excluded from the study. Sample size was calculated from standard WHO guideline^[10] using formula 4PQ/d^[2]. Considering Proportion(P) of HTN=10%^[3], Q=(1-P), and absolute precision 5 with 95% confidence interval minimum sample size came to be 144. We continued data collection through systematic random sampling technique throughout our data collection period without deploying extra resources due to which a total of 208 participants were included. Sample interval of systematic random sampling was pre decided, based up on the previous record on patient attendance.

A predesigned, pretested, semi-structured schedule was used to interview study subjects and relevant clinical methods were applied to note waist circumference (WC), height, weight, BMI, BP etc. Blood pressure profile was taken according JNC8 guideline.^[2]

Operational definition:

Results:

Dataset of 208 study subjects were analyzed. Table 1 revealed that 16.8% of the populations were diagnosed as having Hypertension whereas a large proportion of the study subjects were suffering from Pre-hypertension (43.8%). The study also revealed that major proportion of the study subjects were female (55.8%) and maximum of the population were Literate (70.7%). 66.3% of them were physically active and 73.1% of the study people were devoid of any substance abuse though consumption of junk food (64.4%) was high among them. Mean age of the study population as shown in Table 2, was 37.81 years. Mean waist circumference was 79.98 cm.

It can be seen from Table 3 that Males had more proportion of HTN (29.3%) and Pre-HTN (46.7%). The same table also revealed that HTN was more among people with substance abuse (46.4%). 19% of Literates and 11.5% of Illiterates were suffering from HTN whereas 59% of Illiterates were having Pre-HTN. Table 3 also revealed 50% of junk food consumers were suffering from pre-HTN and only 12.7% of them had of dependent variable as revealed from cox and snell pseudo r^[2] nagelkerke R square statistic. Per-capita income and substance abuse was independent risk factors for HTN (p value <0.05) whereas age, male gender, substance abuse, physical inactivity and junk food consumers were independent risk factors for pre-HTN (p value <0.05)

Discussion:

The study revealed a very common and matching result in terms of proportion of HTN i.e., 16.8% which was as par with many studies^[3-6] but the study revealed another interesting result regarding proportion of pre-HTN. Pre-HTN was surprisingly high (43.8%) in this study as compared to 35% by Wang R et al^[11]. Very soon, if no intervention provided or taken may be converted to HTN in a large proportion and there are very few studies existing that revealed proportion of pre-HTN. Proportion of HTN & pre-HTN were statistically more among males, few other studies reported similar results^[11-12]. It might be due to the more risk factors among males like substance abuse. Result may be because of geographical and cultural variation between the two study countries. 70.7% of the study population was Literate which was a bit less than national standard (74%)^[13]. 19% of literates and 11.5% of illiterates were suffering from HTN whereas in case of pre- HTN, illiterates were more sufferers which were statistically significant. It was seen that 64.4% of the study population were consuming any kind of junk food. Though HTN was only 12.7% among them it should be considered that many more will be in that zone in very near future as proportion of pre- HTN was very high among them (50%). Junk food mainly contains trans fat and more salts, which are proven risk factors^[14,15] for proportion of pre-HTN. Proportion of HTN was quite high among people with substance abuse (46.4%) which was similar to a study finding by a study by Puddey et al^[16] which showed impact of Alcohol in Blood pressure, only hope was that maximum study people were devoid of any substance abuse (73.1%). HTN was relatively low among physically active study subjects which was as par with many studies^[17-18]

Multivariate logistic regression model revealed that Per- capita income and substance abuse was independent risk factors for HTN whereas age, male gender, substance abuse, physical inactivity and junk food consumers were independent risk factors for pre-HTN.

Conclusion:

Proportion of HTN was high among attendees of UHTC but proportion of pre-HTN was even much higher. Age, per capita income, gender, substance abuse, junk food consumption and physical inactivity had an impact on proportion of HTN and pre-HTN.

Recommendation:

Special awareness generation initiative programme should be undertaken to address junk food consumption, Substance abuse control, lifestyle changes. Government, NGO and individual level approach at solo patient care center and community care setting should be very aggressive to detect HTN and Pre-HTN at earliest.