JNC Viii: A Case Study

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JNC Viii: A Case Study



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Current Hypertension Guidelines (JNC-8 vs 2017 ACC/AHA)

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In all study participants, a structured and pretested interview schedule was administered to obtain data on sociodemographic parameters. The average of two readings was used. All the anthropometric measurements were done by the following standardized technique. Weight was measured by Libra weighing machine having an accuracy of 0. Based on BMI obtained, the subjects were classified into different categories according to the WHO global classification [ 16 ]. Waist circumference in cm was measured using a nonstretchable measuring tape. Waist circumference was measured at the smallest horizontal girth between the costal margins and the iliac crest at the end of expiration.

Hip circumference in cm was measured at the broadest part of the hips by using nonstretchable measuring tape. Waist-to-hip circumference WHR was calculated by dividing waist circumference by hip circumference [ 17 ]. Prior written consent was taken from the subjects who volunteered to participate in the study. Identified hypertensive subjects were referred to the nearby clinic for treatment. The information obtained from the survey was entered into a database developed for the study, using SPSS Descriptive statistics mean and standard deviation were calculated for continuous variables and frequencies and percentages were calculated to summarize qualitative data.

Logistic regression was applied to identify the risk factors for hypertension. A significance level of 0. A total of study subjects were interviewed for the survey. Majority of the study subjects were married and one-third of the subjects belonged to the upper socioeconomic class. Table 3 depicts the mean values of systolic and diastolic BP according to age and gender. The mean systolic and diastolic BP of all the study subjects were In men, the highest mean systolic BP and mean diastolic BP were among the eldest age group and preceding eldest age group 45—54 years , respectively, while in female the highest mean value of systolic and diastolic BP both were among the 45—year age group.

With regard to systolic BP, there was significant difference among all the age groups among both male and female study subjects and the same was with diastolic BP as well. The prevalence of isolated systolic BP was found to be The proportion was higher in male Among both groups male and female , prevalence was higher among the eldest age group. The prevalence of isolated diastolic BP was higher among male subjects It was the highest among the second oldest age group among male and oldest age group in female subjects.

With regard to systolic BP, age was associated with hypertension status among both genders, whereas diastolic BP was associated with age in male subjects only. There was no association between age and diastolic BP in female subjects. The overall prevalence of hypertension was The sex specific prevalence was Prehypertension was prevalent in In men, hypertension was significantly associated with age but in women, age does not have any effect on their hypertension status. History of hypertension or the prediagnosed cases of hypertension was more among female 6. Prevalence of hypertension and prehypertension by gender and age groups among the study subjects N Table 5 shows the associated factors of prehypertension and hypertension.

Both the rate of prehypertension and hypertension were higher among male. Hypertension was more prevalent in the 45—54 years, while prehypertension was more in the 35—year age group. Being married and government servant were found to be risk factors for both hypertension and prehypertension. Hypertension was found to be more among illiterate subjects, and with regard to prehypertension, primary educated subjects suffered more.

Study subjects from lower and upper socioeconomic status were almost equal victims of hypertension. Tobacco use and alcohol use were found to be risk factors for being hypertensive in the study subjects. Although alcohol use was not significantly associated with hypertension status but rate of hypertension was higher among the alcohol users. The binary logistic regression analysis showed that odds of being hypertensive were higher among the male subjects OR: 1. With regard to anthropometric risk factors, being overweight OR: 1.

Tobacco use OR: 1. Gender, age, marital status, occupation, BMI, abdominal obesity, and tobacco use were significantly associated with hypertension. Education, socioeconomic status, and alcohol use were not statistically associated with hypertension. Being female, younger in age, unmarried, highly educated, and staying away from any kind of addiction could serve as protective factors against hypertension Table 6.

Univariate analysis for the association of hypertension and sociodemographic characteristics, anthropometric measurements, and behavioral risk factors N Out of the total subjects with hypertension, around one-third of the subjects were aware of their condition. Only a third of the treated subjects with hypertension had their blood pressure adequately controlled Figure 1. Females were marginally more aware of their hypertensive status as compared to male counterparts see Table 4 , history of hypertension.

As age, education status, and socioeconomic status were advancing, the awareness of hypertensive status among study subjects was also increasing not shown in the table. Flow diagram showing awareness, treatment, and adequacy of control of hypertension among study subjects. India is a developing country and like other developing countries, it is going through a rapid demographic and epidemiological transition. In all such transitions, nutrition is the key ingredient and plays prime role. This cross-sectional community based study identified a high prevalence of prehypertension and hypertension in urban areas of Varanasi, which was Only a quarter of subjects were in the normal category, which highlights the escalating burden of this silent killer.

The prevalence of hypertension in the present study Few studies reported the results in line with the present study [ 23 , 24 ]. According to World Health Organization , the overall prevalence of hypertension in India was The prevalence of prehypertension in the present study was The prevalence estimated in the present study was much higher than that estimated by Nellore The difference of prevalence observed between the present study and other studies with respect to hypertension and prehypertension could be due to social and cultural differences, dietary and lifestyle factors, and also the age span as well as the research methodology used.

Men exhibit higher prevalence of hypertension and prehypertension than their female counterparts M: Similarly, various studies came out with the higher percentage of hypertension in men than women [ 20 , 22 , 23 , 26 — 29 ]. One of the possible explanations for this gender disparity in hypertension prevalence could be partially due to biological sex difference and partially due to behavioral risk factors like smoking, alcohol consumption, or physical activity. We speculate that absentia from alcohol and smoking might be few of those protective factors against hypertension in women.

Other than that, women are more interested in health care services utilization and also more frequently report their poor health and therefore they are more likely to have better health [ 6 , 30 ]. Age was found to be an important risk factor for hypertension. As the age was advancing so did the prevalence of hypertension among both the sexes. Similar findings were reported by few other studies also where advancing age was positively related to hypertension [ 1 , 6 , 19 , 21 , 22 , 26 , 31 , 32 ].

With increasing age, the aorta and arteries walls will be stiffened and this contributes to the high prevalence of hypertension in older age groups [ 4 ]. In the present study, marital status, education, occupation, socioeconomic status, BMI, abdominal obesity, tobacco use, alcohol use, and physical activity were significantly associated with the hypertension. Low literacy level and being too rich were associated with hypertension. The higher education level was negatively correlated to hypertension in the present study.

These studies also supported this finding [ 6 , 12 , 33 ]. We speculate that it could be due to the reason that higher education imparts better knowledge and information about hypertension and subsequently those people with higher education had a healthier lifestyle. Though some studies had shown a significant association of these two variables [ 6 , 12 ], in the study performed in the state of Kerala [ 33 ], insignificant association between education and hypertension was observed.

We speculate that this insignificant association could be due to very few subjects in the illiterate and less educated category. There are so many studies which do not refute the finding of the present study that higher socioeconomic status is a risk for hypertension [ 3 , 22 , 24 , 32 , 34 — 36 ]. We assume that better socioeconomic status imparts people with more purchasing power on fast and convenience foods and less physical activity which are already proven to be contributing risk factors for overweight and obesity that subsequently linked to hypertension.

The different anthropometric measurements like BMI, waist circumference, and hip circumference were taken into account to measure overweight, obesity, and central or abdominal obesity. This study showed that overweight and obesity measured by both BMI and waist circumference were major modifiable risk factors to develop hypertension. Overweight subjects had twofold risk of being hypertensive and obese had more than threefold risk for the same in comparison to underweight subjects in this study.

There was positive relation observed between increasing BMI and increasing rate of hypertension, which was consistent with other studies [ 1 — 4 , 6 , 12 , 20 , 21 , 23 , 32 , 36 — 39 ]. South Asians have tendency of developing centralized obesity without developing generalized obesity and because of this waist circumference and waist-hip ratio are better measures of body fat [ 40 ]. Abdominal obesity OR: 1. Various epidemiological and pathophysiological mechanisms explained the link between obesity and hypertension.

One of the probable reasons behind this positive relation between obesity and hypertension could be that increased weight increases cardiac output and increased peripheral resistance of arterioles. Other than that, urbanization is also a cause of changes in dietary habits and reduced physical activity which leads to obesity and subsequently results in hypertension [ 4 ]. Interestingly, we have found inverse association between physical activity and hypertension. Hypertension was more among physically active subjects as compared to inactive subjects OR: 0.

Similar result was reported by other study conducted in Turkey [ 1 ]. The exact reason behind this is unknown and yet to be explored. We speculate that they had started physical activity probably under medical advice after being diagnosed for hypertension or other risk factors like overweight or obesity. As per WHO report, alcohol consumption was the third largest risk factor in the developed countries and tobacco use was being the second major cause of death worldwide [ 17 ]. This study indicated the positive association between alcohol and tobacco use and hypertension. Hypertension was more prevalent in tobacco users OR: 1.

This finding is supported by other studies also [ 19 , 23 , 32 , 36 ]. But there are several other studies with contradictory findings [ 1 , 21 , 41 ]. Although not statistically significant, odds of being hypertensive were more among nonvegetarian OR: 1. Several other studies reported the same result [ 3 , 19 , 33 , 34 ]. A study conducted in Bihar [ 20 ] refutes this finding and reported that vegetarian diet was positively associated with hypertension.

Rate of awareness, treatment, and control in the present study was observed as Previous study conducted in rural Varanasi reported hypertension awareness, treatment, and control From the results of this study, it can be concluded that the prevalence of both prehypertension and hypertension is very high in urban Varanasi. This makes the people of this area vulnerable to several chronic diseases and other unbearable health consequences. Specifically men are at more risk of being hypertensive than female. Increasing age is proved to be an independent risk factor for hypertension.

Programs are needed to improve the surveillance systems and implementation of community based screening programs for early detection of hypertension is also needed. As the awareness of the hypertension status among hypertensive cases was very poor, improving health literacy to increase the awareness of hypertension is also the need of the hour. Interventions like weight management, increased physical activity, increased fruits and vegetables consumption, and reduction in tobacco and alcohol use are required and recommended. Limitations of the Study. This study suffers from few of the following limitations. It could also be considered in the present study for better results. There were no conflicts of interest regarding the publication of this article.

National Center for Biotechnology Information , U. Journal List Int J Hypertens v. Int J Hypertens. Published online Dec 3. Author information Article notes Copyright and License information Disclaimer. Corresponding author. Shikha Singh: moc. Received Aug 19; Accepted Nov 8. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. This article has been cited by other articles in PMC.

Abstract Hypertension is a major public health problem and important area of research due to its high prevalence and being major risk factor for cardiovascular diseases and other complications. Introduction Hypertension is a major public health problem due to its high prevalence all around the globe [ 1 — 4 ]. Materials and Methods 2. Study Design and Sample Size A community based cross-sectional study was carried out among the people aged 25 to 64 years living in the selected study area.

Sampling Methodology A multistage sampling was used for this study. Selection of Study Subjects 2. Inclusion Criteria Individuals aged 25—64 years in the selected study area who gave consent for participation were considered. Exclusion Criteria Individuals who are unable to give response due to serious physical or mental illness and with whom anthropometry measurements cannot be performed were excluded from the study.

Techniques of the Study In all study participants, a structured and pretested interview schedule was administered to obtain data on sociodemographic parameters. Anthropometric Measurements All the anthropometric measurements were done by the following standardized technique. Open in a separate window. Data Processing The information obtained from the survey was entered into a database developed for the study, using SPSS Results A total of study subjects were interviewed for the survey. Table 2 Background characteristics of the study subjects N Excluding known hypertensive. Table 4 Prevalence of hypertension and prehypertension by gender and age groups among the study subjects N Table 6 Univariate analysis for the association of hypertension and sociodemographic characteristics, anthropometric measurements, and behavioral risk factors N Figure 1.

Discussion India is a developing country and like other developing countries, it is going through a rapid demographic and epidemiological transition. Acknowledgments The authors would like to thank all the participants for participating in the study. Additional Points Limitations of the Study.

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