|Year : 2015 | Volume
| Issue : 2 | Page : 92-95
A Community-based Study to Estimate the Prevalence and Determinants of Hypertension in a Rural Area of Puducherry
Saurabh RamBihariLal Shrivastava1, Arun Gangadhar Ghorpade2, Prateek Saurabh Shrivastava1
1 Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Ammapettai, Kancheepuram, Tamil Nadu, India
2 Department of Community Medicine, Sri Manakula Vinayagar Medical College and Hospital, Puducherry, India
|Date of Web Publication||1-Jun-2015|
Dr. Saurabh RamBihariLal Shrivastava
3rd Floor, Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Ammapettai Village, Thiruporur - Guduvancherry Main Road, Sembakkam Post, Kancheepuram - 603 108, Tamil Nadu
Source of Support: None, Conflict of Interest: None
Objectives: The objective was to estimate the prevalence of hypertension and its determinants in a rural setting of Puducherry. Materials and Methods: A community-based study for the duration of 2 years (March 2012-February 2014) was conducted among persons aged 25 years and above, residing in two villages of Puducherry. Single-stage cluster random sampling was employed and subjects were enrolled based on the fulfillment of inclusion criteria. Institutional Ethics Committee permission was obtained prior to the start of the study. SPSS version 16 was used for statistical analysis. Chi-square and unpaired t-tests were employed to study the association between risk factors and hypertension. Results: The prevalence of hypertension in the study population was 24.7%, with higher prevalence being observed in males (28.7%) than females (21.0%). The statistical analysis revealed a significant association between reduced physical activity/week, addiction to smoking and alcohol, abdominal obesity, high salt intake, and presence of hypertension. Conclusion: The prevalence of hypertension was higher in the study subjects residing in rural areas of Puducherry. However, the positive association between the common lifestyle related parameters and presence of hypertension suggest that there is a significant scope to create awareness about these risk factors among the rural population.
Keywords: Hypertension, obesity, physical activity, Puducherry
|How to cite this article:|
Shrivastava SR, Ghorpade AG, Shrivastava PS. A Community-based Study to Estimate the Prevalence and Determinants of Hypertension in a Rural Area of Puducherry. MAMC J Med Sci 2015;1:92-5
|How to cite this URL:|
Shrivastava SR, Ghorpade AG, Shrivastava PS. A Community-based Study to Estimate the Prevalence and Determinants of Hypertension in a Rural Area of Puducherry. MAMC J Med Sci [serial online] 2015 [cited 2020 Jul 7];1:92-5. Available from: http://www.mamcjms.in/text.asp?2015/1/2/92/157921
| Introduction|| |
Over the last few decades, hypertension has emerged as a major public health problem worldwide and has also been identified as the most common potential risk factor for cardiovascular diseases.  The estimates released the World Health Organization revealed that globally in excess of 33% of adults aged 25 years and above are suffering from hypertension, and even accounts for 9.4 million deaths attributed to cardiovascular diseases on an annual basis.  In fact, the recent projection suggests that if no active interventions are performed, almost 23 million cardiovascular diseases can result only because of hypertension by the year 2030, of which about 85% persons will be from developing nations.  Even the epidemiological studies have indicated rising prevalence of hypertension in both rural and urban settings of India. ,
Further, a directly proportional relationship has been established between high blood pressure and early onset/precipitation of multiple disorders. , Various studies have suggested most of the hypertension induced adverse effects can be prevented by ensuring early detection and maintenance of normal blood pressure. , At the same time, encouraging results have been obtained in those settings where awareness about the hypertension and its risk factors was best among the local community.  Thus, smart and universal implementation of appropriate preventive measures can play a crucial role in reducing the prevalence of hypertension, especially in low-resource settings. ,
In India, where close to 70% of the residents live in rural settings, a definitive scarcity has been observed in terms of epidemiological studies performed with an objective to study the prevalence and its determinants. Hence, in the current study a cohort of adults in two villages of rural Puducherry was followed over 2 years to estimate the prevalence of hypertension and its determinants.
| Materials and Methods|| |
A community-based study for the duration of 2 years (March 2012-February 2014) was conducted among persons aged 25 years and above residing in two villages of Puducherry.
Open Epi Version 2.3.10 was used to determine the sample size.  Single-stage cluster random sampling was employed and subjects were enrolled (n = 1083) based on the fulfillment of inclusion criteria.
Inclusion and exclusion criteria
All individuals with age of more than 25 years, residing in the two villages were invited to participate in the present study. However, individuals who were unwilling to participate (n = 33) or with missing forms (7) were eventually excluded from the final statistical analysis. Thus, the final sample size was 1043.
Study tool and variables
A pretested structured questionnaire was utilized to obtain the information from study participants. This questionnaire contained particulars about the socio-demographic profile, family history, level of physical activity, and tobacco/alcohol usage. Further, participants were subjected to anthropometric measurements-height, weight, waist circumference, as well using standardized procedures by trained researcher.
After obtaining written informed consent from the enrolled study participants, a face-to-face interview was performed to elicit the desired particulars. Digital blood pressure monitor (OMRON SEM-1, Japan) was utilized to estimate the blood pressure in the right upper limb with participants in sitting posture. Two such readings were taken, and the mean of two was considered as an individual's blood pressure measurement. Subjects were categorized as hypertensive, if they had a systolic blood pressure of ≥140 mm of Hg or/and diastolic blood pressure of ≥90 mm of Hg or those taking antihypertensive medication.
Institutional Ethics Committee permission was obtained before initiating the study. A written informed consent was obtained from each of the study participants prior to their interview.
Data were entered in Microsoft Excel sheet and statistical analysis was performed using Statistical package for Social Sciences - Version 16.0 for Windows (SPSS Inc., Chicago, United States of America). Chi-square test and unpaired t-test for the categorical (%) and continuous (mean ± standard deviation) variables were employed to study the association between various parameters. Further, variables with P < 0.05 in univariate analysis were then included in the multivariate logistic regression.
| Results|| |
[Table 1] represents the socio-demographic attributes of study subjects with reference to their blood pressure status. The mean age group of study subject was 45.6 years (±13.7 years), with youngest and oldest participant being 25-year-and 98-year-old, respectively. The prevalence of hypertension in the study population was 24.7%, with higher prevalence being observed in males (28.7%) than females (21.0%). A significant relationship was observed between hypertension and decreased physical activity/week, higher pack-year of smoking, increased intake of alcohol, abdominal obesity, deranged lipid profile, and excess consumption of oil/salt. Further, a positive history of hypertension in the family and diabetes co-existence, also accounted for the higher prevalence of hypertension.
[Table 2] represents the results obtained by multivariate analysis, which showed that with the increase in age by every 1-year, the risk of hypertension increased by 2.9%. Even, those with a family history of hypertension and co-existing diabetes had 1.8 and 2.0 times higher chances of having hypertension. In addition, addiction in any form (smoking or alcohol) predisposed to high blood pressure. Further, salt intake was significantly linked with hypertension, with intake of each additional gram of salt per day resulting in augmentation of the risk of hypertension by 4.7%.
| Discussion|| |
In the current study, the prevalence of hypertension was found to be 24.7% (258/1043) among the rural participants, which was slightly higher than a similar study conducted in the urban settings of South India (21.1%).  Findings of a multinational Prospective Urban Rural Epidemiology study conducted across urban and rural settings in the 17 nations showed variable extent of the prevalence of hypertension across higher income nations (urban- 36.4% vs. rural- 40.2%), upper middle income nations (urban- 45.2% vs. rural- 46.9%), lower middle income nations (urban- 34.9% vs. rural- 38.7%), and low income nations (urban- 44.4% vs. rural- 39.2%), respectively.  In most of the studies, a slightly higher prevalence of hypertension has been observed in rural settings as compared to urban settings, probably because of the low literacy rate or poor awareness among the rural population or the limited accessibility to the health centers.
In gender comparison, in our study higher prevalence of hypertension was observed among male (28.7%) participants than among women (21.0%) participants. In contrast, female preponderance has been observed among the estimates released by the World Health Organization in India.  In addition, the findings of the current study revealed a directly proportional relationship between the increase in age and the presence of hypertension. Similar results were observed in an epidemiological study performed in rural settings in Central India.  This is probably because of the adoption of harmful lifestyle habits with an increase in age.
A statistically significant association was observed between hypertension and physical inactivity, smoking/alcohol consumption, obesity, raised total cholesterol levels, and increased calorie consumption. Studies from different settings have revealed similar results. ,, This reflects the constellation of multiple lifestyle habits in the causation of the hypertension.
Similar to our study findings, definite risk of hypertension was being observed in various other studies, provided the subjects had a positive family history of hypertension. , Furthermore, as observed in our study, existence of diabetes augmented the risk of development of hypertension in the study population in studies performed under heterogeneous settings. , These findings clearly reflect the web of causation and the multi-factorial nature of non-communicable diseases. 
Further, it was observed that with every unit increase in pack-year of smoking and gram/day of alcohol, an additional risk was posed on the development of hypertension. Similar sort of findings were observed in a study performed among a population of Afyonkarahisar region.  These findings clearly suggest that the team of health professionals has failed to sensitize the general population about the adverse effects of smoking and alcohol on health.
As most of the information was obtained in a single face-to-face interview, there is a potential scope for recall bias, especially pertaining to information regarding vegetable, oil, and salt intake. In addition, the results of the study cannot be generalized to the entire nation as the study was performed on a nonrandom sample of villages.
| Conclusion|| |
The prevalence of hypertension was higher in the study subjects residing in rural areas of Puducherry. However, the positive association between the common lifestyle related parameters and presence of hypertension suggest that there is a significant scope to create awareness about these risk factors among the rural population.
| References|| |
Moser KA, Agrawal S, Davey Smith G, Ebrahim S. Socio-demographic inequalities in the prevalence, diagnosis and management of hypertension in India: Analysis of nationally-representative survey data. PLoS One 2014;9:e86043.
Kokiwar PR, Gupta SS, Durge PM. Prevalence of hypertension in a rural community of central India. J Assoc Physicians India 2012;60:26-9.
Shrivastava SR, Shrivastava PS, Ramasamy J. The determinants and scope of public health interventions to tackle the global problem of hypertension. Int J Prev Med 2014;5:807-12.
Majgi SM, Soudarssanane BM, Roy G, Das AK. Risk factors of diabetes mellitus in rural Puducherry. Online J Health Allied Sci 2012;11:4.
Shanthirani CS, Pradeepa R, Deepa R, Premalatha G, Saroja R, Mohan V. Prevalence and risk factors of hypertension in a selected South Indian population - the Chennai Urban Population Study. J Assoc Physicians India 2003;51:20-7.
Chow CK, Teo KK, Rangarajan S, Islam S, Gupta R, Avezum A, et al
. PURE (Prospective Urban Rural Epidemiology) study investigators. Prevalence, awareness, treatment and control of hypertension in rural and urban communities in high-, middle-, and low-income countries. JAMA 2013;310:959-68.
Kaur P, Rao SR, Radhakrishnan E, Rajasekar D, Gupte MD. Prevalence, awareness, treatment, control and risk factors for hypertension in a rural population in South India. Int J Public Health 2012;57:87-94.
Basu S, Millett C. Social epidemiology of hypertension in middle-income countries: Determinants of prevalence, diagnosis, treatment, and control in the WHO SAGE study. Hypertension 2013;62:18-26.
Gupta R, Gupta N. Hypertension epidemiology in the 21 century India. J Prev Cardiol 2013;2:350-5.
Min H, Chang J, Balkrishnan R. Sociodemographic risk factors of diabetes and hypertension prevalence in republic of Korea. Int J Hypertens 2010;2010:1-6.
Gupta R, Yusuf S. Towards better hypertension management in India. Indian J Med Res 2014;139:657-60.
Dogan N, Toprak D, Demir S. Hypertension prevalence and risk factors among adult population in Afyonkarahisar region: A cross-sectional research. Anadolu Kardiyol Derg 2012;12:47-52.
[Table 1], [Table 2]