Practices of hypertensive patients visiting O.P.D at D.M.C & H, Ludhiana

Transcription

1 Practices of hypertensive patients visiting O.P.D at D.M.C & H, Ludhiana Kuldeep Kaur, Suresh K. Sharma, Gurmeet Kaur, Deepika, Divya Sharma, Harpreet Rai Abstract : Hypertension is an intermittent or persistent elevation of blood pressure (systolic pressure above 140mm Hg or diastolic blood pressure above 90 mm Hg); or a systolic and diastolic pressure of 20mm Hg above the normal baseline pressure 1. The present study was undertaken with the objectives to assess the practices of hypertensive patients visiting O.P.D at D.M.C & H, Ludhiana. A descriptive approach was used to assess the practices of 50 hypertensive patients by Interview method. Overall practices were not up to the mark. Shortcomings like not maintaining logbook, avoidance of yoga, meditation and physical exercises were found. Key words : Practices, hypertensive patients. Correspondence at : Kuldeep Kaur, Lecturer, CON, DMC&H, Ludhiana Introduction Hypertension is a condition that effects most of the population throughout the world and is a leading cause of morbidity and mortality. Hypertension is much more than a cardiovascular disease because it affects other systems of body, such as kidneys, brain and eyes. It is powerful and independent predictor of premature deaths and is asymptomatic till its damaging effects, such as stroke, myocardial infarction, and renal dysfunction, are observed 1. Hypertension is an intermittent or persistent elevation of blood pressure (systolic pressure above 140mm Hg or diastolic blood pressure above 90 mm Hg or a systolic and diastolic pressure of 20mm Hg above the normal baseline pressure 2. 65

2 Hypertension is highly prevalent worldwide. In 2000, 26.4% of adult population were recorded as hypertensive throughout the world and expected to increase by 60% by Studies have shown poor and faulty self-care practices among hypertensive patients. The National Egyptian Hypertension Project showed that only 37.5% of hypertensive were aware of having high blood pressure, 23.9% were receiving treatment and only 8% had controlled their blood pressure 4. Aubert et al (1998) conducted a study representing sample of 1067 adults aged 25 to 64 years. Among hypertensive patients 50% were aware of their condition, 34% were getting treatment and 10% had controlled thier blood pressure 5. Hypertension is also known as "Silent Killer." Hypertension, if uncontrolled, can lead to large number of complications with consequent death. The W.H.O has estimated that high blood pressure is responsible for every eighth death, making hypertension the third leading killer in the world, and for nearly 20% of all deaths world-wide 7. Moreover, during clinical experience the investigators have found poor lifestyle practices among hypertensive patients, so the need was felt to assess the practices of hypertensive patients to highlight the extent of problem. Moreover, based on the findings of the study the health professionals can plan the health education programmes to improve the rate of control of hypertension among hypertensive patients. Objectives To assess the practices of patients regarding hypertension. Materials and Methods This descriptive study was conducted at D.M.C & H, Ludhiana in the month of February This is an autonomous institute of medical education and research. The hospital has the capacity of 1000 beds, which renders excellent services for all specialties. Target population comprised all the hypertensive patients attending cardiology OPD at DMC&H Ludhiana. Purposive sampling was used to select the sample from target population based on inclusion criteria. A total of 50 hypertensive patients attending outpatients of DMC&H were studied. The data was collected by interview method. Interview schedule comprised of different parts like identification data, sociodemographic data and life style practices. The tool was checked for validity and reliability. The various responses given were given a score. A written permission was sought from the competent authority. Investigator made list of patients to be interviewed and recorded thier blood pressure. Interview of all the patients were conducted separately after explaining the purpose. Thus, a total of 50 patients were interviewed. Data was analyzed by using descriptive statistics and presented through tables and figures. 66

3 Results Socio-demographic profile of hypertensive patients Table 1 depicts that out of 50 patients interviewed, 17(34%) were of age group years, 31(62%) were females, 19(38%) were educated up to matriculation followed by 16(32%) who were illiterate. Majority i.e. 44(88%) were married, 35(70%) were housewives, about half of them 26(52%) were from nuclear families 22(44%) had total monthly income of family less than Rs. 5000/- and more than half 28(56%) were from urban area. In present study majority of patients i.e.49 (98%) were non-smoker, 47(94%) were non-drinker, 38(76%), were having sedentary lifestyle and 37(74%) were vegetarian (Table 1). Lifestyle Practices Of Hypertensive Patients Data given in table 2 reveals lifestyle practices of hypertensive patients to control hypertension. It was found that 24(48%) patients never take fatty foods, 20(40%) sometimes and only 6(12%) were consuming fats most of the times in their daily diet. Majority of them i.e., 45(90%) were not using any alternative medicine/therapy apart from allopathy, 4(8%) sometimes and only 1(2%) subject were taking homeopathic medicine. Regarding regular drug intake, 35(70%) patients were taking antihypertensive drugs regularly, 4(8%) most of times, but 2(4%) were never regular regarding drugs. On the other hand, 21(42%) patients were always maintaining their follow up schedule and 13(26%) most of the times. Approximately 12 (24%) patients were taking fresh fruits daily and 14(28%) were most of the times consuming fresh fruits. Similarly, only 14(28%) were always following yoga/ meditation practices, whereas 27(54%) patients never followed yoga/meditation practice. More than half i.e. 27(54%) of the patients were regular in their blood pressure check up, 10(20%) most of times, 10(20%) sometimes and 3(6%) were never getting it checked. Regarding physical exercise, 21(42%) never performed any physical exercise and 19 (38%) were going for walk daily (30-45min) where as 5(10%) in each were doing exercise or walk most of the times (alternative days) and some times. Only 5(10%) patients were maintaining their log book regularly, 2(4%) most of the times, 2(4%) sometimes and majority 41(82%) were not maintaining their log book. Majority of the patients 49(98%) were taking one teaspoon (5gm.) of salt in their daily diet and only 1(2%) was taking more than one teaspoon. 67

4 Table 1: Socio-demographic profile of hypertensive patients N=50 Variables f (%) Age(in years) (12) (28) (34) > (26) Age: Range=38-85yrs, Mean= 57.22±9.66 Gender Male 19 (38) Female 31 (62) Educational status Illiterate 16 (32) Primary 09 (18) Matric 19 (38) (06) Graduate 03 (06) Marital status Married 44 (88) Widow/widower 06 (12) Occupation Skilled 08 (16) Unskilled 04 (08) Professional 03 (06) Housewives and others 35 (70) Religion Hindu 23 (46) Sikh 23 (46) Any other 04 (08) Habitat Urban 28 (56) Rural 20 (40) Slum 02 (04) Type of family Nuclear 26 (52) Joint 24 (48) Monthly income of family(in Rs.) < (44) (32) (08) > (16) Total monthly income of family: Range=Rs , Mean=10200±10167 Habits Smoking Nonsmoker 49 (98) Smoker 01 (02) Alcohol consumption Nondrinker 47 (94) Moderate drinker 03 (06) Physical activity Sedentary work 38 (76) Moderate work 11 (22) Heavy work 01 (02) Dietary habits Vegetarian 37 (74) Non-vegetarian 02 (04) Eggetarian 11 (22) 68

5 Table 2 : Lifestyle practices of hypertensive patients N=50 Practices Lifestyle practices of hypertensive patients Always Most of Some Never the time times f (%) f (%) f (%) f (%) Intake of fats 00 (00) 06 (12) 20 (40) 24 (48) Use of alternative medicine/therapy 01 (02) 00 (00) 04 (08) 45 (90) Regular drug intake 35 (70) 04 (08) 09 (18) 02 (04) Maintenance of follow up schedule 21 (42) 13 (26) 16 (32) 00 (00) Daily fresh fruit intake 12 (24) 14 (28) 21 (42) 03 (06) Yoga/meditation practices 14 (28) 03 (06) 06 (12) 27 (54) Regular blood pressure check up 27 (54) 10 (20) 10 (20) 03 (06) Physical exercise 19 (38) 05 (10) 05 (10) 21 (42) Log book maintenance 02 (04) 05 (10) 02 (04) 41 (82) Discussion Patients practices regarding high blood pressure plays an important role in the ability to control hypertension. In the present study, 50 hypertensive patients aged years were interviewed to asses their practices regarding hypertension. Life practices of hypertensive patients were assessed in terms of always, most of the time, sometimes, and never. Present study has shown that 70% patients were taking their medication as prescribed and 15% were taking medicine sometimes where as 4% were never taking medicine (Table 2). Similar findings were revealed by Egan reporting that 80% were taking medicine regularly and 20% were no longer taking medicine regularly 7. Present study had shown that 90% of hypertensive subjects were never using alternative medicines, 42% were always maintaining their follow up schedule, 54% of hypertensive patients were going for regular check up and 82% of hypertensive patients were never maintaining their logbooks.(table 2) It was also found that majority were avoiding intake of fats in their daily dietary 69

6 pattern, more than 50% were taking fresh fruits in their daily diet and 98% of hypertensive patients taking one teaspoon of salt daily (Table 2). The dietary approaches to stop hypertension (DASH) eating plan encompasses a diet rich in fruits, vegetables, and low - fat diet production and may lower blood pressure by 8-14mmHg (Swetkey,2001). The DASH trial has shown reduction in blood pressure of 3.5/2. 1mmHg in normotensive individuals on consumption of diet recommended by DASH. Patients can gain from exercise,weight loss, cessation of smoking, reduction of sodium and alcohol intake and increased potassium and calcium intake. These modifications can improve overall health in addition to lowering blood pressure 10. Where as the present study revealed 54% hypertensive patients were not doing physical exercises or yoga /meditation. Only 38% were go for brisk walk daily for minutes (Table 2). So, the present study has thrown significant light on practices of hypertensive patients. Varied practices have been found among hypertensive patients regarding control of hypertension. Based on findings it was recommended that a nursing personnel should be appointed in cardiology O.P.D to motivate the patients to adopt healthy lifestyle practices for controlling blood pressure. References 1. George A M. The global burden of hypertension: good news and bad news. Cardiology clinics 2002; 20: Black M J, Hawks H J, Keene M A. Medical-surgical nursing clinical management for positive outcomes.6th ed. Philedephia: Saunders 2001; Devika S. Global burden of hypertension: analysis of worldwide data. Lancet 2005; 365: Ibrahim M. Future of research in hypertension in developing countries. Clinical research 1996; 2(2): Aubert line et al.knowledge, attitude, and practices on hypertension in a country in epidemiological transition. Hypertension 1998; 31; WHO expert committee. Hypertension control. WHO technical report series no 862.Geneva, Switzerland: World Health Organisation; Egan, Lackland, Cutler. wareness, knowledge, and attitude of older americans about high blood pressure:implications for health care policy,education, and research.arch intern med 2003 Mar 24;163(6); Mark A. Patient knowledge and awareness of hypertension is suboptimal results from a large health maintenance organization. J Clin Hypertensions 2003; 5(4):