RAJIVGANDHIUNIVERSITY OF HEALTH SCIENCES, BANGAORE, KARNATAKA.
SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
MS. V. SUSEELA
1st YEAR M.Sc., NURSING
COMMUNITY HEALTH NURSING
YEAR 2008 – 2009
CAUVERY COLLEGE OF NURSING
# 42/2B, 2C, TERESIAN CIRCLE,
SIDHARTHA LAYOUT,
MYSORE
RAJIVGANDHIUNIVERSITY OF HEALTH SCIENCES, BANGALORE, KARNATAKA.
PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
1. / NAME OF THE CANDIDATEAND ADDRESS / Ms. V. SUSEELA
1st YEAR M. Sc., NURSING,
CAUVERY COLLEGE OF NURSING,
# 42/2B, 2C, TERESIAN CIRCLE,
SIDHARTHA LAYOUT,
MYSORE.
2. / NAME OF THE INSTITUTION / CAUVERY COLLEGE OF NURSING,
# 42/2B, 2C, TERESIAN CIRCLE,
SIDHARTHA LAYOUT,
MYSORE.
3. / COURSE OF STUDY AND
SUBJECT / M. Sc., NURSING
COMMUNITY HEALTH NURSING
4. / DATE OF ADMISSION TO THE COURSE / 30.06.2008
5. / TITLE OF THE TOPIC / KNOWLEDGE REGARDING EARLY DETECTION AND MANAGEMENT OF HYPERTENSION AMONG ADULTS IN SELECTED RURAL AND URBAN AREAS ATMYSORE.
6 BRIEF resume of the INTENDED WORK
6.1 INTRODUCTION
Health is a resource for life, not the object of living; it is a positive concept emphasizing social and personal resources, as well as physical capacities. All communities have highly variable, unique strengths and health needs; and is a common theme in most cultures. Health is multidimensional and is the condition of being sound in body, mind or spirit especially freedom from physical disease or pain. Health is the outcome of a large number of determinants. The list of health determinants is quite long. The factors affecting health may be classified as agent, host and environment. The presence and interaction of these factors initiate the disease process in man.
Health is a common theme in most cultures; in fact all communities have their concepts of health, as part of their culture. Among definitions still used, probably the oldest is that health is the absence of disease. In some cultures, health and harmony are considered equivalent, harmony being defined as being at peace with the self, the community, god and cosmos. The ancient Indians and Greeks shared this concept and attributed disease to disturbances in bodily equilibrium of what they called humors.1
Hypertension, also referred to as high blood pressure, HTN or HPN, is a medical condition in which the blood pressure is chronically elevated. In current usage, the word "hypertension"without a qualifier normally refers to arterial hypertension.Hypertension can be classified either essential (primary) or secondary. Essential hypertension indicates that no specific medical cause can be found to explain a patient's condition. Secondary hypertension indicates that the high blood pressure is a result of (i.e., secondary to) another condition, such as kidney disease or tumours (pheochromocytoma and paraganglioma). Persistent hypertension is one of the risk factors for strokes, heart attacks, heart failure and arterial aneurysm, and is a leading cause of chronic renal failure. Even moderate elevation of arterial blood pressure leads to shortened life expectancy. At severely high pressures, defined as mean arterial pressures 50% or more above average, a person can expect to live no more than a few years unless appropriately treated.
In individuals older than 50 years, hypertension is considered to be present when a person's systolic blood pressure is consistently 140mm Hg or greater. Beginning at a systolic pressure of 115 and diastolic pressure of 75 (commonly written as 115/75mm Hg), cardiovascular disease (CVD) risk doubles for each increment of 20/10mmHg.Prehypertension is defined as blood pressure from 120/80mm Hg to 139/89mm Hg. Prehypertension is not a disease category; rather, it is a designation chosen to identify individuals at high risk of developing hypertension. The Mayo Clinic specifies blood pressure is "normal if it's below 120/80".Patients with blood pressures over 130/80mm Hg along with Type 1 or Type 2diabetes, or kidney disease require further treatment.Resistant hypertension is defined as the failure to reduce BP to the appropriate level after taking a three-drug regimen. The American Heart Association released guidelines for treating resistant hypertension.2
Hypertension is often called the "silent killer" because most people who have it do not feel sick, but if left uncontrolled, it can lead to a heart attack or kidney disease. This is why it is so important to treat hypertension even if you feel fine.Symptoms Most of the time, there are no symptoms. Symptoms that may occur include: Confusion, Chest pain, Ear noise or buzzing, Irregular heartbeat, Nosebleed, Tiredness andVision changes. Diagnosis of hypertension is generally on the basis of a persistently high blood pressure. Usually this requires three separate measurements at least one week apart. Exceptionally, if the elevation is extreme, or end-organ damage is present then the diagnosis may be applied and treatment commenced immediately.3
Drug-free Treatment of Hypertension: Lifestyle modification (nonpharmacologic treatment) includes Weight reduction and regular aerobic exercise, Reducing dietary sugar intake, Reducing sodium (salt) in the diet may be effective, Additional dietary changes beneficial to reducing blood pressure includes the DASH diet (dietary approaches to stop hypertension), which is rich in fruits and vegetables and low fat or fat-free dairy foods, Discontinuing tobacco use and alcohol consumption and Reducing stress, for example with relaxation therapy, such as meditation and other mindbody relaxation techniques, by reducing environmental stress such as high sound levels and over-illumination can be an additional method of ameliorating hypertension. Jacobson's Progressive Muscle Relaxation and biofeedback are also used. Commonly used drugs include:ACE inhibitors such as creatinecaptopril, enalapril, fosinopril (Monopril), lisinopril (Zestril), quinapril, ramipril (Altace), Angiotensin II receptor antagonists: eg, telmisartan (Micardis, Pritor), irbesartan (Avapro), losartan (Cozaar), valsartan (Diovan), candesartan (Amias), Alpha blockers such as prazosin, or terazosin. Doxazosin has been shown to increase risk of heart failure, and to be less effective than a simple diuretic[29], so is not recommended., Beta blockers such as atenolol, labetalol, metoprolol (Lopressor, Toprol-XL), propranolol., Calcium channel blockers such as nifedipine (Adalat)[30]amlodipine (Norvasc), diltiazem, verapamil, Direct renin inhibitors such as aliskiren (Tekturna), Diuretics: eg, bendroflumethiazide, chlortalidone, hydrochlorothiazide (also called HCTZ), Combination products (which usually contain HCTZ and one other drug).
While elevated blood pressure alone is not an illness, it often requires treatment due to its short- and long-term effects on many organs. The risk is increased for: Cerebrovascular accident (CVAs or strokes), Myocardial infarction (heart attack), Hypertensive cardiomyopathy (heart failure due to chronically high blood pressure), Hypertensive retinopathy - damage to the retina, Hypertensive nephropathy - chronic renal failure due to chronically high blood pressure, Hypertensive encephalopathy - confusion, headache , convulsion due to vasogenic edema in brain due to high blood pressure.4
The investigator is planning to conduct the present study to consider the early detection and prevention and management of hypertension.
6.2 NEED FOR THE STUDY
Prevalance of Hypertension is 50 million Americans, Prevalance Rate:approx 1 in 5 or 8.38% or 50 million people in USA , Undiagnosed prevalence of Hypertension:more than 15 million (more than 30% of 50 million are undiagnosed), Undiagnosed prevalence rate: approx 1 in 18 or 5.51% or 15 million people in USA, undiagnosed cases of Hypertension: 80-85% affected are not treated in England. Worldwide prevalence of Hypertension is estimated 600 million people affected worldwide. Hypertension affects 25% of adults in the United States. If untreated, it carries a high mortality. Risk factors for hypertension include family history, race (most common in blacks), stress, obesity, a diet high in saturated fats or sodium, tobacco use, sedentary lifestyle, and aging.
The age-adjusted prevalence of hypertension in overweight U.S. adults is 23.9% for men and 23.0 percent for women, compared with 18.2% for men and 16.5% for women who are not overweight. The prevalence for obese adults is 38.4% for men and 32.2% for women. (Hypertension is defined as mean systolic blood pressure 140 mm Hg, mean diastolic 90 mm Hg, or currently taking antihypertensive medication.). The following statistics relate to the prevalence of Hypertension: 50 million cases in the USA, 35% of cases are unaware of their condition USA, Estimated 50,000,000 in the USA 2001, 50,000,000 cases in the USA, 32% of noninstitutionalised adults over 20 had hypertension in the US 2000, 41,900 home health care patients had hypertension as a primary diagnosis in the US 2000, 3.1% of home health care patients had hypertension as a primary diagnosis in the US 2000, 20 million cases in Africa, 9% of men reported high blood pressure in Canada 1996/97, 27.2% of female population have high blood pressure in Australia 1999-2001, 32.3% of male population have high blood pressure in Australia 1999-2001.
Hypertension is common cardiovascular diseases in adults above 40 years. Nearly 11% of the urban population is suffering from Ischaemic Heart Disease and / or Hypertension. Prevalence is increasing year by year. Heart attack is a common cause for death. Prevention is better than cure. Hence, I request every one of you to follow the below mentioned guidelines and help in reducing the cardiovascular diseases in our state. MYSORE: The incidence of heart disease has doubled in India during the last 20 years on account of changes in lifestyle and economic development.5
The United States' National High Blood Pressure Education Program (NHBPEP) has updated recommendations for preventing hypertension to include advice such as an adequate intake of potassium and a diet rich in fruit and vegetables. New recommendations to lower blood pressure also advise a diet rich in low-fat dairy products, lowin saturated and total fat, and reinforcesearlier recommendations to limit consumption of sodium andalcohol, reduce excess body weight, and increase levels ofphysical activity. Nurses will educate clients about self/home blood pressure monitoring techniques and appropriate equipment to assist in potential diagnosis and the monitoring of hypertension. Nurses will educate clients on their target blood pressure and the importance of achieving and maintaining this target. Nurses will work with clients to identify lifestyle factors that may influence hypertension management, recognize potential areas for change, and create a collaborative management plan to assist in reaching client goals, which may prevent secondary complications. Nurses will assess for and educate clients about dietary risk factors as part of management of hypertension, in collaboration with dietitians and other members of the healthcare team. Nurses will counsel clients with hypertension to consume the DASH Diet (Dietary Approaches to Stop Hypertension), in collaboration with dietitians and other members of the healthcare team. Nurses will advocate that clients with a BMI greater than or equal to 25 and a waist circumference over 102 cm (men) and 88 cm (women) consider weight reduction strategies.6
Singh RB, Beegom R, Mehta AS et al. (2008) conducted a study on prevalence and risk factors of hypertension and age-specific blood pressures in five cities: a study of Indian women. The study revealed that the prevalence of hypertension (>140/90 mm Hg) was significantly high in Trivandrum, South India (30.7%), and Bombay, West India (28.0%), compared to Moradabad, which is in northern India (22.6%), Nagpur, in central India (24.2%), and Calcutta, in east India (19.1%). Mean systolic and diastolic blood pressures were significantly higher in Trivandrum and Bombay compared to the other three cities. The overall prevalence of hypertension was 25.6% and isolated diastolic hypertension was the most common form of hypertension (50.5%) in the five Indian cities.7
Singh RB, Beegom R, Ghosh S et al. (2007) conducted a epidemiological study of hypertension and its determinants in an urban population of North India. The study revealed that the prevalence of hypertension according to WHO/ISH criteria was 23.7% and by old WHO criteria 13.3%. In the WHO/ISH (International society of hypertension) hypertensive group, isolated diastolic hypertension was present in 47.3% males and 40.6% females. Males have a slightly higher prevalence than females in the young age group. Association of higher socioeconmic status, higher body mass index and central obesity in North Indian adults with higher fat intake, lower physical activity and higher prevalence and level of hypertension indicate that these populations may benefit by decreasing the dietary fat intake and increasing physical activity, with an aim to decrease central obesity for decreasing hypertension in North Indians.8
Singh RB, Rastogi SS, Rastogi V et al. (2007) conducted a study on blood pressure trends, plasma insulin levels and risk factors in rural and urban adult populations of north India. The findings indicate that urban subjects had higher blood pressures than did rural subjects and that age, body mass index, central obesity and 2 h plasma insulin levels were significant risk factors for hypertension in an adult population.9
SavithaMR, KrishnamurthyB, Fatthepuret al. (2007) conducted a study on essential Hypertension in Early and Mid-Adults. The results showed that 6.16% of adults had high blood pressure at the end of fourth screening. Both systolic and diastolic hypertensions were documented. Increased body mass index and reduced consumption of vegetables and fruits were found to be statistically significant risk factors for hypertension. Conclusion. Multiple blood pressure recordings are essential for accurate diagnosis of hypertension. There is a high prevalence of essential hypertension amongst adults in Mysore city with modifiable risk factors for hypertension.10
Gupta R (2004) conducted a study on trends in hypertension epidemiology in India. The study revealed that hypertension is directly responsible for 57% of all stroke deaths and 24% of all coronary heart disease deaths in India. Recent studies using revised criteria (BP > or =140 and/or 90 mmHg) have shown a high prevalence of hypertension among urban adults: men 30%, women 33% in Jaipur (1995), men 44%, women 45% in Mumbai (1999), men 31%, women 36% in Thiruvananthapuram (2000), 14% in Chennai (2001), and men 36%, women 37% in Jaipur (2002). Among the rural populations, hypertension prevalence is men 24%, women 17% in Rajasthan (1994). Hypertension diagnosed by multiple examinations has been reported in 27% male and 28% female executives in Mumbai (2000) and 4.5% rural subjects in Haryana (1999). There is a strong correlation between changing lifestyle factors and increase in hypertension in India. The nature of genetic contribution and gene-environment interaction in accelerating the hypertension epidemic in India needs more studies. Pooling of epidemiological studies shows that hypertension is present in 25% urban and 10% rural subjects in India. At an underestimate, there are 31.5 million hypertensives in rural and 34 million in urban populations. Population-based cost-effective hypertension control strategies should be developed.11
The nurse plays an vital role in educating adults to adopt a healthy life style modification, which may be considered under seven headings: (i) Quit smoking (ii) manage weight (iii) taking reasonable exercise (iv) cut down on salts (v) manage alcohol intake (vi) keep cholesterol level under check (vii) taking antioxidant foods.
The investigator from his clinical experience has observed that most of the adult patients are admitted withhypertension. Based on the above facts and figures, it is found that the adults have very little knowledge about the early detection and prevention and management of hypertension.Hence the investigator felt a need to give aplanned teaching programme to adults regarding antioxidant diet to prevent the complications related to heart diseases.
6.8 Review of literature
1. REVIEW RELATED TO THE INCIDENCE AND PREVALENCE OF HYPERTENSION
Cutler JA, Sorlie PD, Wolz M et al. (2008) conducted a study on trends in hypertension prevalence, awareness, treatment, and control rates in United States adults between 1988-1994 and 1999-2004. The study revealed that the age-standardized prevalence rate increased from 24.4% to 28.9%, with the largest increases among non-Hispanic women. Among hypertensive persons, there were modest increases in awareness, from 68.5% to 71.8%. The rate for men increased from 61.6% to 69.3%, whereas the rate for women did not change significantly. Rates remained higher for women than for men, although the difference narrowed considerably. Improvements in treatment and control rates were larger: 53.1% to 61.4% and 26.1% to 35.1%, respectively. The greatest increases occurred among non-Hispanic white men and non-Hispanic black persons, especially men. Mexican American persons showed improvement in treatment and control rates, but these rates remained the lowest among race/ethnic subgroups (47.4% and 24.3%, respectively).12
Gupta R (2007) conducted a study on meta-analysis of prevalence of hypertension in India. Trend analysis comparable studies among urban areas show a significant increase in the prevalence of hypertension. Studies in rural areas also show an increase in prevalence of hypertension although the rise is not as steep as in urban populations. In India, hypertension is emerging as a major health problem and is more in urban than in rural subjects.13
Hajjar I, Kotchen JM and Kotchen TA (2006) conducted a study on hypertension: trends in prevalence, incidence, and control. The study revealed that hypertension is the leading cause of cardiovascular disease worldwide. Prior to 1990, population data suggest that hypertension prevalence was decreasing; however, recent data suggest that it is again on the rise. In 1999-2002, 28.6% of the U.S. population had hypertension. Hypertension prevalence has also been increasing in other countries, and an estimated 972 million people in the world are suffering from this problem. Incidence rates of hypertension range between 3% and 18%, depending on the age, gender, ethnicity, and body size of the population studied. Despite advances in hypertension treatment, control rates continue to be suboptimal. Only about one third of all hypertensives are controlled in the United States. Programs that improve hypertension control rates and prevent hypertension are urgently needed.14
Shyamal Kumar Das, Kalyan Sanyal and Arindam Basu (2005) conducted a study of urban community survey in India: growing trend of high prevalence of hypertension in a developing country. The prevalence pattern of hypertension in developing countries is different from that in the developed countries. In India, a very large, populous and typical developing country, community surveys have documented that between three and six decades, prevalence of hypertension has increased by about 30 times among urban dwellers and by about 10 times among the rural inhabitants. Results showed pre-hypertensive levels of blood pressures among 35.8% of the participants in systolic group (120-139mm of Hg) and 47.7% in diastolic group (80-89 mm of Hg). Systolic hypertension (140 mm of Hg) was present in 40.9% and diastolic hypertension (90 mm of Hg) in 29.3% of the participants. Age and sex-specific prevalence of hypertension showed progressive rise of systolic and diastolic hypertension in women when compared to men. Men showed progressive rise in systolic hypertension beyond fifth decade of life.15