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 pressure1. 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.

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
Key words :
eyes. It is powerful and independent predictor
Practices, hypertensive patients. of premature deaths and is asymptomatic till
its damaging effects, such as stroke,
myocardial infarction, and renal dysfunction,
are observed1.
Hyper tension is an intermittent or
persistent elevation of blood pressure (systolic
Correspondence at : pressure above 140mm Hg or diastolic blood
Kuldeep Kaur, pressure above 90 mm Hg or a systolic and
Lecturer, CON, diastolic pressure of 20mm Hg above the
DMC&H, Ludhiana normal baseline pressure2.
Nursing and Midwifery Research Journal, Vol-3, No. 2, April 2007 65
 Hyper tension 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
20253.
Studies have shown poor and faulty
self-care practices among hyper tensive
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 pressure4.
Aubert et al (1998) conducted a study
representing sample of 1067 adults aged 25
to 64 years. Among hyper tensive patients
50% were aware of their condition, 34% were
getting treatment and 10% had controlled thier
blood pressure5.
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-wide7.
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.
Nursing and Midwifery Research Journal, Vol-3, No. 2, April 2007
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 2006. 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, socio-
demographic 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
Results
Socio-demographic profile of hypertensive
patients
Table 1 depicts that out of 50 patients
interviewed, 17(34%) were of age group
55-65 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
hyper tension. 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%)
Nursing and Midwifery Research Journal, Vol-3, No. 2, April 2007
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
Table 1: Socio-demographic profile of Habitat
hypertensive patients N=50 Urban 28 (56)
Variables f (%) Rural 20 (40)
Slum 02 (04)
Age(in years)
35 - 45 06 (12) Type of family
45 - 55 14 (28) Nuclear 26 (52)
55 - 65 17 (34) Joint 24 (48)
> 65 13 (26)
Monthly income of family(in Rs.)
Age: Range=38-85yrs, Mean= 57.229.66
<5000 22 (44)
Gender 5001-10000 16 (32)
Male 19 (38) 10001-15000 04 (08)
Female 31 (62) >20000 08 (16)
Educational status
Total monthly income of family:
Illiterate 16 (32) Range=Rs.500-50000,
Primary 09 (18) Mean=1020010167
Matric 19 (38) Habits
10+2 03 (06) Smoking
Graduate 03 (06) Nonsmoker 49 (98)
Marital status Smoker 01 (02)
Married 44 (88) Alcohol consumption
Widow/widower 06 (12) Nondrinker 47 (94)
Moderate drinker 03 (06)
Occupation
Physical activity
Skilled 08 (16)
Unskilled 04 (08) Sedentary work 38 (76)
Professional 03 (06) Moderate work 11 (22)
Housewives and others 35 (70) Heavy work 01 (02)

Religion Dietary habits

Hindu 23 (46) Vegetarian 37 (74)

Sikh 23 (46) Non-vegetarian 02 (04)
Any other 04 (08) Eggetarian 11 (22)

Nursing and Midwifery Research Journal, Vol-3, No. 2, April 2007 68

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 38-80 years
were interviewed to asses their practices
regarding hypertension.
Life practices of hyper tensive
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
Nursing and Midwifery Research Journal, Vol-3, No. 2, April 2007
by Egan reporting that 80% were taking
medicine regularly and 20% were no longer
taking medicine regularly7.
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 log-
books .(Table 2)
It was also found that majority were
avoiding intake of fats in their daily dietary
69
pattern , more than 50% were taking fresh
fr uits 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 pressure10.
Where as the present study revealed 54%
hyper tensive patients were not doing
physical exercises or yoga /meditation . Only
38% were go for brisk walk daily for 30-45
minutes (Table 2).
So, the present study has thrown
significant light on practices of hypertensive
patients. Varied practices have been found
among hyper tensive 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.
Nursing and Midwifery Research Journal, Vol-3, No. 2, April 2007
References
1. George A M. The global burden of
hypertension: good news and bad news.
Cardiology clinics 2002; 20: 181-185
2. Black M J, Hawks H J, Keene M A.
Medical-surgical nursing clinical management
for positive outcomes.6th ed. Philedephia:
Saunders 2001; 1379-94
3. Devika S. Global burden of hypertension:
analysis of worldwide data. Lancet 2005; 365:
217-23.
4. Ibrahim M. Future of research in
hypertension in developing countries. Clinical
research 1996; 2(2): 202-05.
5. Aubert line et al .Knowledge, attitude, and
practices on hyper tension in a country in
epidemiological transition. Hypertension 1998;
31; 1136- 45.
6. WHO expert committee. Hypertension
control. WHO technical report series no
862.Geneva, Switzerland: World Health
Organisation; 1996.
7. 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);654-56.
8. Mark A. Patient knowledge and
awareness of hypertension is suboptimal results
from a large health maintenance organization.
J Clin Hypertensions 2003; 5(4):254-60.
70