6 · web viewprehypertension is defined as blood pressure from 120/80 mm hg to 139/89 mm hg....
TRANSCRIPT
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGAORE, KARNATAKA.
SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
MS. V. SUSEELA1st YEAR M.Sc., NURSING
COMMUNITY HEALTH NURSINGYEAR 2008 – 2009
CAUVERY COLLEGE OF NURSING# 42/2B, 2C, TERESIAN CIRCLE,
SIDHARTHA LAYOUT,
MYSORE
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE, KARNATAKA.
1
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
AT MYSORE.
6 BRIEF RESUME OF THE INTENDED WORK
2
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.
3
In individuals older than 50 years, hypertension is considered to be present when a
person's systolic blood pressure is consistently 140 mm Hg or greater. Beginning at a systolic
pressure of 115 and diastolic pressure of 75 (commonly written as 115/75 mm Hg),
cardiovascular disease (CVD) risk doubles for each increment of 20/10 mmHg.
Prehypertension is defined as blood pressure from 120/80 mm Hg to 139/89 mm 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 130/80 mm Hg
along with Type 1 or Type 2 diabetes, 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
4
and biofeedback are also used. Commonly used drugs include: ACE inhibitors such as
creatine captopril, 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.
5
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.
6
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
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
Savitha MR, Krishnamurthy B, Fatthepur et 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
8
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 with hypertension. 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 a planned teaching
programme to adults regarding antioxidant diet to prevent the complications related to heart
diseases.
9
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
10
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
SV Joshi, JC Patel and HL Dhar (2000) conducted a study on prevalence of
hypertension in Mumbai. The study revealed that there are few reports on prevalence of
hypertension in India. We are presenting a study of its incidence in OPD of hospital patients
in Mumbai. Prevalence of hypertension was 7.82% in all subjects, however, it was higher in
females 10.5% than in males 6.1%.16
2. REVIEW RELATED TO THE EARLY DETECTION AND MANAGEMENT OF
HYPERTENSION
Firdaus, Muhammad, Sivaram, Chittur A et al. (2008) conducted a study on
prevention of Cardiovascular Events by Treating Hypertension in Older Adults. The findings
revealed that the lowering BP in these individuals significantly reduces the risk of coronary
11
artery disease, stroke, and cardiovascular and all-cause mortality. Based on trial evidence, a
low-dose diuretic should be considered the most appropriate first-step treatment for
preventing cardiovascular morbidity and mortality.17
Mohan N, Campbell and A Chockalingam (2007) conducted a study on management
of hypertension in low and middle income countries. The study discussed that the barriers
and challenges to implementing this approach and what can be done regarding prevention,
screening, lifestyle modification and pharmacotherapy in developing countries. By adopting
a comprehensive population based approach including policy level interventions directed at
promoting lifestyle changes; a healthy diet (appropriate calories, low in saturated fats and salt
additives and rich in fruits and vegetables), increased physical activity, and a smoke free
environment, properly balanced with a high risk approach of cost effective clinical care,
developing countries can effectively control hypertension and improve public health.
Existing scientific knowledge regarding prevention, treatment and management should be
harnessed as a health priority to reduce the disease burden associated with uncontrolled
hypertension.18
Saverio Stranges, Francesco P and Cappuccio (2007) conducted a study on
prevention and Management of Hypertension Without Drugs. The study revealed that
Lifestyle modifications and non-drug therapies are a vast group of measures essential to the
prevention and management of hypertension. International experts unanimously recommend
some of them. However, not all measures are equally valuable or have the same evidence
base. The first step in the management of patients at any age who have hypertension should
be a reduction in salt intake, either alone or in combination with drug therapy, to which is
often additive. A high potassium diet achieved with an increase in the consumption of fruit
and vegetables is also recommended. Weight reduction, regular dynamic exercise and
reduction of alcohol consumption should be included in management plans for the prevention
and non-pharmacological treatment of hypertension.19
Miura K (2004) conducted a study on strategies for prevention and management of
hypertension throughout life. The study revealed that Hypertension has been acknowledged
as one of the greatest and established risk factors for cardiovascular diseases. In this special
12
article, strategies for the prevention and management of hypertension throughout human's
life were discussed. Studies showing the relationship of birth weight and height increase in
childhood to future blood pressure suggest that both environments during pregnancy and
during childhood and adolescence are important to prevent hypertension. The promotion of a
DASH (Dietary Approach to Stop Hypertension) dietary pattern, rich in fruits and vegetables,
is important not only for treatment of high blood pressure but also for long-term prevention
of blood pressure rise as well. Blood pressure measured in young adulthood can effectively
predict long-term risks of cardiovascular and all-cause mortality, so population-wide primary
prevention of high blood pressure for young adults is important.20
6.3 STATEMENT OF THE PROBLEM
A comparative study to assess the knowledge regarding early detection and
management of hypertension among adults in selected rural and urban areas at Mysore.
6.4 OBJECTIVES
1. To assess the knowledge regarding early detection and management of hypertension
among adults in selected rural areas.
2. To assess the knowledge regarding early detection and management of hypertension
among adults in selected urban areas.
3. To correlate the knowledge regarding early detection and management of hypertension
among adults in selected rural and urban areas.
4. To associate the knowledge with selected demographic variables among adults in selected
rural and urban areas.
13
6.5 OPERATIONAL DEFINITIONS
a) KNOWLEDGE: refers to the correct response of adults to the structured questionnaire on
the role of antioxidant diet in prevention of CVD. It refers to the awareness and
understanding of adults regarding antioxidant diet which covers the general information on
antioxidant, food sources of antioxidant, benefits in intake of antioxidant and its effects on
cholesterol level.
b) EARLY DETECTION: refers to the process of identifying the hypertension in its earliest
initiation and stage.
c) MANGEMENT: refers to the action taken to treat the hypertension. It includes non-
pharmacological and pharmacological treatment.
b) HYPERTENSION: refers to the increased blood pressure i.e., elevation of systolic blood
pressure equal or more than 140mmHg and diastolic blood pressure equal or more than
90mmHg.
c) ADULTS: It refers to the persons both male and females who are aged between 18 to 50
years and residing at selected rural and urban areas at Mysore.
6.6 HYPOTHESES
H01: There is no significant relationship between the knowledge of adults of selected rural and
urban areas.
H02: There is no significant association between selected demographic variables with the
knowledge among adults of selected rural and urban areas.
14
6.7 ASSUMPTIONS
1. Adults of rural areas may have inadequate knowledge on early detection and management
of hypertension.
2. Adults of urban areas may have some knowledge on early detection and management of
hypertension.
3. There will be no association between selected demographic variables with the knowledge
among adults of selected rural and urban areas.
4. Knowledge on early detection and management of hypertension among adults is
measurable.
6.8 DELIMITATION
The study is delimited to the adults who are aged between 18 to 50 years and residing at
selected rural and urban areas at Mysore.
7. MATERIAL AND METHODS
7.1 SOURCE OF DATA
Data will be collected from the adults who are aged between 18 to 50 years and residing at
selected rural and urban areas at Mysore.
7.2 METHOD OF COLLECTION OF DATA
Structured interview schedule method will be used to collect the data.
VARIABLES
Dependent (study) variable refers to : Knowledge
Extraneous variable refers to : Demographic variables viz. age, sex,
religion, education, marital status, type
of family, family income etc.
15
7.2.1 RESEARCH APPROACH
Descriptive survey approach will be used to carry out the study.
7.2.2 RESEARCH DESIGN
Descriptive design will be used.
7.2.3 SETTING
Selected rural and urban areas of Mysore.
7.2.4 POPULATION
The population of the present study consists of the adults who are aged between 18 to 50
years and residing at selected rural and urban areas at Mysore.
7.2.5 SAMPLE SIZE
The sample size of the present study comprises 60 adults.
7.2.6 SAMPLING TECHNIQUE
Purposive Sampling technique will be adopted to select the sample.
7.2.7 SAMPLING CRITERIA
Inclusion criteria:
The adults who are willing to participate in the study.
The adults who are available during the period of data collection.
The adults who are in the age group of 18 to 50 years
The adults who can able to communicate either in Kannada or English
Exclusion criteria:
The adults who are not willing to participate in the study.
The adults who are absent during the period of data collection.
The adults who are aged below 18 and above 50 years.
16
7.2.8 TOOL FOR DATA COLLECTION
The tool for the data collection consists of two sections:
Section A: Socio-demographic proforma of the study participants.
Section B: Structured questionnaire to assess the knowledge on early detection and
management of hypertension among adults.
7.2.9 METHOD OF DATA ANALYSIS AND PRESENTATION
Data analysis will be through descriptive and inferential statistics.
Descriptive Statistics:
Frequency, percentage, mean, median, and standard deviation will be used to explain
demographic variables and to compute the knowledge.
Inferential Statistics:
Chi-square test will be used to find out the association between the selected
demographic variables with the knowledge among adults.
PROJECTED OUTCOME
The findings of the study would reveal the existing knowledge of adults regarding the
early detection and management of hypertension in selected rural and urban areas at Mysore.
7.3 DOES THE STUDY REQUIRE ANY INVESTIGATION OR INTERVENTIONS
TO BE CONDUCTED ON PATIENTS OR OTHER HUMANS OR ANIMALS? IF SO,
PLEASE DESCRIBE BRIEFLY.
No
7.4 HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR INSTITUTION?
YES, copy enclosed.
17
8. LIST OF REFERENCES
1. Park K. Text book of preventive and social medicine. 16 th ed. banarsidas bhanot
publishers. Jabalpur 2001; 11-40.; 2.
2. Hypertension. Wikipedia, the free encyclopedia.
http://en.wikipedia.org/wiki/Hypertension
3. What is hypertension? http://www.pfizerindia.com/health_hy.html
4. Hypertension. Wikipedia, the free encyclopedia.
http://en.wikipedia.org/wiki/Hypertension
5. Prevalence and Incidence of Hypertension. Wrong Diagnosis.
http://www.wrongdiagnosis.com/h/hypertension/prevalence.htm
6. Hypertension report stresses role of diet.
http://www.library.nhs.uk/stroke/ViewResource.aspx?resID=59773.
http://www.nutraingredients.com/Research/Hypertension-report-stresses-role-of-diet.
http://www.guideline.gov/summary/summary.aspx?ss=15&doc_id=8342&nbr=4669
7. Singh RB, Beegom R, Mehta AS et al. Prevalence and risk factors of hypertension
and age-specific blood pressures in five cities: a study of Indian women. Int J Cardiol.
1998 Jan 31;63(2):165-73
8. Singh RB, Beegom R, Ghosh S et al. A epidemiological study of hypertension and its
determinants in an urban population of North India. J Hum Hypertens. 1997
Oct;11(10):679-85. Links
9. Singh RB, Rastogi SS, Rastogi V et al. Blood pressure trends, plasma insulin levels
and risk factors in rural and urban adult populations of north India. Coron Artery Dis.
1997 Jul;8(7):463-8
18
10. Savitha MR, Krishnamurthy B, Fatthepur et al. Essential Hypertension in Early and
Mid-Adults. Article.
11. Gupta R. Trends in hypertension epidemiology in India. J Hum Hypertens. 2004
Feb;18(2):73-8
12. Cutler JA, Sorlie PD, Wolz M et al. Trends in hypertension prevalence, awareness,
treatment, and control rates in United States adults between 1988-1994 and 1999-
2004. Hypertension. 2008 Nov;52(5):818-27. Epub 2008 Oct 13.
13. Gupta R. Meta-analysis of prevalence of hypertension in India. Indian Heart J. 1997
Jan-Feb;49(1):43-8
14. Hajjar I, Kotchen JM and Kotchen TA. Hypertension: trends in prevalence, incidence,
and control. Annu Rev Public Health. 2006;27:465-90.
15. Shyamal Kumar Das, Kalyan Sanyal and Arindam Basu. Urban community survey in
India: growing trend of high prevalence of hypertension in a developing country. Int J
Med Sci 2005; 2:70-78
16. SV Joshi, JC Patel and HL Dhar. Prevalence of hypertension in Mumbai. Indian J Of
medical sciences Year : 2000 | Volume : 54 | Issue : 9 | Page : 380-3
17. Firdaus, Muhammad, Sivaram, Chittur A et al. Prevention of Cardiovascular Events
by Treating Hypertension in Older Adults. The Journal of Clinical Hypertension,
Volume 10, Number 3, March 2008 , pp. 219-225(7)
18. Mohan N, Campbell and A Chockalingam. Management of hypertension in low and
middle income countries. Indian journal of pediatrics 2007, vol. 74, no11, pp. 1007-
1011
19. Saverio Stranges, Francesco P and Cappuccio. Prevention and Management of
Hypertension Without Drugs. Current Hypertension Reviews, Volume 3, Number 3,
August 2007 , pp. 182-195(14)
19
20. Miura K. Strategies for prevention and management of hypertension throughout life.
J Epidemiol. 2004 Jul;14(4):112-7
9. SIGNATURE OF THE CANDIDATE
10. REMARKS OF THE GUIDE
11. NAME AND DESIGNATION OF (IN BLOCK LETTERS)
11.1 GUIDE
11.2 SIGNATURE
11.3 CO-GUIDE (IF ANY)
11.4 SIGNATURE
11.5 HEAD OF DEPARTMENT
11.6 SIGNATURE
12. 12.1 REMARKS OF THE
CHAIRMAN AND PRINCIPAL
20
12.2 SIGNATURE
21