Cardiovascular Risk Assessment in Hypertensive patients:

A Perspective Observative Study

 

T. Praveen Kumar1*, P. Prashanthi2, Shaik Sabiya2, M. Chinna Eswaraiah3

1Department of Pharmaceutics, Anurag Pharmacy College, Kodad (M), Suryapet (D),

Telangana State. 508206, India.

2Department of Pharm D, Anurag Pharmacy College, Kodad (M), Suryapet (D), Telangana State. 508206, India.

3Department of Pharmacognosy, Anurag Pharmacy College, Kodad (M), Suryapet (D),

Telangana State. 508206, India.

*Corresponding Author E-mail: thirunagarii.praveen@gmail.com

 

ABSTRACT:

Congestive heart disease (CHD) is considered to be the leading cause of mortality and morbidity in both gender groups in developed and developing countries. Hypertension is one of the main mortality risks and is attributed to over 45% of all deaths from CHD. The main objective of our work was to evaluate cardiovascular risk in hypertensive patients attending a tertiary care hospital in the Khammam region. The study was a prospective observational study conducted over an 8-month period from June 2019 to January 2020. 192 subjects were selected based on the inclusion criteria. CVD risk was assessed using Q Risk 3 software and the results were presented as CVD risk and relative risk. The same number of men and women (96) was selected in the study to evaluate the influence of gender on CVD risk. Other risk factors such as BMI, marital status, literacy rate, occupation, physical activity and lifestyle were assessed to determine CVD risk. Abnormal HTN values ​​were found in 66 men and 63 women. Age progression was found to be an important factor in CVD risk in both men and women. Social status and literacy rates in patients over 50 have also been found to cause CVD risk. Our study showed that physical inactivity, eating habits, obesity, smoking, alcohol and hypertension had a direct effect on cardiovascular risk.

 

KEYWORDS: Age, Cardiovascular risk, Hypertension, lifestyle, Relative risk.

 

 


INTRODUCTION:

High blood pressure (BP) is the main risk factor for cardiovascular disease (CVD) and hypertension is the leading cause of disability worldwide1,2. There is a decrease in vascular compliance and endothelial damage due to hypertension3,4.

 

The most common responsible risk factor for cardiovascular disease and cerebro vascular disease is suboptimal blood pressure control, which includes stroke (58%) and ischemic stroke (50%), ischemic heart disease (55%) and other forms of cardiovascular disease (58%), including cardiac arrest and peripheral arterial disease (PAD). In addition, hypertension is a major cause of chronic kidney disease (CKD), progression of kidney disease and end-stage kidney disease, including dementia due to white matter disease5-8.

 

The underlying factors which often develop smoothly in childhood and adulthood, are weight gain leading to overweight/obesity, a harmful diet, excess sodium in the diet and insufficient potassium intake, inadequate physical activity and drinking liquor9.

 

Eating healthy foods lowers blood pressure. The Dietary Approach to Stop Hypertension (DASH) is an effective program primarily for lowering blood pressure10,11. The DASH diet is rich in vegetables, fruits, nuts, whole grains, legumes, lean proteins and low-fat dairy products and is significantly reduced in processed sugars, saturated fats and cholesterol. The combination of low sodium intake and the DASH diet provides a significantly greater reduction in BP than the sodium restriction or DASH12 diet alone.

 

Observational studies have eternally played a key role in physical activity in preventing hypertension and regulating blood pressure with each other with hypertension13. However, modest levels of physical activity correspond to reducing the likelihood of incident hypertension14. Studies in various populations reveal a direct effect, almost linear relationship of the body mass index (BMI) with BP15. The risk of hypertension increases continuously with increasing anthropomorphic calculations (measurement of life, waist-hip ratio and height-life ratio) according to BMI16.

 

Clinical studies often indicate that weight loss reduces the risk of hypertension17,18. The social determinants of well-being are widely defined as "the conditions in which people are born, are incorporated, reside, work and age and the systems together deal with disease19. The socio-economic state includes capital and income, education, employment/occupation status, access to medical care and other items.

 

METHODOLOGY:

Study design and period:

This was a prospective observational study conducted for an 8-month period (June 2019 to January 2020) in patients admitted to tertiary care hospitals in the Khammam district, Telangana.

 

Ethical consideration:

The study protocol was approved by the institutional ethics committee of Anurag Pharmacy College.

 

All participants were informed of the study details and informed consent was obtained before the study started. Informed consent is included.

 

Inclusion criterion:

·       Patients aged> 18 years.

·       Patients voluntarily agreed to participate with a written consent form.

·       Patients whose records had no consolidated history or CVD history and are willing to participate.

 

Exclusion criteria:

·       Patients over the age of 70.

·       Patients whose early hospitalization is less than 24 hours.

·       Patients who do not respond and/or are not communicative.

·       Patients who are discharged on medical advice.

·       Patients whose records have shown an established history or a history of cardiovascular disease.

 

Study procedure:

A total of 192 patients who met the inclusion criteria were recruited into the study. An appropriate data collection form and patient consent form were designed and used in the study. Only with the patient's consent, relevant data were collected. All necessary data, including patient demographics, medical and drug history, diagnosis, treatment table and laboratory investigation data were collected and documented in a data collection form specially designed for the study.

 

CVD risk assessment from hypertension:

Using the Q RISK 3 software, we estimated CVD risk and relative risk in participants in both genders.

 

RESULTS:

A total of 192 respondents participated in the study. The same number of men and women (96) was selected in the study to evaluate the influence of gender on CVD risk.

 

Considered the social status of men and women, among whom 66 subjects belonged to urban areas and 126 to rural areas. When considering the literacy rate for both men and women, 99 of them had an education and 93 had no education. Occupations of men and women are taken, 150 subjects were employed and 42 subjects were unemployed. The results were reported in Table 1.

 

Among 192 subjects, 69 were active smokers and 87 were alcoholics. The results are shown in Figure 2. Tobacco and alcohol consumption was observed only in men. Among 192 subjects, 96 subjects had daily physical activity, 54 subjects had weekly physical activity and 42 subjects had rarely physical activity.

 

The eating habits included in male and female subjects, including 36 subjects had a low intake of sugar/salt, 114 subjects had a moderate consumption and 42 subjects had a high intake of salt and sugar. 54 subjects had a low intake of fatty eating habits, 81 subjects had a moderate intake of fatty eating habits and 57 subjects had a high intake of fatty eating habits. The results have been reported in figure 3.

 

Among 192 subjects, 90 reported having stress. Among 192 subjects, normal HTN levels were found in 63 subjects and 129 subjects with abnormal HTN levels. The results were reported in Table 2.

 

Figure No: 1: Age and gender wise distribution of patients.

 

Table No: 1: Social status of patients

Variables

Males

Females

Total

Urban

30

36

66

Rural

66

60

126

Educated

42

57

99

Uneducated

54

39

93

Employed

93

57

150

Unemployed

3

39

42

 

Figure No: 2: Smoking and alcoholic distribution of patients.

 

Figure No: 3: Physical activity and dietary habits of patients

 

Table No: 2: Hypertension Profile Distribution of patients

Hypertension range

Males

Females

Total

Normal

30

33

66

Abnormal

66

63

129

 

Assessment of CVD risk and Relative risk due to Hypertension:

Using the Q RISK 3 software, we estimated CVD risk and relative risk in participants of male and female hypertension individually. In males, the risk 0-10 in 12 subjects, the risk 11-20 was in 3 subjects, the risk 31-40 was observed in 3 subjects, the risk 41-50 in 6 subjects, the risk 51-60 in 30 subjects, the risk 61-70 in 42 subjects.

 

Participating women observed a 0-10 risk in 6 subjects, a 11-20 risk in 3 subjects, a 21-30 risk in 3 subjects, a 31-40 risk in 12 subjects, a 41-50 risk in 21 subjects, a 51-60 risk in 24 subjects, 61-70 risk in 27 subjects. The results are presented in Table 3.

 

In men it was found that less than 3% of relative risk in 9 subjects, 3-6% of relative risk in 18 subjects, over 6% of relative risk in 69 subjects.

 

In women It was found that less than 3% of relative risk in 6 subjects, 3-6% of relative risk in 18 subjects, over 6% of relative risk in 72 subjects. The results were reported in Table 4.

 

Table No: 3: Q Risks 3 Software Score Distribution in Males and females patients

CVD Risk

Males

Females

Total

0-10

12

6

18

11-20

3

3

6

21-30

0

3

3

31-40

3

12

15

41-50

6

21

27

51-60

30

24

52

61-70

42

27

71

 

Table No: 4: Gender wise Relative Risk Profile of patients

Relative Risk

Males

Females

<3

9

6

3-6

18

18

>6

69

72

 

DISCUSSION:

Hypertension occurs due to numerous parameters such as age, BMI, lifestyle, marital status. The educational status of subjects can also contribute to CVD risk. In this study, both men and women are equally prone to HTN. Among them, hypertension is most present in the 50-70 age group in men and women. This indicates that age is the main contributing factor to CVD risk.

 

The BMI was calculated and among these many of them have normal weight and few were overweight. Due to the weight gain which leads to the narrowing of the blood vessels due to the deposition of fat.

 

The socioeconomic status, like the people in whom they are born, grow and live, the work area, education and the availability of medical facilities are also considered CVD risk factors.

 

 

Due to the busy schedule of life in urban areas, the majority of subjects were subject to hypertension compared to rural areas.

The uneducated were more prone to CVD risk due to their lack of knowledge and medical facilities. Lack of disease awareness and effective management skills lead to chronic diseases.

 

Depending on the state of employment, students and unemployed subjects are less subject to CVD risk than professionals and the workforce due to workload and stress.

 

In this study, men were more prone to CVD risk due to alcohol consumption and cigarette smoking. Tobacco and alcohol use has been reported to have a direct effect on heart risk.

 

Today, due to changes in eating habits and physical activity and salt intake, it can also contribute to CVD risk.

 

Eating habits, such as an increased intake of salt and fatty foods, also increase the risk of CVD due to the increase in BP levels in the body. Excessive sodium intake is positively related to hypertension.

 

It has been observed that due to rare physical activity, the HTN level may increase. Studies Show that physical activity is most important for maintaining a healthy body. Even moderate levels of physical activity reduce the risk of hypertension.

 

If we look at the stress parameter, most of the subjects were in stress conditions, due to the stress that leads to an increase in blood pressure which carries a risk of CVD. Blood pressure levels have been classified into 4 stages; level 4 HTN levels were prone to an increased risk of CVD

 

In our study, the results were calculated using the Q RISK 3 software scale, a 61-70% risk was observed in the age group of 60-70 years in men and women. Relative risks> 6 have been reported in men and women.

 

CONCLUSION:

The present study reveals that with age progression, physical activity, eating habits, smoking and alcohol consumption have a direct effect on cardiovascular risk. All factors are directly related to each other to contribute to CVD risk. The findings indicate the importance of managing these risk factors among patients who come to the hospital. The clinical outcome will be delayed due to the poor management of these risk factors and may lead to greater health complications and increase the cost of therapy. Patients attending hospitals need to be well informed about risk factors and encouraged to adapt to good lifestyle changes. This study also highlights the need for further studies on inflammatory markers such as CRP and ALT that are involved in the pathogenesis of coronary artery disease.

 

ABBREVIATIONS:

BP: Blood pressure, ALT: alanine transaminase, CVD: cardio vascular diseases, CHF: congestive heart failure, CHD: Congestive heart diseases, HTN: hypertension, BP: Blood pressure, BMI: Body mass index. DASH: Dietary Approaches to Stop Hypertension,

 

ACKNOWLEDGEMENT:

The authors would like to thank Dr. M. Chinna Eswaraiah, Principal of Anurag Pharmacy College, for granting us the necessary permission for the study. The authors also thank all the faculty members of Anurag Pharmacy College for their constant support and guidance.

 

CONFLICT OF INTEREST:

The authors declare that they have no conflict of Interest.

 

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Received on 16.07.2020           Modified on 21.08.2020

Accepted on 17.09.2020         © RJPT All right reserved

Research J. Pharm. and Tech. 2021; 14(8):4420-4424.

DOI: 10.52711/0974-360X.2021.00767