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