Journal Club Presentation

Presented by : Dr. Kunal ModakGuided by : Dr. Abhay Mudey

05/01/2023 2

Title:- Prevalence and Risk Factors of Hypertension among Bank Employees in Urban Puducherry, India

Authors:- S Ganesh Kumar, N Deivanai Sundaram

Published in International Journal of Occupational & Environmental Medicine

Month/ Year: April/2014 I Volume: 05 I Issue:01Page:94 -100

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BackgroundThe prevalence of cardiovascular diseases

(CVDs) is on the rise, It is expected that by 2020, this group of diseases will be the largest cause of death in India.

Hypertension (HTN) is globally one of the most important risk factors for CVD.

The risks of CVDs are higher among the urban population.

HTN has several risk factors of which sedentary lifestyle and mental stress are a major component.

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Continued….Since the bank employees have

exposed to higher levels of these risk factors, they form an important high-risk group for screening HTN.

Bank employees undergo varying levels of mental stress to reduce the possibility of manual error and are thus more prone for chronic diseases like HTN.

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ObjectiveTo assess the prevalence and risk

factors of hypertension among bank employees in Puducherry, India.

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Previous Work Done Which Has Lead Up To The Study

Mohan V, Deepa S, Farooq V, et al found diabetes 11.9%; hypertension 25.4%; dyslipidaemia 40.2%; hypertriglyceridaemia 28.3%; overweight (body mass index > or = 23 kg/m2) 60.2%; and metabolic syndrome 34.1%. Use of tobacco in any form was present in 22.9% of men and 0.5% of women; 79% of the subjects followed a sedentary lifestyle. Among subjects receiving medication, 42.1% of subjects with diabetes and 55.3% of subjects with hypertension had their disease under adequate control.

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Continued….K. Srinath Reddy & Salim Yusuf, et al. found if

population levels of CVD risk factors rise as a consequence of adverse lifestyle changes accompanying industrialization and urbanization, the rates of CVD mortality and morbidity could rise even higher than the rates predicted solely by demographic changes.

A cross sectional survey of urban Delhi and its rural environs revealed that a higher prevalence of coronary heart disease (CHD) in the urban sample was associated with higher levels of body mass index, blood pressure, fasting blood lipids (total cholesterol, ratio of cholesterol to HDL cholesterol, triglycerides), and diabetes.

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Materials and Methods

Study Area : 12 Nationalized Banks in Urban Puducherry.

Study Duration : May to August, 2012Study Design : The study design was cross

sectional. The sampling design used was simple random sampling.

Study Sample : Assuming non response rate of 10% & consideration based on various studies in the west as well as in India and taking into account time constraints the sample size of 192 was taken.

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Inclusion Criteria:All the employees including managerial,

official and clerical staff of the selected banks were included in the study.

Subject should be the national banks in urban Puducherry were listed out.

Subject should be willing to be in study.If the selected subject could not be

contacted after at most three visits or refused to participate in the study, they were considered as non-respondents.

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The investigator took prior permission from respective bank managers for doing the study.

Days and time were fixed as per the convenience of workers and investigator.

Informed written consent was taken from each participant before initiating the study and strict confidentiality has been maintained.

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Data Collection After taking informed consent from the subject,

a self-administered questionnaire was given to them to obtain the baseline characteristics and identify the risk factors.

Blood pressure and height and weight of each participant were also measured.

Procedure Followed:-1) Blood pressure was measured using a

mercury sphygmomanometer of appropriate cuff size.

2) After 5 min of rest with the participant in sitting position, feet relaxed on the floor and arm supported at chest level.

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Precaution Taken:-the subject avoided caffeine, smoking or exercise for at least 30 min prior to measurement.Data classified into:-

1)Normal2)Pre- Hypertension3)Hypertension

Criteria used:- Joint National Committee (JNC) VII

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A questionnaire on the risk factors of HTN was prepared based on the questions taken from World Health Organization (WHO) STEPS self-administered instrument.

Data on addition of extra salt while eating food, eating foods with high-salt content, eating junk food, and servings of fruits and vegetables in the preceding week were also collected.

Assessment of Stress Scale:-Cohen’s Perceived Scale

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Stress level was Classified into;1)Low 2)Average 3)High4)Very High

Height & Weight was measured using a non- stretchable measuring tape. Standing against a wall bare foot.

Weight was measured using an electronic weighing scale.

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Statistical analysis

The collected data was analyzed by SPSS® for Windows® vertion 16.

χ2 test and multiple logistic regression analysis were used for data analyses.

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ResultVariable No. of

employeesNo. of patients with HTN (%)

p value

Age (yrs)21–3031–4041–5051–60

39585144

11 (28)28 (48)23 (45)23 (52)

0.132

OccupationManagerialOfficialClerical

1754121

9 (53)26 (48)50 (41)

0.529

Table 1: Prevalence of HTN according to age and occupation (n=192)

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Continued….Variable No. of

employeesNo. of patients with HTN (%)

p value

BMI (kg/m2)<25

9778

39 (40)35 (45)

0.170

25–30>30

17 11 (65)

SmokingYesNo

11181

7 (64)78 (43)

0.183

Alcohol useYesNo

58134

33 (57)52 (39)

0.020

Adding extra salt while eating foodYesNo

79113

42 (53)43 (38)

0.038

Tabl

e 2:

 Pre

vale

nce

of H

TN a

ccor

ding

to th

e st

udie

d ris

k fa

ctor

s (n=

192)

.

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Continued….Eating foods with high salt contentYesNo

79113

34 (43)51 (45)

0.774

Eating junk foodYesNo

79113

38 (43)47 (45)

0.780

Eating fruits≥7 servings/week<7 servings/week

9498

40 (43)45 (46)

0.639

Eating vegetables≥7 servings/week<7 servings/week

12666

75 (60)34 (52)

0.144

Tabl

e 2:

 Pre

vale

nce

of H

TN a

ccor

ding

to th

e st

udie

d ris

k fa

ctor

s (n=

192)

.

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Continued….Moderate Physical activityNil≤2 hrs2.1–4 hrs>4 hrs

62803020

37 (60)38 (48)3 (10)7 (35)

<0.001

Perceived stress levelLowAverageHighVery high

16316481

7 (44)13 (42)26 (41)39 (48)

0.823

DiabetesYesNo

22170

14 (64)71 (42)

0.052

Table 2: Prevalence of HTN according to the studied risk factors (n=192).

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Continued….Variable Adjusted OR (95% CI)Age (yrs)31–4041–5051–6021–30

3.13 (1.15–8.47)1.89 (0.67–5.45)3.11 (1.02–9.48)1.00

SexMaleFemale

1.74 (0.67–4.49)1.00

OccupationManagerialOfficialClerical

1.101 (0.30–4.04)1.263 (0.58–2.73)1.00

BMI (kg/m2)<2525–30>30

0.46 (0.13–1.61)0.43 (0.12–1.51)1.00Ta

ble

3: R

isk fa

ctor

s of H

TN d

eter

min

ed

by m

ultip

le lo

gist

ics re

gres

sion

anal

ysis

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Continued….SmokingYesNo

1.27 (0.28–5.79)1.00

Alcohol useYesNo

1.40 (0.61–3.20)1.00

Adding extra salt while eating foodYesNo

2.49 (1.21–5.11)1.00

Eating high-salt foodYesNo

1.21 (0.55–2.70)1.00

Eating junk foodYesNo

0.76 (0.34–1.70)1.00Ta

ble

3: R

isk fa

ctor

s of H

TN d

eter

min

ed

by m

ultip

le lo

gist

ics re

gres

sion

anal

ysis

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Continued….Eating fruits≥7 servings/wk<7 servings/wk

0.72 (0.34–1.53)1.00

Eating vegetables≥7 servings/week<7 servings/week

2.07 (0.87–4.94)1.00

Moderate physical activity≥2 hrs/wk<2 hrs/wk

0.21 (0.08–0.57)1.00

Perceived stress levelLowAverageHighVery high

0.66 (0.19–2.21)0.80 (0.29–2.19)0.73 (0.33–1.62)1.00

Table 3: Risk factors of HTN determined by multiple logistics regression analysis

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Significance of ResultAll the 192 selected respondents participated in the study, there were 128

(66.7%) men & 64 (33.3%) women in study population.

One third of them aged between 30 & 40 years.The prevalence of HTN was 44.3% among the

bank employees.Of the 85 participants with HTN, 47 (55%) was

known case & 38 (45%) were newly diagnosed in study.

47 employees who were known case of HTN, 41(87%) were taking medications regularly.

HTN was significantly (p<0.001) more prevalent among men than women.

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Whereas age & occupation of participants did not significantly affect the prevalence of HTN.

Alcohol use, adding extra salt while eating food & lesser physical activity were significantly associated with the prevalence of HTN.

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DiscussionLike other studies, in study it was found that

prevalence is higher among those with higher age.

The prevalence was more in men than women, this could be the attribute to the fact that most of the studied women were young.

Obesity, smoking and alcohol consumption were shown to be significantly associated with the prevalence of HTN.

Yet BMI did not have any significant effect on the prevalence that may be due to the considerably few number of subjects with BMI >30 kg/m2.

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It was also found that significant association between the prevalence of HTN and smoking and alcohol consumption.

No significant association between the level of perceived stress and the prevalence of HTN.

The study has got the inherent limitations of a cross-sectional study.

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Detailed dietary history and quantification of certain risk factors were not assessed due to feasibility constraints.

The study gave valuable information regarding the prevalence of HTN and its risk factors among this vulnerable group.

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ReferenceYusuf S, Reddy S, Ounpuu S, Anand S. Global

burden of cardiovascular diseases: part II: variations in cardiovascular disease by specific ethnic groups and geographic regions and prevention strategies. Circulation2001;104:2855-64.

Grundy SM, Pasternak R, Greenland P, et al. Assessment of cardiovascular risk by use of multiple-risk-factor assessment equations: a statement for healthcare professionals from the American Heart Association and the American College of Cardiology. Circulation 1999;100;1481-92.

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Continued….Reddy KS, Yusuf S. Emerging epidemic of

cardiovascular disease in developing countries. Circulation 1998;97:596-601.

Mohan V, Deepa S, Farooq V, et al. Surveillance for risk factors of cardiovascular disease among an industrial population in southern India. Natl Med J India 2008;21:8-13.

Chantal G, Chantal B, Gilles RD, et al. Effects of job strain on blood pressure: a prospective study of male and female white-collar workers. Am J Public Health 2006;96:1436-43.

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Continued….Maroof KA, Parashar P, Bansal R, Ahmad S. A

study on hypertension among the bank employees of Meerut district of Uttar Pradesh. Indian J Public Health 2007;51:225-7.

Shivaramakrishna HR, Wantamutte AS, Sangolli HM, Mallapur MD. Risk factors of coronary heart disease among bank employees of Belgaum city—aross-sectional study. Al Ameen J Sci 2010;3:152-9.

Momin MH, Desai VK, Kavishkar AB. Study of socio-demographic factors affecting prevalence of hypertension among bank employees of Surat city. Indian J Public Health 2012;56:44-8.

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Continued….Ganesh Kumar S, Unnikrishnan B, Nagraj K. Self

reported chronic diseases and occupational health risks among bank employees of southern Karnataka city, India. Indian J Community Medicine 2013;1:63-4.

Chor D. High blood pressure among bank employees in Rio de Janeiro. Arq Bras Cardiol 1998;71:653-60.

Konradi AO, Rotar OP, Korostovtseva LS, et al. Prevalence of metabolic syndrome components in a population of bank employees from St. Petersburg, Russia. Met Syndr Relat Disord 2011;9:337-43.

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Continued….Thomas G P, John EH, Lawrence JA, et al.

Recommendations for blood pressure measurement in humans: a statement for professionals from the subcommittee of professional and public education of the American Heart Association council on high blood pressure research. Hypertension 2005;45;142-61.

Chobanian AV, Bakris GL, Black HR, et al. The seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure: the JNC 7 report. JAMA 2003;289:2560-72

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Continued….WHO. WHO STEPwise approach to chronic

disease risk factor surveillance—instrument v2.1, Available from www.who.int/chp/steps/STEPS_Instrument_v2.1.pdf (Accessed August 20, 2013).

Cohen S, Kamark T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav 1983;24:385-96.

Mohan V, Deepa M, Farooq S, et al. Prevention, Awareness and control of hypertension in Chennai—the Chennai Urban Rural Epidemiological study (CURES-52). J Assoc Physicians India 2007;55:326-32.

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ConclusionThe prevalence of cardiovascular

diseases is on the rise worldwide.Bank employees experience varying

levels of mental stress to reduce the possibility of manual error and are thus more prone for chronic diseases like hypertension.

The prevalence of hypertension has been found to be higher among bank employees than in the general urban population.

05/01/2023 35Thank

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