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| ORIGINAL ARTICLE |
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| Year : 2023 | Volume
: 11
| Issue : 1 | Page : 70-75 |
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Prevalence and risk factors of complications related to hypertension at a tertiary care hospital
Venkata Rambabu Mallela1, Amith Kumar Pendurthi1, Srjana Karumanchi2, Krishna Chaitanya Alam1
1 Department of General Medicine, Malla Reddy Institute of Medical Sciences, Hyderabad, Telangana, India
2 Department of General Medicine, Malla Reddy Medical College for Women, Hyderabad, Telangana, India
| Date of Submission | 03-Jul-2022 |
| Date of Decision | 21-Aug-2022 |
| Date of Acceptance | 02-Sep-2022 |
| Date of Web Publication | 02-Dec-2022 |
Correspondence Address:
Krishna Chaitanya Alam
Department of Internal Medicine, Malla Reddy Institute of Medical Sciences, Suraram, Hyderabad, Telangana
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/mjhs.mjhs_36_22
Background: Studies on complications of hypertension (HTN) are required to identify risk factors so that patients with HTN can be educated. Individuals are more amenable as they seek advice from the clinician and this fact can be taken advantage of, in preventing or delaying complications.
Objective: The objective of this study is to study the prevalence and risk factors of complications of HTN.
Materials and Methods: Hospital-based cross-sectional study was carried out among 200 patients with known HTN. Blood pressure was recorded using standard equipment and standard guidelines. Anthropometric measurements such as height and weight were measured as per the standard guidelines. Investigations such as electrocardiogram, ophthalmoscopy, and urine albumin were carried out for all enrolled patients to assess the presence of complications of HTN. Binary logistic regression analysis was carried out to study the independent association between variables and complications of HTN.
Results: The prevalence of complications of HTN was 57% in the present study. The most common complication of HTN was an ischemic cerebrovascular accident in 25% of the cases and coronary artery disease as well as left ventricular hypertrophy in 21% of the cases each. The odds of having complications of HTN among smokers was 3.138 (95% confidence interval [CI] =1.141–8.629; P = 0.027) times more compared to nonsmokers. The odds of having complications of HTN among those without regular treatment was 8.265 (95% CI = 3.977–17.177; P = 0.000) times more compared to those taking regular treatment. The odds of complications of HTN increased by 1.113 (95% CI = 1.045–1.186; P = 0.001) times with each increase in the duration of HTN.
Conclusion: The prevalence of complications of HTN among known hypertensive was high in the present study. It was significantly associated with smoking, irregular treatment, and duration of HTN.
Keywords: Blood pressure, complications, hypertension, prevalence, risk factors
How to cite this article:
Mallela VR, Pendurthi AK, Karumanchi S, Alam KC. Prevalence and risk factors of complications related to hypertension at a tertiary care hospital. MRIMS J Health Sci 2023;11:70-5 |
How to cite this URL:
Mallela VR, Pendurthi AK, Karumanchi S, Alam KC. Prevalence and risk factors of complications related to hypertension at a tertiary care hospital. MRIMS J Health Sci [serial online] 2023 [cited 2023 Mar 30];11:70-5. Available from: http://www.mrimsjournal.com/text.asp?2023/11/1/70/362533 |
| Introduction | |  |
Hypertension (HTN) is a major public health problem due to its high prevalence all around the globe.[1] Around 7.5 million deaths or 12.8% of the total of all annual deaths worldwide occur due to high blood pressure (BP).[2] It is predicted that by 2025, adults with HTN will increase to 1.56 billion.[3]
Raised BP is a major risk factor for chronic heart disease, stroke, and coronary heart disease. Elevated BP is positively correlated to the risk of stroke and coronary heart disease. Other than coronary heart disease and stroke, its complications include heart failure, peripheral vascular disease, renal impairment, retinal hemorrhage, and visual impairment.[2]
HTN or high BP is defined as abnormally high arterial BP. According to the Joint National Committee 7, normal BP is a systolic BP <120 mmHg and diastolic BP <80 mmHg. HTN is defined as a systolic BP level of ≥140 mmHg and/or diastolic BP level of ≥90 mmHg. The gray area falling between 120 and 139 mmHg systolic BP and 80–89 mmHg diastolic BP is defined as “prehypertension.”[4] Although pre HTN is not a medical condition in itself, prehypertensive subjects are at more risk of developing HTN.[1]
It is a silent killer as very rarely any symptoms can be seen in its early stages until a severe medical crisis takes place such as heart attack, stroke, or chronic kidney disease (CKD).[5] Since people are unaware of excessive BP, it is only through measurements at regular intervals that detection can be done. Although the majority of patients with HTN remain asymptomatic, some people with HTN report headaches, light-headedness, vertigo, altered vision, or fainting episode.[6]
Studies on complications of HTN are required to identify the risk factors so that patients with HTN can be given the education to prevent or postpone complications. As they are patients, they are more amenable to listen to the advice of the doctor and hence there is a possibility that the complications associated with HTN can be prevented. The present study was carried out to study the prevalence and risk factors of complications related to HTN and to study the factors associated with complications related to HTN.
| Materials and Methods | | |
The institutional ethics committee permission was obtained. Informed consent was obtained from all study participants. A hospital-based cross-sectional study was carried out for 2 months from December 2021 to January 2022 among patients attending the Outpatient Department of General Medicine, Malla Reddy Hospital, Hyderabad.
Nayak et al.[7] found that in 67% of the cases with acute ischemic stroke, HTN was seen. Based on this prevalence of 67% with a 95% confidence level and 10% allowable error of prevalence, the sample size came out to be 197.
Two hundred patients with known HTN were included. They were enrolled using the random sampling method. Age more than 18 years of either gender and patients with known HTN other than pregnant women were included. Individuals not willing to give the data or not willing to participate in the study and pregnant women with HTN were excluded.
All patients of either gender confirmed to have HTN admitted to the wards of general medicine were enrolled after taking informed consent. General details such as age, sex, duration of HTN in years, residence, smoking, alcohol, and tobacco chewing were recorded. The patients were already having one or more complications at the time of enrolment. In all cases, the secondary causes of HTN were excluded. Medication history was based on the past history and review of prescriptions the patients had. There was no follow-up.
BP was recorded using standard equipment and standard guidelines.
Detailed history in the pretested, predesigned, and semistructured study questionnaire was taken. Anthropometry such as height and weight were measured as per the standard guidelines. Body mass index (BMI) in kg/m2 was calculated using height and weight. Investigations such as electrocardiogram, ophthalmoscopy, urine albumin, and lipid profile were carried out for all enrolled patients to assess the presence of complications of HTN with standard guidelines and standard procedures.
The data were entered into the SPSS version 16. Descriptive statistics with numbers and proportions were presented. Bivariable analysis was carried out using Chi-square test for proportions and t-test for continuous variables to assess the association between variables and outcome, i.e. complications of HTN: yes or no as the outcome was dichotomous, binary logistic regression analysis was carried out to study the independent association between variables and outcome after adjusting for other variables.
| Results | | |
Males were slightly more than females (55% vs. 45%). Patients from urban areas were more than that from rural areas (67% vs. 33%). About 19.5% were smokers, 40% were alcoholics, and 12.5% were tobacco chewers. The mean age was 58.34 ± 13.68 years [Table 1]. | Table 1: Distribution of study subjects as per sociodemographic characteristics
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Thirty-seven percent reported having a family history of HTN, whereas 44.5% were taking the treatment regularly. About 71.5% were obese (BMI more than 30), whereas 50% had abdominal obesity. The mean duration of HTN was 6.79 ± 6.25 years with a range from 6 to 30 years [Table 2]. | Table 2: Distribution of study participants as per clinical characteristics
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The prevalence of complications of HTN was 57% in the present study [Table 3].
Forty-three percent of the participants had no complications of HTN. The most common complication was an ischemic cerebrovascular accident in 25% of the cases and coronary artery disease as well as left ventricular hypertrophy in 21% of the cases each [Table 4]. | Table 4: Distribution of study participants as per different complications of hypertension
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On bivariable analysis, it was found that the prevalence of complications of HTN was significantly more in smokers, alcoholics, and those not taking treatment regularly. Other factors were not found to be significantly associated with the risk of complications of HTN [Table 5]. | Table 5: Bivariable analysis for exploring risk factors of complications of hypertension
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Factors having P value up to 0.1 (residence, smoking, alcohol, tobacco, regularity of treatment, abdominal obesity, and duration of HTN) from [Table 5] are entered into the binary regression model. These factors were able to explain 36.2% of the variability in complications of HTN (Nagelkerk's R2 = 0.362). The predictive accuracy of the model increased from 57% to 74.5% after these variables were entered. The omnibus test of model coefficients was statistically significant (χ2 = 62.768; df = 7; P = 0.000) which meant that residuals are independent of each other. The Hosmer–Lemeshow test was statistically not significant meaning that the difference between observed and predicted values was statistically not significant (χ2 = 8.629; df = 8; P = 0.408). There was no multicollinearity between the entered variables, which was tested by the variance inflation factor. Thus, the model was fit to predict the presence or absence of complications of HTN.
Out of all the variables entered into the binary logistic regression model, only smoking, regularity of treatment, and duration of HTN in years were found to be significantly associated with the complications of HTN. The odds of having complications of HTN among smokers was 3.138 (95% confidence interval [CI] =1.141–8.629; P = 0.027) times more compared to nonsmokers. The odds of having complications of HTN among those without regular treatment was 8.265 (95% CI = 3.977–17.177; P = 0.000) times more compared to those taking regular treatment. The odds of complications of HTN increased by 1.113 (95% CI = 1.045–1.186; P = 0.001) times with each increase in the duration of HTN [Table 6]. | Table 6: Binary logistic regression analysis for an independent association of factors with complications of hypertension
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| Discussion | | |
Males were slightly more than females (55% vs. 45%). Patients from urban areas were more than that from rural areas (67% vs. 33%). About 19.5% were smokers, 40% were alcoholics, and 12.5% were tobacco chewers. The mean age was 58.34 ± 13.68 years. Thirty-seven reported having a family history of HTN, whereas 44.5% were taking the treatment regularly. About 71.5% were obese, whereas 50% had abdominal obesity. The mean duration of HTN was 6.79 ± 6.25 years with a range from 6 to 30 years. The prevalence of complications of HTN was 57% in the present study. Forty-three percent of the participants had no complications of HTN. The most common complication was an ischemic cerebrovascular accident in 25% of the cases and coronary artery disease as well as left ventricular hypertrophy in 21% of the cases each. On bivariable analysis, it was found that the prevalence of complications of HTN was significantly more in smokers, alcoholics, and those not taking treatment regularly. Other factors were not found to be significantly associated with the risk of complications of HTN. Out of all the variables entered into the binary logistic regression model, only smoking, regular treatment, and duration of HTN in years were found to be significantly associated with the complications of HTN. The odds of having complications of HTN among smokers was 3.138 (95% CI = 1.141–8.629; P = 0.027) times more compared to nonsmokers. The odds of having complications of HTN among those without regular treatment was 8.265 (95% CI = 3.977–17.177; P = 0.000) times more compared to those taking regular treatment. The odds of complications of HTN increased by 1.113 (95% CI = 1.045–1.186; P = 0.001) times with each increase in the duration of HTN.
Nayak et al.[7] found that in 67% of the cases with acute ischemic stroke, HTN was seen. We found that 25% of the hypertensive cases had acute ischemic stroke and 3.5% had a hemorrhagic stroke. Gaciong et al.[8] reported from their clinical trial data and meta-analyses that as the BP is more than 115/75, the risk of stroke increases. They also stated that high BP was the most important modifiable risk factor. It accounts for about 54% of stroke cases globally. In our study, it accounted for 25% of the cases. This difference may be due to the small sample size in the present study and it was a single-center study.
Tackling and Borhade[9] mentioned that it takes about 14.1 years (median) in hypertensive patients for the failure of the heart. They also mentioned the reports of meta-analyses that there is log–linear relationship between BP and the risk of cardiovascular diseases. It was 36.1% in males and 33.2% in females in the age group of 45–54 years. About 57.6% in males and 55.5% in females in the age group of 55–64 years. It was 63.6% in males, 65.8% in females in the age group of 65–74 years, 73.4% in males, and 81.2% in females in the age group of 75 years and more. Weber et al.[10] in the joint scientific statement stated that among all coronary artery disease cases, the major modifiable risk factor is high BP. Lower the BP (systolic = 90–114 and diastolic = 60–74 mmHg), lower the risk of coronary artery disease. Wu et al.[11] found that the hazard ratio of cardiovascular disease mortality in patients with HTN was 1.31 (95% CI = 1.05–1.64) among those above 65 years of age. Milane et al.[12] noted that late-onset coronary artery disease was associated with HTN. Similarly, regular use of drugs for the control of HTN was also associated with delayed onset of coronary artery disease.
Tedla et al.[13] in their discussion of HTN and CKD stated that in the USA population, in patients with stage I CKD, HTN was seen in 35.8% of the cases and increased to 48.1% in stage II CKD cases, and again increased to 59.9% in stage III CKD patients.
Limitations
The limitation of a cross-sectional study is over 2 months. The number of subjects is too small to draw meaningful conclusions.
| Conclusion | | |
In the present study, among 200 known cases of HTN, the overall prevalence of complications related to HTN was 57%, which is very high given the range of age from 23 to 94 years in the present study. Smoking, irregular treatment, and increasing duration of HTN were independently associated risk factors of complications related to HTN in the present study. Educating hypertensive individuals regarding smoking cessation and regularity in treatment can significantly reduce complications. The most common complication was ischemic stroke in 25% of the cases followed by coronary artery disease and left ventricular hypertrophy in 21% of the cases each.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]
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