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Batch:AFMC-
12
Session No:2009-2010
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BANGLADESH UNIVERSITY OF
PROFESSIONALS
FACULTY OF MEDICINE
Students of AFMC 12
e
r
2.
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Acknowledgement
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mental support behind the screen. We would like to
express our gratitude and humble gratefulness and
thanks to him from core of our heart.
e
o
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Content
Contents
List of tables 6
List of figures 7-8
Abstract 9
Chapter1: Introduction
Introduction 11-15
Justification of the study
Objectives 20
Key variables 21-22
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Chapter 3: Methodology
Chapter4: Results
36-57
Results
Tables & figures
Chapter 5: Discussion
Conclusion
63
Recommendation
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LIST OF TABLE
Table Title
1 Distribution of respondents according to age group
2 Distribution of the religion of respondents
3 Distribution of respondents according to their marital
4 Distribution of respondents according to their occupat
5 Distribution of respondents according to their family i
6 Distribution of respondents in relation to type of prote
7 Distribution of respondents according to blood pressur
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List of Figures
Figure Title
1 Pie diagram showing distribution of the respondents accordi
2 Bar diagram showing educational status of the respondents
3 Pie diagram showing distribution of respondents in relation
work
4 Pie diagram showing distribution of respondents in relatio
food intake
5 Pie diagram showing distribution of respondents in relation
at least 30 minutes a day
6 Pie diagram showing distribution of respondents according t
habits among male
7 Pie diagram showing user of Contraceptive Pill among
female respondents
8 Pie diagram showing extra salt intake among the respondent
9 Pie diagram showing percentage of known
hypertensive among respondents
10 Pie diagram showing distribution of respondents
according to family history of hypertension
11 Pie diagram showing distribution of hypertention resp
relation to compliance to hypertensive drug
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49
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A
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C
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Introduction
10 | P a g e
Blood is the most commonly tested part of the body, and it is truly the river of
life. Every cell
in the body gets its nutrients from blood.
Understanding blood will help us as our doctor
explains the results of our blood tests. In
addition, we will learn amazing things about
this incredible fluid and the cells in it.
The adult human body contains approximately 5 liters (5.3 quarts) of blood; it
makes up 7 to
8 percent of a person's body weight.
Approximately 2.75 to 3 liters of blood is
plasma and the rest is the cellular portion.
c
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1
)
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(
p
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)
(2)Secondary
Although the body can tolerate increased blood
pressure for months and even years, eventually the
heart may enlarge (a condition called hypertrophy),
which is a major factor in heart failure.
Some studies suggest that in people over 45 years
old, every 10 mm Hg increase in pulse pressure
increases the risk for stroke rises by 11%, cardiovascular
disease by 10%, and overall mortality by 16%. (In
younger adults the risks are even higher.)
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12 | P a g e
Chapter 1
Classification of blood pressure in adults:
= 180 = 110
Grade 3
Hypertension/
severe
Measurement of
blood pressure:
(1) Direct method
(2)Indirect method-a.Palpatory method. b.Auscultatory method.
13 | P a g e
Chapter 1
as hypotension. Hypotension is a medical concern only if
it causes signs or symptoms, such as dizziness, fainting, or
in extreme cases, shock.
14 | P a g e
Chapter 1
There are two reasons for studying the blood pressure
measurements along with related test results in rural
community. First, it gives a rough idea of the health
scenario of general population of a country. And this
information helps to allocate resources between projects
and other measures which are designed to improve
health. Health impact data inform the discussion on
the external efficiency of investments of budget on
the chronic non- communicable diseases. Second,
knowledge of this study assists with designing projects
so that they optimize their impact on health at a
given cause which reflects the internal efficiency.
Findings from this study may help to inform needs
for public health interventions/recommendations, to
identify potential risk factors and guide prevention
strategies, and to set a baseline for monitoring the
changing pattern of disease in an area that is hopefully
experiencing a socioeconomic transition associated with
poverty alleviation.
15 | P a g e
Chapter 1
Justification of the study
16 | P a g e
Chapter 1
Countless epidemiological surveys have shown that
there are striking inter individual and inter population
differences in blood pressure. In mostbut not all
populations, blood pressure generally rises (more or less)
with age from youth into older age. The exceptions are
isolated preliterate groups in remote locations, where
average systolic and diastolic blood pressures are
optimal at all adult ages, manifesting little or no upward
slope with ageand where lifestyles differ markedly
compared to those of other populations worldwide.
Data
from migration studiesfor example, the Luo Migrant
Study in Kenya and the Ye Migrant Study in China
strongly indicate that changes in lifestyle and nutrition
explain increases in blood pressure and vascular disease
following migration and adoption of diets broadly
similar to those of host populations. Furthermore, an inverse
relation between socioeconomic status (SES) and blood
pressure has also been recorded repeatedly in many
population studies of specific ethnic groups.
Chap
ter 1
The public-private initiatives have been taken in the health
sector since independence of Bangladesh is treated
positive, but the health services didnt reach to the
most of the peoples yet. The epidemiological studies in
Bangladesh are largely confined to the primary health care
facilities, basic
sanitation, maternal and child health. But recent health
scenario shows increasing occurrence of cardiovascular
diseases, diabetes mellitus, and renal diseases among
affluent populations of the country as well as in rural
community. High blood pressure imposes potential threat on
occurrence of these diseases by 80%. So, high blood pressure
(hypertension) has become a major concern in recent years.
1
3
5 7
2
4 6 8
50% of the
hypertensive patients
are aware of
hypertension. 50% of
treated.
18 | P a g e
Chapter 1
As the nutritional determinants of hypertension in
Bangladesh and other low-income countries are largely
unknown, blood pressure survey can address the
determinants which are directly or indirectly imposing
threat on mass health.
19 | P a g e
Chapter 1
Objectives
General objectives:
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Specific objectives:
20 | P a g e
Chapter 1
Key Variables
Socio-economic variables:
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E
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of
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on
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M
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T
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Number of family members
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21 | P a g e
Chapter 1
Variables related to blood pressure status:
M
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M
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a
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n
Co
mpl
icat
ion
rela
ted
to
hyp
erte
nsio
n
Fa
mili
al
hyp
erte
nsio
n
Other diseases
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Chapter 1
O
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Blood pressure:
Hypertension:
Normotensive:
| P a g e
23
Chapter 1
Myocardial infarction:
Smoker:
Non- smoker:
Those persons who have never smoked cigarettes, biri, cigar, hukkah or pipe.
Physical exercise:
It refers to physical movements in addition to the
normal day to day routine activities so as to burn the
extra energy or calorie intake and hence preventing
the unnecessary accumulation of fat in the body.
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24
Chapter 1
Sedentary job:
In spite of our best efforts, there were many limitations in our study which are as
follows:
Money allocated for the study was not sufficient enough for such kind of
study.
Many respondents failed to give the exact figure of their monthly family
income.
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26
Chapter 1
Maximum number of respondents belongs to almost similar socio-economic
group of people.
Investigations related to blood pressure level could not be done for resource
constraints.
The allocated time for study was not enough to carry on comprehensively.
27 | P a g e
Chapter 1
C
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2
Review of literature
28 | P a g e
Coronary heart disease (CHD) is estimated to be the
most common cause of death globally by 2020 and
hypertension is one of the most important modifiable
risk factors for CHD and in Western and Asian
population. Studies from India and Bangladesh
have shown an increasing in the prevalence of
hypertension. So all societies are confronted with the
problem of defining a strategy to control high blood
pressure. There is an increasing emphasis in the
major general and specialized scientific journals on the burden of
cardiovascular disease in
terms of mortality and morbidity and of hypertension is a
leading risk factor in low income countries like ours. The
instruments and strategies prepared to deal with this
problem however derived mostly from experimental and
observational studies. Observational studies
in low income countries aiming to assure not only the
causal side of the risk but the critical question of
transferability of measures recommended to identify
patients at risk and to influence their clinical outcomes.
Different literatures such as books, journals and
magazines were reviewed in order to gain through
knowledge on the status of the blood pressure and
treatment compliance among rural people. Some
contributory studies have been found in our country as
well as in international sphere. A few have been
reviewed having special significance with our present
study.
Hypertension & Cardiovascular Risk:
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Chapter 2
Most population based studies confirm that hypertension
increases on individual's risk of various cardiovascular
consequences approximately two to three times. Large
population based cohort studies consistently show
continuous, strong, graded relation between blood pressure
and cardio-vascular system but no clear threshold value
separates hypertensive patients who will experience future
cardiovascular events from those who will not multiple
high quality long term cohort studies and randomized
clinical trials have shown that the risk
from raised blood pressure can be partially reversed. Hypertension is
implicated in 35% of all
atherosclerotic cardiovascular events including 49% of all cases of heart
failure.
Cholesterol:
A strong graded r elation raised serum cholesterol
and coronary artery in run total values above
220mg/dL. The protective effect of high density
lipoprotein cholesterol runs to be at least as strong as
the effect of the low density fraction particularly in
woman.
Smoking:
Diabetes Mellitus:
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Chapter 2
It is one of the strongest modifiable risk factors for
cardiovascular disease and its effect in woman is
relatively greater than in man for all cardiovascular events
except congestive heart failure. Diabetes often co-exist
with obesity, hypertension and (syndrome x); these
patients are particularly predisposed to atherosclerotic
diseases.
Sites of study:
Duration of study:
Study population:
The study population was adult household members of the above mentioned
villages.
Inclusion criteria:
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33
Chapter 3
Exclusion criteria:
Sample size:
Sampling technique:
Before data collection, the purpose of the study was explained to each
respondent.
.Data was collected for 3 consecutive days from 9:00 am to 1:30
pm. At first day the data was collected from
Khatra, next day from Dhigol and on third
Data was collected through face to face
interview based on semi
structured questionnaire.
Chap
ter 3
34 |
Procedures of blood pressure measurement:
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Chapter 3
Chapter 4
Result
36 | P a g e
Table 1: Distribution of
respondents according
to age group
40| P a g e
TABLE 5: DISTRIBUTION OF
RESPONDENTS ACCORDING TO THEIR
FAMILY INCOME
44 | P a g e
PIE CHART 5:DISTRIBUTION
RESPONDENTS ACCORDING TO
SMOKING
HABITS AMONG MALE
Pie chart shows that most of the male respondents (72.23%) do
not smoke.
45 |P a g e
PIE CHART 6: PIE CHART SHOWING
USES OF CONTRACEPTIVE PILL
AMONG FEMALE
RESPONDENTS
.
Pie chart shows that most of the respondents
(91.54%) take extra salt in their food
47| P a g e
PIE CHART 8:PIE CHART SHOWING
PERCENTAGE OF KNOWN HYPERTENSIVE
AMONG RESPONDENTS
Among the respondents 89.74% were hypertensive
whereas rest were normotensive
48| P a g e
PIE CHART 9:DISTRIBUTION OF
RESPONDENTS ACCORDING TO OF
FAMILY HISTRY OF
HYPERTENSION
60.59% of the respondents had a history of hypertension in their
family and 39.49% did not
4|9 P a g e
TABLE 7:DISTRIBUTION OF RESPONDENTS
ACCORDING TO BLOOD PRESSURE
STATUS
87.26% of the respondents were normotensive and 3.20%
had grade 3 (severe) hypertension
50|P a g e
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Chapter 4
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Chapter 4
PIE CHART10:DISTRIBUTION OF
HYPERTENTION RESPONDENTS IN
RELATION TO
IN RELATION COMPLIANCE
HYPERTENSIVE DRUG
Approximately 91.30% hypertensive respondents took anti-
hypertensive medication regularly
51 | P a g e
C
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Discussion
58 | P a g e
The study entitled 'status of blood pressure and
treatment compliance among adult population in
DHAMRAI Upazilla' was a descriptive cross sectional
study. The study was carried out from 14 November to
20 November 2012. The objective of this study was to
assess the blood pressure status and socio-demographic
characteristics of the respondents. A total
of 360 respondents were included in this study aged 20 years or above.
Information about
socio demographic characteristics, life style, risk
factors were collected, compiled and analyzed.
59 | Cha
pter
5
suggests that most of the male person had been
working outdoor at that time and which is the reason
for having less male respondent.
15
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60
Chapter 5
In our study 27.77% of the male
respondents were smoker and 72.23%
were non-smokers. The risk of CVD in
smokers is proportional to the number of
cigarettes smoked smoked per day and
how deeply the smokers inhales. This was in with a research by Ernest E et al.
16
61 | P a g e
Chapter 5
C
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Conclusion & Recommendation
62 | P a g e
According to the survey findings it could be stated that knowledge about blood
pressure and
the low level of compliance to anti-hypertensive medication
found in this study, which is consistent with findings in other
countries, emphasizes the need for population-wide primary
prevention of elevated BP and cardiovascular disease. Such
measures include educational, legislative, and fiscal actions to
encourage the adoption of a healthy diet (particularly lower
salt intake) and to increase facilities and opportunities for physical
activity in leisure. It has
been estimated in the Asia- Pacific region, for example,
that reducing the population systolic BP by as little as
3% would prevent 15% of all stroke deaths and 6% of all
coronary deaths.
63 | P a g e
Chapter 6
Recommendations
should be changed by
following activities.
Life style changes:
1. Weight
reduction
and regular
exercise
(like,
jogging)
2Reducing
Sugar in
diet.
be avoided.
64 | P a g e
Chapter 6
7. Should practice of eating vegetables & low fat diet.
Life Style changes canreduce the blood pressure to a safe level, But
Drug Therapy can still not be avoided
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65
Chapter 6
References:
edition 2010.
6. www.nationmaster.com
7. www.MedicineNet.com
8. www.wikipedia.org
66 | P a g e
10. Gupta R-Meta analysis of prevalence of hypertension in Indian Heart
J:1997;490-500
12. Census-2001,BANBEIS
16. Ernes E, Resch KL; smoking as a CVD risk factor a meta-analysis and
review of literature A
.Intern Med;118;956-63
17. Khalil SA, Elzubier AG. Drug compliance among hypertensive patients in
Tabuk, Saudi Arabia.
Journal of hypertension1997;15(5):561-5
67 | P a g e
A
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68 | P a g e
Status of Blood Pressure and
Treatment
compliance in
selected rural
area of Dhamrai
Upazilla, Dhaka
Questionnaire
Ide
ntit
no:
Dat
e:
A. Particulars of the respondent
1. Name of the respondent:
2. Present address:
V
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a
g
e
W
a
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d
n
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U
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U
p
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a
D
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t
r
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t
B. Socio-economical information
1. How old are you? (Years) .
2. Which religion you follow?
69 | P a g e
6. Do you physical work?
a) Yes b) No
a) Yes b) No
a) Yes b) No
5. D
o you
say
your
prayer
regularl
y?
a)Yes
b) No
6. Do you smoke?
a) Yes b) No
a) Yes b) No
70 | P a g e
10.Do you take extra salt in food?
a) Yes b) No
a) Yes b) No
a) Yes b) No
a) Yes b) No
4. If yes, for how long are you taking medicine for hypertension?
..
5. Do you take anti-hypertensive medicine regularly?
a) Yes b) No
a) Yes b) No
long? .. Month/years
a) Yes b) No
a) Yes b) No
71 | P a g e
If yes, what are the diseases?
E . Information regarding
treatment
1. Whom from have you come to know that you are suffering from
hypertension?
a) Yes b) No
a) Yes b) No
a) Yes b) No
Left arm:
.
Right arm:
...
Average:
Right arm:
... Average:
MC No: . Group:
.. Batch: .
72 | P a g e
Map of Dhamrai Upazilla showing study
areas
S
u
t
i
p
a
r
a
a
Choybaria
Barigao
73 | P a g e
Photographs during the visit