Dhara Hypertension

CASE STUDY OF HYPERTENSION INTRODUCTION "The past can never be affected, since the recollecting of it is an element in shaping the future." -Jeunes Bryte Mankind is fighting against diseases from time when life on earth had started. Till now we have controlled many diseases and now we are new diseases whose prevalence was not much in past. Today, in world, most deaths are attributed to noncommunicable diseases like cardiovascular diseases, mental illness etc. Among cardiovascular diseases, “HYPERTENSION” is one of the chronic non-communicable diseases, responsible for causation of coronary heart disease, stroke and other vascular complications. So the control of hypertension is much importance to us. In lay man language, its only high level of blood pressure and unfortunately high blood pressure is invariably not accompanied by symptoms and therefore its detection and management is a challenge. This is fact, why it has been described as a "Silent Killer".

Definition:-

According to WHO, a person having systolic blood pressure ≥160mmHg and/or diastolic blood pressure ≥95mmHg is said to have hypertension. According to Joint National Committee V and International Society of hypertension, “Blood pressure ≥140mmHg systolic and ≥90mmHg diastolic is called hypertension.”

Classification:-

Hypertension can be classified in various ways, A. According to causation. 1. Essential Hypertension, in which causes are generally unknown & are responsible for 90% of all causes. 2. Secondary hypertension, in which some other disease or abnormality is responsible in its causation, like, diabetes mellitus, Cushing syndrome, kidney diseases, etc. B. According to Blood pressure measurement: - According to level of blood pressure, category of hypertension is decided. Most commonly we are considering WHO criteria for diagnosis, which we will discus later in Methodology. C. Classification by JNV-VII :Category Systolic BP(mmHg) Diastolic BP(mmHg) Normal ≤120 ≤80 Pre- hypertension 120-139 80-89 Hypertension140-159 90-99 Stage -1 Hypertension≥160 ≥100 Stage -2

Diagnosis:-

It is done by measuring the blood pressure with the help of mercury manometer. But due to subjective variations, anxiety, fear, inexperienced interpretation of korotkow sound, faulty instrument etc, errors occur. So, WHO study group has mentioned standard method of measuring BP. Standard method of measuring BP1. Position of patient – sitting position. 2. Position of mercury manometer – at the level of patient’s heart. 3. Arm to be used – In any arm, but clinic policy must be uniform. 4. It should be measured at least 3 times over a period of 3 minutes & lowest reading is recorded. From total number of cases of HT, only 50% are aware of this condition & 25% are taking treatment regularly & only 12.5% cases are controlled successfully. These figures vary from country to country. According to American Heart Association,  One in 3 US adults has high Bp.  28% of people with high BP don’t know that they have it.  Among other who knows, 64.9% do not have it controlled.

Statistics:-

Hypertension is a major health problem in world. To reveal it incidence has limited value because of variability in reading of an individual.

Prevalence:-

In industrialized countries 25% of adults and in developing & European countries 20% of adults are affected. Prevalence is high in U.S. blacks, Russia, Finland (30-40%), usual in Europe, Japan, U.S. whites (15-30%), low in rural Africa, south china (7-15%). And absent in Yanomani, Paeitic Island. In India, urban areas prevalence rate is 164.18/1000 & in rural areas prevalence rate is 157.44/1000. More incidences are found in males than in females.

Mortality: - 20-50% of total death occurs due to hypertension.

In India, 91 deaths/hour occur due to cardiac diseases in which one of the major risk factor is hypertension. High blood pressure killed 54.19 people in the United States in 2004. It was listed as a primary or contributing cause of death in about 277000 U.S. deaths in 2004. (Ref. American Heart Association) This is why identification of risk factors & prevention is necessary to stop this slow epidemic.

Risk factors associated with hypertension:-

Classified in 2 groups. 1. Non-modifiable risk factors like, age, gender, genetic inheritance etc. 2. Modifiable risk factors like obesity, smoking, high salt intake, stress, faulty diet, alcohol consumption, life style etc.

Preventive measures include regular exercise, restriction of salt intake & avoidance of alcohol and smoking, weight control & early detection and treatment.

METHOD OF STUDY Case study is a good tool for understanding a disease in community medicine. It not only guides us for scientific methods of prevention but also tells about social, economical, cultural, moral factors which might interfere in control measures.

Aims of case study on hypertension:-

To know the pattern, presentation and progress hypertension.  To understand effect & risk factors of hypertension.  To establish control measures for hypertension. 

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Objective of case study on hypertension:-

 To understand effect of hypertension on patients life.  To determine risk factors of hypertension present in particular case.  To find out any other member of patient’s family suffering from hypertension.  Establish integrated approach to control hypertension.

Case selection:-

This study was conducted in group & we were allotted subject of hypertension. We selected one patient who had essential hypertension. We got her from our hospital. We conformed that she’s living within limits of Baroda city as we had given limitation of travel expenditure from department & she is co-operative.

Processes in study:-

We visited patient’s house, met her family & following steps were taken.  History taking & examination of patient to confirm diagnosis.  Family health checks up.  Detailed study of diet of patient & her family.  Study of housing, environment & sanitation.

 Socio-economic states of patient.  Advised her for controlling the disease.

Regarding the visit:Visit 1 – we visited patient’s house on with our teacher and guide Dr. Prakash Vaghela.  There we took detailed history of patient & did whole family health check up & inquired about diet & social and economical states of family.  In diet, we used questioners’ method to get data & asked them about their menu, amount of food required per month, method of cooking etc.  In family health check up, we measured vitals of members and did general examination of them.  We inquired about housing & sanitation in details. We had asked about water supple, latrine, urinal sewage, disposal facility, noise pollution etc. Visit 2 – dated on  We inquired about their weekly diet and collected all data for calculation of nutritional status.  We again asked some questions on topics of previous visit to solve some confusion. Visit 3 – dated on  We had advised patient about his condition & informed her family about control measures of hypertension. Thus, we had visited the patient 3 times to collect data for satisfactory case study & patient gave us co-operation.

“Attempt the end & never stand to doubt, nothing so hard but search will find out.”

- Robert Harrick

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