RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE- KARNATAKA

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

SUKANYA. KAMALAPURAM

A.E. & C.S. PAVAN COLLEGE OF NURSING

KOLAR- 563101

I

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA.

PROFORMA FOR REGISTRATION OF SUBJECT

FOR DISSERTATION

1. / NAME OF THE CANDIDATE & ADDRESS / SUKANYA. KAMALAPURAM,
A.E & C.S. PAVAN COLLEGE OF
NURSING, KOLAR-563101 KARNATAKA
2. / NAME OF INSTITUTION / A.E & C.S. PAVAN COLLEGE OF NURSING, KOLAR
3. /
COURSE OF STUDY AND THE SUBJECT /
M.Sc. (NURSING)
MEDICAL SURGICAL NURSING
4. / DATE OF ADMISSION TO COURSE / 31/05/2007
5. / TITLE OF THE TOPIC:
A STUDY TO ASSESS KNOWLEDGE, ATTITUDE AND PRACTICE OF HYPERTENSIVE CLIENTS REGARDING PREVENTION OF HYPERTENSIVE COMPLICATIONS IN SELECTED HOSPITALS KOLAR, WITH A VIEW TO DEVELOP SELF INSTRUCTION MODULE

II

6. BREIF RESUME OF THE INTENDED WORK:

INTRODUCTION:

Tomorrow

Tomorrow, Tomorrow

Tomorrow, Tomorrow, Tomorrow

Tomorrow, Tomorrow, Tomorrow, Tomorrow

Tomorrow, Tomorrow, Tomorrow, Tomorrow, Tomorrow,

Tomorrow, Tomorrow, Tomorrow, Tomorrow, Tomorrow, Tomorrow,

Tomorrow, Tomorrow, Tomorrow, Tomorrow, Tomorrow, Tomorrow, Tomorrow

“IF YOU WANT TO SEE ALL THESE TOMORROW’S,

CONTROL YOUR HYPERTENSION TODAY,

TAKE MEDICATIONS REGULARLY”.

BY - G.Kadhilal.MD.,Ph.D.

Epidemics of non-communicable disease or life style related to disease are growing alarmingly in most developed countries. Infection and nutritional deficiencies are revealing and leading contributors to death and disability. While cardio vascular diseases, cancers and diabetesmellitus are becoming major contributors to the burden of disease1.

Hypertension is a multifactorial disease with its prevalence being particularly high in developed countries. Hypertension can be formed as “ice berg disease”. The submerged proportion of the ice berg represent the hidden mass of the disease while the floating tips denotes the clinical signs and symptoms most of the hypertension subjects are aware of the condition and half of those treated are considered adequately treated2.

Hypertension is often called as a “silent killer” because without actually having the blood pressure measured the person would not necessarily known their habits, it can leads to dangerous complications without producing any symptoms The client with hypertension if not taken proper care may leads to many complications like Heart failure Ischemic heart disease, chronic kidney disease, recurrent stroke, dementia, aneurysm, Blindness and high coronary disease risk3.

Worldwide prevalence estimated that hypertension may be as much as one billion individuals and approximately 7.1 million deaths per year may be attributable to Hypertension4.

The World Health Organization reports that suboptimal blood pressure (>115 mm Hg systolic blood pressure) is responsible for 62% of cerebrovascular diseases and 49% of ischemic heart decease, with little variation by sex. In addition suboptimal blood pressure is the number one attributable risk factor for death throughout the World with last two decades; better treatment of Hypertension has been associated with a considerable reduction in the hospital case fatality rate for heart failure5.

In India found that of the 3000 apparently normal people who signed or with Delhi based MaxMed centre preventive health checkup programme. A sample 300 was analyzed to evaluate the life style diseases among urban middle class Indians 85 had high pressure, sugar counts 58 had hypertension clients and 22 had heart problem4.

The prevalence of hypertension increases with advancing age to the point where more than half of people 60-69 years of age and approximately three, fourths of those 70 years of age and older are affected5. Framingham heart study (2004) investigators recently reported the lifetime risk of hypertension to be approximately 90% for men and women who were non-hypertensive at 55 years or 65 years and survived to age 80-85 years6. Being an African - American is one risk factor for developing Hypertension complications blacks who maintain traditional life styles have few problem with hypertension blacks in U.S also seems to be more sensitive to salt7.

Hypertension is very dangerous because blood pressure in force extends the blood on arteries as it flows throughout the body. If the individuals have high blood pressure it means that the blood is exerting too much force on arteries and in making the heart, job is more difficult. The heart has powerful and co-efficient muscle, but it’s forced to work too hard for longtime or too slow, it can enlarge or fail causing heart attacks, strokes, aneurysms and end death8.

To prevent these complications pre-hypertension can be diagnosed the high risk of developing hypertension so they both clients and clinicians are allert to this and encouraged to intervene and prevent the disease2.

6.1. NEED FOR STUDY:

Heart is the beginning of life Diseases of the heart and blood vessels constitute a major health problem to day8. Hypertension is a nutrional – hygienic disease. The seeds of Hypertension are rooted in physical inactivity, long term caloric intake in excess of energy expenditure, chronic supra physiological intake of dietary sodium, excessive alcohol consumption and psychosocial stressors, these all contribute to the development, of Hypertension through out the World9.

In Asia, Island and Pacific, Hypertensive, Cardiovascular diseases are soon expected to be responsible for one out of four deaths in developing countries. By 2020 researchers expected to be 13.8 million people will affect cardiovascular diseases in these countries9.

The epidemiological study carried out in India is estimated that these would be approximately 50 million cases of hypertension in India with a prevalence of 2.3% to 15.4% at the beginning of year 20002.

Few studies on prevalence on hypertension are available from eastern Indian population. In 2002, Hazarika reported 61% prevalence among man and women aged thirty and above in Assam10.

Few studies were carried out comparing different socio economic groups. The initial study from urban Chennai, Mohan reported 8.4% prevalence of hypertension among men and women aged 20 years and above and belonging to the low socio economic group (based on house hold , occupation and dietary pattern). Similarly, in the middle socio economic group had a higher prevalence (15%) during 1996-97. A study conducted in the urban areas of Chennai during 2000 (age group>=40) reported a higher prevalence of hypertension (54%) among low income group (monthly income < Rs 30000/annum) and 40% prevalence among high-income group (monthly income Rs 60000/annum).

Cardiovascular diseases already account for almost 10% of the developing countries burden of disease and to become the developing World’s leading cause of death. The non communicable diseases are the new pandemic of the 21st century and they threaten to swamp the measure health care resources of many countries.

While high BP is common in men above 30-35 years of age it is much less prevalent in women of the same age groups. The female hormones are supposed to protest against high BP and prevent heart related illnesses. It is also reported that above the age of 55 years that in after menopause when this hormonal protection no longer exists women are as prone to blood pressure and related heart diseases as men8.

Health awareness in a central issue on the control of hypertension. In India awareness of hypertension its risk factors and complications is very poor. Hence it goes undiagnosed and untreated for a long time2.

Patient education programme is very important in cases with hypertension. According to federal bureau prisons clinical practice guidelines given like life style changes are the first line treatment for hypertension and include the Weight reduction, Aerobic exercise, Restrict (sodium) intake, Restrict dietary fat, stop smoking, Avoid extra caffeine11.

Damage to the renal vessels because renal failure it is also called silent killer because of the hypertensive person will be symptom free in the beginning8.

According to Survey conducted by Association of Physician of India(API) (2004) conducted survey, urban areas in the country had a significantly higher incidence of Hypertension (27-37%) as compared to rural areas (2-8%) prevalence is slightly more in women2.

Data from epidemiological studies and clinical trails have demonstrated that elevations in resting heart rate and reduced heart rate variability are associated with higher cardiovascular risk12.

The WHO reports that 62% of cerebro vascular diseases and 49% of Ischemic Heart Disease (IHD) little variation of sex. In addition suboptimal blood pressure is the number of attribute risk factor for death through the world5.

Suddenly stopping high blood pressure medications can cause a sudden, life threatening increase in blood pressure. To prevent these complications controlling the B.P is very important5.

The nurses health study (2004) finds that current users of oral contraceptives had a significant increases [(relative risk) RR=1.8, 95% confident interval (CI=1.5-2.3)] risk of hypertension when compared with who had never use oral contraceptives2.

Clinical trails (2004) have demonstrated that control of isolated systolic hypertension reduces total mortality, cardiovascular mortality, stroke and heart failure events9.

The recent recommendations by the American public health association and the coordinating committee that the food industry including manufactures and restaurants, reduce sodium in the food supply by 50% over the next decade is the type of approach which if implemented World reduce blood pressure in the population13.

Based on the investigator clinical experience and the literature review the investigator found that many clients admitted with hypertensive complications. Many of these patients does not have sufficient knowledge regarding prevention of hypertensive complications. So the investigator would like to do the study on prevention of hypertensive complications and their practices. After collecting data researcher want to develop self instruction module to improve their knowledge, attitude and practices in their life.

6.2 REVIEW OF LITERATURE

According to Polit and Beck (2006) as a broad comprehensive, in depth, systematic and critical review of scollerly publications, unpublished materials, audio visual materials and personal communications is called as review literature14.

An extensive search of literature was done by the investigator to elicit factual information about prevention of hypertensive complications. The related literature is organized under the following heading.

a.  Literature on prevention of cerebrovascular diseases related to hypertension.

b.  Literature on prevention of cardiovascular disease related to hypertension.

c.  Literature on prevention of renal diseases related to hypertension.

A) LITERATURE ON PREVENTION OF CEREBROVASCULAR DISEASES RELATED TO HYPERTENSION.

Luders.S (2007) discussed about hypertension is the major risk factor for ischemic and hemorrhagic clinical strokes as well as for silent brain infacts with a continuous association between systolic and diastolic blood pressure, study conducted on hypertensive clients that increases the risk of recurrent strokes. Only limited data directly address the role of Blood pressure treatment among individual with stroke or Transient ischemic attack.Experimental data and clinical data used in this study they suggest that reducing the activity of the renin- angiotensin aldosterone system (RAAS) may have beneficial effects beyond the lowering of Blood pressure.. They concluded that currently the most important goal in primary and secondary prevention of stroke is a strict normotensive blood pressure control. Anti hypertensive treatment is recommended for both prevention of recurrent stroke and prevention of other vascular events in individuals who have had an ischemic stroke15.

Wang J.G., LiY, (2004) explained about hypertension is the most powerful risk factor for stroke. Antihypertension drug treatment reduces the incidence of stroke. In a meta analysis of actively controlled trails calcium- channel blockers including (-8%, p=0.07) or excluding verapamil (-10%.: p=0.02) as well as angiotension type 1 receptor blockes (-24%, p=0.002) resulted in better stroke prevention than the old drugs (diuretics or Betablockers) where as opposite trend was observed for angiotension converting enzyme inhibitors (+10% : p=0.03) An over view of six trails conducted in patients with a history of cerobro vascular disease demonstrated that blood pressure lowering therapy reduced stroke recurrence by 25% (p=0.004). A meta regression analysis showed that with in trail differences in systolic blood pressure accounted for the prevention of stroke in most trails16.

Panademetriou.V, Farsang C, ElmFeldt D, Hofman A, (2004) conducted study on cognition and prognosis in the elderly (scope) 4.964 patients were randomly assigned to double blind candesastan or placebo with open-label antihypertensive drugs therapy (mostly thiazide diuretics) added as needed to control blood pressure of the 4,964 patients 1,518 had ISH (systolic blood pressure > 160mm Hg and DBP < 90 mm Hg. The result of ISH (Isolated systolic Hypertension) patients, 754 were randomized to the candesartan group and 764 to the controlled group over the study period BP was reduced by 22/6mm Hg in the candesartan group and by 2015mm Hg in the control group (difference between treatments 2/1mm Hg: p=0.101 and 0.064). The total of 20 fatal/non-fetal strokes occurred in the candesatan group (7.2/1000 patient/years) and 35 in the control group (12.5/1000patient-years) relative risk (RR) was 0.58 (95% confident interval 0.33 to 1.00) that is RR reduction of 42% (p=0.050 unadjusted, p=0.049 adjusted for baseline risk). They concluded that elderly patients with isolated systolic hypertension treatment, despite little difference in blood pressure reduction17.

FlachskampF FA, Gallasch J, Gefeller O, Gan J, Mao J, Wortmeann et al. (2007), conducted study on randomized trail of acupuncture to lower blood pressure and Arterial hypertension is a prime cause of mortality and morbidity in the general populations. The investigator invested whether traditional Chinese medicine acupuncture is able to lower blood pressure, they randomized 160 out patients (age 58 + 18 years= 78 men) with uncomplicated arterial hypertension in a single-blind Fashion to a 6 weeks of course of active acupuncture or Shan acupuncture according to traditional Chinese medicine, but not sham acupuncture, after 6 weeks of treatment significantly lowered mean 24 hour ambulatory blood pressure. The effect disappeared after cessation of acupuncture treatment18.

B). LITERATURE ON PREVENTION OF CARDIOVASCULAR DISEASES RELATED TO HYPERTENSION.

Nishikage T,Kokumai M, Nagakura T, Otani S,Lang Rm, et al. (2007) study done on reduced and delayed untwisting of the left ventricle in patients

With Hypertension and left ventricular hypertrophy, (LV) a study using two-dimensional speckle tracking imaging. Finally they concluded the observed delayed and reduced diastolic untwisting during the isovolumic relaxation period noted in 49 hypertensive patients with left ventricular hypertrophy may contribute towards the LV relaxation abnormality two dimensional speckle imaging a novel tool which can be used for the non-invasive assessment of LV relaxation19.