Familial Trend and Socioeconomic Status of the Hypertensive Patients Attending at Hypertension Clinic

The aim of the study was to investigate familial trend and socioeconomic status of the hypertensive patients attending at the Hypertension Clinic of Dhaka Medical College Hospital, Dhaka. The study period was from July 2009 to June 2010. A total of 417 patients were recruited of which 245 were male and 172 female respectively, and selected consecutively on the basis of defined criteria. The research instrument was an interviewer-administered questionnaire. For assessment of familial trend of hypertension, first and second degree relatives of the respondents were investigated. Results showed that majority of the respondents were educated of which 22.1%(n=92), 18.2%(n=76), 19.9%(83) and 13.7%(n=57) were secondary, higher secondary, graduate and postgraduate educated respectively. In profession, 64.4%(n=111) female had household works, and 56.8%(n=139) male were in service and 41.2%(n=101) businessmen and had monthly income of Tk. 10,000 to 80,000. The mean age of them was 47.4±6.9 years and BMI was 25.5±3.0 kg/m. The nutritional status of them were normal in 40.5%(n=169) and rest had different degree of malnutrition. In malnutrition, 53.1%(n=130) male were overweight, 2.9%(n=7) obese and 0.8%(n=2) undernourished; and 51.2%(n=88) female were overweight, 11.0(n=19) obese and 1.2%(n=2) undernourished respectively. About 70.5%(n=294) of the studied hypertensive patients had positive history of hypertension in first and second degree relatives of which 17.3%(n=72) had single member positive history of hypertension, 18.2%(n=76) two, 16.8%(n=70) three, 14.1%(n=69) four and 4.1%(n=17) five members. In single member positive, most of them were in first degree relatives; in two members, 67.1%(n=51) were in first degree relatives and 27.6%(n=21) in both first and 2 degree relatives; in three members, 64.3%(n=45) were in 1 degree and 31.4%(n=22) in both 1 and 2 degree; in four members, 31.9%(n=22) were in 1 degree relationship, 17.4%(n=12) in 2 degree and 50.7%(n=35) in both 1 and 2 degree; and in five members, 17.6%(n=3) and 82.4%(n=14) in second degree, and both 1 and 2 degree relatives respectively. Heath education and behavioral change intervention programs among the hypertensive population may be one of the most important applicable ways to control and/or prevention of hypertension and its complications in Bangladesh. Keyword: Familal trend, Hypertension, Socioeconomic status 1. Assistant Professor, Department of Health Education, NIPSOM, Mohakhali, Dhaka 2. Senior Stuff Nursem, Dhaka Medical College Hospital, Dhaka 3. Assisant Professor and Head, Department of Occupational and Environmental Health, NIPSOM, Mohakhali, Dhaka 4. Medical Officer, Department of Health Education, NIPSOM, Mohakhali, Dhaka 5. Assistant Professor, Department of Nutrition and Biochemistry, NIPSOM, Dhaka Correspondence : Dr. Kazi Jahangir Hossain,Assistant Professor, Department of Health Education, National Institute of Preventive and Social Medicine (NIPSOM), Mohakhali, Dhaka, Email: hossain.jahangir59@yahoo.com Introduction: Hypertension is the most common and leading cause of morbidity and mortality in the industrial world as well as becoming an increasingly widespread disease in the developing countries. It is one of the 10 leading reported causes of death and about 4.0% deaths are due to hypertension and/or complications of hypertension in Bangladesh1. The top-most risk factors for the development of future hypertension are increased intake of sodium salt, use of tobacco products such as cigarette, bidi, sadapata, jarda and gul, obesity, elevated level of serum cholesterol, lack of physical exercise, excess stress and anxieties, and positive genetic predisposition2-7. In fact, an individual cannot change his/her genetic predisposition, age or gender, but he/she can change or modify or avoid other risk factors. The risk factors, which can be adjusted or modified through lifestyle advice, are sodium salt intake, tobacco products use, obesity, serum cholesterol level, physical exercise, stress and anxieties, dietary intake and improper lifestyle functions8. Prevalence of hypertension is 15-20% among adult population in Bangladesh9. The cardiovascular diseases such as ischemic heart diseases, stroke, and heart failure are one of the major chronic diseases and are the leading cause of death and disability in Bangladesh. High blood pressure is one of the most important direct causes, accounting 60 percent of all strokes and 50 percent of all J MEDICINE 2012; 13 : 10-15

The aim of the study was to investigate familial trend and socioeconomic status of the hypertensive patients attending at the Hypertension Clinic of Dhaka Medical College Hospital, Dhaka.The study period was from July 2009 to June 2010.A total of 417 patients were recruited of which 245 were male and 172 female respectively, and selected consecutively on the basis of defined criteria.The research instrument was an interviewer-administered questionnaire.For assessment of familial trend of hypertension, first and second degree relatives of the respondents were investigated.Results showed that majority of the respondents were educated of which 22.1%(n=92), 18.2%(n=76), 19.9%(83) and 13.7%(n=57) were secondary, higher secondary, graduate and postgraduate educated respectively.In profession, 64.4%(n=111) female had household works, and 56.8%(n=139) male were in service and 41.2%(n=101) businessmen and had monthly income of Tk. 10,000 to 80,000.The mean age of them was 47.4±6.9 years and BMI was 25.5±3.0kg/m 2 .The nutritional status of them were normal in 40.5%(n=169) and rest had different degree of malnutrition.In malnutrition, 53.1%(n=130) male were overweight, 2.9%(n=7) obese and 0.8%(n=2) undernourished; and 51.2%(n=88) female were overweight, 11.0(n=19) obese and 1.2%(n=2) undernourished respectively.About 70.5%(n=294) of the studied hypertensive patients had positive history of hypertension in first and second degree relatives of which 17.3%(n=72) had single member positive history of hypertension, 18.2%(n=76) two, 16.8%(n=70) three, 14.1%(n=69) four and 4.1%(n=17) five members.In single member positive, most of them were in first degree relatives; in two members, 67.1%(n=51) were in first degree relatives and 27.6%(n=21) in both first and 2 nd degree relatives; in three members, 64.3%(n=45) were in 1 st degree and 31.4%(n=22) in both 1 st and 2 nd degree; in four members, 31.9%(n=22) were in 1 st degree relationship, 17.4%(n=12) in 2 nd degree and 50.7%(n=35) in both 1 st and 2 nd degree; and in five members, 17.6%(n=3) and 82.4%(n=14) in second degree, and both 1 st and 2 nd degree relatives respectively.Heath education and behavioral change intervention programs among the hypertensive population may be one of the most important applicable ways to control and/or prevention of hypertension and its complications in Bangladesh.

Introduction:
Hypertension is the most common and leading cause of morbidity and mortality in the industrial world as well as becoming an increasingly widespread disease in the developing countries.It is one of the 10 leading reported causes of death and about 4.0% deaths are due to hypertension and/or complications of hypertension in Bangladesh 1 .The top-most risk factors for the development of future hypertension are increased intake of sodium salt, use of tobacco products such as cigarette, bidi, sadapata, jarda and gul, obesity, elevated level of serum cholesterol, lack of physical exercise, excess stress and anxieties, and positive genetic predisposition [2][3][4][5][6][7] .In fact, an individual cannot change his/her genetic predisposition, age or gender, but he/she can change or modify or avoid other risk factors.The risk factors, which can be adjusted or modified through lifestyle advice, are sodium salt intake, tobacco products use, obesity, serum cholesterol level, physical exercise, stress and anxieties, dietary intake and improper lifestyle functions 8 .Prevalence of hypertension is 15-20% among adult population in Bangladesh 9 .The cardiovascular diseases such as ischemic heart diseases, stroke, and heart failure are one of the major chronic diseases and are the leading cause of death and disability in Bangladesh.High blood pressure is one of the most important direct causes, accounting 60 percent of all strokes and 50 percent of all J MEDICINE 2012; 13 : 10-15 .heart diseases.Nearly 15 million adults have been suffering from hypertension, among them, 49.0% in urban and 17.0% in rural elderly hypertension population are found aware of their high blood pressure of which, only 4.5% in urban and 3.1% in rural have found controlled blood pressure 10 .However, awareness about hypertension among the hypertensive population is one of the important applicable ways to minimize this human catastrophe.
The ultimate aim of this study is to investigate familial trend and socioeconomic status of the hypertensive patients to decrease morbidity and mortality due to hypertension.It is a grave threat to the public health in Bangladesh.Because of, most of the risk factors are highly prevalent in Bangladesh.In addition, people living with hypertensions are the topmost high-risk subpopulations who become physically disabled all on a sudden.Therefore, the aim of this work and in continuation of research in this field was to investigate familial trend and socioeconomic status of the hypertensive patients attending at hypertension clinic in Dhaka Medical College, Dhaka.The outcome will, significantly, be supportive and enhance the national preventive activities against hypertension

Study population
The studied populations were the patients had been suffering from hypertension.Most of them attended voluntarily at the Hypertension Clinic of the Dhaka Medical College Hospital Dhaka and few were refereed patients from other departments from July 2009 to June 2010.A total of 417 patients were included in this study, among them, 245 were male and 172 female respondents.They were selected consecutively on the basis of defined criteria that were included in clinical manifestation of hypertension, irrespective of age and gender, and did not suffer from co-morbid mental disorders and used illicit drugs.Research instrument was an interviewer-administered questionnaire.The questionnaire was developed and pre-tested among the admitted patients, who were excluded from the study population.The questionnaire was designed to include general information, socioeconomic, anthropometrical data and family profile of the respondents.The socioeconomic profile included education, occupation, monthly income, age and marital status of the respondents.The anthropometrical device included height, weight and body mass index (BMI).The BMI was used to assess nutritional status of the respondents.For assessment of the familial trend of hypertension, first and second degree relationship such as father, mother, brother and sister; and chacha, fupu, mama and khala of the respondents were investigated.
Initially, an appointed research assistant briefed objectives, benefits, risks and burdens of this study to the patients and their close relatives.Only positive respondents were selected as research participant consistent with the selection criteria.A written informed consent was taken from each of the selected patients maintaining full autonomy.The research assistant also recorded socioeconomic-family profile of them following the questionnaire.A Medical Officer, under the direct supervision of the Resident Physician, was assigned for the diagnosis of hypertension and to take interview about familial trend of hypertension following the questionnaire.Each of the participants was examined individually in a separate room for maintaining their privacy and confidentiality strictly as well.In addition, close relatives were also interviewed, if necessary.Finally, the research assistant measured height and weight of the hypertensive patients using standard measuring scale.The study did not involve in any social, mental or physical risk to the patients.Prior to conduct, institutional permission was taken from the concerned authority of the hospital.The procedures followed for this study were in accordance with the CIOMS guidelines as updated in 2002 11 .No wedge-compensation was given to the participants.

Statistical analysis
A software package of SPSS (version 12.0: SPSS Inc., Chicago, IL, USA) was used to analysis the data.Descriptive statistics was used for all variables.Values were expressed as percentage.

Results:
Socioeconomic profile of the studied hypertensive patients is summarized in the Table-I.Majority of the respondents were found educated, among them, 22.1%(n=92), 18.2%(n=76), 19.9%(83) and 13.7%(n=57) were secondary, higher secondary, graduate and postgraduate educated respectively.In graduate and postgraduate, male were found comparatively higher status than that of female.In profession, 64.4%(n=111) female had household works only and 32.0%(n=55) had service.Among male, about 57.0%(n=139) were service holders and 41.2%(n=101) businessmen.Almost all male respondents had monthly income ranged 10,000 to 80,000 Taka.On the other hand about 65.0%(n=112) female had no income.
The familial trend of hypertension was summarized in the Table-III.Results showed that 70.5%(n=294) of the studied hypertensive patients had positive history of hypertension in first and second degree relationship.Among them, 17.3%(n=72) had single member positive history of hypertension, 18.2%(n=76) two members positive, 16.8%(n=70) three members positive, 14.1%(n=69) four members positive and 4.1%(n=17) five members positive history of hypertension.Only 29.5%(n=123) had no family history of hypertension.In single member positive, most of members were in first degree relationship (Table 3).In two members positive, 67.1%(n=51) were found in first degree relationship, 5.3%(n=4) in second degree and 27.6%(n=21) in both first and 2 nd degree relationship respectively.Among the history of three members positive, 64.3%(n=45) were in 1 st degree relationship, 4.3%(n=3) in 2 nd degree, and 31.4%(n=22) in both 1 st and 2 nd degree relationship.In the history of four members positive, 31.9%(n=22) were 1 st degree relationship, 17.4%(n=12) in 2 nd degree and 50.7%(n=35) were in both 1 st and 2 nd degree relationship.Finally, in five members positive history of hypertension, 17.6%(n=3) and 82.4%(n=14) in second degree, and both 1 st and 2 nd degree relationship respectively.There was no 1 st degree positive among the five members positive history of hypertension.

Discussion:
Hypertension is the leading cause of morbidity and mortality among the adult human; no nation in the globe is immune to its fatal consequences.It is one of the major noncommunicable health problems in Bangladesh.In most cases, there is no specific causative agent for hypertension 12 .The top-most risk factors for the development of future hypertension are perhaps due to increased intake of sodium salt and sugar, increase use of tobacco products, overweight, dyslipidemia and hyperlipidemia, lack of physical exercise, excessive stress and anxiety, and positive genetic transmission [2][3][4][5][13][14] . Therefre, in order to address this national issue, the present study attempted to focus familial trend of hypertension and socioeconomic status of the hypertensive patients in Bangladesh.
Most of the respondent hypertensive patients were educated.Among them, males were found higher status in degree and above than that of female.In profession, majority of the female occupation was household works, and male had specific jobs such as business, service etc and had monthly income of Taka 10 thousands to 80 thousands but reverse scenario was found in female participants and they had no income.As a whole, Bangladesh is a densely populated country.About 160 million people live in this country.The trend in population growth, fertility, morbidity, mortality and migration from rural to urban areas are persistently creating hurdles in socioeconomic development.At present, nearly 48.0%people live below the poverty line.The socioeconomic characteristics of the studied hypertensive patients are consistent with the reported national statistical data 15 .The possible explanation is that the patriarchal society, religious stigmatism or fundamentalism as well as conventional sociocultural impact may be the important contributing factor for such type of socioeconomic characteristics of the women in Bangladesh.Socio-culture and religious backward tradition may be the unavoidable factors against women empowerment in the community.This trend of socioeconomic status is gradually changeing in Bangladesh.However, the socioeconomic status of the studied patients was found comparatively better than that of others.Education, family income and relatively better occupation are the leading factors for better socioeconomic status of them.
Eighty percent of the respondent patients had age above 40 years.Hypertension is an adult onset disease.Results are very much consistent with the other studies.Assessment of adult nutritional status is a complex procedure.No single method is available for assessment of the nutritional status of an adult individual.Multiple nutritional profiles such as anthropometrical, biochemical, clinical and dietary intake indices are need to analyze for the assessment of complete nutritional status [16][17] .Of the anthropometrical indices, body mass index (BMI), is usually and widely used to assess nutritional status of the adult population.It is relatively insensitive to 05% weight loss within 30 days or 10% weight loss over 6 months 18 .In this study, BMI was used to assess nutritional status of the hypertension patients.Results showed that about 60.0% in both sexes had different degree of malnutrition such as overweight and obese etc.The possible explanation, in general, occupation and income have a direct positive correlation with BMI.The socioeconomic status of the participant hypertension patients was found better than other population.Similar results were found in other studies 19 .
Around 70.0% respondents had positive family history of hypertension.They ensured 1-5 relatives suffered or had been suffering from hypertension.Of them, first-degree relationship (father, mother, brother and sister) was highly prevalent.Second degree relationship (Chacha, Fupu, Mama and Khala) and both of them were also significantly prevalent.The possible explanation is that the risk of hypertension is increased with age and some inherited genetic mutations, nervous sysytem overactivity, and insulin related metabolic syndrome, and low birth weight which are highly prevalent among the hyperternsive patients in Bangladesh.Similar result is also found in other studues [5][6][7]20 . Theefore, the familial trend of hypertension was found in the study strongly supported the genetic transmission of hypertension from parent to children.
In conclusion, socioeconomic status of the hypertensive patients was good and age of them was 47.4±6.9years.First degree and mixed relationship familial trend of hypertension was found significantly prevalent.Hypertension is a multifactorial disorder; no single factor is responsible for the development of hypertension.In fact, an individual can change or modify or avoid many risk factors to control hypertenaion or minimize the complication of hypertension.Heath education and behavioral change intervention programs among the hypertensive population may be one of the most important applicable ways to control and/or prevention of hypertension and its complications in Bangladesh.