Smoking hazards

PSBH PROJECT HYPERTENSION – SMOKING OR SEDENTARY LIFE-SYTLE?

INTRODUCTION  An elevated arterial pressure is probably the most important public health problem in developed and developing countries as well.  It is common, asymptomatic, readily detectable, usually easily treatable, and often leads to lethal complications if left untreated.  “ By definition it is difficult and by necessity arbitrary”  There is a direct relation between cardiovascular risk and blood pressure. The higher the blood pressure the higher the risk of both stroke and coronary events.

The reason for choosing the project is mainly because hypertension is major factor in cardiovascular mortality, which accounts for 30% of the deaths in the community.  The aim while choosing the project was to bring an awakening among us about the possible interventions, which can help, in controlling this end organ disease.  The goal of the hypothesis is to determine association of the modifiable risk factors like sedentary life style and smoking.

Aims and objectives Aim :  To the association of modifiable risk factors namely sedentary life style and smoking with hypertension in patients coming to V.S. OPD of Ahmedabad city. Objective : Analysis of the data according o To Age and Gender o Smoking, and its details of years of smoking and number of cigarette smoked per day o Sedentary life style Comparison between the patients having smoking history and sedentary life style.

Research question Q: a study of association of modifiable risk factors (smoking and sedentary life style) with hypertension in the patients coming to V.S. OPD from June 23 rd to July 10 th

TIME LINE CHART 6 5 4 3 2 1 0 Official permission Annexure Data collection Analysis

Review of The literature In today’s world, most of the deaths are due to the non-communicable diseases (32 millions) and half of these have been due to cardiovascular diseases. In India an estimated 2.7 million died due to cardiovascular disease in 1990 and the toll is estimated to rise very steeply in the 21 st century with hypertension being one the major causes of cardiovascular diseases. Thus looking at the problem the hypertension is itself a major problem, which also causes other morbid conditions like stroke, renal disease.

Risk factors Non-modifiable risk factors include:  Age  Sex  Genetic factors  Ethnicity Modifiable risk factors include:  Obesity  Salt intake  Saturated fats  Dietary fiber  Alcohol  Socioeconomic status  Smoking  Sedentary life style  Stress  Others

Hypertension It is an iceberg disease. It became evident in the early 1970’s tat only about half of the hypertensive subjects in the general population of most developed countries were aware of the condition, only half of those aware of the problem were being treated and only half of those treated were considered adequately treated. The regarding the prevalence of the disease it is found to be present in 59.9 and 69.9 per 1000 in males and females respectively in urban while 35.5 and 35.9 per 1000 in males and females respectively in rural population. (REF: 2)

Sedentary life style Sedentary life style has crept into the lives of urban population. A normal workingman of a city hardly does any exercise which can be helpful to him so as keep him fit and healthy. More over the sedentary life style is also responsible for causing obesity, which again is a major risk factor for hypertension. Researches have showed that a person doing regular exercise can actually be free from most of the non communicable disease and this is a major break through for primordial prevention of most of the non-communicable diseases in the western world and with increasing prevalence of the diseases in India as well it would be really helpful in deciding the future trends.

Smoking Smoking which is now looked as one of the style statements among people in India mainly those in the younger age groups and this is more alarming then any other preventable causes of many morbid conditions. Apart from causing lung cancer for which the association is already proved it also is a major cause of hypertension. Smoking causes carbon monoxide induced atherogenesis , Nicotine stimulation of adrenergic drive raising the blood pressure. It also causes decreased levels of High Density Lipoproteins, which are again very important.

Methodology Design of study : this is a cross sectional study as there was no follow up. Also, this was a descriptive study as only the data collected was analyzed. Study area : the area of study was V.S. General Hospital Out Patient Dept. Subject : known cases of hypertension, which came for, follow up visit Sample size : 200 hypertensives Sampling procedure : randomly selected first 200 known cases of hypertension Study period : 23 rd June to 10 th July Study material : we had pre-designed questionnaire to include the history of risk factors under study. Procedure : After a taking permission from concerned authorities, data was collected by interviewing each patient, individually. By data thus collected was compiled and after compiling the data was computerized, refined and analyzed using SPSS. Ethical considerations : as consent was taken from Dean of the college, Head of Preventive and Social Medicine, Superintendent of V.S. General Hospital. Limitation of study : the exact degree of hypertension wasn’t known since the patients were already taking the anti-hypertensive drugs.

Observation Statistics Above is the table under which the collected data is analyzed upon i.e. the variables, which we took under consideration. Frequency 200 200 200 200 200 200 200 AGE SMOKING NOC DUR PE RELIGION SEX

Hypertension and age wise distribution “ The pie chart above shows the percentage age wise distribution of hypertensive patients The maximum hypertensive patients are in age group in 50-60yrs. This goes to show relation of age with hypertension.” Age 30-40 40-50 50-60 >60 Frequency 22 24 80 74 Percentage 11 12 40 37

Hypertension and sex wise distribution SEX “ The Male: Female ratio in case of hypertensive patients is 1.38:1 ” “ The Male: Female ratio in case of hypertensive patients is 1.38:1 ” “ The Male: Female ratio in case of hypertensive patients is 1.38:1 ” “ The Male: Female ratio in case of hypertensive patients is 1.38:1 ” Valid F 84 42.0 42.0 42.0 M 116 58.0 58.0 100.0 Frequency Percent Valid Percent Cumulative Percent Total 200 100.0 100.0

Hypertension and smoking “ The smoker: non-smoker is ratio in hypertensive patients is 3:7 ” Smoker 60 30.0 30.0 30.0 Non-smoker 140 70.0 70.0 100.0 Frequency % Valid Percent Cumulative Percent Total 200 100.0 100.0

Hypertension among smokers and number of cigarette/day “ The chart here shows that the hypertensive patients among the group of >20 cig/day is maximum” 1-10 12 20.0 20.0 20.0 11-20 22 36.67 36.67 56.67 >20 26 43.33 43.33 100.0 Cigarette/day Frequency % Valid Percent Cumulative Percent Total 60 100.0 100.0

Hypertension among smokers and duration of smoking “ The pie-chart here shows maximum no. of hypertensive patients in the group of >10yrs of cig. Smoking” 1-5 3 5 5 5 5-10 10 16.67 16.67 21.67 >10 47 78.33 78.33 100.0 Duration of smoking in years Frequency % Valid Percent Cumulative Percent Total 60 100.0 100.0

Hypertension and sedentary life-style “ The maximum no. of hypertensive patients are those who are not doing any physical exercise the ratio of exercising to sedentary life style being 3:22” No 24 12.0 12.0 12.0 Yes 176 88.0 88.0 100.0 Sedentary life-style Frequency % Valid Percent Cumulative Percent Total 200 100.0 100.0

Statistics on smokers and sedentary life-style among the study group In percentages that is: Smokers Non-smokers Sedentary life style 40 136 Regularly exercising 20 4 Smokers Non-smokers Sedentary life style 20% 68% Regularly exercising 10% 2%

“ The table shows that people having sedentary life-style and non-smokers are the maximum in percentage” “ The people who are having no risk factor under study (sedentary life style/smoking) are just 2% showing that these people are those in whom there will be other risk factor associated”

For males the data is as follows In percentage that is: “ The interpretation here is that males are having hypertension more than female in the study because as we can see the percentage of males having both the risk factors is 34.5% which is much higher when compared with the whole group (20%)” Smoker Non-smoker Sedentary life style 40 52 Regularly exercising 20 4 Smoker Non-smoker Sedentary life style 34.5% 44.8% Regularly exercising 17.2% 3.5%

Discussion FROM ABOVE DATA AND THE OBSERVATIONS WE CAN CONCLUDE FOLLOWING THINGS:  THE PREVALANCE OF HYPERTENSION AMONG THE STUDY GROUP, IN THE TERMS OF GENDER WISE DISTRIBUTION IS 58% IN MALES AND 42% IN FEMALES.THE REASON FOR THIS HIGH PREVALANCE AMONG MALES AS WE CAN SEE IS BECAUSE % OF MALES HAVING BOTH THE RISK FACTORS IS MORE AND THUS GOES TO SHOW THAT THOUGH THE NORMAL SEX DISTRIBUTION OF HYPERTENSION AS DESCRIBED BEFORE SHOWS MORE FEMALE HYPERTENSIVES; FOR OUR STUDY GROUP THE SEX DISTRIBUTION IS CHANGED WITH NO. OF MALE HYPERTENSIVES BEING MORE.  THE PREVALANCE OF HYPERTENSIVES WHO HAVE A H/O SMOKING COMES OUT TO BE JUST 30% WHILE THE REST 70% HYPERTENSIVES DO NOT HAVE A H/O SMOKING

 MOREOVER TAKING INTO THE CONSIDERATION THAT FEMALES WHO WERE HYPERTENSIVE DID NOT HAVE A H/O SMOKING WE CONCLUDE THAT OF ALL 116 MALES 60 HAVE A POSITIVE H/O SMOKING SO 51.72% OF THEM HAVE BEEN SMOKING  AMONG SMOKERS IF WE SEE THE ANALYSIS WE CAN CLEARLY SEE THAT THE NUMBER OF SMOKERS WHO HAVE BEEN SMOKING FOR MORE THAN 10 YEARS IS THE HIGHEST.  SIMILARLY THE PEOPLE WHO HAVE BEEN SMOKING OVER 20 CIGARETTE A DAY IS MORE THAN THE OTHER GROUPS.  THE PERCENTAGE OF HYPERTENSIVE WITH SEDENTARY LIFE STYLE IS 88% WHICH IS MUCH HIGHER THAN THE PERCENTAGE OF THOSE WHO ARE SMOKING.  ALSO WHEN WE SEE THE DATA IT IS CLEARLY EVIDENT THAT THE STUDY GROUP HAS JUST 2% PEOPLE WHO HAD NO RISK FACTOR INCLUDED IN THE STUDY SHOWING THAT THE RISK FACTORS UNDER STUDY ARE SO VERY COMMON AMONG THE POPULATION.  THE FEMALES OF THE STUDY GROUP HAD NO H/O SMOKING BUT STILL WE SEE THAT THERE IS A CONSIDERABLE NO. OF FEMALES WHO ARE HYPERTENSIVE BECAUSE MOST OF THE FEMALES ARE HAVING SEDENTARY LIFE STYLE.

RECOMENDATIONS  THE STUDY WAS TAKING UNDER CONSIDERATIONS THE RISK FACTORS FOR HYPERTENSION AND THUS ITS QUITE EVIDENT THAT RISK FACTORS SHOULD BE CURBED DOWN SO AS TO DECREASE THE OCCURENCE OF HYPERTENSION IN THE COMMUNITY.  THE IMPORTANT THING THAT WE INTERPRETED WAS THAT MORE THAN SMOKING; SEDENTARY LIFE STYLE IS A MAJOR FACTOR FOR HAVING HYPERTENSION.  THUS IF WE MAKE DUE CHANGES IN OUR LIFE STYLE BY DOING REGULAR EXERCISE WHICH CAN BE IN FORM OF WALKING/JOGGING FOR MORE THAN HALF AN HOUR DAY, THEN WE CAN HAVE A GREAT CHANGE IN THE PREVALNCE OF HYPERTENSION.  WELL ABOUT SMOKING WE CAN JUST SAY “SOME PEOPLE COMMIT SUICIDE AND OTHER JUST SMOKE”  SMOKING IN ANY FORM CAN HAZARDOUS TO THE HEALTH. THUS MORE EFFORTS ABOUT THE AWARENESS OF THE SMOKING HAZARDS.

Bibliography  REF.1 Harrison’s Text book on Internal Medicine  REF.2 Text book on Preventive and Social Medicine –James park

ANNEXURE  NAME:  AGE:  SEX:  OCCUPATION:  RELIGION:  SMOKING: IF YES NO. OF CIGARETTES/DAY: 1-10 11-20 >20 DURATION SMOKING: 1-5 5-10 >10  PHYSICAL EXECISE: (AS A MEASURE OF SEDENTARY LIFE STYLE)

Smoking hazards

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