Study on Assessment of Knowledge Attitude and Practice amongHypertensive Patients in a Tertiary Care Teaching Hospital

INTRODUCTION

Hypertension has become a significant problem in many developing countries experiencing epidemiological transition from communicable to non-communicable chronic diseases. The emergence of hypertension and other cardiovascular diseases (CVDs) as a public health problem in these countries is strongly related to the aging of the populations, urbanization, and socioeconomic changes favoring sedentary habits, obesity, alcohol consumption, and salt intake, among others.¹

Hypertension is not a disease but it is an important risk factor for cardiovascular complications. It can be defined as a condition where blood pressure is elevated to an extent where clinical benefit is obtained from blood pressure lowering.²

The 8th Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High BP (JNC-8) reports that it affects 1 billion people worldwide.³ It is estimated that by 2025, 1.56 billion adults will be living with Hypertension. Increased blood pressure is estimated to cause 7.5 million deaths accounts for 57 million disability adjusted life years (DALYs).² A survey in 2013 revealed that the prevalence of hypertension in India was 33% in urban and 25% in rural population, Of these, 25% rural and 42% urban Indians are aware of their hypertensive status. Only 25% rural and 38% of urban Indians are being treated for hypertension. One-tenth of rural and one-fifth of urban Indian hypertensive population have their BP under control.⁴

In India, 23.10% of men and 22.60% of women over 25 years suffer from hypertension.² Level of knowledge, a positive attitude, and lifestyle modifications are important for effective control of hypertension. This can be achieved by lifelong adoption of healthy lifestyles.⁵

Assessment of knowledge, attitudes, and practices (KAP) is a crucial element of hypertension control, but little information is available from developing countries where hypertension has lately been recognized as a major health problem.⁶

KAP Study and its Significance:

KAP study shows that what people know about certain things, about their feelings and behaviours towards the disease management. The Knowledge, Attitude and Practice are the crucial factors which are characterized by interdependence uniquely. It serves as an educational diagnosis of the community. It suggests that an improvement in the knowledge and Attitudes towards disease management can reform the kindsof practices which are followed regarding management of disease.

So as we know that there are several complications due to Hypertension and its incidence is also increasing day by day so it is necessary that more attention should be directed towards better control of the disease and towards studying and enhancing compliance. Improving the KAP of the patients regarding the disease and drugs can improve the medication adherence behaviour, enhances compliance as well as which in turn improves the therapeutic outcomes and this can be done by many ways including group education as well as through patient counselling. Thus, this study will explore the potential role of the pharmacist as a patient educator in the management of hypertension.⁷

Therefore, a prospective cross sectional study was needed to assess the knowledge, attitude and practice among hypertensive patients attending tertiary care teaching hospital for the effective control of hypertension.

MATERIALS AND METHODS

Study design and setting:

The cross sectional study was conducted for 6 months, in the inpatients of different wards of Navodaya Medical College Hospital and Research Center, Raichur. Data was collected by using specially designed data entry form. The special data entry form is prepared, containing all the information as name, age, sex, address, family history, personal history, social history and educational history, marital status of the patients. The special questionnaire to study the KAP of the patients toward hypertension is also included in the data entry form. The questionnaire for assessment of KAP’s regarding the hypertension included a total of 18 questions for hypertension, with 6 questions related to knowledge about hypertension, 6 questions to assess the attitude of the patient toward the disease, and 6 questions regarding the practices. The questionnaire was filled in at a faceto-face interview with the participant. scores: each correct answer =1 mark; each incorrect answer =0 mark. Minimum score was “o” and maximum score was “6” for each knowledge, attitude, and practice.

Poor scorer: who scored up to 3 marks

Good scorer: who scored more than 3 marks.

Subjects: The current cross-sectional study used a prospective audit of 120 Hypertensive patients with or without co-morbidity admitted in different wards during the study period.

Inclusion Criteria: Hypertensive patients with (or) without comorbid condition admitted in different wards were included and age18-80 years.

Exclusion criteria: Individuals who refused to participate will be excluded Pediatrics, pregnant and lactating women will also be excluded from the study.

Ethical consideration: The ethical approval to conduct the study was obtained from the Ethical Review Committee of Navodaya Medical College Hospital and Research Centre. Written consents were obtained from each participant.

Data analysis: The collected data were analyzed by using graph pad prism version 16 software.

RESULTS

A prospective cross-sectional study was carried among 120 hypertensive patients. The patients were categorized on the basis of Gender, Age, education qualification, marital status, department wise distribution, duration of stay in hospital, smoking and alcoholic habit, patient’s previous history of hypertension, duration of patient’s previous history of hypertension, mostly prescribed antihypertensive drugs.

According to this, Out of 120 hypertensive patients (55.8%) were males and (44.1%) were females. The larger numbers of patients were in age groups of 51-60years (30.83%) and 61-70 years (30%), followed by 41-50 years (20%), 31-40 years (9.16%), 71-80 years (5.83%), and least were found in the age groups of 20-30 years (2.5%), and 81-90 years (1.66%). In this study out of 120 hypertensive patients, 110 (91.6%) patients were illiterates, (5 4.16%) patients were studied primary school, 4 (3.3%) patients were studied secondary school and 1 (0.83%) patient was a graduate. More number of hypertensive patients (91.6%) were illiterates. Out of 120 hypertensive patients all were married only.. Among 120 patients, 90 (75%) non - smokers, 18 (15%) were smokers, and 12 were past smokers. It was also observed that out of 120 hypertensive patients, 95 (79.1%) were non – alcoholics, 25 (20.83%) were alcoholics.

Most of hypertensive patients 86(71.6%) were admitted in general medicine ward of the hospital, followed by 22 (18.33%) hypertensive patients were admitted in causality, 5 (4.16%) patients were admitted in ICU ward, 4 (3.3%) patients were admitted in ortho ward, and lest number of hypertensive patients 2 (1.6%) in surgery and 1 (0.83%) in OBG were admitted.

The total 120 hypertensive patients were divided based on the duration of stay in hospital into 4 groups like 1-5 days, 6-10 days, 11-15 days and 16-20 days. most number of the admitted hypertensive patients 64 (53.3%) were stayed around 6-10 days period, followed by 1-5 days 45 (37.5%) and lest number of hypertensive patients 10 (8.3%) were stayed around 11-15 days period and no patient were stayed around 16-20 days period.

According to previous history of hypertension the hypertensive patients were categorized into 3 groups like patient with past history of hypertension, patient presently diagnosed with hypertension and both. Most of the patients 61 (50.83%) were admitted in hospital with past history of hypertension, 44 (36.66%) hypertensive patients were admitted with past history of hypertension and also presently diagnosed with hypertension while admitted in hospital and least number of patients 15 (12.5%) were diagnosed with hypertension while they were admitted in hospital.

According to duration of previous history of hypertension, the study population were classified into 7 groups like <1 month, > 1 month to 6 months, 7 months to 1 year, > 1 year to 5 years, >5 years to 10 years, >10 years to 15 years, > 15 years to 20 years. More number of hypertensive patients 42 (35%) were having duration previous history of hypertension about more than 1 year to 5 years before admitted to the hospital, followed by >5 years to 10 years 27 (22.5%), 7 months to 1 year 14 (11.6%), > 1 month to 6 months 8 (6.6%), >10 years to 15 years 6 (5%) and least number of patients 4 (3.3%) and 3 (2.5%) were having duration previous history of hypertension > 15 years to 20 years and <1 month respectively.

According to this the mostly prescribed antihypertensive drug is amlodipine, it was prescribed to the 37 (30.83%) hypertensive patients, followed by cilnidipine was prescribed to the 28 (23.33%) patients, telmisartan was prescribed to the 22 (22%) patients, atenolol was prescribed to the 7 (5.83%) patients, losartan was prescribed to the 6 (5%) patients, Ramipril was prescribed to the 5 (4.16%) patients, atorvastatin, labetalol, each drug were prescribed to the 4 (3.3%) patients, combination therapy was prescribed to the 3 (2.5%) patients, and drugs like Olmesartan, carvedilol, levipril, lisinopril and furosemide spironolactone which were prescribed to the very less number 1 (0.83%) hypertensive patients.

Table 9 shows that, out 120 patients 47 patients had good score and remaining 73 patients were poor scorers regarding attitude of hypertension.

Above table illustrates that, Descriptional and Inferential statistical analysis of poor and good scorers regarding Knowledge, Attitude and Practice of hypertension.

DISCUSSION

The increasing prevalence and severity of hypertension is associated with various risk factors such as alcoholism, smoking, and obesity.

Level of knowledge, a positive attitude, and lifestyle modifications are important for effective control of hypertension. The main purpose of this is to examine knowledge, attitude and practice for hypertension and associated risk factors in hypertensive adults. A Prospective - cross-sectional study was carried out by reviewing prescriptions of 120 hypertensive patients.

Out of 120 hypertensive patients (55.8%) were males and (44.1%) were females as shown in. In our study found that prevalence of hypertension was more in males than females, male hypertensive patients were more because of the more habit of cigarette smoking and alcohol in males than females. This finding is in accordance with results of the previous studies conducted by Ikasaya I et. al

Among the total prescriptions collected, age was taken into consideration by dividing into 7 groups being kept at interval of 10 years each. The larger number of patients were in age groups of 51-60years (30.83%) and 61-70 years (30%), followed by 41-50 years (20%), 31-40 years (9.16%), 71-80 years (5.83%), and least were found in the age groups of 20-30 years (2.5%), and 81-90 years (1.66%). More number of hypertensive patients were in age groups of 51-60 years and 61-70 years due to more incident of comorbid conditions like diabetes, coronary artery diseases, and chronic kidney diseases. This finding is in accordance with results of the previous studies conducted by Pirasath S et.al Aparajita D et.al and Rajiv Kumar G et.al. In these previous studies also the more number of patients were affected by hypertension at the group of 50 - 70 years.

In this study out of 120 hypertensive patients, 110 (91.6%) patients were illiterates, (5 4.16%) patients were studied primary school, 4 (3.3%) patients were studied secondary school and 1 (0.83%) patient was a graduate. More number of hypertensive patients (91.6%) were illiterates because most of the patients have low economic status and also, they were coming from village.

Out of 120 hypertensive patients all were married only. In his study all taken patients were above 20 years of age only. This finding is in accordance with results of the previous studies conducted by Yaseen R et.al and Sofia N et.al.

Among 120 patients, 90 (75%) non - smokers, 18 (15%) were smokers, and 12 were past smokers. History of cigarette smoking is the major cause of hypertension because, the nicotine in cigarette smoke is a big part of the problem. It raises your blood pressure and heart rate, narrows your arteries and hardens their walls, and makes your blood more likely to clot. It stresses your heart and sets you up for a heart attack or stroke. This finding is in accordance with results of the previous studies conducted by Puveearasan K et.al.

It was also observed that out of 120 hypertensive patients, 95 (79.1%) were non – alcoholics, 25 (20.83%) were alcoholics. History of alcohol consumption is the major cause of hypertension because, alcohol consumption increases the amount of lipids, or fats, that are in the bloodstream, which can damage the arteries, leading to hardening; this can increase blood pressure. Hardened arteries also increase the risk of blood clots, which can cause heart attack or stroke. This finding is in accordance with results of the previous studies conducted by Aghoja OC et.al.

In this study, the hypertensive patients joined in study hospital were divided according to department in which they were joined. Most of hypertensive patients 86(71.6%)were admitted in general medicine ward of the hospital, followed by 22 (18.33%) hypertensive patients were admitted in casualty, 5 (4.16%) patients were admitted in ICU ward, 4 (3.3%) patients were admitted in ortho ward, and lest number of hypertensive patients 2 (1.6%) in surgery and 1 (0.83%) in OBG were admitted.

The total hypertensive patients 120 were divided based on the duration of stay in hospital into 4 groups like 1-5 days, 6-10 days, 11-15 days and 16-20 days. most number of the admitted hypertensive patients 64 (53.3%) were stayed around 6-10 days period, followed by 1-5 days 45 (37.5%) and lest number of hypertensive patients 10 (8.3%) were stayed around 11-15 days period and no patient were stayed around 16-20 days period.

According to previous history of hypertension the hypertensive patients were categorized into 3 groups like patient with past history of hypertension, patient presently diagnosed with hypertension and both. Most of the patients 61 (50.83%) were admitted in hospital with past history of hypertension, 44 (36.66%) hypertensive patients were admitted with past history of hypertension and also presently diagnosed with hypertension while admitted in hospital and least number of patients 15 (12.5%) were diagnosed with hypertension while they were admitted in hospital.

According to previous history of hypertension, the patients were classified into 7 groups like <1 month, > 1 month to 6 months, 7 months to 1 year, > 1 year to 5 years, >5 years to 10 years, >10 years to 15 years, > 15 years to 20 years. More number of hypertensive patients 42 (35%) were having duration previous history of hypertension about more than 1 year to 5 years before admitted to the hospital, followed by >5 years to 10 years 27 (22.5%), 7 months to 1 year 14 (11.6%), > 1 month to 6 months 8 (6.6%), >10 years to 15 years 6 (5%) and least number of patients 4 (3.3%) and 3 (2.5%) were having duration previous history of hypertension > 15 years to 20 years and <1 month respectively. This finding is in accordance with results of the previous studies conducted by Aghoja OC et.al. and Rajiv Kumar Get.al. and Raghdaa S et.al. In these study also the more number of hypertensive patients had 1-5 years and 5-10 years.

The mostly prescribed anti-hypertensive drug is amlodipine, it was prescribed to the 37 (30.83%) hypertensive patients, followed by cilnidipine was prescribed to the 28 (23.33%) patients, telmisartan was prescribed to the 22 (22%) patients, atenolol was prescribed to the 7 (5.83%) patients, losartan was prescribed to the 6 (5%) patients, Ramipril was prescribed to the 5 (4.16%) patients, atorvastatin, labetalol, each drug were prescribed to the 4 (3.3%) patients, combination therapy was prescribed to the 3 (2.5%) patients, and drugs like Olmesartan, carvedilol, levipril, lisinopril and furosemide spironolactone which were prescribed to the very less number 1 (0.83%) hypertensive patients. This finding is in accordance with results of the previous studies conducted by Manasa B et.al. In that study also amlodipine is the mostly prescribed anti-hypertensive drug.

CONCLUSION

It was observed that majority of the patients in the study had poor awareness of hypertension. Adequate knowledge, a positive attitude was important for effective control of hypertension. Therefore, strengthening of health services is recommended in the form of organizing health education camps. Also people have to be educated through mass media on hypertension and its risk factors for effective control of hypertension in the community.