Title

Epidemiological studies of elevated blood pressure among ismaili muslims in Karachi Pakistan

Date of Award

1999

Document Type

Thesis

Degree Name

Master of Science in Epidemiology & Biostatistics (MSc Epidemiology & Biostats)

Department

Community Health Sciences

Abstract

Hypertension is a common clinical condition. It plays a major role in causation of circulatory diseases together with hyperlipediemia and smoking. Cardiovascular morbidity and mortality together with hypertension have emerged as a major public health burden in the developing countries including Pakistan. Proportional Mortality of Cardiovascular diseases in Pakistan is 12%; whereas prevalence of hypertension, is almost 30% among urban individuals (age > 25 years) in the country. Among the hypertensive individuals in Pakistan, 70% are unaware of their elevated blood pressure. This current scenario of unawareness of hypertension in Pakistan urges public health professionals to identify factors associated with unawareness, recommend appropriate public health policies, develop and implement preventive measures to reduce the burden of hypertension. Present study was conducted among Ismaili-Muslim community because of the alarming proportional mortality of cardiovascular diseases received through their Health Management Information System. These were 24Vo and 30Va in 1993 and 1996 respectively. Hypertension was present among 70Va of the individuals who died of cardiovascular diseases in 1996 as extracted from death certificates. A hypertension survey was deemed necessary to develop public health interventions within the community. A cross-sectional study was conducted during July-September 1998, among 546 randomly selected Ismaili-Muslim adults (age 2 25 years) in Karachi-Pakistan. The questionnaire was administered and measurements were taken to assess the prevalence of elevated blood pressure. Prevalence of unawareness of elevated blood pressure, factors associated with elevated blood pressure and factors associated with unawareness of elevated blood pressure. Among all respondents 47% had elevated blood pressure. Amongst individuals having elevated blood pressure, 64Va were unaware of their elevated blood pressure. In addition, out of 116 physician confirmed hypertension cases, 21Va had blood pressure below cutoff l40l90 mm Hg. Analysis regarding unawareness of elevated blood pressure indicates that the adjusted odds of not utilizing general health screening amongst the unaware elevated blood pressure group was 3 times of the same odds among the aware group IAOR 2.8 (95% CI 1.6, 4.9)]. Further, the adjusted odds of having age equal to or less than 40 years among the unaware elevated blood pressure was2 times of the same odds among the aware group IAOR 2.2 (95% CI 1.1, 4.4)]. Regarding factors associated with elevated blood pressure, the adjusted odds of having body mass index at least 25 Kg/m2 among elevated blood pressure group was twice of the same odds among normal blood pressure group [AOR 1.6 (95% CI 1.L,2.3)]. Stress was another significant factor associated with elevated blood pressure IAOR 1.8 (95% CI I.Z, Z.7)]. Due to alarming prevalence of elevated blood pressure and its unawareness among respondents as compared to other studies from developing countries in the 90's, we recommend that the community should adopt primary and secondary prevention strategies to control hypertension. The community has an infrastructure for conducting screening programs. We recommend that they implement strategies to improve awareness of elevated blood pressure through mass well focused screening program as well as weight reduction and physical exercise within the community.

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