Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore s26

A STUDY OF PREVALENCE OF HYPERTENSION AMONG BANK EMPLOYEES IN BANGALORE URBAN DISTRICT

SYNOPSIS OF DISSERTATION SUBMITTED TO RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE

In partial fulfillment of the regulations for the award of M.D Degree in Community Medicine

Submitted by DR. KAUSHIK. K. N, MBBS Post Graduate Student In Community Medicine (M.D.)

Under the guidance of DR.JAYANTH KUMAR K, MBBS, MD Professor, Department Of Community Medicine, Rajarajeswari Medical College & Hospital, Kambipura, Bangalore - 560074

DEPARTMENT OF COMMUNITY MEDICINE, RAJARAJESWARI MEDICAL COLLEGE AND HOSPITAL, KAMBIPURA, BANGALORE - 560074 2012 RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA, BANGALORE

ANNEXURE - II

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

Dr. Kaushik. K .N.

nd th NAME OF THE CANDIDATE AND #180 ‘Benaka’, 2 A Cross 7 Block 1. ADDRESS (in block letters) Nagarabhavi 2nd Stage, Bangalore-560072

Rajarajeswari Medical College And 2. NAME OF THE INSTITUTION Hospital, Kambipura, Mysore Road, Bangalore - 560 074.

3. COURSE OF STUDY AND M.D In Community Medicine SUBJECT

4. DATE OF ADMISSION TO 30th May 2012 COURSE

5. TITLE OF THE TOPIC

“ A STUDY OF PREVALENCE OF HYPERTENSION AMONG BANK EMPLOYEES OF BANGALORE URBAN DISTRICT.” 6. BRIEF RESUME OF THE INTENDED WORK

INTRODUCTION

At the beginning of the 20th century, cardiovascular disease (CVD) was responsible for fewer than 10% of all deaths worldwide. Today that figure is about 30% with 80% of burden now occurring in developing nations [1]. A recent report on the global burden of hypertension indicates that nearly 1 billion adults (more than a quarter of the world’s population) had hypertension in 2000 and this is expected to increase to 1.56 billion by 2025.[2] In India, cardiovascular diseases (CVDs) are estimated to be responsible for 1.5 million deaths annually.[3] Indeed, it is estimated that by 2020, CVDs will be the largest cause of mortality and morbidity in India.[4] Hypertension is a major risk factor for CVDs, including stroke and myocardial infarction, and its burden is increasing disproportionately in developing countries. Hypertension is defined as systolic blood pressure measuring 140 or more mm of Mercury and Diastolic blood pressure of 90 or more mm of Mercury recorded in an individual.[5] It is an important worldwide public health challenge because of its high frequency & concomitant risks of cardiovascular & kidney disease. It has been identified as the leading risk factor for mortality and is ranked third as a cause for disability-adjusted life-years. Given the rising prevalence of hypertension in developing countries undergoing epidemiological transition like India, increased awareness, treatment and control of high blood pressure are critical in preventing the burden of the illness. India has noted a rising trend in the prevalence of hypertension over the last three decades particularly in the urban population. Even in the urban areas, the prevalence of hypertension is higher among professional people than among industrial & other workers. Stress is one of the important risk factors for hypertension. Professionals who have a stressful job and a sedentary life style are at a greater risk of developing the disease. Bank employees fit in this picture as they represent the subset of population at risk to develop hypertension. 6.1 NEED FOR THE STUDY 1. Occupational settings have a dual risk to the people working there. Some occupations have varying levels of stress and activity levels among them. 2. One such occupation is of bank employees who deal with various types of customers, involves economic liabilities, high levels of accountability, greatly reduced physical activity, sedentary mode of functioning may predispose for the development of various diseases life hypertension, obesity, diabetes mellitus. 3. Long hours of work, habits, heavy work load, administration, handling cash, processes and procedures of approval of various types of loans be it gold, personal or home loan and as well as its recovery, tallying of accounts are some of the factors to mention that cause hypertension among bank employees. 4. Given the large size of the banking sector, the human resource value of people working and employed there, leads to a need in quantifying the magnitude of hypertension among these employees. The investigators strongly believe that evidence regarding the prevalence of hypertension and its associated factors among bank employees which is a closed group will help in the following.  Plan suitable evidence based intervention to mitigate the same.  Collate baseline information for a bank employee cohort which may be useful for planning future prospective studies.  Provide evidence for proportional contribution from this closed group for occurrence of hypertension hence helping in the risk stratification among occupations. Hence it was decided to conduct this study. 6.2 REVIEW OF LITERATURE

1. A study conducted by Patricia M Kearney et al (2005)2 found the global burden of hypertension 26.4% of the adult population in 2000 had hypertension and 29.2% were projected to have hypertension by 2025.It also interpreted that hypertension is an important public health challenge worldwide. Prevention, detection, treatment and control of this condition should receive high priority. Changes in the lifestyles of the general population would result in a lower prevalence of hypertension. Hypertension is important not only because of its high frequency but also it is a major modifiable risk factor for cardio vascular and kidney disease. 2. Mohammedirfan H Momin et al (2012)6 concluded in their study that the overall prevalence of hypertension among 1493 randomly selected bank employees of Surat city was found to be 30.55% and 48.5% of the study population aged 50 & above had hypertension. 3. A cross sectional study by Ashwinkumar M Undhad et al7 in seven purposively selected banks of Surat city on a total of 218 bank employees highlighted the burden of hypertension among the study population. The prevalence was found to be a staggering 69.5% among the study population and hypertension was significantly associated with age 45 years or more, alcohol intake, waist circumference, body mass index & Diabetes. 4. 31% of the study population of bank employees in Belgaum city had hypertension as per H R Shivaramakrishna et al 20108. The study also found smoking to be a risk factor for Coronary heart disease among 26% of the study population. 5. A study by Vinod R K et al 20129 opined that more than half of the selected bank officers examined in various banks of Gulbarga city were at risk for cardiovascular diseases. 6. A Study conducted by V Mohan et al (2007)15 on prevalence, awareness and control of hypertension in Chennai – the Chennai Urban Rural Epidemiology study (CURES 52) found hypertension to be present in 1/5th of urban South Indian population and isolated systolic hypertension was more common. The overall prevalence of hypertension in the study population was 20%.Compared to the subjects below 35 years, those subjects between 35-49 years were at 3 times higher risk of hypertension. 7. M Deepa et al (2011)16found a high prevalence of hypertension among urban residents in India (self reported of 15.1% and newly diagnosed of 19.3%). It concluded in saying non-communicable disease risk factor surveillance is quite challenging. AIM

To assess the prevalence of hypertension and associated risk factors among bank employees in Bangalore urban district.

OBJECTIVES OF THE STUDY: 1. To estimate the prevalence of hypertension among bank employees in Bangalore urban district. 2. To study the risk factors associated with hypertension among the study population. 7. MATERIALS & METHODS: 7.1 SOURCE OF DATA

Bank employees selected from commercial banks in Bangalore urban district. 7.2 METHOD OF DATA COLLECTION

A cross sectional study adopted with a Multistage sampling technique will be conducted for duration of one year. A sampling frame of all the commercial banks in Bangalore (both private & nationalized) will be prepared. From the sampling frame one private and one nationalized bank will be randomly selected by using lottery method. From the sampling frame a list of all the branches of each bank will be obtained. The branch for our study will be selected from the list using lottery method. A list of all the employees working in the branch for more than a year will be enumerated. Employees of multiple branches of the bank will be included until the adequate sample size is obtained. The same process is carried out for both private & nationalized bank till the required sample number is reached. Permission from the concerned authority will be obtained prior to the study. Informed consent from the study participants will be taken before conducting the study. The study protocol will be produced in the institutional ethical committee for ethical clearance. Each of the bank employees under this study will be interviewed personally by the investigator. A questionnaire will be developed to achieve the statistical objectives based on known standard instruments and guidelines. This questionnaire will be validated and field tested in a pilot study before used in the main study. The information is collected using a pre-designed, pre-tested, semi structured questionnaire. Two blood pressure readings 5 minutes apart are obtained in seated position using a standard Sphygmomanometer and a standard stethoscope. The arms are bared and supported at the heart level. The first Korotkoff sound (phase-I) is taken as the Systolic BP and disappearance of sound (phase-V) is taken as Diastolic BP. Increased readings is confirmed in the contra lateral arm (as per JNC 7 criteria for BP measurement in office setting). The classification of BP is based on the new hypertension guidelines : JNC 7 Normal: systolic BP <120 mm of Hg and diastolic BP <80 mm of Hg Pre hypertension: SBP 120-139 or DBP 80-89 mm of Hg Stage 1 hypertension: SBP 140-159 or DBP 90-99 mm of Hg Stage 2 hypertension: SBP 160 or DBP 100 mm of Hg INCLUSION CRITERIA :  Those bank employees who have served at least a year or more in the selected branch of the banks.  Those who are willing to participate in the study. EXCLUSION CRITERIA:  Those who were unavailable for the study even after 3 visits by the investigator.

In order to calculate the sample size for this study, 31% prevalence of hypertension is considered based on Mohammedirfan.H.Momin et al study of socio demographic factors affecting prevalence of hypertension among bank employees of Surat city. The sample size required is estimated based on 5% significance levels & 80% power with an allowable error of 20% of prevalence. The following formula provides the required sample size.

2 n= (Zα+Z1-β) pq ------E2 Where ‘n’ is the required sample size, Zα= 1.96 for 5% significant level, Z1-β = 0.841 for 80% power, p (prevalence)=31, q = 69, e = 6.2(20% of prevalence) n= (1.96-0.841)2 31x69 = 437 ------(6.2)2 Thus the sample size of 437 is obtained.

PLAN FOR DATA ANALYSIS

 The data is compiled and analyzed for prevalence of hypertension and its associated factors by using valid statistical software.  Descriptive statistics- all qualitative variables will be presented as frequency and percentages.  All quantitative variables will be presented as mean and standard deviation.  The prevalence rates are given in percentages.  Suitable test of significance will be applied as relevant.  Multivariate analysis will be conducted to correlate factors associated with hypertension among the study population.

7.3 DOES THE STUDY REQUIRE ANY INVESTIGATIONS OR INTERVENTION TO BE CONDUCTED OR OTHER HUMANS OR ANIMALS? IF SO, PLEASE DESCRIBE BRIEFLY.------NO

7.4 HAS ETHICAL CLEARENCE BEEN OBTAINED FROM YOUR INSTITUITION IN CASE OF 7.3?------YES

8. LIST OF REFERENCES

1) Gaziano TA, Cardiovasular disease in the developing world and its cost effective management. Circulation 2005; 112:3547-53. 2) Patricia M Kearney, Megan Whelton, Kristi Reynolds, Paul Muntner, Paul k Whelton, Jiang He. Global burden of hypertension: analysis of worldwide data. Lancet 2005; 365: 217-23 3) Gaziano T, Reddy KS, Paccaud F, Horton S, Chaturvedi V. Cardiovascular disease. In: Jamison DT, Mosley WH, editors. Disease Control Priorities in the Developing World. Oxford: Oxford University Press; 2006. pp. 645–62. 4) The World Health Report 2002: Reducing Risk, Promoting Healthy Life. Geneva, Switzerland: World Health Organization; 2002. World Health Organization. 5) Reference card from the seventh report of Joint National Committee on Prevention, detection, Evaluation & Treatment of High Blood Pressure (JNC 7),NIH publication No. 03-5231, May 2003 accessed on 10th Oct 2012. 6) Mohammedirfan H. Momin et al. Study of socio demographic factors affecting prevalence of hypertension among bank employees of Surat city. Indian Journal of Public Health 2012; 56:44-48. 7) Ashwinkumar M Undhad et al. Correlates of hypertension among the bank employees of Surat city of Gujarat. National Journal of Community Medicine 2011; 2: 123-125. 8) H R Shivaramakrishna et al. Risk factors of coronary heart disease among bank employees of Belgaum city- cross sectional study. Al Ameen J Med Sci 2010; 3:152-159. 9) Vinod R K et al. Screening for risk of cardiovascular disease among officer grade bank employees of Gulbarga city. Journal of Cardiovascular Disease Research 2012; 3:218-24. 10) He J, Whelton PK. Epidemiology and prevention of hypertension, Med Clin North Am 1997;81: 1077-97 11) Whelton P K epidemiology of hypertension, Lancet 1994;344:101-06 12) Ezzati m, Lopez AD, Rodgers A, Vander Hoorn S, Murray CJ. Selected major risk factors and global and regional burden of disease. Lancet 2002; 360: 1347-60 13) Gupta R, Al-Odat Na, Gupta VP. Hypertension epidemiology in India: meta- analysis of 50 year prevalence rates and blood pressure trends. J Hum Hypertens 1996; 10: 465-472 14) P Malhotra, S Kumari, R Kumar, S Jain and BK Sharma. Original Article , Prevalence and determinants of hypertension in an un-industrialised rural population of North India: Journal of Human Hypertension 1999; 13, 467-472 15) V Mohan, M Deepa, S Farooq, M Datta, R Deepa. Original article, prevalence, awareness and control of hypertension in Chennai- The Chennai Urban Rural Epidemiology Study (CURES-52), JAPI May 2007; vol 55:326-332 16) M Deepa, R Pradeepa, Rm Anjana, V Mohan. Indian Journal of Community Medicine, December 2011;36: S50-S56

9. SIGNATURE OF THE CANDIDATE 10. REMARKS OF THE GUIDE

11. NAME AND DESIGNATION (in block letters)

11.1 GUIDE DR.JAYANTH KUMAR

11.2 SIGNATURE

. 11.3 CO-GUIDE (if any)

11.4 SIGNATURE

DR.SHASHIKALA 11.5 HEAD OF THE DEPARTMENT MANJUNATHA

11.6 SIGNATURE

12. 12.1 REMARKS OF THE CHAIRMAN AND PRINCIPAL

12.2 SIGNATURE