a comprehensive report on hypertension: primary and
TRANSCRIPT
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A COMPREHENSIVE REPORT ON HYPERTENSION: PRIMARY AND
SECONDARY STUDIES
Shahrukh1*, Mohammad Zaid
1, Shahnawaz Alam
2 and Harit Kumar
3
1,2
Student of M. Pharm at MIET, Meerut.
3Student of M. Pharm at Uttrakhand Technical University, Uttrakhand.
INTRODUCTION
Hypertension
According to WHO Hypertension is also known as high or raised
blood pressure, is a condition in which the blood vessels have
persistently raised pressure. Blood is carried from the heart to all parts
of the body in the vessels. Each time the heart beats, it pumps blood
into the vessels. Blood pressure is created by the force of blood
pushing against the walls of blood vessels (arteries) as it is pumped by
the heart. The higher the pressure the harder the heart has to pump.
Blood pressure is determined both by the amount of blood your heart pumps and the amount
of resistance to blood flow in your arteries. The more blood your heart pumps and the
narrower your arteries, the higher your blood pressure.
Obesity, heredity and life style also play a role in the development of hypertension. When
symptoms do occur, they can differ between individuals depending on such factors as the
level of blood pressure, age, underlying cause, medical history, the presence of complications
and general health. For more information on symptoms and complications, refer to symptoms
of hypertension.
How blood Pressure and Circulatory system work
In order to survive and function properly, your tissues and organs need the oxygenated blood
that your circulatory system carries throughout the body. When the heart beats, it creates
pressure that pushes blood through a network of tube-shaped blood vessels, which include
arteries, veins and capillaries.
WORLD JOURNAL OF PHARMACY AND PHARMACEUTICAL SCIENCES
SJIF Impact Factor 7.632
Volume 10, Issue 10, 1432-1447 Research Article ISSN 2278 – 4357
*Corresponding Author
Shahrukh
Student of M. Pharm at
MIET, Meerut.
Article Received on
30 July 2021,
Revised on 20 August 2021,
Accepted on 10 Sept. 2021
DOI: 10.20959/wjpps202110-20178
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Blood pressure is the result of two forces: The first force (systolic pressure) occurs as blood
pumps out of the heart and into the arteries that are part of the circulatory system. The second
force (diastolic pressure) is created as the heart rests between heart beats. (These two forces
are each represented by numbers in a blood pressure reading.)
High blood pressure is a “silent killer” You may not feel that anything is wrong, but high
blood pressure could be quietly causing damage that can threaten your health. The best
prevention is knowing your numbers and making changes that matter in order to prevent and
manage high blood pressure.
Types of hypertension
There are two primary hypertension types. For 95 percent of people with high blood pressure,
the cause of their hypertension is unknown; this is called essential, or primary, hypertension.
When a cause can be found, the condition is called secondary hypertension.
Essential hypertension
This type of hypertension is diagnosed after a doctor notices that your blood pressure is high
on three or more visits and eliminates all other causes of hypertension. Usually people with
essential hypertension have no symptoms, but you may experience frequent.
Headaches
Tiredness
Dizziness
Nose bleeds
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Blood in urine
Obesity
Smoking
Alcohol
Diet
Heredity
Lack of exercise
Unhealthy eating habits
Secondary hypertension
The most common cause of secondary hypertension is an abnormality in the arteries
supplying blood to the kidneys. Other causes include;-
Airway obstruction during sleep
Diseases and tumors of the adrenal glands
Hormone abnormalities
Thyroid disease
Too much salt or alcohol in the diet.
Drugs like ibuprofen (Motrin, Advil, and others) and pseudoephedrine (Afrin, Sudafed
can cause secondary hypertension
Additional hypertension types
Except primary and secondary types of hypertension there are some others or additional types
of hypertension which are classified in three different categories, which are as following;
Isolated systolic hypertension: Blood pressure is recorded in two numbers:
Systolic pressure, Is the upper pressure exerted during the heartbeat;
Diastolic pressure Is the lower pressure as the heart is resting between beats.
Normal blood pressure is considered under 120/80. With isolated systolic hypertension, the
systolic pressure rises above 140, while the lower number stays near the normal range, below
90. This type of hypertension is most common in people over the age of 65 and is caused by
the loss of elasticity in the arteries.
The systolic pressure is much more important than the diastolic pressure when it comes to the
risk of cardiovascular disease for an older person.
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Malignant hypertension: This hypertension type occurs in few of people with hypertension.
It is more common in younger adults. Malignant hypertension occurs when your blood
pressure rises extremely quickly.
If your diastolic pressure goes over 130, you may have malignant hypertension. This is a
medical emergency and should be treated in a hospital. Symptoms include numbness in
the arms and legs, blurred vision, confusion, chest pain, and headache.
Resistant hypertension: If a doctor prescribed three different types of antihypertensive
medications and the blood pressure of patient is still too high, he may have resistant
hypertension. Resistant hypertension may occur in 20 to 30 percent of high blood pressure
cases.
Resistant hypertension may have a genetic component and is more common in people who
are older, obese, female, or have diabetes or kidney disease.
Symptoms of hypertension
Severe headache
Fatigue or confusion
Vision problems
Chest pain
Difficulty breathing
Irregular heartbeat
Factors of hypertension
Volume of blood
Force of contraction of the heart
Viscosity of blood
Nature of the blood
Elasticity of blood vessel.
Complications of hypertension
When blood pressure stays high over time, it can damage the body and cause complications.
Some common complications and their signs and symptoms include:
Chronic kidney disease: When blood vessels narrow in the kidneys, possibly causing
kidney failure.
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Aneurysm: When an abnormal bulge forms in the wall of an artery. Aneurysms develop
and grow for years without causing signs or symptoms until they rupture, grow large
enough to press on nearby body parts, or block blood flow.
Cognitive changes: Research shows that over time, higher blood pressure numbers can
lead to cognitive changes. Signs and symptoms include memory loss, difficulty finding
words, and losing focus during conversations.
Heart attack: When the flow of oxygen-rich blood to a section of heart muscle suddenly
becomes blocked and the heart doesn’t get oxygen. The most common warning symptoms
of a heart attack are chest pain or discomfort, upper body discomfort, and shortness of
breath.
Heart failure: When the heart can’t pump enough blood to meet the body’s needs.
Common signs and symptoms of heart failure include shortness of breath or trouble
breathing; feeling tired; and swelling in the ankles, feet, legs, abdomen, and veins in the
neck.
Eye damage: When blood vessels in the eyes burst or bleed. Signs and symptoms include
vision changes or blindness
Peripheral artery disease: A disease in which plaque builds up in leg arteries and affects
blood flow in the legs. When people have symptoms, the most common are pain,
cramping, numbness, aching, or heaviness in the legs, feet, and buttocks after walking or
climbing stairs.
Stroke: When the flow of oxygen-rich blood to a portion of the brain is blocked. The
symptoms of a stroke include sudden onset of weakness; paralysis or numbness of the
face, arms, or legs; trouble speaking or understanding speech; and trouble seeing.
Diagnosis
To measure your blood pressure, doctor or a specialist will usually place an inflatable arm
cuff around your arm and measure your blood pressure using a pressure-measuring gauge.
A blood pressure reading, given in millimeters of mercury (mm Hg), has two numbers. The
first, or upper, number measures the pressure in your arteries when your heart beats (systolic
pressure).
The second, or lower, number measures the pressure in your arteries between beats (diastolic
pressure).
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Normal blood pressure ranges as120/80 mm Hg. Here, 120 is the upper (systolic pressure)
and 80 is the lower (diastolic pressure).
Blood pressure measurements fall into four general categories
Normal blood pressure: Your blood pressure is normal if it's below 120/80 mm Hg.
Elevated blood pressure: Elevated blood pressure is a systolic pressure ranging from
120 to 129 mm Hg and a diastolic pressure below 80 mm Hg. Elevated blood pressure
tends to get worse over time unless steps are taken to control blood pressure.
Stage 1 hypertension: Stage 1 hypertension is a systolic pressure ranging from 130 to
139 mm Hg or a diastolic pressure ranging from 80 to 89 mm Hg.
Stage 2 hypertension: More severe hypertension, stage 2 hypertension is a systolic
pressure of 140 mm Hg or higher or a diastolic pressure of 90 mm Hg or higher.
Less than150/90 mm Hg If you're a healthy adult age 60 or older
Less than140/90 mm Hg If you're a healthy adult younger than age 60
Less than140/90 mm Hg If you have chronic kidney disease, diabetes
or coronary artery disease or are at high risk
of coronary artery disease
Preventive measures
To avoid a hypertension diagnosis, make these healthy lifestyle choices:
Maintain a healthy weight: When it comes to hypertension prevention, your weight is
crucial. People who are overweight should try to lose weight, and people of normal
weight should avoid adding on any pounds. If you are carrying extra weight, losing as
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little as 10 pounds can help prevent high blood pressure. Talk with your doctor about the
best weight for you.
Eat a balanced diet: Eating healthful foods can help keep your blood pressure under
control. Get plenty of fruits and vegetables, especially those rich in potassium, and limit
your intake of excess calories, fat, and sugar. Consider following the Dietary approaches
to Stop Hypertension, Or DASH Diet which has been shown to help manage blood
pressure.
Cut back on salt: For many people, eating a low sodium diet can help keep blood
pressure normal. "The higher the sodium intake, the higher the blood pressure,"
Exercise regularly: Get moving to prevent hypertension. "Physical activity is crucial,"
The more exercise you get, the better, but even a little bit can help control blood pressure.
Moderate exercise for about 30 minutes three times a week is a good start.
Limit the alcohol: Drinking too much alcohol can lead to high blood pressure. For
women, that means no more than one drink a day, and for men, no more than.
Monitor your blood pressure: Make sure that you have your blood pressure measured
regularly, either at your doctor's office or at home. High blood pressure often occurs with
no symptoms, so only blood pressure readings will tell you if your blood pressure is on
the rise. If your doctor determines that you have pre-hypertension — blood pressure in
the range of 120-139/80-89 millimeters of mercury (mmHg) that puts you at increased
risk of developing hypertension — your doctor may recommend extra steps as a
safeguard.
Literature review
Aakriti gupta, Behnood bikdeli: The authors found a steady improvement in blood pressure
control among US veterans over a 10-year period; control did not significantly vary by
patient age, sex, or race. The degree of improvement in blood pressure control in this patient
cohort greatly outstrips that of the US in general, which was from 35% to 50% over a similar
time period. The source of this substantial difference is unknown, though may relate to the
implementation of electronic medical records into the VA system that automatically notify
doctors of patients’ blood pressure elevation as well as significant outpatient capacity in
which to schedule frequent follow up appointments until blood pressure is adequately
controlled.
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Bryan C. batch, Greg samsa: A treatment goal of 130-135mm Hg is associated with better
outcomes compared to a target BP of <140/90 mm Hg. Lowering of BP below <130/80 leads
to reduced risk of stroke, at the expense of increased adverse events, and showed no benefits
with regard to other micro or macro vascular events. As with most meta-analyses, there are
some limitations which should be considered when interpreting these findings. Only 5 of the
13 trials were designed to specifically test a strategy of intensive versus standard BP
lowering. Furthermore, the heterogeneity of the patient populations, co morbid conditions,
and variations in the treatments used are potential drawbacks.
David B. matchar, Pao-Hwa Lin: Authors found significant variation in estimates of
hypertension prevalence and control in the current medical literature even when using the
same baseline data from NHANES because of different definitions. These findings
demonstrate the need to standardize definitions in epidemiologic surveys in order to permit
valid comparisons between populations and calculation of trends over time. Readers of the
hypertension literature should be made aware that study definitions and methodology can
significantly influence epidemiologic estimates. Although not tested in this study, it is
possible that significant variability in the definitions of hypertension and hypertension control
is also present in clinical trials. It may therefore be prudent to standardize definitions of
hypertension-related parameters for trials in a parallel way to what has been done by the
Bleeding Academic ResearchConsortium16 and Valve Academic Research Consortium.
Kumar A. Pankaj, Ghosh satya; A large proportion of patients with hypertension seen in
cardiology clinics have sub optimally controlled BP which varies widely across cardiologists
and is often is not addressed during the course of the clinic visit. These results may not be
generalize able since the study was performed at a single center and 98% of these patients
had health insurance. However, given the co-morbid effects that hypertension has on a large
number of cardiovascular diseases, cardiologists should not overlook the importance of BP
management and need take on an active role, sharing responsibility for effective control
together with primary care providers.
Purav S. mody, Isuru ranasinghe: Adverse markers of health outcomes including blood
pressures, body mass index, and waist circumference have increased along with the
prevalence of hypertension. However, awareness, treatment, and control of hypertension are
poor, remaining unchanged or worse, suggesting that clinical care in the region has not
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improved to meet the increased needs of the population. Similar findings have been shown
from national surveys which have indicated a prevalence of hypertension at 17% to 27%,
awareness at 24% to 45%, treatment at 28% to 78%, and control at 8% to 19%.These national
findings together with the results of this study highlight the major challenges in detecting and
managing hypertension in China, as they lag far behind the 77% treated and 47% controlled
seen in the US population. With numbers comparable to the lower end of the national
spectrum or worse, Guangdong Province may be an important underperforming region which
requires particular attention and resources in the future.
William S. yancy, Rowena J. dolor: Data from the ONTARGET study suggests that tightly
controlled BP <130/80 mmHg does not necessarily lower cardiovascular events compared to
a target BP of <140/90mmHg, raising debate as to the appropriateness of the targets
recommended in current guidelines.3 However, many patients fail to meet either of these
targets in clinical practice and achieving any form of BP control remains a challenge. As
indicated in this study, tight BP control does have additional non-cardiac benefits including
reducing the risk of stroke and renal events, which are important endpoints from a patient
perspective. Furthermore in these high risk individuals, tighter BP control <130/80 was not
necessarily associated with adverse patients outcomes and thus may be an appropriate goal
for these patients. These results must also be interpreted with caution; this study is a non-
randomized post-hoc observational analysis, subject to potential bias, and is not a substitute
for a well-designed randomized trial.
Ruijun chen, ba; Kumar dharmarajan: The study is the most recent nationally
representative study to document trends of antihypertensive medication use and disease-
specific rates of blood pressure control. The authors found encouraging evidence of
improvement in blood pressure control in the US adults during the past decade, which
appears to have been facilitated by increased use of combination therapy regimens in the
treated hypertensive population. However, disparities remain in blood pressure control among
specific subpopulations such as younger persons. Furthermore, despite these encouraging
improvements, less than one-half of the population appears to have adequate blood pressure
control, which presents substantial opportunities for improvement.
Sheta ara: The primary goal of managed care organizations (MCOs) is to provide high-
quality, cost-effective health care services. Subsequently, DM and QI programs have become
increasingly common in managed care settings DM can benefit an MCO by managing rising
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costs of chronic diseases while obtaining accreditation by attaining national standards of care,
especially those set forth by the National Commission for Quality Assurance. To obtain
accreditation, health care systems must demonstrate improvement in the quality of care
achieved by self-evaluation to determine deficiencies, the development and implementation
of initiatives to improve outcomes, and the reevaluation of initiatives to measure their impact.
All of these may be accomplished through DM strategies. The chronic nature of CVD and its
contribution to high medical resource utilization, costs, and high rates of morbidity and
mortality make it an ideal disease category upon which MCOs may focus. MCOs are in an
ideal position to manage CVD because they have the potential for innovative population
management strategies based on the following characteristics:
MCOs have access to a large, well-defined population of enrollees.
MCOs have electronic databases that can link information for members, health care
providers, care processes, and health outcomes
Vivek T. kulkarni, Natdanai punnanithinont: This study shows that the diagnosis,
treatment, and control of hypertension have improved drastically from 1980 to 2009 in the
Minneapolis/St. Paul region, with better levels of treatment and control along with lower
average blood pressures than observed nationally. It is important to note that compared to the
entire US, survey population is 90% white, has one of the highest levels of health insurance
coverage, fewer people in poverty, and higher average educational levels. Despite these
differences, these results demonstrate that high levels of control are already possible in
certain regions, providing support that in time, the Healthy People 2020 goal of having 61.2%
of the hypertensive population aware, treated, and controlled may be achievable nationwide.
A case study on hypertension was conducted in Delhi/NCR region, India by taking
following parameters into consideration as follows
1. To find out the percentage of people suffering from hypertension in DELHI/NCR.
2. To understand the brand preference of anti-hypertensive drugs by Patients.
3. To understand the Knowledge, Practise and Attitude of patients regarding Hypertensive
drugs.
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INTRODUCTION
The main objective of this project was to study the effects and severity of hypertension
between the people of different areas of Delhi/NCR and to find out most effective and
popular antihypertensive drug in the market of Delhi/NCR.
The project gives us idea about the different factors (like age, gender, profession etc.) which
affects the health of individual. This project will also help us in analyzing the different factors
and age groups in which people are more prone to develop problems related to heart. and
severity of hypertension between the people of different areas of Delhi/NCR and to find out
most effective and popular antihypertensive drugs in the market of Delhi/NCR.
Research methodology
Research is a systematic and continues method of defining a problem, collecting the facts and
analysing them, reaching conclusion forming generalizations.
Research methodology is a way to systematically solve the problem. It may be understood as
a science of studying how research is done scientifically. In it we study the various steps that
all generally adopted by a researcher in studying his research problem along with the logic
behind them.
The scope of research methodology is wider than that of research method. Thus when we talk
of research methodology we not only talk of research methods but also consider the logic
behind the method we use in the context of our research study and explain why we are using
a particular method.
Research problem
This research was done to learn the actual status of hypertension and most popular anti-
hypertensive drugs in Delhi/NCR. Nowadays, hypertension is the most common and critical
problem which was required to study and to know which age group is highly effected or
suffering from the hypertension.
Types of study
Exploratory study
Data collection technique
Primary research
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Data collection tool
Questionnaire.
Source of data
i) Primary data
Primary data are those, which are collected afresh and for the first time, and thus happen to
be original in character. It is the backbone of any study. It is obtained from respondents with
the help of widely used and well-known method of survey through a well-structured
questionnaire.
ii) Secondary data
Secondary data are those which have already been collected by someone else and which have
already been passed through the statistical process. In this case one is not confronted with the
problems that are usually associated with the collection of original data. Secondary data
either is published data or unpublished data. Secondary data is collected from govt.
Publications, journals, magazines, financial records, web sites and annual publications of the
company. In this study secondary source used is websites.
Sample population Sample is taken from societies of DELHI/NCR. These include different
people like students of different universities, colleges, schools etc. It also includes people of
different age groups in Delhi/NCR
Sample size: A sample of participated respondents will be selected from various areas of
DELHI/NCR. The survey is carried out on 150 random respondents.
Sampling unit: - It indicates who is to be surveyed. The researcher must define the target
population that will be sampled. In this project sampling unit is people with different
kinds of occupations like Businessman, Businesswoman, Students, Government
Employees, Ex-Government employees, Employees of private sectors etc.
Sampling technique: For the purpose of research people of different areas of DELHI /
NCR were asked to fill the questionnaire, every respondent has his different viewpoint
and they fill the questionnaire accordingly
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The primary objective was to find out the percentage of people suffering from
hypertension in DELHI/NCR.
Interpretation
Out of 150 Respondent
Male are 58%
Female 42%
Age group of respondents No. of respondent
21-25 5
26-30 8
31-35 18
36-40 21
41-45 18
46-50 22
51-55 25
56-60 33
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Where Do You live? No of Respondents
Delhi 60
Gurgaon 70
Faridabad 20
Suffering from hypertension %
Yes 34.70%
No 10%
Don’t Know 56.30%
Interpretation
We have to focus on Males age group of between 45-60 Age in Gurgaon, and 150
respondents only 52 Respondents taking proper medication.
Common brands used to control hypertension
1. Amlong – Micro Labs
2. Amlovas- Macleods Pharma
3. Angicam - Blue cross laboratories
4. Amlokind- Mankind
5. Amlopress - Cipla
6. Amlogard – Pfizer
7. Telma - Am – Glenmark Pharma
8. Cresar- AM-Cipla
9. Telmikind - Mankind
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10. Amlopress - Tl- Cipla
11. Telvas-Am – Aristro Pharma
RESULTS
Brands No. of respondents
Amlong 5
Amlovas 6
Angicam 4
Amlokind 4
Amlopress 7
Amlogard 3
Telma-Am 5
Cresar- AM 3
Telmikind 3
Amlopress-Tl 2
Telvas-Am 3
Others 7
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REFERENCES
1. https://en.wikipedia.org/wiki/Hypertension
2. https://www.everydayhealth.com/hypertension/preventing.aspx
3. https://www.mayoclinic.org/diseases-conditions/high-blood-pressure/diagnosis-
treatment/drc-20373417
4. https://www.medicalnewstoday.com/articles/150109.php
5. https://www.nhlbi.nih.gov/health-topics/high-blood-pressure
6. https://www.jmcp.org/doi/pdf/10.18553/jmcp.2004.10.4.326
7. https://www.webmd.com/hypertension-high-blood-pressure/guide/hypertension-
symptoms-high-blood-pressure
8. https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0021546/
9. https://www.tandfonline.com/doi/abs/10.5172/conu.15.3.274?journalCode=rcnj20