A COMPREHENSIVE REPORT ON HYPERTENSION: PRIMARY AND ...

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Shahrukh et al. World Journal of Pharmacy and Pharmaceutical Sciences

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

52


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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

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