International Journal of Health Sciences and Research

www.ijhsr.org ISSN: 2249-9571

Original Research Article

Prevalence of Hypertension Among Fisherman Community in The Island of

Bengre, Mangalore
Shankarappa M Mudgal1, Srinivas Kosgi2*, Vaishali N Hegde3, Raghava Sharma2, Satheesh Rao2
1
Raichur Institute of Medical Sciences, Raichur 584101
2
K S Hegde Medical Academy, Deralakatte, Mangalore 575018
3
Father Muller Medical College, Fr Muller Road, Kankanady, Mangalore 575002
*
Correspondence Email: [email protected]

Received: 19/11//2011 Revised: 28/11/2011 Accepted: 29/11/2011

ABSTRACT

Hypertension is one of the major causes of disease and disability worldwide. It is associated with
an increased risk of stroke and myocardial infarction etc.It is easy to detect by simple means, but
most of them are unaware of their hypertension and had no treatment. In those on treatment,
blood pressure control is unsatisfactory.
The factors affecting the prevalence of hypertension are many that including ethnicity, life style
changes and diet. Epidemiological data shows variation in prevalence of hypertension. Some
show an increase in blood pressure with age, while others show no significant increase. Present
study examined 1016 (M: 500; F: 516) from local fisherman community in the age group of 20-
70 years. Study showed 4.62% prevalence of hypertension (M: 4.40; F: 4.84) and 40% were
aware of their hypertensive state. Only 4.2% were on regular treatment and the rest,
noncompliant population had uncontrolled blood pressure. None had any idea about hypertensive
related risk factors, symptoms, complications and preventive measures. Hypertension among
fisherman community showed lower prevalence than compared to various prevalence studies in
India.
Key words: Hypertension, Prevalence, Risk factors

INTRODUCTION disability in the adult population all over the

world. (1-2)
Hypertension is prevalent throughout High blood pressure is associated with an
the world, but it is potentially preventable. It increased risk of stroke, myocardial
is one of the major causes of disease and infarction, heart failure, renal failure, and
cognitive impairment. Systolic blood
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Vol.1; Issue: 2; Jan.2012
pressure above 115 mm Hg is the most obligatory finding. Some population show
important determinant of the risk of death an increase in blood pressure with age, while
worldwide. This alone being responsible for others show no significant increase as shown
7.6 million cardiovascular deaths annually, in Pacific Island population studies.(12)
accounting to 20-50% of all deaths and In India, there are only very few community
morbidity and contributes to disability and based studies which have estimated
health care costs.(3-5) prevalence of hypertension. Present study
Hypertension is the commonest aimed at looking the pattern of blood
cardiovascular disorder posing a major pressure and prevalence of hypertension in
public health challenge to societies which the local fisherman community in the
are in socioeconomic and epidemiological outskirts of Mangalore.
transition. Two major contributors to global
cardiovascular disease mortality and METHODOLOGY
disability are coronary heart disease and
cerebrovascular disease. The relative burden The study was conducted on
of these varies across the developing fisherman community residing in Bengre.
countries.(6) Our country being no exception, Bengre is a small Island about a kilometer
it is rather alarming. Globally and in our off the shore of Mangalore, it is thickly
country, the proportion of elderly population populated and most of the inhabitants are the
is on the rise and hypertension is extremely traditional fisherman regardless of caste and
common.(7) religion. A door to door field survey
The awareness and proper control of conducted on the adult population in the age
high blood pressure have contributed to group of 20-70 years was surveyed. Each
dramatic reduction in morbidity and participant’s socio-demographic variables
mortality attributable to hypertension.(8) such as age, marital status, religion,
Hypertension per se is not a disease. It is at education, income, diet, habits,
best a risk factor for future degenerative anthropometric measurements height,
disease like stroke, heart attack and renal weight, were recorded.
failure.(9) Despite the fact that hypertension Blood pressure was recorded in a
is easy to detect by simple means, most of standardized fashion using equipment that
the hypertensive population are unaware of met certification criteria. (8, 13-14)
their hypertension and have had no Following defined criteria’s used for
treatment. In those who are being treated, purpose of study
blood pressure control is unsatisfactory in
most cases. (10-11) Definition of hypertension:
The factors affecting the prevalence The hypertension status of the study
of hypertension are many that include participants was assessed by using standard
nationality and ethnic group, urbanization criteria formulated by the WHO and the
and industrialization, population migration, Sixth Report of the Joint National
crowding and changes in life style including Committee on Prevention, Detection,
diet.(12) Epidemiological a distinct variation Evaluation and Treatment of
(11)
in prevalence of hypertension in most hypertension. Hypertension was defined
industrialized population blood pressure as Systolic Blood Pressure (SBP)  140mm
rises with age, and in most non Hg, and/or Diastolic Blood Pressure (DBP)
industrialized population in whom the rise in  90mm Hg and/or treatment with
blood pressure with age is by no means an antihypertensive medication. (11)
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 lowering elevated blood pressure among
Definition of awareness: hypertensive subjects, in our sample, the
Awareness of hypertension was only treatment considered was
defined as the subject reporting a prior pharmacological.
diagnosis of hypertension (or high blood
pressure) made by health personnel. Control of hypertension was defined as
pharmacological treatment associated with
Treatment of hypertension was defined as SBP and DBP less than 140 and 90mm of
current use of a prescription medication for Hg respectively.

RESULTS

Table-I

Socio-Demographic details N=47

Variables Frequency Percentage Mean Standard

Deviation
AGE 52.53 9.77
Marital status Married 44 93.6
Unmarried 3 6.4
Religion Hindu 46 97.9
Muslim 1 2.1
Christian 0 0

Education in 4.17 3.80

years
Occupation Fishing 19 40.42
Fish 4 8.51
marketing
Household 16 34.1
Fish Drying 8 17.0
Fish consumption 200 9 19.2 273.40 40.17
/day in grams 250 7 14.9
300 31 65.9
Alcohol Present 11 23.4
consumption Absent 36 76.6
Duration of 17.45 6.26
alcohol
consumption in
years
Smoking in years 16.62 9.73
Tobacco Present 2 4.3
consumption Absent 45 95.7

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Duration of 5 years 1 2.1 7.5 3.5
tobacco 10 years 1 2.1
consumption in
years
Hypertension Present 14 29.8 1.70 0.46
Absent 33 70.2
Duration of 3.43 3.76
hypertension in
years
Other disorders Paresis in left 1 2.1 2.5 0.75
limb
Bronchial 2 4.3
asthma
Diabetes 5 10.6
mellitus

Duration of other 7.66 6.42

disorders in years
Family h/o Present 6 12.8
Hypertension Absent 41 87.2

GRAPH -I
200
180
185
180 Age and sex distribution of whole
160 population
136
132
140
No. of persons

120
100
100 89
80 Males
6265
60 Series 2
40 3334

20
0
20-29 30-39 40-49 50-59 60-69
Age in years

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GRAPH-II

Prevalence of hypertension in Males & Females to the

population surveyed
600
500 516
476 491
500
Number of cases

400

300
Total population
200 NO
YES
100
22(4.40% 25(4.84%)
0
Male Female

Sex

GRAPH-III

Mean Systolic and Diastolic Blood pressure in males

According to age Group

Standard Deviation (SD)

160

140 144
137
129
Blood pressure in MMhg

123 126
120

100 systolic
86 90 Diastolic
80 80 81 83

60

40

20

0
20-29 30-39 Age40-49
in years 50-59 60-69

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GRAPH-IV

diastolic
systolic

250
145
Blood pressure in MMHg

138
200 120 125 127

150

100 91
79 81 82 88
50

0
20-29 30-39 40-49 50-59 60-69
Age in years

GRAPH-V
Mean Systolic and Diastolic blood pressure in Males and Females
160
Blood pressure mmHG

140
120
100
80
Systolic(Male)
60 systolic (Female)
40 Diastolic(Male)
20
Diastolic (Female)
0
20-29 30-39 40-49 50-59 60-69
Age in years

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GRAPH-VI
Mean systolic and Diastolic Blood pressures in Males by
body Mass index

160
140
132 135
128
120 117
Blood pressure

116
100
85 90 Systolic
80 78 82
76
Diastolic
60
40
20
0
< 18.5 18.5-24.9 25.0-29.9 30-34.9 >35

Body Mass Index

GRAPH-VII

Mean systolic and Diastolic Blood pressures in Females by

Body Mass index

180
160 160
Blood pressure

140
126 131
120 115 120
100
80 80 81 83 88
79
60 Systolic
40
Diastolic
20
0
< 18.5 18.5-24.9 25.0-29.9 30-34.9 >35

BMI

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 Table-II
Pearson correlation
AGE DIABETES HYPERTENSION
AGE Pearson 1.0 -0.088 -0.277
Correlation
Sig. (2- 0 0.55 0.059
tailed)
DIABETES Pearson -0.088 -0.227
Correlation
Sig. (2- 0.55 0.12
tailed)
HYPERTENSION Pearson -0.277 0.227
Correlation
Sig. (2- 0.059 0.12
tailed)
FAMILY HISTORY OF Pearson 0.212 0.28 0.029
HYPERTENSION Correlation
Sig. (2- 0.15 0.055 0.84
tailed)

DISCUSSION entire pitfalls trend was towards higher

prevalence rates.
There is paucity of large authentic Review of studies from 1963 till
epidemiological studies on hypertension in 2010 which adopted WHO guidelines to
our country. Approximately there are about diagnose hypertension showed prevalence
thirty to thirty five epidemiological studies rates in the range of as low as 3.14 to as high
on hypertension prevalence in Indian as 50.04 %. (15-26)
Population being carried out. (15-38) Mathur et al, Malhotra, Gupta et al, Wasir et
Chopra in 1942 and subsequently Dotto al and Chadda et al studied hypertension
(1949), Dubey(1954) and Sathe (1959) prevalence among urban population by
reported meta-analysis of large scale adopting blood pressure ≥ 160/95 mmHg as
epidemiological studies looking at the hypertension defining criteria. These studies
changing trends in prevalence of reported hypertension prevalence rates of
hypertension and mean blood pressure (BP) 4.35, 6.2, 6.43, 3.14 and 13.14 percent
levels in India among urban and rural respectively. (15-17, 19, 21)
population. These studies reported On analyzing the entire population
prevalence of 1.24 ±0.2, 4.24 ± 0.4 and 3.03 surveyed in these studies( i.e. 9705 males
±0.3 percent in urban populations of and 11719 females) in the age group of 18
Calcutta, Kanpur and Mumbai, respectively. to 65 years showed average prevalence of
However these studies had several 10.31% (1001 males) and 12.7% (1488
shortcomings. They adopted differing females).
examination techniques, differing diagnostic
criteria and used screening blood pressure Later studies by Hussain et al ,Gupta
values for defining hypertension. With this et al,Anand,Bharucha et al,Shanthirani et al,

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Mandal et al in urban population which mmHg as criteria to define hypertension.
adopted blood pressure ≥ 140/90 mmHg as Hypothetically it can be derived that large
defining criteria for hypertension, showed number of male population suffer from
prevalence rate 6.15,30,26.78,45.5,19.77and hypertension in the range of 140/90 mmHg
49.41 respectively. (20,22-26) The analysis of to 160/95mmHg probably missed in the
entire population surveyed in these studies( earlier studies.
i.e. 8389 males and 5039 females) in the Present study examined blood
age group of ≥ 20 years showed average pressure among fisherman community with
prevalence of 30.19% (3036.44 males) and 140/90 mmHg as hypertensive defining
25.99% (1309.64 females) respectively. criteria showed prevalence rate of 4.62%.(40-
41)
Results of these two groups of The prevalence is comparable to the
studies showed that with much stringent urban and rural studies.(15-17, 19, 21, 27-28, 30, 32-
34)
defining guidelines and broad range of age
groups, the prevalence of hypertension is Present study results score higher by fact
high in urban areas. Male population that it adopted much stringent hypertension
showed higher trend compared to female defining criteria (i.e. 140/90) when
population. compared above studies (i.e.160/90). Even
Similarly studies in rural population by on comparing studies with stringent WHO
Gupta et al, Wasir et al, Puri et al, Kumar et defining criteria, the results of this study
al, Joshi et al, Agarwal et al with defining show very low prevalence of hypertension.
(20, 22-26)
criteria for hypertension as ≥ 160/95mmHg
reported prevalence of Present study also showed a
3.58,2.89,2.41,6.05,3.82,3.59 and 5.40 marginal higher prevalence of hypertension
repectively. (27-28, 30, 32-34) among women (F 4.84% > M: 4.40). On
The analysis of entire population surveyed comparing mean arterial pressure among
in these studies ( i.e. 10916 males and both sexes (Graph-V), the mean arterial
6185 females) in the age group in the range pressure relatively lower in females in the
of 15 to 82 years showed average younger age group, than in males of similar
prevalence of 3.30 % (360.76 males) and age group: but this difference is narrowed in
3.53 % (218.34 females) respectively. the older age group (more than 50 years).
Studies by Baldwa et al, Hussain et al, Women in the post menopausal age group
Prasanth et al, addo et al, Zhaoqing et al showed slightly higher Mean Arterial
with hypertension defining criteria as ≥ Pressure than men in the same age group.
140/90 mmHg reported prevalence of Results are comparable to most of the
7.89,6.05,19.21,25.37 and 29.33 studies reviewed, but one can attribute
respectively. (29, 31, 36-38) reason for such cause is because of over-
The analysis of entire population representation of female population in
surveyed in these studies i.e. 9164 males sample, higher body mass index among
and 7248 females in the age group in the females than males and 81 % percent being
range of 16 to 100 years showed average in menopausal age.
prevalence of 15.05 % (1379 males) and Study by Shirakawa et al, analyzed by 10-
10.69 % (7248 females) respectively. year age groups (20s, 30s, 40s and 50s) to
Analysis of large pool of data from these look into family history and aging as
studies, one can conclude that female independent risk factors for the development
preponderance in earlier studies may be of hypertension and diabetes.(49) He found
attributed to blood pressure of 160/90 that prevalence of hypertension increased
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with age group either in the absence (12% in different level. (56) Study by Jay et al
the 20s and 39% in the 50s) or in the demonstrated that men at least BMI values
presence (21% in the 20s and 59% in the <21 kg/m2 linearly related to blood pressure.
(51)
50s) of family history of hypertension.
While the impact of family history on the Present study concords with the
risk of diabetes was strong and appeared to above study findings. Male population
increase with age (4% in the 20s and (Graphs VI) shows linear increase in mean
progressively increased to 20% in the 50s. systolic blood pressure with BMI 18.5 to 25
The similar observation was noticed in after that there is exponential growth with
present study, prevalence of hypertension increase in BMI, whereas diastolic blood
increased with the advancing age (Graphs pressure showed marginal increase with
III-V). 12.8% of population had family BMI. Female population (Graph VII) show
history of hypertension and 10.6% had co- linear increase in mean Systolic blood
morbid diabetes (Table I). On correlating pressure with BMI from 18.5 till 34.9 and
age with family history of hypertension and subsequently showed exponential growth.
diabetes there was no significant correlation In nutshell it appears that fishermen
(Table-II). population show lower prevalence for
hypertension. One can attribute the same to
Weight gain is recognized to be an physical exercise and dietary patterns of the
important contributor to hypertension. Body population. Logistically though nearer to
mass index (kg/m2) is the measure of relative city, but life pattern resembles rural
weight. Association between body mass population. They reside in isolation and all
index (BMI) and blood pressure (BP) have of them belonged to lower socio-economic
been consistently observed, but remain group. They have strong cultural and
poorly understood. The two important communal support systems in which
mechanisms for such an association is individuals have clear responsibilities
altered renal function and insulin resistance. towards the community. They are engaged
Insulin resistance and hyperinsulinemia in heavy physical activities like deep sea
causes activation of the sympathetic nervous fishing and subsidiary activities like fish
and renin-angiotensin systems, and physical drying, fish selling etc.
changes within the kidney itself. There is Among diet they consumed
increase renal plasma flow, glomerular parboiled rice, vegetables and fish being the
filtration rate and tubular reabsorption staple food. Their average fish consumption
compared with normal. (51) per day ranged from 200 to 300 Gm/day.
It is also observed that persons with higher One of the factors that contribute to
BMI values consume more sodium, and hypertension is food habits. National Heart,
engage in less physical activity. (52-54) To Lung, and Blood Institute (part of the NIH, a
make matters more complex, changes in United States government
body composition and fat distribution are not organization) recommends DASH diet
linear with BMI and vary by gender. A (Dietary approaches to Stop Hypertension)
study by using bioelectric impedance for hypertensive and pre-hypertensive
analysis demonstrated a curvilinear conditions. It is a high fiber, low to
relationship between BMI and percent body moderate fat diet, and is rich in potassium,
fat. (55) Women have twice the percent body calcium, and magnesium. The diet plan
fat at a given BMI than men and appear to includes: Grains and grain products (include
regulate related hormones, like leptin, at a at least 3 whole grain foods each day),
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Vol.1; Issue: 2; Jan.2012
Fruits, Vegetables, Low fat or non fat dairy findings of low awareness of hypertension
foods, Lean meats, fish, poultry, Nuts, seeds, could be because of low education, poor
and legumes. (44-47) The population in study socio-economic condition and traditionally
consume fish as a staple food which forms practices of treatment for symptoms of
part of DASH diet, this could be one of the hypertension. There is also no gender
factors for low prevalence of hypertension. difference in awareness of hypertension.
Prior in his study reported low prevalence of
hypertension in an ethnic population which CONCLUSION
share similar characteristics of present study.
(12)
On examining the fishermen
We found a striking lack of population one could infer that low
awareness of elevated blood pressure among prevalence rate of hypertension may be
hypertensive participants in present study; because of Physical activities and dietary
only 40.4 % aware of their condition and patterns. Advancing age and female gender
lower portion i.e. 4.3% of them treated had were risk factors. Family history of
irregular compliance. These figures are hypertension and diabetes did not show any
substantially lower than corresponding correlation with hypertension. BMI above
figures from developed countries, but they 25 in men and 35 in women showed
are comparable to data from other increased risk for systolic hypertension.
developing countries. (57-62) Interpretation of Only 40 % of affected population was aware
data on awareness, treatment and control of of hypertension. No gender difference was
hypertension is complex in developing found in awareness. Low education, poor
countries because it reflects intricate socioeconomic condition and traditionally
interplay between availability, accessibility practices of treatment for symptoms of
and affordability of physician services and hypertension were reason for low awareness.
pharmacological medication. Education Considering the above facts there is need to
socioeconomic status of patient, awareness conduct large multicentre prospective
of guidelines among practitioners and epidemiological studies with a focus on
individual physicians’ thresholds for ethnicity and food habits .There is increased
treatment of high blood pressure also effect need to generate adequate quality awareness
on control of hypertension. Of this multiple programmes focusing on signs/symptoms,
factors, it is noteworthy though Bengre is risk factors, complications and importance
near to Mangalore; there is easy availability of adherence to treatment of hypertension at
and accessibility of medical care. Our various levels of medical services.

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