STATEMENT OF THE PROBLEM

A CORRELATIONAL STUDY ON BLOOD PRESSURE WITH STRESS, BODY

MASS INDEX(BMI) AND LIFE STYLE PATTERN AMONG ACADEMICIANS OF
VARIOUS DISCIPLINE WITH A VIEW TO DEVELOP PAMPHLET AT VARIOUS
SCHOOL AND COLLEGE OF BHILAI (C.G)

OBJECTIVES OF THE STUDY

1. TO ASSESS THE BLOOD PRESSURE WITH STRESS , BMI AND LIFESTYLE
PATTERN AMONG ACADEMICIANS OF VARIOUS DISCIPLINE.

2. TO FIND THE CORELATION OF BLOOD PRESSURE WITH STRESS ,BMI

AND LIFE STYLE PATTERN

3. TO FIND OUT ASSOCIATION BETWEEN BLOOD PRESSURE WITH

SELECTED SOCIODEMOGRAPHIC VARIABLES.

4. TO DEVELOP PAMPHLET REGARDING KNOWLEDGE OF BLOOD

PRESSURE ,STRESS ,BMI AND LIFE STYLE PATTERN

INTRODUCTION

PART 1 HYPERTENSION

Increasing trends of hypertension is a worldwide phenomenon. India is a very

large and populous and typical developing country. It has been documented that
during past few decades, the prevalence of hypertension has increased many
folds not only among urban dwellers but also in rural inhabitants in India.
Various factors might have contributed to this rising trends and among others,
consequences of urbanization such as a change in life style pattern, diet, and
stress; increasing population and shrinking employment have also been
implicated.
Hypertension is one of the most common diseases affecting humans worldwide.
In 2004, high blood pressure was identified in GLOBAL HEALTH RISKS
report by WHO as the fifth ranked factor for disability-adjusted life [Link]
2010, high blood pressure was identified by Lim et al as the first ranked factor
for disability-adjusted life years. Uncontrolled hypertension results in various
complications (e.g., coronary heart disease, stroke, congestive heart failure,
renal insufficiency and peripheral vascular disease). Hypertension has become a
significant problem in many developing countries experiencing epidemiological
transition from communicable to non-communicable chronic diseases.
Hypertension has also been attributed as one of the leading causes of death and
disability in the developing countries. The emergence of hypertension and other
cardio vascular diseases as a public health problem in these countries is strongly
related to the aging of the populations, urbanization, and socioeconomic
changes favouring sedentary habits, obesity, alcohol consumption, and salt
intake, among others. Assessment of knowledge, attitudes, and practices (KAP)
is a crucial element of hypertension control, but little information is available
from developing countries where hypertension has lately been recognized as a
major health problem.

Hypertension is an important risk factor for future cardiovascular diseases,

stroke, nephropathy, and retinal damage. Therefore, regular BP measurement is
very important in children and especially adolescents for early detection,
intervention, and prevention of complications due to hypertension. The present
study was conducted to know the prevalence of hypertension in apparently
healthy school going adolescent children and to evaluate the correlation
between BMI and other life style factors with hypertension in them.

Globally, the overall prevalence of high blood pressure (BP) in adults aged 25
and over was around 40% in 2008. The proportion of the world's population
with high BP or uncontrolled hypertension fell modestly between 1980 and
2008. However, because of population growth and aging, the number of people
with uncontrolled hypertension rose from 600 million in 1980 to nearly 1 billion
in 2008. Across the WHO regions, the prevalence of high BP was highest in
Africa, where it was 46% for both sexes combined.

High blood pressure (BP) is a major global health risk, affecting 1 billion people
worldwide . High BP is estimated to cause 7.5 million deaths worldwide, about
12.8% of the total of all deaths, and it accounts for 57 million disability-
adjusted life years (DALYS), or 3.7% of the total DALYS . Globally, the
overall prevalence of high blood pressure (systolic BP ≥140 mmHg and/or
diastolic BP ≥90 mmHg) in adults exceeds 40% . The prevalence of
hypertension in the World Health Organisation (WHO) European region has
been reduced since 1980 and now averages about 30%, with noticeable
differences in average BP levels across countries . An elevated BP is an
important risk factor for premature disability and mortality and contributes to
the burden of heart disease, stroke and kidney failure

PART 2 BMI

Body mass index (BMI) is generally recognized as the most reliable method to
determine increased adiposity. Tracking of BMI in adolescents have high
predictive value for adult obesity. The rate of increase in BMI is a good
predictor of the adult level of BP, insulin resistance, hyperlipidemia, and other
complications associated with obesity
Body mass index (BMI) is a measure of the human body weight in relation to
the height, calculated by dividing the weight of a person in Kg by the square of
the height in meters. The WHO classifies BMI as normal (18.5–25 kg/m 2),
overweight (26–30 kg/m 2), and obese (>30 kg/m 2). BP is the pressure of the
resistance of blood flow against the walls of the arteries. Systolic blood pressure
(SBP) is the top number refers to the amount of pressure in your arteries during
contraction of your heart muscle. Diastolic pressure, however, is the pressure
required to allow constant flow in the blood vessels and filling of the ventricles
before the next systole.

BMI and Blood Pressure

Overweight and obesity are the fifth leading risk factor for death, and have
become a severe worldwide pandemic whose prevalence has nearly doubled
since 1980 . According to the WHO, 35% of adults aged 20 years and over were
overweight in 2008, and around 12% were obese [21]. In 2008, over 50% of
both men and women in the WHO European region were overweight, and
roughly 23% of women and 20% of men were obese . Excess body weight and
obesity are serious public health threats, as they significantly increase the risk of
chronic diseases such as cardiovascular disease, type-2 diabetes mellitus,
hypertension, coronary heart disease, osteoarthritis, and certain types of cancer.
The relationship between overweight/obesity and hypertension has long been
investigated, with the risk of hypertension being up to five times higher among
obese people than among those of normal weight . In addition, a large number
of studies have concluded that there is a strong and independent positive
correlation between increased BMI and office or ambulatory BP.
The prevalence of overweight/obesity found in the present study is comparable
with the data for young adults in Great Britain (overweight=15.4%;
obese=4.0%), but these rates are much lower compared to young adults in other
countries, such as Cyprus and Germany . Our results agree with those of
numerous other studies showing that BMI and BP levels are positively
correlated, in both sexes and in all ages
While the relationship between overweight/obesity and increased BP is well
established, the physiological connection between them is not so clear,
especially concerning essential hypertension. A number of pathways have been
described, with recent research focusing more on the neurohormonal aspect.
The interrelation between those mechanisms is in itself an active field of
research. Most explanations fall into one of two categories (or both): BP in
overweight/obese people is increased either through stimulated activation of the
sympathetic nervous system, or via increased sodium retention by the kidneys .
• The renin–angiotensin–aldosterone system (RAAS). The RAAS is a feedback
mechanism originating in the kidney that, through the activation of angiotensin
II, helps elevate BP to normal levels when it drops (e.g. as a result of bleeding).
It has been shown that, as BMI and fat tissue increase, so does the volume of
circulating angiotensin . Angiotensin II has both a short- and a long-term action
in increasing BP levels. In the short term it acts rapidly as a powerful
vasoconstrictor, and over the course of days or weeks it raises BP through
decreased salt excretion from the kidneys, therefore increasing fluid volume .

Physical Activity and Blood Pressure

Although a plethora of epidemiological studies have underscored the
importance and effectiveness of PA and exercise, the prevalence of physical
inactivity is increasing worldwide, to the extent that it has become a substantial
public health concern and a considerable economic burden . Low levels of PA
are inversely related with cardiovascular morbidity, and are strong prognostic
indexes of mortality, with 1.9 million deaths per year being attributed to this
cause.
Concerning PA levels, our results place Greek young adults at a level below the
EU averages . Our findings are comparable with those of others who reported
high rates (>45%) of low PA or physical inactivity among Greek university
students. Regarding the sex-related differences, the present data are in line with
other reports, inasmuch as young men tend to be more physically active than
young women.

Smoking and Blood Pressure

Smoking is a major risk factor for cardiovascular morbidity and mortality, and
is considered to be the leading preventable cause of death in the world, causing
25% of deaths from cardiovascular disease in the middle-aged population . Our
findings indicated a pattern of smoking prevalence (35.1%) in Greek young
adults that was comparable with European youth smoking rates (35%), in line
with previously published data for Greek young adults .
Adaptation mechanisms and the biochemical or haemodynamic effects of
chronic smoking, such as the chronic effect of cotinine on vascular smooth
muscle fibres , or the nicotine sympathetic pressor effect , may explain the
lower BP that many have found in smokers. has also been noted that chronic
smoking induces selective changes in autonomic cardiac control during
standing, differentiates the responses of the autonomic nervous system to
excitatory stimuli, and blunts the posture reactions of the circulatory system .
Thus, a paradoxical lower BP measured in a sitting position in smokers can
probably be explained . On the other hand, if this is the case, it is difficult to
explain the results of numerous studies that either did not find significant
differences in resting BP between smokers and non-smokers, or indicated that
smokers had a higher BP in a sitting position. Differences in the study
methodologies, such as the heterogeneity and size of the sample, measurement
techniques, matching for confounding variables, etc., may explain the conflict
between the published results . For instance, in most studies, BP is obtained at
rest after long abstention from smoking, alcohol and coffee. Thus, the recorded
values do not represent the mean ambulatory BP, which is usually higher in
smokers during daytime activities .

PART 3 STRESS

Stress can cause hypertension through repeated blood pressure elevations as well as by
stimulation of the nervous system to produce large amounts of vasoconstricting hormones that
increase blood pressure. Factors affecting blood pressure through stress include white coat
hypertension, job strain, race, social environment, and emotional distress. Furthermore, when
one risk factor is coupled with other stress producing factors, the effect on blood pressure is
multiplied. Overall, studies show that stress does not directly cause hypertension, but can have
an effect on its development. A variety of non-pharmacologic treatments to manage stress have
been found effective in reducing blood pressure and development of hypertension, examples of
which are meditation, acupressure, biofeedback and music therapy. Recent results from the
National Health and Nutrition Examination Survey indicate that 50 million American adults have
hypertension (defined to be a systolic blood pressure of greater than 139 mm Hg or a diastolic
blood pressure of greater than 89 mm Hg). In 95% of these cases, the cause of hypertension is
unknown and they are categorized as "essential" hypertension. Although a single cause may not
be identified, the general consensus is that various factors contribute to blood pressure elevation
in essential hypertension. In these days of 70 hour work weeks, pagers, fax machines, and
endless committee meetings, stress has become a prevalent part of people's lives; therefore the
effect of stress on blood pressure is of increasing relevance and importance. Although stress
may not directly cause hypertension, it can lead to repeated blood pressure elevations, which
eventually may lead to hypertension. In this article we explore how stress can cause
hypertension and what can be done about it.
Occupational Stress
Most adults spend a substantial portion of their lives at work, so it should not be
surprising that chronic job stress can have a powerful impact on health. The
most widely studied model of occupational stress is the job strain model of
Karasek et al., which focuses on two characteristics of the work environment:
job demands, or workload, and decision latitude, or the degree of control an
employee has in performing his or her work. According to this model, the
combination of high demand and low control, referred to as high strain,
produces the most stress. High job strain has been associated with increased
ambulatory BP at work, at home, and during sleep, as well as increased left
ventricular mass, consistent with the anticipated effects of sustained BP
elevation . Overcommitment and an imbalance between effort at work and
rewards received, two components of an alternative model of work stress
proposed by Siegrist , have also been related to BP both during and outside
work .
A number of longitudinal studies have demonstrated that high job strain is
associated with increases in BP and the development of hypertension , though
some have failed to show a relationship. Stressful work conditions, like other
stressors, can fluctuate over time, and the chronicity of exposure appears to be
an important factor in predicting hypertension risk. For example, increasing job
strain over an 8-year follow-up period predicted hypertension incidence in 3200
young, healthy, employed participants of the Coronary Artery Risk
Development in Young Adults (CARDIA) study . In a study of 8395 white-
collar workers in Canada, both cumulative and new exposure to job strain
predicted increases in BP over 7.5 years; these effects were stronger among
workers with low levels of social support at work .

Low Socioeconomic Status

Numerous indices of SES have been studied, the most common being
educational attainment, occupational status, and income; others include social
class, social status, and neighborhood characteristics. Although these are
generally correlated, each provides unique information and may affect various
health outcomes differently. Epidemiologic studies consistently demonstrate
graded associations between SES and risk of hypertension, cardiovascular
disease, and mortality . Low SES has also been related to BP patterns that are
related to hypertension, including reduced nocturnal BP dipping and delayed
BP recovery following laboratory stress . Hypothesized mechanisms of the
association between low SES and hypertension include a poorer health behavior
profile and greater exposure to stress, as well as the availability of fewer
resources with which to cope with stress. In an analysis of the Work Site Blood
Pressure Study, Landsbergis et al. found that associations between high job
strain and ambulatory BP at work were stronger among participants with low
SES versus those with high SES, suggesting that low SES may exacerbate the
effects of other chronic stressors.
SES can be highly variable over time, particularly with regard to income, and it
appears that BP may be sensitive to these fluctuations. Matthews et al.
evaluated changes in several socioeconomic indicators as predictors of incident
hypertension in 10-year follow-up of CARDIA study participants. There was a
trend for an association between decline in income and incident hypertension,
and difficulties paying for basics at baseline and during the follow-up period
each predicted hypertension incidence, independent of standard covariates.
Earning a new educational degree, on the other hand, did not significantly affect
risk. A smaller study of 160 adults found that improvement in financial strain,
defined as difficulty paying bills, replacing needed items, and providing for
one’s family, was associated with reduced ambulatory BP 3 years later .
Neighborhood characteristics reflect another aspect of SES that may influence
health. A cross-sectional analysis of 2612 participants from 495 neighborhoods
included in the Multi-Ethnic Study of Atherosclerosis (MESA) found that
poorer conditions regarding walking environment, availability of healthy foods,
safety, and social cohesion were each associated with a greater likelihood of
hypertension . Traditional socioeconomic indicators (education, income) were
strongly related to neighborhood conditions, but did not account for these
effects when included in the analysis. Adjusting for race, however, reduced or
eliminated associations between neighborhood conditions and hypertension.
PART 4 LIFESTYLE PATTERN

Lifestyle factors are critical determinants of blood pressure levels operating

against a background of genetic susceptibility. Excess body fat is a predominant
cause of hypertension with additive effects of dietary salt, alcohol, and physical
inactivity. Controlled trials in hypertensives show blood pressure lowering
effects of supplemental potassium, fibre, n-3 fatty acids, and diets rich in fruit
and vegetables and low in saturated fats.

Lifestyle or behavioral factors critically determine the level of blood pressure in

individuals and the prevalence of hypertension in populations.1 Multiple and as
yet largely unidentified genetic factors influence individual susceptibility to
different aspects of diet and lifestyle: these will determine interindividual
variations in blood pressure between subjects exhibiting common behavioral
patterns that promote blood pressure elevation.
In this review we focus on recent data concerning the role of body fat, alcohol
consumption, dietary sodium and potassium intake, complex dietary changes
including fruit, vegetables, fats, fiber, n3 fatty acids, and dietary fish
consumption, physical activity, psychologic factors, and some of the
interactions between them.

Body fat

Excess body fat is the dominant factor predisposing to blood pressure elevation
in cross-sectional and longitudinal population studies. The effect is apparent
from infancy and childhood through to the elderly, with a continuum of effect
throughout the entire distribution of body fat. Body fat excess, particularly
central obesity, is associated with the so-called metabolic syndrome of
impairment of insulin sensitivity, glucose intolerance, and dyslipidemia, which
compounds with the effects of blood pressure elevation to increase the risk of
cardiovascular disease.

Physical activity and fitness

Population studies show an inverse relation between physical fitness and blood
pressure levels independent of all other risk factors for hypertension. Similar
relationships are seen between physical fitness or activity and cardiovascular
morbidity and mortality. Randomized controlled trials of the effects of exercise
training show that blood pressure falls more consistently in those with
established hypertension. Metaanalyses suggest reductions of around 7 to 11
mm Hg systolic in hypertensives and 3 mm Hg systolic in
normotensives, although the latter changes remain in dispute15 and one
relatively large study in hypertensives showed no effect on ambulatory
pressures.
Combining an exercise program with weight reduction had additive effects on
blood pressure reduction in one study in hypertensives, whereas another,
involving a factorial design in obese subjects with high normal pressures,
showed weight loss to have the dominant effect on ambulatory blood pressures,
but effects were more sustained throughout the 24 h when weight loss and
exercise were combinedA third study of independent and combined effects of
weight loss and exercise showed no additive effects but lacked a true control
group, as has been a feature of many trials in this field.

Dietary salt

The role of dietary salt in increasing population blood pressure levels and the
rise in blood pressure with age is now well [Link], there is still
some dissension over the magnitude of the blood pressure fall with salt
restriction. A metaanalysis of 32 randomized controlled trials of reducing salt
intake estimated a blood-pressure–lowering effect of around 6 mm Hg systolic
in hypertensives and around 2 to 3 mm Hg systolic in normotensives, for a 100-
mmol reduction in sodium intake. Another analysis of 56 trials reached more
conservative findings of a fall of 3.7 mm Hg systolic in hypertensives, for a
mean reduction in sodium intake of 95 mmol/day and a fall of 1 mm Hg systolic
in normotensives.

Complex dietary changes: fruit, vegetables, fats, and

fiber

Vegetarians who consume diets rich in fruits and vegetables and fiber and low
in total and saturated fat have lower blood pressures and less hypertension than
the general population.50 Randomized controlled trials in meat eaters have
confirmed the blood-pressure–lowering effects of such vegetarian dietary
patterns in both normotensive and hypertensive [Link], these effects
were independent of changes in body mass or dietary sodium. Subsequent
controlled trials failed to identify a specific dietary component, such as
polyunsaturated fat, fiber, or vegetable protein, that was responsible for these
effects and indicated that they were not dependent on the presence or absence of
meat protein per. Thus a so-called prudent diet containing lean meat had a
similar blood-pressure–lowering effect as a strict lacto-ovovegetarian diet in
normotensives. As a result of a series of such studies it was suggested that the
blood-pressure–lowering effects of a vegetarian diet might depend on a
combination of complex dietary changes including an increase in fruit and
vegetable consumption and a reduction in total and saturated fat intake. This
hypothesis has been substantiated in the recent DASH study in the United
States, in which 459 subjects with mild hypertension (< 160 mm Hg systolic
and diastolic 80 to 95 mm Hg) were randomized to either continue their normal
diet or increase their fruit and vegetable consumption, or, in a third group, to
reduce their total and saturated fat intake. The group increasing fruit and
vegetable consumption showed falls in blood pressure of 2.8/1.1 mm Hg
compared with controls, whereas those also reducing fat intake showed the
greatest blood pressure reduction, 5.5/3.0 mm Hg (Figure 4). Among the 133
subjects with hypertension, pressures fell by 11.4/5.5 mm Hg. Although the
dietary intervention only lasted 8 weeks, this study is important in
demonstrating the antihypertensive effects of relatively modest dietary changes
that are likely to be more acceptable to the general population than measures
that are more radical. The dietary patterns involved in this study are also likely
to reduce the risk of cardiovascular disease independently of effects on blood
pressure