Hypertension (HTN or HT), also known as high blood pressure (HBP), is a long-term medical condition in which the blood pressure in the arteries is persistently elevated.

1. Presented By:
Md. Nahian Rahman
Roll No:4602
Reg. No:2011-813-392
Session: 2015-2016
INFS, University of Dhaka

2. 
 Hypertension (HTN or HT), also known as high
blood pressure (HBP), is a long-term medical
condition in which the blood pressure in the arteries
is persistently elevated.
Introduction

3. 
Mechanisms of Hypertension
*Stenosis-the abnormal narrowing of a body channel

4. 
Source: WHO(A global brief on Hypertension,2013)
Risk factors and complications

5. 
Hypertension Symptoms

6. 
Blood Pressure Categories

7. 
Global Hypertension
Prevalence

8. 
BMI Classification
 BMI(Body Mass Index)=
𝑊𝑒𝑖𝑔ℎ𝑡(𝑘𝑔)
𝐻𝑒𝑖𝑔ℎ𝑡 𝑚 ×𝐻𝑒𝑖𝑔ℎ𝑡 𝑚

9. 
Blood Glucose Level
Source: American Diabetes Association (ADA)

10. 
FCS Calculation
 FCS= Σ(Food Group’s Weight × Maximum Days
Eaten)

11. 
 Poor Food Consumption: 0 - 28
 Borderline Food Consumption: 28 – 42
 Acceptable Food Consumption: > 42* acceptable.
However, for detailed analysis sometimes ‘acceptable
threshold’ is divided by low-acceptable(42-51) & high-
acceptable (>52) groups.
FCS Level

12. 
 General objective:
 To assess Knowledge, Attitude and Practice about
Hypertension of Adult People of Selected Areas of
Bangladesh
 Specific objective:
 To observe the socio-economic condition of the study
population.
 To Assess the Nutritional Status (BMI, Hypertension,
Diabetes) of the study population of Selected areas
OBJECTIVE(1)

13. 
 To observe the tobacco and Alcohol uses of the study
population of Selected areas
 To assess the knowledge and attitude of adults about
Hypertension
 To identify the practices on Hypertension of adults of
the selected areas
 To observe the food intake pattern ( food consumption
Score,7 days frequency method and 24 hour recall
method) of adults
 To observe the Physical Activity Pattern of the study
population
 To observe the risk factors of hypertension
OBJECTIVE(2)

14. 
 DATA SOURCES: Primary Data
 SAMPLING METHOD: Random Sampling
 STUDY POPULATION: More than 18 years old of four divisions
(Dhaka, Mymensingh, Khulna and Sylhet)
 Dhaka- Dhamrai Upazilla;
 Mymensingh- Jhinaighati Upazilla;
 Khulna- BatiaghataUpazilla ;
 Sylhet- Jamalganj Upazilla
 STUDY DESIGN: Cross-sectional study.
 STUDY PERIOD: December 20, 2017 to March 9, 2018.
METHODOLOGY(1)

15. 
DETERMINATION OF SAMPLE SIZE:
Sample size is calculated using the following formula.
n=z2pq/d2
(Where Z= 1.96 at 95% confidence interval ; P=
50%=0.5;q= 1-P=0.5;d=Acceptable error=10% =0.1)
n=z2pq/d2= (1.96)2*(0.5)*(0.5) / (0.1)*(0.1)=96
To make more accurate and more significant we have
taken a sample of 120 respondents. 30 Respondents
were taken from each division.
METHODOLOGY(2)

16. 
 Questionnaire: A pre-coded questionnaire was
prepared considering all variables. It consisted of
Socio-economic, Tobacco and Alcohol Uses, Physical
Activity, Anthropometric, KAP about Hypertension,
Dietary information related questions.
 Weight Scale: For weight measurement
 Height Scale: For height measurement
 BP machine: Sphygmomanometer and Stethoscope
 Glucometer
DATA COLLECTION TOOLS

17. 
Study Areas(1)
Bondovatpara, Jhinaighati,
Sherpur, Mymensingh
Sundarmahal, Batiaghata,
Khulna

18. 
Study Areas(2)
Jamalganj, Sunamganj,
Sylhet

19. 
Data Collection(1)
Height measurement BP Measurement

20. 
Data Collection(2)
Blood Sugar
Measurement Questionnaire Fill-up

21. 
 SPSS (Statistical Package for the Social Sciences)
Version 23 was used for data processing and analysis.
The following analyses were done:
 Frequency Distribution
 Descriptive statistics
 Independent t-test
 ANOVA test
 Correlation
 Regression
Data Processing and
Analysis

22. 
 CHARACTERISTICS OF STUDY POPULATION:
 TABLE-1: Distribution of Total Study Sample
according to Gender and Divisions
Result

23. 
 Table-2 and Figure-1: Distribution of Study Sample
According to Age Categories
CHARACTERISTICS OF STUDY
POPULATION(1)

24. 
Figure-2: Distribution of Study Sample According to
Age and Gender
CHARACTERISTICS OF STUDY
POPULATION(2)

25. 
Figure-3: Distribution of the Study Population According
to Religion
CHARACTERISTICS OF STUDY
POPULATION(3)

26. 
Table-3: Distribution of Education level among four
divisions
SOCIO-ECONOMIC CONDITIONS

27. 
Figure-4: Marital Status of the respondents
SOCIO-ECONOMIC CONDITIONS (1)

28. 
Figure-5: Distribution of the occupation of respondents
SOCIO-ECONOMIC CONDITIONS (2)

29. 
Table-4: Distribution of Body Mass Index according
to Asia Pacific Cutoff Point
Nutritional Status(BMI)

30. 
 Figure-6: Comparison of BMI Categories between Asia
Pacific and WHO Cutoff Point
BMI(2)

31. 
Figure-7 and Table-5 : Prevalence of Blood Pressure
according to Systolic Pressure and Diastolic Pressure
Cutoff Point
PREVALENCE OF
HYPERTENSION

32. 
Figure-8: Percentage of Blood Sugar Level
Prevalence of Diabetes Mellitus

33. 
 KNOWLEDGE RELATED QUESTIONS:
Table-6: Distribution (%) of Knowledge Related
Questions about hypertension
KNOWLEDGE, ATTITUDE AND
PRACTICES

34. 
 ATTITUDE RELATED QUESTIONS:
FIGURE-9:Distribution (%) of Proper attitude about Hypertension
KAP(2)

35. 
 PRACTICES RELATED TO HYPERTENSION:
Table-7: Distribution (%) of Practices related to
Hypertension
KAP(3)

36. 
Figure-10 and Table-8:Distribution of KAP Score
about Hypertension
KAP score

37. 
Figure-11: Percentage of Tobacco and Alcohol User
TOBACCO AND ALCOHOL USES

38. 
 Table-9:Frequency of Type of Tobacco used by
respondents
TOBACCO AND ALCOHOL USES(1)

39. 
 Figure-12: Distribution (%) of Extra Salt Intake
Extra Salt Intake

40. 
 FOOD CONSUMPTION SCORE
 Table-10: Distribution of Food Consumption
among divisions
Dietary Habit Related

41. 
7 DAYS FOOD FREQUENCY
Table-11: Distribution of Food items intake of last 7
days

42. 
 24 Hour Recall Method:
Table-12:Distribution of Calorie intake between Male
and Female
Distribution of Calorie
Intake

43. 
Figure-13 and Table-13: Distribution of Nutrients
intake
Distribution of
Nutrients intake

44. 
 TYPE OF PHYSICAL ACTIVITY:
 Figure-14: Distribution (%) of the type of physical
activity
PHYSICAL ACTIVITY RELATED

45. 
 Figure-15: Distribution of Mean (min/day) duration of
different activities
MEAN (MIN.) DURATION OF
ACTIVITY

46. 
Table-14: Distribution (%) of Physical activity level
between Male and Female
DISTRIBUTION OF PHYSICAL ACTIVITY
LEVEL BETWEEN MALE AND FEMALE
Phyiscal Activity Male Female Total Chi-square t-test P-value
Less than 150min 18.30% 15.80% 34.10%
151-200min 4.20% 6.70% 10.90%
201-250min 12.50% 5.80% 18.30% 3.696 0.449
251-300min 6.70% 3.30% 10.00%
More than 300min 14.20% 12.50% 26.70%
Total 55.80% 44.20% 100.00%

47. 
Distribution of physical
activities of last 24 hours
 Figure-16: Distribution of physical activities of last 24
hours

48. 
Boxplot-1 :Distribution of Systolic Blood Pressure among
Divisions
One Way ANOVA

49. 
Boxplot-2:Distribution of Diastolic Blood Pressure among
divisions
One Way ANOVA(2)

50. 
Table-15 &16:Descriptive Statistics of Blood pressure
of Male Vs Female
INDEPENDENT SAMPLE TEST OF BLOOD
PRESSURE OF MALE VS FEMALE

51.  Blood Pressure and Nutrients:
Table-17:Correlations among Nutrients in (gm)
(Carbohydrates, Protein, Fats, Fiber) and Systolic
Pressure
Association

52. 
 Table-18: Correlations among Nutrients in (gm) (Carbohydrates,
Protein, Fats, Fiber) and Diastolic Pressure
Association among Blood Pressure
and Nutrients

53. 
 Scatter Diagram-1 &2:Linear Relationship between
blood pressure & Physical activity (in minutes)
Blood Pressure and
Physical Activity

54. 
Table-19: Correlation between blood pressure and
physical activity in (min)
Blood Pressure and
Physical Activity(2)

55. 
Correlations between
Occupation and Blood Pressure

56. 
Linear Relationship between Blood Pressure
and Randomly collected Blood Sugar

57. 
 Predicting Systolic Blood Pressure:
Regression

58. 
Predicting Systolic
Blood Pressure

59. 
Predicting Systolic
Blood Pressure(1)

60. 
 PREDICTING DIASTOLIC BLOOD PRESSURE:
Regression(1)

61. 
PREDICTING DIASTOLIC BLOOD
PRESSURE

62. 
PREDICTING DIASTOLIC BLOOD
PRESSURE(1)

63. 
 According to STEPS report of Bangladesh (2010), 12.5% of
the Bangladeshi population (adults>18 years old) have
hypertension, yet it was more than 40% in this study .
 According to STEPS report of Bangladesh (2010),about
one fourth of the populations were underweight (BMI
<18.5), 14.3% were overweight (BMI 25-29.9) and 3.6%
were obese (BMI >30). In this study, 11.70% of the
respondents were Underweight , 58.30% of the
respondents were Normal Weight,8.30% of the
respondents were Overweight, 8.30%of the respondents
were Obese Class I and 0.8% of the respondents were
Obese class II.
Discussion

64. 
 In this study, 27.50% of the respondents were
consuming less than 1805Kcal (* Hard Core Poor),
43.30% of the respondents were consuming below
2122 Kcal (**Absolute poor), 29.20% were consuming
2122-2600 Kcal and 27.5% of the respondents were
consuming more than 2601Kcal. According to HIES
(2010), 18.13% of the respondents were Hard core
poor and 40.22% of the respondents were absolute
poor.
Discussion(1)

65. 
 According to Steps report of Bangladesh (2010),
31.7% used smokeless tobacco and 26.2% were
smokers. In this study, 44.20% of the respondents
used Smokeless tobacco, 19.20% of the respondents
were smokers and 3.3% of the respondents were
Alcohol Consumers.
 56.36% of the respondents scored “High” on
Knowledge, 65.30% of the respondents scored
“High” on attitude and 44% of the respondents
scored “Low” on Practices.
Discussion(2)

66. 
 68.3% of the respondents never checked their BP.
 65.8% of the respondents visited doctor last month.
 76.70% and 75% of the respondents never checked
their Urine and Blood Sugar respectively.
 51.20% of the respondents have “Highly Acceptable
FCS”, 26.30% of the respondents have “Low
Acceptable FCS”, 21.7% of the respondents have
“Borderline FCS” and only 0.8% of the respondents
have “Poor FCS”.
 About 94% of the respondents consume extra salt.
Discussion(3)

67. 
 This survey revealed specific lapses in knowledge,
attitude, and practice behaviors in regards to
hypertension. A poor understanding of diet and exercise
in reducing hypertension and the association of tobacco
smoking with hypertension was demonstrated.
 The findings demonstrate that individuals with Physical
activity in minutes, Weight in kg, Divisions, Extra Salt
Intake, Smoking, Randomly Collected Blood sugar level,
Smokeless Tobacco, Age in year, Occupation, Food
consumption score and Gender have a significant
influence on hypertension.
Conclusion

68. 
 Lack of time to gather more samples was the main
limitation of the study.
 Some respondents felt uncomfortable during
interview
 The Respondents expected immediate benefits
(medicine) from the Study. So the purpose of the
study had to be explained and rapport building had
to be developed.
 Due to small size of samples, the significant levels of
statistics were comparatively lower.
LIMITATIONS OF THE STUDY(1)

69. 
 It was found difficult to collect information on
physical activity level, tobacco use related data,
Alcohol consumptions and food intake data as the
respondents were not mentioning their physical
activity level and food intake data properly.
LIMITATIONS OF THE STUDY(2)

70. 
 Future preventive programs encouraging regular
exercise and healthy dietary habits may be more
effective if they empower women.
 Tobacco cessation campaigns and aspirin
prophylaxis need to be spread as they are under-
estimated and undervalued in this population.
 The health system of the country needs to develop
strategies to increase the required screening and
diagnosis of the hypertension in both rural and
urban areas.
Recommendation(1)

71. 
 Comprehensive and integrated intervention
programs should be implemented to make
awareness so that the primary health care services go
towards the primary prevention and management of
the needs of older adults.
 Future programs can be more effective if it is led by
the government, hospitals, local doctors, agriculture
and nutritionists.
 Furthermore, longitudinal research is required to
find out the underlying causes of risk of
hypertension across the regions of Bangladesh.
Recommendation(2)

72. 
…anything is possible!
“The only reason the bumble bee can fly is because
no one told him that he can’t!”
Believe…

73. 
.