Understanding Health Related Quality of Life in Hypertensive Patients: Interrogating Effect of Psychological and Environmental Factors

Abstract

INTRODUCTION Blood Pressure is a condition in which the blood vessels have persistently raised arterial blood pressure and is the major risk factor for cardiovascular morbidity and mortality. 1,2 World Health Organization has proclaimed hypertension as the global public health crises because of its high prevalence. 1 Hypertension is classified as primary (essential) or secondary hypertension. 3 Over 90% of individual has high blood pressure that results from unknown pathophysiologic etiology which is known as essential hypertension. Fewer than 10% of individual have secondary hypertension which is either due to a co-morbid disease or an effect of a drugs. 4 Lifestyle factors that elevate the risk of high blood pressure includes stress, obesity, smoking, alcohol consumption, physical inactivity and excess salt intake in diet. 5 One billion people are affected by hypertension globally worldwide and is cause of mortality, exceeding 10 million people per year. 6 The prevalence and morbidity of hypertension is greater among older adults who often have multiple comorbidities. 7 In the year 2000, 972 million people worldwide were living with hypertension. This number was predicted to increase by about 60% to a total of 1.56 billion by the year 2025. 8 It is one of the most controllable chronic conditions and adults with it are more likely to have other chronic condition. 8 It was also ranked third as a cause of disability adjusted life years (DALYS) [8]. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure (JNC-7 guidelines) has classified hypertension into following: 9 • Normal BP:<120mmHg and diastolic BP <80mmHg • Prehypertension: SBP 120-139 mmHg or DBP 80-89 mmHg • Stage 1 hypertension: SBP 140-159 mmHg or DBP 90-99 mmHg • Stage 2 hypertension: SBP ≥160 mmHg or DBP ≥100 mmHg Rarely accompanied by symptoms, hypertension is generally identified while seeking medical care for any unrelated problem. People with hypertension have complaints of headache at back of the head, vertigo, lightheadedness, tinnitus, blurred vision, sweating, facial flushing and palpitations. 10 Uncontrolled or poor management of hypertension results in serious complications like coronary heart disease, cerebrovascular disease, vision loss, peripheral arterial disease and renal insufficiency. 11 To alleviate the risk of hypertension related cardiovascular disease, accurate measurement and recording of blood pressure is necessary which can be done either by Home Blood Pressure Monitoring (HBPM) or Ambulatory Blood pressure monitoring (ABPM). HBPM refers to the self-monitoring of blood pressure by the patients at home or outside clinic while ABPM refers to monitoring and recording of blood pressure at regular interval over a 24-hr period. 12 Diagnosis of hypertension also include assessment of target organ damage, cardiovascular risk and concomitant disease like diabetes mellitus, chronic kidney disease etc. that may affect blood pressure. 13 For better management of hypertension and to abate the risk of cardiovascular disease or complication, lifestyle changes are ABSTRACT Background: Health-related quality of life has become an important aspect in the field of healthcare as an important outcome measure for chronic diseases like hypertension. Improvement in HRQoL have become a focal point in health research, with clinicians, scientists and policy makers realizing the value of individual's self-rated experience, beyond or in addition to objective and clinical measure of health. Aim: To study the effect of psychological and environmental factors on HRQoL in patients suffering from hypertension using WHOQOL-BREF questionnaire. Methods and Materials: The study was carried out for six weeks in medicine outpatient and inpatient department of a tertiary care hospital. All patients diagnosed with essential hypertension were recruited and socio-demographic and clinical data were noted. Patients were interviewed using WHOQOL-BREF using questionnaire. Results: Of total 100 patients, female was more prevalent to hypertension compared to male. Mean score of environmental domain was greater than the psychological domain [72.375 (SD ±19.23) and 68.91667 (SD ± 19.59), respectively] suggesting the inverse correlation of quality of life with negative thoughts, blue mood, anxiety and depression. Regarding individual questions, most of the participants felt safe in their