Do joint national committee VII criteria also need to take non pharmacological measures into conside

JNC VII criteria and non pharmacological measures

International Archives of Integrated Medicine, Vol.

Copy right © 2015, IAIM, All Rights Reserved.

Original Research Article

Do joint national committee VII criteria

also need to take non pharmacological

measures into consideration?

evidence from slum resettlement colony

Sanjeet Panesar1, Sanjay Chaturvedi

Abhishek Singh1Senior Resident, Department of Community Medicine, Vardhman Mahavir Medical College and

Safdarjung Hospital, New Delh2Professor, Department of Community Medicine, UCMS, Delhi

3 Assistant Professor, Department of Community Medicine, UCMS, Delhi4 Professor,

5Assistant Professor, Department of Community Medicine

6Assistant Professor, Department of F

*Corresponding author email:

How to cite this article: Sanjeet Panesar, Sanjay Chaturvedi

Pankaj Chikkara. Do joint national committee VII crit

measures into consideration? - Empirical evidence from slum resettlement colony from Delhi

2015; 2(1): 15-21.

Available online at

Received on: 03-12-2014

Abstract

Background: Currently Joint National Committee (JNC) VII criteria are used worldwide to d

hypertension but it does not take non pharmacological measures into consideration. Also, it does

not consider Indian system of medicine.

Objectives: To assess whether JNC

or revision is required especially for Indian communities where such practices are prevalent.

Material and methods: The present community based cross

Nagri, a slum resettlement of East Delhi which comes un


International Archives of Integrated Medicine, Vol. 2, Issue 1, January, 2015.

Rights Reserved.



measures into consideration? - Empirical


from Delhi

, Sanjay Chaturvedi2, NK Saini

3, R.

Abhishek Singh5*

, Pankaj Chikkara

6

Senior Resident, Department of Community Medicine, Vardhman Mahavir Medical College and

Safdarjung Hospital, New Delhi, India

Department of Community Medicine, UCMS, Delhi, India

, Department of Community Medicine, UCMS, Delhi

Professor, Department of Medicine, UCMS, Delhi, India

Assistant Professor, Department of Community Medicine, SHKM Govt. Medical College, Haryana

India

Assistant Professor, Department of Forensic Medicine, PGIMS, Rohtak, Haryana

*Corresponding author email: [email protected]

Sanjeet Panesar, Sanjay Chaturvedi, NK Saini, R. Avasthi,

Do joint national committee VII criteria also need to take non pharmacological

Empirical evidence from slum resettlement colony from Delhi

Available online at www.iaimjournal.com

2014 Accepted on:

Currently Joint National Committee (JNC) VII criteria are used worldwide to d

not take non pharmacological measures into consideration. Also, it does

not consider Indian system of medicine.

To assess whether JNC VII in its present form is valid to diagnose hypertension correctly


The present community based cross-sectional study was carried out in Na

Nagri, a slum resettlement of East Delhi which comes under field practice area of the D

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ISSN: 2394-0034 (O)

Page 15



Empirical


, R. Avasthi4,

Senior Resident, Department of Community Medicine, Vardhman Mahavir Medical College and

, India

, Department of Community Medicine, UCMS, Delhi, India

, SHKM Govt. Medical College, Haryana,

, PGIMS, Rohtak, Haryana, India

R. Avasthi, Abhishek Singh,

eria also need to take non pharmacological

Empirical evidence from slum resettlement colony from Delhi. IAIM,

Accepted on: 19-12-2014

Currently Joint National Committee (JNC) VII criteria are used worldwide to diagnose

not take non pharmacological measures into consideration. Also, it does

VII in its present form is valid to diagnose hypertension correctly


sectional study was carried out in Nand

der field practice area of the Department of




Community Medicine, UCMS, Delhi from

59 years were selected through multistage systematic random

cut-offs considered in our criteria was similar to the JNC VII cut

≥90 mmHg), the difference was in the last part of JNC VII definition of hypertension i.e. treatment by

anti hypertensive medicines; our criteria comprised of this statement as “any anti hypertensive

measure”. Chi-square (χ²) test was applied

Results: Overall 54 were found to have hypertension by JNC VII criteria whereas 61 by our criteria.

Seven patients who were not hypertensive by JNC VII but hypertensive by our criteria and the

difference was found to be statistically highly significant (p<0.001).

non pharmacological measure adopted by male gender where as in females

most common measure adopted.

Conclusion: Our study emphasized inclusion of non

making diagnosis of hypertension in our setup.

Key words

Treatment, Control, Non pharmacological

Introduction

Non-communicable diseases especially

cardiovascular diseases (CVD) are major causes

of death and disability in low and

countries [1]. Over 80% of CVD deaths occur in

such countries as their populations are more

exposed to risk factors, and have less access to

preventive efforts [2]. By 2020, it is expected

that India will have more than 50% of the CVD

cases in the world. World Health Organization

(WHO) has named hypertension as ‘Silent Killer’

and it has been reported as seventh contributor

to premature death in developing countries

Hypertension is most commonly associated with

cardiovascular diseases worldwide and is the

most important modifiable risk factor for

cardiovascular mortality. According to WHO,

each year at least 7.1 million people die as a

result of hypertension [3]. Despite the high

prevalence; prevention, detection, treatment,

and control of hypertension is suboptimal and

unsatisfactory in developing coun

[4].



Rights Reserved.

nity Medicine, UCMS, Delhi from August 2010 to February 2012. Total 310

59 years were selected through multistage systematic random sample. Though the blood pressure

offs considered in our criteria was similar to the JNC VII cut-offs (SBP ≥140 mmHg and or DBP

90 mmHg), the difference was in the last part of JNC VII definition of hypertension i.e. treatment by

dicines; our criteria comprised of this statement as “any anti hypertensive

square (χ²) test was applied for analysis.

54 were found to have hypertension by JNC VII criteria whereas 61 by our criteria.

not hypertensive by JNC VII but hypertensive by our criteria and the

difference was found to be statistically highly significant (p<0.001). Exercise was the most common

non pharmacological measure adopted by male gender where as in females, salt restricti

most common measure adopted.

Our study emphasized inclusion of non-drug therapy measures into consideration while

making diagnosis of hypertension in our setup.

n pharmacological interventions, Hypertension.

communicable diseases especially

cardiovascular diseases (CVD) are major causes

and middle income

. Over 80% of CVD deaths occur in

countries as their populations are more

exposed to risk factors, and have less access to

. By 2020, it is expected

that India will have more than 50% of the CVD

World Health Organization

n as ‘Silent Killer’

and it has been reported as seventh contributor

to premature death in developing countries [3].

Hypertension is most commonly associated with

cardiovascular diseases worldwide and is the

most important modifiable risk factor for

ovascular mortality. According to WHO,

each year at least 7.1 million people die as a

. Despite the high

prevalence; prevention, detection, treatment,

and control of hypertension is suboptimal and

unsatisfactory in developing countries like India

It is established fact that non pharmacological

measures also have significant role in treatment

and control of hypertension. Currently JNC VII

criteria are used worldwide to diagnose

hypertension but it does not take non

pharmacological measures into consideration.

Also, it does not consider Indian system of

medicine. Therefore it becomes essential to

assess whether JNC VII in its present form is

valid to diagnose hypertension correctly or

revision is required especially for Indian

communities where such practices are

prevalent.

Material and methods

The present community based cross

study was carried out in Nand

resettlement of East Delhi which comes under

field practice area of the D

Community Medicine, University College of

Medical Sciences (UCMS), Delhi from August

2010 to February 2012. It has a population of

over 50,000 and mostly falling in

low socio-economic status.

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Page 16

310 subjects aged 20-

Though the blood pressure

140 mmHg and or DBP

90 mmHg), the difference was in the last part of JNC VII definition of hypertension i.e. treatment by

dicines; our criteria comprised of this statement as “any anti hypertensive

54 were found to have hypertension by JNC VII criteria whereas 61 by our criteria.

not hypertensive by JNC VII but hypertensive by our criteria and the

Exercise was the most common

salt restriction was the

herapy measures into consideration while

non pharmacological

measures also have significant role in treatment

and control of hypertension. Currently JNC VII

criteria are used worldwide to diagnose

hypertension but it does not take non

cal measures into consideration.

Also, it does not consider Indian system of

medicine. Therefore it becomes essential to

assess whether JNC VII in its present form is

valid to diagnose hypertension correctly or

revision is required especially for Indian

ommunities where such practices are

The present community based cross-sectional

study was carried out in Nand Nagri, a slum

resettlement of East Delhi which comes under

ractice area of the Department of

dicine, University College of

Medical Sciences (UCMS), Delhi from August

2010 to February 2012. It has a population of

over 50,000 and mostly falling in the category of




The sample size was calculated with anticipated

prevalence of hypertension as 27.5%

Absolute precision, 95% Confidence Interval and

10% non response error, as 310 adults over the

age of 20 years. The study subjects were

selected through multistage systematic random

sampling technique. One sub block was

randomly selected from each of the five blocks

of the study area. Sampling unit was a

household; a household was randomly selected

from first 20 households (sampling interval for

5%). Thereafter, starting from that household,

every 20th household was selected

years subjects, residing in the selected

household for 6 months or more, were included

in the study. If there were no eligible subj

the selected household or the house was closed

for 3 consecutive visits, it was replaced by a

contiguous household without disturbing the

allocation of next 20th sampling unit.

Blood pressure of all the subjects was measured

according to JNC VII / American Heart

Association (AHA) recommendations. JNC

guidelines [6, 7] were followed for defining

awareness, treatment and control of

hypertension. Among the hypertensive’s,

subjects with prior diagnosis of hypertension/

high BP were considered as ‘aware’; those with

current anti hypertensive drug therapy as

‘treated’; and subjects showing SBP

DBP <90 mmHg, and taking anti

medication as ‘controlled’. Though the blood

pressure cut-offs considered in our criteria was

similar to the JNC VII cut-offs (SBP

and or DBP ≥90 mmHg), the difference was in

the last part of JNC VII definition

i.e. treatment by anti hypertensive medicines;

our criteria comprised of this statement as “any

anti hypertensive measure”; these measures

taken include anti hypertensive drugs (which

could be allopathic, ayurvedic, homeopathic,

unani, siddha, herbal medicine, indigenous

medicines), non pharmacologic measures like



Rights Reserved.

The sample size was calculated with anticipated

of hypertension as 27.5% [5], 5%

Absolute precision, 95% Confidence Interval and

10% non response error, as 310 adults over the

age of 20 years. The study subjects were

selected through multistage systematic random

sampling technique. One sub block was

domly selected from each of the five blocks

of the study area. Sampling unit was a

household; a household was randomly selected

from first 20 households (sampling interval for

5%). Thereafter, starting from that household,

household was selected. All the 20-59

years subjects, residing in the selected

household for 6 months or more, were included

in the study. If there were no eligible subject in

or the house was closed

for 3 consecutive visits, it was replaced by a

us household without disturbing the

sampling unit.

Blood pressure of all the subjects was measured

according to JNC VII / American Heart

Association (AHA) recommendations. JNC

were followed for defining

treatment and control of

sion. Among the hypertensive’s,

subjects with prior diagnosis of hypertension/

high BP were considered as ‘aware’; those with

hypertensive drug therapy as

‘treated’; and subjects showing SBP <140 mmHg,

, and taking anti hypertensive

Though the blood

offs considered in our criteria was

offs (SBP ≥140 mmHg

90 mmHg), the difference was in

the last part of JNC VII definition of hypertension

i.e. treatment by anti hypertensive medicines;

our criteria comprised of this statement as “any

anti hypertensive measure”; these measures

taken include anti hypertensive drugs (which

could be allopathic, ayurvedic, homeopathic,

dha, herbal medicine, indigenous

medicines), non pharmacologic measures like

weight reduction, exercise, salt restriction,

smoking cessation, reduction in alcohol intake,

stress management, yoga, meditation, etc.

In depth enquiry was made regarding afore

mentioned non-pharmacological anti

hypertensive measures taken by them. Relevant

socio-demographic data of the individuals was

also recorded. Ethical committee approved the

study. Informed consent was obtained from the

study participants.

The collected data was coded and entered in

Statistical Package for Social Sciences (SPSS),

version 20. The results were expressed as

proportions. Chi-square (χ²) test was applied to

test the difference across the groups and p<0.05

was considered statistically significan

Results

The comparison made between JNC VII and our

criteria to diagnose the hypertension among 310

subjects as per Table - 1. Overall 54 were found

to have hypertension by JNC VII criteria whereas

61 by our criteria. Seven patients who were not

hypertensive by JNC VII but hypertensive by our

criteria and the difference were found to be

statistically highly significant. (p<0.001)

Proportion of aware subjects who controlled

their blood pressure by adopting one

non pharmacologic measure or life style was

calculated. According to it,

non pharmacologic medication to control their

BP of which 7 subjects were able to achieve BP

control. All the 8 subjects who used non

pharmacologic measures w

hypertension as per Table - 2

The most common non pharmacological

measure adopted by the subjects was salt

restriction in diet (87.5%), among males most

common measure was exercise (100%) where as

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Page 17

weight reduction, exercise, salt restriction,

smoking cessation, reduction in alcohol intake,

stress management, yoga, meditation, etc.

In depth enquiry was made regarding afore

pharmacological anti

hypertensive measures taken by them. Relevant

demographic data of the individuals was

also recorded. Ethical committee approved the

study. Informed consent was obtained from the

ata was coded and entered in

Statistical Package for Social Sciences (SPSS),

version 20. The results were expressed as

square (χ²) test was applied to

test the difference across the groups and p<0.05

was considered statistically significant.

The comparison made between JNC VII and our

criteria to diagnose the hypertension among 310

. Overall 54 were found

to have hypertension by JNC VII criteria whereas

61 by our criteria. Seven patients who were not

rtensive by JNC VII but hypertensive by our

criteria and the difference were found to be

statistically highly significant. (p<0.001)

Proportion of aware subjects who controlled

eir blood pressure by adopting one or more

non pharmacologic measure or life style was

8 subjects adopted

non pharmacologic medication to control their

BP of which 7 subjects were able to achieve BP

control. All the 8 subjects who used non

s were having Grade 1

2.

The most common non pharmacological

measure adopted by the subjects was salt

restriction in diet (87.5%), among males most

common measure was exercise (100%) where as




in females salt restriction was the

measure adopted (100%). Any other system of

medicine other than allopathic system

used by study subjects as per Table

Discussion

The successive reports of the Joint National

Committee on prevention, detection, evaluation

and treatment of high blood pressure (HBP), non

drug therapy is recommended as

been considered efficacious [8]

reports on primary prevention of HBP including

the primary prevention

hypertension (report of a WHO s

[9] and National High Blood Pressure Education

Program’s (NHBPEP) working groups report on

primary prevention of hypertension

stressed on the non drug therapy.

The JNC VII criteria to diagnose hypertension

were put forth way back in 2003.

study, we observed that 54 were diagnosed to

have hypertension by JNC VII criteria where

61 by our criteria in a study of mere 310

subjects. Difference between JNC VII and our

criteria was in the last part of JNC VII definition

of hypertension i.e. treatment by anti

hypertensive medicines; our criteria comprised

of this statement as “any an

measure.” Seven patients were non

hypertensive by JNC VII but diagnosed to have

hypertension by our criteria. Issue would look

more relevant and serious when this aspect is

applied to the bigger population of our

communities where they prac

pharmacologic measures to live healthy. It can

be said that we are underestimating the actual

burden of hypertension. How policies can be

made to manage a public health problem

without knowing its actual magnitude!

It was observed in our study that out of 8

subjects who adopted non pharmacologic



Rights Reserved.

in females salt restriction was the most common

measure adopted (100%). Any other system of

medicine other than allopathic system was not

Table - 3.

The successive reports of the Joint National

detection, evaluation

pressure (HBP), non

drug therapy is recommended as it has long

[8]. In addition,

revention of HBP including

of essential

hypertension (report of a WHO scientific group)

and National High Blood Pressure Education

Program’s (NHBPEP) working groups report on

primary prevention of hypertension [10], have

drug therapy.

The JNC VII criteria to diagnose hypertension

were put forth way back in 2003. In the present

we observed that 54 were diagnosed to

have hypertension by JNC VII criteria where as

61 by our criteria in a study of mere 310

subjects. Difference between JNC VII and our

criteria was in the last part of JNC VII definition

of hypertension i.e. treatment by anti

hypertensive medicines; our criteria comprised

of this statement as “any anti hypertensive

measure.” Seven patients were non

hypertensive by JNC VII but diagnosed to have

hypertension by our criteria. Issue would look

more relevant and serious when this aspect is

applied to the bigger population of our

where they practice non

pharmacologic measures to live healthy. It can

be said that we are underestimating the actual

burden of hypertension. How policies can be

made to manage a public health problem

without knowing its actual magnitude!

It was observed in our study that out of 8

subjects who adopted non pharmacologic

medication to control their BP

practiced ‘Salt restriction’. Cutler

their analysis of 23 randomly controlled trials

showed that 100 mmol/day re

intake was associated with a

mmHg SBP and 2.7 mmHg DBP in hypertensive

subjects and 2.2 mmHg/1.3 mm

normotensives. Others also observed the similar

findings [8, 12].

Physical activity in the form of exercise was

adopted by 5 individuals in our study. Today,

physical exercise is considered as an important

component of the non

hypertension. Physically active persons have

lower blood pressure, reduced risk for

cardiovascular and all cause mortality and l

longer. The benefit of physical activity to the

primary prevention of hypertension has been

documented by both clinical trials and

longitudinal studies [13, 14, 15]

Smoking independently raises BP, although

epidemiologically the relationship between

smoking and hypertension is often confounded

by other factors such as alcohol consumption

and lower consumption of fruits and vegetables

(anti-oxidants) amongst smokers than

smokers [8].

JNC VI report [16] found no support for the use

of relaxation techniques for the prevention of

hypertension. Yoga, meditation (mind

techniques) are widely practiced for stress

reduction in India. In our study also 3 subjects

adopted such techniques to reduce their blood

pressure. BP lowering effect of

meditation has been further supported by two

meta-analyses; each suggesting TM can reduce

both SBP and DBP.

Several clinical studies Viz. Framingham off

spring study [19], INTERSALT study

II [21, 22] have shown direct benefit

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Page 18

medication to control their BP, 7 of them had

practiced ‘Salt restriction’. Cutler, et al. [11] in

analysis of 23 randomly controlled trials

showed that 100 mmol/day reduction in sodium

intake was associated with a decline of 5.7

Hg DBP in hypertensive

subjects and 2.2 mmHg/1.3 mmHg in

normotensives. Others also observed the similar

Physical activity in the form of exercise was

ed by 5 individuals in our study. Today,

physical exercise is considered as an important

component of the non drug treatment of

hypertension. Physically active persons have

lower blood pressure, reduced risk for

cardiovascular and all cause mortality and live

longer. The benefit of physical activity to the

hypertension has been

documented by both clinical trials and

[13, 14, 15].

Smoking independently raises BP, although

epidemiologically the relationship between

smoking and hypertension is often confounded

factors such as alcohol consumption

of fruits and vegetables

oxidants) amongst smokers than non-

found no support for the use

echniques for the prevention of

Yoga, meditation (mind-body

techniques) are widely practiced for stress

reduction in India. In our study also 3 subjects

adopted such techniques to reduce their blood

lowering effect of transcendental

meditation has been further supported by two

analyses; each suggesting TM can reduce

Several clinical studies Viz. Framingham off-

, INTERSALT study [20], TOPH-I,

have shown direct benefit of weight




reduction on hypertension. During weight loss, a

rapid reduction in BP is seen over 8

There seems to be a linear relationship between

weight and blood pressure. The BP falls as there

is reduction of weight. With reduction of weight,

one can reduce or even stop the medications

[23].

Conclusion

To conclude, we have accumulated knowledge

and empirical evidences over decades of

research but made poor use of them.

emphasized inclusion of non drug t

measures into consideration while making

diagnosis of hypertension in our setup. Large

scale studies are recommended to support our

findings.

References

1. Gupta R, Guptha S, Joshi R, Xavier D.

Translating evidence into policy for

cardiovascular disease control in India.

Health Res Policy Syst., 2011

2. Gersh B, Mayosi B, Sliwa K, Yusuf S.

epidemic of cardiovascular diseases in

the developing world: Global

implications. Eur Heart J,

648.

3. Deepa R, Shanthirani CS, Pradeepa R,

Mohan V. Is the 'rule of halves' in

hypertension still valid?

the Chennai Urban Population

Assoc Physicians India, 2003

4. Gandhi S, Chaudhari N, Bh

K, Vasava B. Awareness and prevalence

of myocardial infarction and

hypertension in general population of

Surat city. National Journal of

Community Medicine, 2010; 1(2):

42.



Rights Reserved.

reduction on hypertension. During weight loss, a

rapid reduction in BP is seen over 8-10 weeks.

There seems to be a linear relationship between

weight and blood pressure. The BP falls as there

is reduction of weight. With reduction of weight,

can reduce or even stop the medications

To conclude, we have accumulated knowledge

and empirical evidences over decades of

use of them. Our study

emphasized inclusion of non drug therapy

n while making

diagnosis of hypertension in our setup. Large

scale studies are recommended to support our

S, Joshi R, Xavier D.

Translating evidence into policy for

cardiovascular disease control in India.

, 2011; 9: 8.

Gersh B, Mayosi B, Sliwa K, Yusuf S. The

epidemic of cardiovascular diseases in

the developing world: Global

Eur Heart J, 2010; 31: 642-

Deepa R, Shanthirani CS, Pradeepa R,

Is the 'rule of halves' in

hypertension still valid? - Evidence from

the Chennai Urban Population Study. J

Assoc Physicians India, 2003; 51: 153-7.

Gandhi S, Chaudhari N, Bhuva R, Mallick

K, Vasava B. Awareness and prevalence

of myocardial infarction and

hypertension in general population of

Surat city. National Journal of

, 2010; 1(2): 139-

5. Chaturvedi S, Pant M, Neelam, Yadav G.

Hypertension in Delhi: pr

awareness, treatment and control. Trop

Doct, 2007; 37: 142-

6. Chobanian AV, Bakris GL, Black HR,

Cushman WC, Green LA, Izzo JL Jr, et al.

The Seventh Report of the Joint National

Committee on prevention, detection,

evaluation, and treatment of hi

pressure: The JNC 7 report. JAMA

289: 2560-72.

7. Burt VL, Cutler JA, Higgins M, Horan MJ,

Labarthe D, Whelton P, Brown C,

Roccella EJ. Trends in the prevalence,

awareness, treatment, and control of

hypertension in the ad

Hypertension, 1995; 26: 60

8. Labarthe Darwin,

Drug interventions in hyper

prevention and control. Cardiol Clin

2002; 20: 249-63.

9. World Health Organization

prevention of essential hypertension

report of a WHO Scientific

Geneva, Switzerland: World Health

Organization; Technical Report Series

1982, 678.

10. National High Blood Pressure Education

Program (NHBPEP) Working Group.

National High Blood Pressure Education

Program Working Group report on

primary prevention of hy

Arch Intern Med, 1993;

11. Culter JA, Follmann D, Elliott P,

overview of randomized trials of sodium

reduction and blood pressure.

Hypertension, 1991;

33.

12. Dole PV, Dahl LK, Cotzias GC, Eer HA,

Krebs ME. Dietary treatment of

hypertension: Clinical and metabolic

studies of patients on rice

Clinc Invest, 1950; 29:

ISSN: 2394-0026 (P)

ISSN: 2394-0034 (O)

Page 19

Chaturvedi S, Pant M, Neelam, Yadav G.

Hypertension in Delhi: prevalence,

awareness, treatment and control. Trop

-5.

Chobanian AV, Bakris GL, Black HR,

Cushman WC, Green LA, Izzo JL Jr, et al.

The Seventh Report of the Joint National

Committee on prevention, detection,

atment of high blood

he JNC 7 report. JAMA, 2003;

Burt VL, Cutler JA, Higgins M, Horan MJ,

Labarthe D, Whelton P, Brown C,

Roccella EJ. Trends in the prevalence,

awareness, treatment, and control of

hypertension in the adult US population.

1995; 26: 60-69.

Labarthe Darwin, Ayala Carma. Non

Drug interventions in hyper-tension,

prevention and control. Cardiol Clin,

World Health Organization - Primary

prevention of essential hypertension

report of a WHO Scientific Group.

Geneva, Switzerland: World Health

Organization; Technical Report Series


Program (NHBPEP) Working Group.


Program Working Group report on

primary prevention of hypertension.

1993; 153: 186-208.

r JA, Follmann D, Elliott P, Suhl I. An

overview of randomized trials of sodium

reduction and blood pressure.

1991; 17(suppl. I); 1: 27-

Dahl LK, Cotzias GC, Eer HA,

ary treatment of

linical and metabolic

studies of patients on rice-fruits diet. J

29: 1189-1206.




13. Crespo CJ, Keteyian SJ, Health GW, et al.

Leisure-time physical activity among US

adults: Results from the Third Nationa

Health And Nutrition Examination

Survey. Arch Intern Med

8.

14. Heini AF, Weinsier RL. Divergent trends

in obesity and fat intake patterns: T

American pararox. Am J Med

102(3): 259-64.

15. Taylor-Tolbert NS, Dengel DR, Brown

MD, et al. Ambulatory blood pressure

after acute exercise in older men with

essential hypertension. Am J Hypertens

2000; 13(1 pt 1): 44-51.

16. The sixth report of the Joint National

Committee on the Prevention.

Detection, evaluation, and treatment of

high blood pressure (JNC

Med, 1997; 157: 2413-46.

17. Anderson JW, Liu C, Kryscio RJ. Blood

pressure response to t

meditation: A meta-analysis. Am J

Hypertens, 2008; 21: 310

18. Rainforth MV, Schneider RH, Nidich SI

et al. Stress reduction programs

patients with elevated blood pressure: A

systematic review and meta

Curr Hypertens Rep, 2007;

19. Garrison RJ, Kannel WB, Strokes III J, et

al. Incidence and precursors of

Table - 1: Comparison of our criteria to define hypertension with respect to JNC criteria

By our criteria By JNC criter

Hypertensive

Hypertensive 54 (88.5)

Not hypertensive 0 (0.00)

Total 54 (17.4)

*p<0.001, Highly significant



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Crespo CJ, Keteyian SJ, Health GW, et al.

ical activity among US

esults from the Third National

Health And Nutrition Examination

Survey. Arch Intern Med, 1996; 156: 93-

Heini AF, Weinsier RL. Divergent trends

esity and fat intake patterns: The

American pararox. Am J Med, 1997;

Tolbert NS, Dengel DR, Brown

bulatory blood pressure

after acute exercise in older men with

essential hypertension. Am J Hypertens,

The sixth report of the Joint National

Committee on the Prevention.

Detection, evaluation, and treatment of

(JNC-VI). Arch Intern

46.

Anderson JW, Liu C, Kryscio RJ. Blood

pressure response to transcendental

analysis. Am J

310-16.

Rainforth MV, Schneider RH, Nidich SI,

et al. Stress reduction programs in

with elevated blood pressure: A

systematic review and meta-analysis.

2007; 9: 520–8.

Garrison RJ, Kannel WB, Strokes III J, et

al. Incidence and precursors of

hypertension in young adults. The

Framingham Offspring Study. Pre

1987; 16: 235-51.

20. Intersalt Cooperative Research Group.

INTERSALT: an international study of

electrolyte excretion and blood

pressure. Results for 24 hour urinary

sodium and potassium excretion. BMJ

1988; 297: 319-28.

21. Trials of Hypertension Prevent

Collaborative Research Group. The

effects of non

interventions on blood pressure of

persons with high n

of the trials of hypertension prevention,

phase I. JAMA, 1992;

22. Tunstall-Pedoe H, Woodward M,

Tavendale R, et al. Comparison of the

prediction by 27 different factors of

coronary heart disease and death in

men and women of the Scottish Heart

Study: cohort study. BMJ

722-9.

23. Sainani GS. Non

prevention and control of hyperte

J Assoc Physicians India, 2003

6.

Comparison of our criteria to define hypertension with respect to JNC criteria

By JNC criteria Total (%)

Hypertensive (%) Non Hypertensive (%)

7 (11.5) 61 (19.7)

249 (100) 249 (80.3)

256 (82.6) 310 (100)

ISSN: 2394-0026 (P)

ISSN: 2394-0034 (O)

Page 20

hypertension in young adults. The

Framingham Offspring Study. Prev Med,

Intersalt Cooperative Research Group.

INTERSALT: an international study of

electrolyte excretion and blood

pressure. Results for 24 hour urinary

sodium and potassium excretion. BMJ,

Trials of Hypertension Prevention

Collaborative Research Group. The

effects of non-pharmacologic

interventions on blood pressure of

persons with high normal levels: Results

of the trials of hypertension prevention,

1992; 267: 1213-20.

Pedoe H, Woodward M,

Tavendale R, et al. Comparison of the

prediction by 27 different factors of

coronary heart disease and death in

men and women of the Scottish Heart

Study: cohort study. BMJ, 1997; 315:

GS. Non-drug therapy in

prevention and control of hypertension.

J Assoc Physicians India, 2003; 51: 1001-

Comparison of our criteria to define hypertension with respect to JNC criteria.

Total (%) p-value

61 (19.7)

<0.0001* 249 (80.3)

310 (100)




Table - 2: Type of therapy taken by total aware subjects.

Anti hypertensive treatment

Pharmacologic medications

≥ 1 Non pharmacologic measures

Figures in parenthesis indicate percentage.

Table - 3: Distribution of various types of non pharmacologic interventions according to gender.

Classification of non pharmacologic measures

adopted by subjects

Weight reduction

Exercise

Salt restriction

Smoking cessation

Ayurvedic, Homeopathic, Unani, Siddha, Herbal

medicine, Indigenous medicines

Reduction of salt intake

Stress management/ yoga, etc.

Source of support: Nil



Rights Reserved.

therapy taken by total aware subjects.

Total aware subjects Controlled (%) Uncontrolled (%)

21 (61.8) 10 (47.6) 11

pharmacologic measures 8 (38.2) 7 (87.5) 1

parenthesis indicate percentage.

Distribution of various types of non pharmacologic interventions according to gender.

Classification of non pharmacologic measures Males (n=3) Females (n=5)

No. % No.

1 33.3 0

3 100 2

2 66.7 5

0 0 0

Ayurvedic, Homeopathic, Unani, Siddha, Herbal

0 0 0

1 33.3 0

2 66.7 1

Nil Conflict of interest:

ISSN: 2394-0026 (P)

ISSN: 2394-0034 (O)

Page 21

Uncontrolled (%)

11 (52.4)

(12.5)

Distribution of various types of non pharmacologic interventions according to gender.

(n=5) Total (n=8)

% No. %

0 1 12.5

40 5 62.5

100 7 87.5

0 0 0

0 0 0

0 1 12.5

20 3 37.5

Conflict of interest: None declared.

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Do joint national committee VII criteria also need to take non pharmacological measures into conside