Hypertension is an emerging public health challenge because of its increasing burden and being risk factor for many diseases [1]. It is a major risk factor of Cardiovascular Disease (CVD), which causes 45% of mortality and morbidity globally [2]. Importantly, it is a prevailing risk factor for Myocardial Infraction (MI) in the general population [3]. CVDs are expected to be the major causes of morbidity and mortality in many developing countries of the world by 2025, [4] yet it is preventable [5]. Knowledge about prevention and control of complication especially MI is crucial. It has been reported that South Asians have a very poor degree of knowledge regarding coronary heart disease [6]. In India, people have very basic ideas about MI but a detailed study on this topic is still required [7]. Therefore, this study aimed to identify the level of knowledge and the practice of hypertensive patients for the prevention of myocardial infarction.

Hospital based cross-sectional study was conducted among hypertensive patients attending in Outpatient departments of Dr RPGMC Tanda, Zonal Hospital Dharamshala and Civil Hospital Kangra, located in Kangra district of Himachal Pradesh for a duration of six weeks. Non-probability purposive sampling method was used to select hypertensive patients presenting in the OPD of these hospitals. Ninety-six previously diagnosed hypertensive patients were taken for the study. Structured questionnaire on (knowledge and practice) were used to collect data through interview method. There were total twelve questions about knowledge and thirteen questions about practice so total knowledge score was 12 and 13 for practice. Mean score of knowledge (8.29) and practice (7.94) was taken for categorization. If knowledge score obtained by the participants was above mean score then it was categorized as high level knowledge and if it was below mean score then it was graded as low level knowledge.

Similarly, if the practice score was above mean then it was categorized as good practice and if it was less than mean, it was graded as poor practice. Those participants who could read and write were taken as literate and those who were unable to do so were taken as illiterate. Modified BG Prasad socio-economic status scale was used for classification of socio-economic status. Data was analysed in Epi-info version 8 using descriptive (mean and standard deviation) and analytical (Chi square test) statistics. Approval was taken from Chief Medical Officer Kangra before conducting study and informed consent was also taken from each participant.

Out of total hypertensive respondents, more than half (60.4%) had high level of knowledge whereas 39.6% had low level of knowledge regarding prevention of MI. Similarly, 57.3% had good practice and were taking the appropriate preventive measures of MI, though, 42.7% had poor practice as shown in the Table 1.

Table 1: Level of Knowledge and Practice (n = 96)

This study revealed that knowledge level was significantly (p = 0.002) higher among female (74.1%) than to male (42.9%). In the same manner, literate participants (69.9%) were significantly (p = <0.001) more aware about the prevention of MI compared to illiterate participants. Around three fourth (70.15%) of participants, having high level of knowledge, were from upper class and rest (37.93%) were from lower class as shown in Table 2. 

Table 2: Association between the Socio-Demographic Variables and the Knowledge (n = 96)

*** Significant p value

Moreover, those participants who were involved in awareness programs of prevention of MI previously, (86.67%) had good practice of prevention of MI (p = 0.012) than the participants not involved in such programs earlier (51.85%) as presented in Table 3.

Table 3: Association between the Socio-Demographic Variables and the Practice (n = 96)

*** Significant p value

This study showed that the maximum numbers of respondents were overweight (49%) followed by obese (32.3%) and normal weight (17.7%) respectively. The calculated mean Body Mass Index (BMI) was 26.64 and standard deviation was 4.07. Out of the total respondents, 86 (89.6%) were at risk of cardiovascular disease according to increased waist hip ratio.

This study assessed level of knowledge and practice of hypertensive patients regarding prevention of MI, where more than one quarter (34.4%) of participants were between the age of 55-65 years. In contrast, study carried out in the North-Eastern part of India had only 20.8% participants of this age group [9]. More than half (56.3%) of the hypertensive participants were male in present study which is similar with the study population of Nagpur (66.7%) [7]. about three fourth (72.9%) of our study participants were living in urban area which is similar to study done in Ludhiana [10]. It may be due to our study area located in the capital city of Himachal Pradesh. Around 86% were literate in our study which is similar to (80%) study conducted in a Gujarat. In the same manner, more than half of participants (57.3%) were unemployed in our study which is higher than a study conducted in Rohtak (12.94%) [11]. Moreover, half of our participants were in upper middle class whereas a study conducted in Rohtak showed that 24.11% were from class II socioeconomic status [11]. This might be due to different geography and different tools used for classification of socio- economic status.

Nearly half of our participants (49%) were overweight followed by 32.3% obese based on the World health Organization (WHO) classification of BMI for Asian people [12]. Whereas, 65% had BMI more than or equal to twenty-five in a similar study of Rohtak [11]. We found that 89.6% were at risk of cardiovascular disease due to increased waist hip ratio on the basis of the cutoff point of the waist-hip ratio of WHO. In contrast, 39.4% of hypertensive men had ≥ 0.85 waist hip ratio and 50.8% of hypertensive women had ≥0.95 waist hip ratio in Surat city of India [3].

Moreover, this study identified around more than half (60.4%) had high knowledge and 39.6% had low knowledge about prevention of MI which is higher than study conducted in Ludhiana which revealed 15.33% had good knowledge and 84.67% had poor knowledge of prevention of cardiovascular diseases [10]. This observed difference might be due to different characteristics of study participants. This study also revealed high level knowledge among female (74.07%) than male (42.86%). As this study, did not analyzed educational and other characteristics based on gender so it needs to be explored. In contrast, mean score of knowledge was little bit higher in male (13.86) than in female (13.29) in the study conducted in Ludhiana [10]. Similarly, this study shows that the mean score of knowledge is 8.29 out of 12 total score, while mean score was three, range (0-11) out of 15 in a similar study done in Pakistan [6]. This shows that mean knowledge score is comparatively greater in our study. The differential result might be due to different tools used to assess knowledge in both studies and ethnicity differences. On the other hand, more than half (57.3%) of the hypertensive patients had good practice and (42.7%) had poor practice of prevention of MI in our study. Study of Pakistan revealed that although three quarter of the total participants felt that the preventive practice of the Coronary Heart Disease was needed, implementation of that thought in their real life was largely lacking [6]. Likewise, another study of Karachi, Pakistan revealed good level of knowledge regarding modifiable risk factors, however, that study dealt about knowledge of modifiable risk factors rather than about prevention of MI only and the participants were already diagnosed as MI so that might have influenced the knowledge level [13]. In line with our study, the knowledge score of MI and Hypertension were 6±1 and 11±1 respectively in the study done in Nagpur [7]. Likewise, a study conducted among hypertensive patients in Nepal showed more than half of the participants had 50% knowledge about disease and 54% were giving more than 50% emphasis about self-care to prevent the complication of hypertension [14] which is similar to our findings. It might be due to similar study setting as both are central level referral hospital and other socio demographics characteristics of participants might be similar in both studies, however, tools of measurements were not alike.

This is a small-scale hospital cross sectional study which only included the hypertensive patients of OPD of Secondary and Tertiary care hospitals of India. So, we could not generalize our study findings in different settings.

This study showed that only around half of the participants had high level of knowledge and good practice. It also found that knowledge and practice are influenced by the gender, education, socio-economic status and awareness. Thus, further awareness regarding prevention of MI needs to be provided to hypertensive patients and large-scale study should be planned to identify the determinants of knowledge and practice of prevention of MI among hypertensive patients.

1. Kearney, P.M. et al. “Global burden of hypertension: analysis of worldwide data.” The Lancet, vol. 365, no. 9455, 2005, pp. 217–223.

2. Goyal, A. and S. Yusuf. “The burden of disease in the Indian subcontinent.” Indian Journal of Medical Research, vol. 124, 2006, pp. 235–244.

3. Gandhi, S. et al. “Awareness and prevention of myocardial infarction and hypertension in general population of Surat city.” National Journal of Community Medicine, vol. 1, no. 2, 2010, p. 139.

4. Celermajer, D.S. et al. “Cardiovascular disease in the developing world.” Journal of the American College of Cardiology, vol. 60, no. 14, 2012, pp. 1207–1216.

5. Vaidya, A. et al. “Prevalence of coronary heart disease in the urban adult males of eastern Nepal: A population-based analytical cross-sectional study.” Indian Heart Journal, vol. 61, no. 4, 2009, pp. 341–347.

6. Jafary, H.F. et al. “Cardiovascular health knowledge and behavior in patient attendants at four tertiary care hospitals in Pakistan: A cause for concern.” BMC Public Health, vol. 5, 2005, p. 124.

7. Shankar, P.R. et al. “Knowledge about heart attack and hypertension among individuals attending a cardiac camp in Nagpur City.” KU Medical Journal, vol. 5, no. 2, 2015, pp. 273–278.

8. Gosh, A. “Knowledge about cardiovascular diseases among hypertensives in Assam.” Indian Pediatrics, vol. 46, 2009, pp. 1104–1105.

9. Bhandari, B. et al. “Prevalence of other associated risk factors of cardiovascular disease among hypertensive patients in eastern Nepal.” Nepalese Heart Journal, vol. 11, no. 1, 2014, pp. 27–31.

10. Choudhary, M. et al. “Knowledge regarding preventive measures of coronary artery disease among patients attending outpatient departments of a selected Hospital of Ludhiana City.” International Journal of Healthcare Sciences, vol. 2, no. 1, 2014, pp. 60–63.

11. Mahajan, H et al. “Assessment of KAP, risk factors and associated co-morbidities in hypertensive patients.” IOSR Journal of Dental and Medical Sciences, vol. 1, no. 2, 2012, pp. 6–11.

12. World Health Organization. The Asia-Pacific Perspective: Redefining Obesity and Its Treatment. Health Communications Australia, 2000.

13. Khan, S.M. et al. “Knowledge of modifiable risk factors of heart disease among patients with acute myocardial infarction in Karachi, Pakistan: A Cross-Sectional Study.” BMC Cardiovascular Disorders, vol. 6, 2006, p. 18.

14. Bhandari, B. et al. “Awareness of disease and self-care among hypertensive patients attending Tribhuvan university teaching hospital, Kathmandu, Nepal.” Journal of Nobel Medical College, vol. 1, no. 2, 2012, pp. 29–35.