MATERIALS AND METHODS

The study period was from June 2002 to December 2002. The study was based on the data collected from 418 male individuals who were non-diabetic and taking no antihypertensive medications. Many of them were unaware even they had hypertension. Efforts were made to include samples of only those individuals who were apparently normal, without any diagnosis of hypertension and untreated or freshly diagnosed. Patients suffering from secondary hypertension, myocardial infarction, congestive cardiac failure, renal failure, diabetes mellitus, hypothyroidism, nepthrotic syndrome and bilary obstruction were excluded from the study. The male population aging from 16 years to 85 years were divided into three age groups i.e old male (above 50 years), mature male (31 to 50 years) and young male (16 to 30 years). Body mass index was noted by using the formula.

The obesity was calculated as per criteria laid down by Bray^[16]. For males, BMI of <20 corresponded to thin, 20-24 to average, 25-29 to over weight and 30 to obese. Height of all the subjects was measured on Holtain portable stadiometer . Weight was recorded in kilogram (Kg) to the nearest half kilogram on beam scale. From hypertensive, the presenting complaints and the history of the subjects with a special emphasis on personal past history, family history, lifestyle, family and job stresses, fears and shocks were also recorded. Blood pressure was measured with standard mercury sphygmomanometer. The measurement of blood pressure was carried out when patient was comfortable in a quiet room with arm’s muscles relaxed and fore arm supported and positioned at heart level. They had not smoked or ingested caffeine within 30 min. prior to measurement. Blood pressure of newly diagnosed patient was taken at 3 or more occasions in a month’s time before they were registered as hypertensive. The patients with hypertension were marked mild, moderate and severe in other three different groups with different age according to the following:

Diastolic blood pressure 95-104 mm Hg=Mild Hypertension.
Diastolic blood pressure 105-114 mm Hg=Moderate Hypertension
Diastolic blood pressure more then 115 mm Hg=Severe hypertension.

Patients with intake of oral contraceptives, renal hypertension, presence of protein urea, urinary tract infections, tuberculosis, renal colic haematurea, polyurea, dysurea, were excluded. The patients of Diabetes, Jaundice, Liver and gallbladder enlargement was also excluded. Urea and creatinine levels were assessed. Their marital status was also noted and was classified as married and unmarried

RESULTS

The results from the present study suggested that among the observed male population of Multan (n=418), prevalence of hypertension was 15.07% (Table 1). The prevalence of hypertension when studied in different age groups, it was found that there was highly significanteffect of age on hypertension.

Table 1:	Percentage of prevalence of hypertension in males of different age groups

Table 2:	Percentage of prevalence of obesity in males of different age groups.

The prevalence of hypertension was maximum (17.08%) in males of age group >50 as compared to mature males (14.16%) and young males (13.48%) (Table1). The results suggested that among the observed population, prevalence of obesity was 11.49% (Table 2). The obesity was maximum (12.19%) in males of age group >50 as compared to mature males (11.51%) and young males (10.64%) (Table 2). In the normotensive patients, the prevalence of obesity was 8.74% as compared to hypertensive individuals where it was (26.99%) (Table 3 and 4). When a comparison was made between mild, moderate and severe hypertensive individuals, it was found that obesity was maximum (19.05%) in severe hypertensive patients as compared to (7.94%) in moderate hypertensive individuals (Table 5). Among the hypertensive individuals it was found that 46.04% were smokers as compared to normotensive individuals where smoking was only in 16.90% individuals (Table 3 and 4). In severe hypertensive individuals smoking was maximum (33.34%) as compared to individuals with moderate hypertension (12.70%) and mild hypertension where it was (1.59%) (Table 5). From personal past history, it was observed that (34.9%) hypertensive individuals were with some socio-economic stress or with some personal psychological problems. In normotensive individuals, it was found that occurrence of stress is (5.92%) (Table 3 and 4). In severe hypertensive individuals stress was maximum (23.81%) as compared to individuals with moderate hypertension (9.53%) and mild hypertension (1.59%) (Table 5). It was revealed from present study that (55.5%) hypertensive individuals had family history of hypertension. In normotensive individuals it was found that (9.3%) individuals were with family history of hypertension (Table 3 and 4). In severe hypertensive individuals, family history was maximum (47.62%) as compared to individuals with moderate hypertension (7.94%) (Table 5). It was observed that (81.1%) hypertensive individuals were married as compared to normotensive individuals (64.79%).

Table 3:	Percentage of obesity, smoking, stress, family history and marital status among normotensive individuals

Table 4:	Percentage of obesity, smoking, stress, family history and marital status among hypertensive individuals

Table 5:	Presentation of obesity, smoking, stress, family history and marital status among hypertensive individuals according to severity of hypertension

DISCUSSION

The present study comprised of a random sample of male population, which has been selected on strict criteria based on healthy, non-obese, obese, normotensive and hypertensive individuals. The results from the present study suggested that there was highly significant effect of age on hypertension. The prevalence of hypertension was maximum (17.08%) in males of age group >50 as compared to mature males (14.16%) and young males (13.48%). When comparison was made between mild, moderate and severe hypertensive patients, it was found that old males (age group >50) were maximum with severe hypertension. It means that age has an effect on severity of hypertension. The findings of this study are similar to that of Assmann et al.^[17] with a difference that it was designed to identify risk factors for coronary artery disease among a population without strict criteria of excluding obesity, diabetes, complications and without selecting the specific age range of subjects. Secondly, there may be some environmental, racial and dietary factors, which are underlying these differences. The level of physical activity is related with fatness and blood pressure^[18]. The study conducted on families by Williams et al.^[19] found a strong correlation of dyslipdaemia and hypertension. Among 131 hypertensive subjects in 58 siblings similar abnormalities in fasting serum lipid concentrations were observed in two or more siblings in 48% of sub ships. More than one lipid levels were abnormal in almost all concordant sib ships, suggesting an association between hypertension and a syndrome of mixed lipid abnormalities probably Familial Combined Dyslipidaemia. The lipid abnormalities were higher cholesterol, higher triglycerides, higher L.D.L. cholesterol and lower H.D.L. Although present study has not been conducted in this pattern, but in about 16.27% of subjects gave a family history of hypertension. For, men and women, hypertension increases with age, ranging from a low of 3% for urban females aged 15-24 years to a high of 58% for urban females aged 65 years and over. Prevalence of hypertension for females is lower than for males at younger ages and then crosses over, exceeding that of males for ages 35-44 years. This has been observed in US population^[20]. Over all, urban Pakistanis have a higher prevalence of hypertension than rural dwellers. Hypertension at most age groups for men and women in urban areas appears to being at earlier ages^[5]. A decrease in diastolic blood pressure combined with an increase in systolic blood pressure is associated with a higher cardiovascular mortality in men. A strong positive relationship between cardiovascular disease and the blood pressure has been reported by several groups^[15,21]. At national level, in a study conducted by Haider^[22] hyperlipideamia was found in 48% of patients with hypertension. The type IV lipoprotein abnormalities was found in 32% of hypertensive subjects as compared to 39% of hypertensive subjects in the present study with the same abnormality. Type IIB abnormality was found in 10% of hypertensive subjects, the results of which are very similar to the present study. However, type IIA abnormality was found in 6% of the hypertensive subjects as compared to 1% of hypertensive subjects in the present study. The criterion of selection was nearly similar. However, in the present study the criterion of age is in a different pattern in which children have been completely excluded and study is based only on males. The increased association of cholesterol and blood pressure has also been observed in high-risk population such as Eastern Thailand than in low risk population such as in South California^[23]. A higher trend towards LDL cholesterol has been observed in case of hypertensive group in the above study. Another research work by Ekelund et al.^[24] observed the lowering of LDL cholesterol levels with lowered incidence of hypertension. Still another research has shown that LDL cholesterol level may blunt endothelium dependent vasorelaxation^[25]. The understanding of metabolism of lipoprotein by artery wall has yielded new insights into the factors that may be involved in arterial response^[26]. The study was primarily conducted for the collection of basic health data about, BMI, shock, smoking, age, martial status and family history of myocardial infarction and in relation to hypertension for the detection of risk factors for coronary artery disease in healthy persons. Obesity can be of different types^[7]. Life long obesity begins in childhood and characterized by an increase both in number and in size of adipose cells. Adult onset obesity begins at the time of maturity and characterized by increase in size of adipose cells with no increase in number. Exogenous obesity is due to over eating and endogenous obesity is due to metabolic or endocrine abnormalities. Association of lipid and insulin abnormalities with hypertension have been detected by many other studies^[27,28]. Njolstad et al.^[29] conducted a study to examine the association between smoking, serum lipids, blood pressure and myocardial infarction on 11843 men and women aged 35-52 years. During twelve years 495 cases of first myocardial infarction among men and 103 cases among women were identified. Myocardial infarction incidence was 4.6 times higher among men. The incidence was increased six fold in women and three fold in men who smoked at least twenty cigarettes per day as compared with never smokers. The extensive literature review indicates that such type of studies, which were focused to show relationship of these parameters with that of hypertension are rare in Pakistan. Researchers in Pakistan are stimulated to begin to identify strategies for hypertension screening, medication compliance and adherence to lifestyle change recommendations. Therefore results of this study might gave a wake up call to influence the attitude of physicians as well as the society towards control and prevention of these multitude factors.