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ASSESSMENT OF QUALITY OF LIFE OF

ASSESSMENT OF QUALITY OF LIFE OF HYPERTENSIVE PATIENT

Vipin Kumar*,S.K. Srivastava **

*      Adhoc Lecturer in Psychology

**    Professor of Psychology

Gurukul Kangri University, Haridwar (UK-India)

 

Abstract

The purpose of this study was to compare the quality of life in Hypertensives and Normotensives male and female parsons. One hundred Hypertensives were selected for this research paper, before and after treatment. Untreated hypertensives suffer many problems such as - physical, psychological, social, environmental and general well being. The patient suffering from hypertension experience few symptoms – headaches, depression, nocturia, tinnitus, dizziness, epistaxis, eye problems, fatigue, impaired concentration, anorexia, loss of weight, obesity and a chilly feelings as whole and sudden change in behavior. It is clears from the observation of patients before treatment that females were not as good as were after treatment in comparison to males. And finally the result which comes out of the whole study is that females were found better than males after treatment. 

Key Words: Hypertensive and Quality of Life

Introduction

Human body and mind are a complicated structure develops by creator. This structure can regulate itself with complete harmony. Whenever the harmony is disturb due to some conflicts in mind. The body becomes ill. Therefore, while treating any patient we have to consider all parameters of health. Today an individual is not satisfied with what he has and is always in search of what he has not and the list of his needs is endless. Consequently modern life-style of blindly imitating the western culture has led to a life full of luxuries. The discrepancy between levels of aspiration and level of individual’s achievements leads to an altered state of mind known as stress. This brings certain disorders in human body especially endocrine and cardiovascular system which in turn results in anxiety, depression, headache, backache, diabetes, asthma, ulcers, insomnia, hypertension, heat-attack and gynecological disorders. Besides this noise, overcrowding, air pollution and heat have effects on human health and behavior that can be characterized as stress effects.

Hypertension is commonly regarded as an asymptomatic disease, only recognized as “an illness following a physician’s diagnosis (Turner, 1992). It is unclear whether this illness behavior, i.e., thoughts, feelings and patterns of behavior relating to one’s illness (Pilowsky, 1978) is a result of hypertension, the side effects of antihypertensive pharmacological treatment or the “labeling effect” identified among hypertensive (Polk et al, 1984). This effect includes an increase in work absenteeism, a decrease in marital and home satisfaction and heightened concern about ill health and other negative factors, including decline in financial status (Johnson et al, 1984) other study from Norway (Moum et al, 1990) compared unaware-hypertension and aware hypertensive and previously treated hypertensive. They found that psychological well-being did not correlate significantly with labeling or blood pressure status. Shapiro et al, (1987), in their discussion of the behavior consequences of labeling, claim that the impact of labeling produces a modest transient increase in absenteeism and that most aspects of labeling are largely undocumented and require controlled studies.

Labeling, however, is not the only possible cause for one’s feeling ill when diagnosed as hypertensive. The disease itself may produce systems. In most cases, it is difficult, if not impossible, to differentiate between the effect of labeling and that of the disease. Several studies show that untreated hypertensive suffers certain symptoms such as headache, dizziness and breathlessness (Vandenburg et al, 1984). Mccorvey, et. Al, (1989) report that although patients with hypertension experience few symptoms headaches depression, nocturia, tinnitus, dizziness, epistaxis and impotence have been reported more frequently in hypertensive patients than in normotensives. Other studies (Shapiro et. Al, 1984) suggest that there is indeed evidence of central nervous system impairment in hypertensive patients, resulting in specific deficits in certain behaviors. Kullman and Svardsudd (1990), in the Gotheborg follow-up study, found that untreated hypertensives suffer from eye (problems, fatigue, impaired concentration, anorexia, loss of weight, obesity and a chilly feeling). One may be influenced adversely not only by hypertension or labeling as such, but also by hypertensive medication. Since Croog et. Al, (1986) published the results of the first major trial using quality of life methods in hypertension studies, several other large-scale studies have been conducted to assess quality of life in drug trails (see, for example, Fletcher et. Al, 1987) compared four aspects of untreated and treated hypertensive: physical symptoms, mental alertness, emotional well-being and work performance. They found that only symptom, sleep disturbance, was significantly more frequently present in the treated group, indicating that treatment could be related to sleep impairment.

These studies, involving drug trials or patients previously treated for hypertension, have yielded a wide range of results, some pointing to differential influence of certain drugs on quality of life or simply to the general effects of drugs treatment. It was unclear whether the poorer quality of life in the hypertensive group found in some studies was due to extended drug treatment, sometimes several years in duration (Fletcher and Bulpitt, 1993; Rastam and Ryden, 1987) or to the condition of hypertension, i.e., the disease itself. Often, studies comparing quality of life of healthy and hypertensive populations do not differentiate between patients formerly treated and those formerly untreated. Some concluded that hypertensives suffer a poorer quality of life than do normotensives (Dimenas et. Al, 1989; Miller et. Al, 1984) where as others failed to detect differences between the groups regarding these variables (Kottke, et. Al, 1979). 

Quality of life of hypertensives has become an important issue over the last decade. There has been considerable discussion of what constitutes quality of life some agreement has been reached in four broad areas: psychological well-being, physiological well-being, social relations and family functioning (Aaronson, 1988) recently the WHO undertook a multinational study of quality of life in various cultures, defining quality of life as “the individual’s perception of their position in life in the context of the culture and value systems in life in which they live and in relation to their goals, expectations, standards and concerns” (Kuyker, et. Al, 1994). In the WHO-study, quality of life is viewed as a broad-ranging concept affected in a complex manner by the following domains: physical health, psychological state, level of independence, social relationships environmental and spirituality. Fletcher and Bulpitt (1993) suggest that a good measure of quality of life has to include the following measures: demographic measures, such as intellectual performance, ability to perform tasks and libido: physical performance, such as performance at work, mobility and confinement and spiritual factors. Kuyken et. Al, (1994) argue that quality of life measures should be subjective and allow people to define what is important for them in their own lives, rather than functional measures or those defined by the researcher. Studies to date have rarely adopted the same measures of quality of life, possibly explaining the variability in results obtained.

Objectives and hypotheses

            The main objective of the present study is to study the quality of life among treated and untreated hypertensive.

i.                    Is there any significant difference between treated and untreated hypertensives on quality of life before and after?

There are three hypothesis formulated, in this research work.

1.                  There is no significant difference between hypertensives and normal persons in

          the terms of their quality of life.

2.                  There is no significant difference between male and female treated hypertensives

            in the terms of their quality of life.

3.                  There is no significant difference between male and  female untreated    

            hypertensives in terms of quality of life.

Methodology

Sample

            The aim of the present research is to study, sample comprised of Hypertensive people. Sample of hundred hypertensives and hundred normotensives matched for age and their social economic status were be selected. Subjects between the age 30 to 50 years and family income range between Rs. 20000/= to Rs. 30000/= were included in this study.   

Tools

Quality of life scale: This scale was introduced by WHO in (1993). It covers five dimensions i.e. Physical health, psychological functioning, social relationships, environment and general well being with the help of 26 items.

Variables

A total no of variables used in this study is four. Out of which three variables are independent and one is dependent.

Independent variables:

Hypertensive patients

Sex factors

Treatment

Dependent variable

Quality of life

Procedure

A survey was conducted and respondents were located after going through different hospitals of Haridwar. Subjects were first briefed individually about the purpose and were total that the responses made by them would be kept confidential after consent. Demographic information about the subject was collected and the copy of the one questionnaire quality of life.

Statistical Technique

            T-test is used to test the significant difference between the groups.

 

Results and discussion

Hypothesis 1:  There is no significant difference between hypertensives and normal persons in terms of their quality of life.

Table 1: Showing difference on different aspects of quality of life between hypertensives and normotensives.

 

Aspects of QOL

Normotensives, N=100

Hypertensives, N=100

T-value

Mean

SD

Mean

SD

Physical Health

21.38

6.14

17.06

7.12

4.81**

Psychological functioning

18.33

4.41

16.20

5.14

3.29**

Social relationship

10.47

2.32

10.20

3.06

0.74

Environment

21.35

7.71

18.19

8.00

3.00**

General well being

07.11

2.16

6.54

2.37

1.86

Total

78.65

16.35

68.19

20.34

4.18**

*Significant at 0.05 level

**Highly significant at 0.01level

The hypothesis we addressed inquired whether any difference between the normatensives and hypertensives could be detected with our QOL measure. The above table 1 shows the means, standard deviations and t values on the QOL measures for the two groups table 1 that there is a significant difference between normotensive and hypertensives all dimension of quality of life namely physical health  (t=4.81, p<0.01), psychological functioning (t=3.29, p<0.01), social relationships  (t=0.74, p>0.05), environmental (t=3.00, p<0.01), general well being (t=1.86, p>0.05),  and total quality of life (t=4.18, p<0.01), comparison of mean values of normatensives and  hypertensives reveals that normotensives have highly value of  mean on physical health (normotensive = 21.38, hypertensives = 17.06), psychological functioning (normotensive = 18.33, hypertensives = 16.20 ), social relationship (normotensive = 10.47, hypertensives = 10.20), environment (normotensive = 21.35, hypertensives = 18.19 ), general well being (normotensive = 7.11, hypertensives = 6.54 ),  and total quality of life (normotensive = 78.65, hypertensives = 68.19 ). Obtained mean value clearly indicate that normative have better quality of life than hypertensives.

On the basis of the result table, obtained t-value is greater than the table value at 0.05 level of confidence and the mean values shows that there was significance difference between hypertensives and normal persons in terms of their quality of life.

Since the null hypothesis 1is rejected.

Mccorvey, et. Al, (1989) report that although patients with hypertension experience few symptoms headaches depression, nocturia, tinnitus, dizziness, epistaxis and impotence have been reported more frequently in hypertensive patients than in normotensives.

Hypothesis 2: There is no significant difference between male and female treated hypertensives in terms of their quality of life. 

 

Table 2: Showing difference on different aspects of quality of life between male and female treated hypertensives in terms of their quality of life. 

 

Text Box: Aspects of QOL	Male Treated Hypertensives,  N=50	Female reated Hypertensives,  N=50	  T-value
	Mean	SD	Mean	SD	
Physical Health	18.98	7.08	19.07	6.99	0.09
Psychological functioning	17.12	4.97	17.22	4.92	0.14
Social relationship	10.25	2.65	10.39	2.85	0.37
Environment	19.47	8.15	19.79	7.90	0.30
General well being	6.75	2.29	6.85	2.29	0.33
Total	72.58	19.31	73.32	19.38	0.29

 

 

 

 

 

 

 

 

 

*Significant at 0.05 level

**Highly significant at 0.01level

The hypothesis we addressed inquired whether any difference between male and female treated hypertensives could be detected with our QOL measure. The above table 2 shows the means, standard deviations and t values on the QOL measures for the two groups table 2 that there is a significant difference between male and female treated hypertensives all dimension of quality of life namely physical health  (t=0.09, p>0.05), psychological functioning (t=0.14, p>0.05), social relationships  (t=0.37, p>0.05), environmental (t=0.30, p>0.05), general well being (t=0.33, p>0.05),  and total quality of life (t=0.29, p>0.05), comparison of mean values of male and female treated hypertensives reveals that female have highly value of  mean on physical health (male hypertensives = 18.98, female hypertensives = 19.07), psychological functioning (male hypertensives = 17.12, female hypertensives = 17.22), social relationship (male hypertensives = 10.25, female hypertensives = 10.39), environment (male hypertensives = 19.47, female hypertensives = 19.79), general well being (male hypertensives = 6.75, female hypertensives = 6.85),  and total quality of life (male hypertensives = 72.58, female hypertensives = 73.32). Obtained mean value clearly indicate that male and female hypertensives have almost same quality of life after treatment but the mean value of female hypertensives is greater than male hypertensives on the bases of this result female hypertensives quality of life increase than male hypertensives. 

On the basis of the result table, obtained t-value is less than the table value at 0.05 level of confidence and the mean value shows that there is no significance difference between male and female treated hypertensives.

Since the null hypothesis 2 is not rejected.

Mild to moderate hypertension is often an asymptomatic disease, but it is strongly associated with increased risk of cardiovascular, renal and central nervous system morbidity and mortality. Because of the chronic nature of the disease, treatment involves the reduction of blood pressure without functional impairment. Since the adverse effects of pharmacological agents greatly reduce compliance, it is of prime importance not only to control blood pressure but also to preserve the patient's quality of life. Previous studies have demonstrated the adverse effects observed in patients treated with antihypertensive medications, but few have attempted to analyse the impact on the quality of life. Therefore, a multicentre trial was carried out to investigate the quality of life in hypertensive patients before and after treatment with the padrenergic blocker propranolol or the calcium channel blocker nitrendipine. Both treatments were effective in the reduction of blood pressure. Preliminary results indicated that patients taking nitrendipine were more vigorous (P<0.01) and less fatigued (P<0.05) than those taking propranolol. In addition, patients in the propranolol group perceived a decrease in a partner's sexual satisfaction (P<0.05). No other major negative impacts on the quality of life were caused by either drug. These preliminary data indicate that nitrendipine and propranolol reduced blood pressure equally, but that nitrendipine caused less of a negative impact on the quality of life than propranolol.

Hypothesis 3: There is no significant difference between male and female untreated          hypertensives in terms of quality of life.

Table 3: Showing difference on different aspects of quality of life between male and female untreated hypertensive in terms of quality of life.

 

Aspects of QOL

Male Untreated Hypertensive,  N=50

Female Untreated Hypertensive,  N=50

 T-value

Mean

SD

Mean

SD

Physical Health

20.98

4.78

18.70

7.52

1.32

Psychological functioning

18.74

5.04

16.72

4.82

2.58**

Social relationship

10.64

1.39

10.17

3.01

1.52

Environment

17.96

7.59

20.11

8.08

1.68

General well being

6.60

2.20

6.86

2.32

0.70

Total

74.32

14.95

72.56

20.41

0.07

*Significant at 0.05 level

**Highly significant at 0.01level

The hypothesis we addressed inquired whether any difference between male and female untreated hypertensives could be detected with our QOL measure. The above table 3 shows the means, standard deviations and t values on the QOL measures for the two groups table 3 that there is a significant difference between male and female untreated hypertensives all dimension of quality of life namely physical health  (t=1.32, p>0.05), psychological functioning (t=2.58, p<0.01), social relationships  (t=1.52, p>0.05), environmental (t=1.68, p>0.05), general well being (t=0.70, p>0.05),  and total quality of life (t=0.07, p>0.05), comparison of mean values of male and female untreated hypertensives reveals that male have highly value of  mean on physical health (male hypertensives = 20.98, female hypertensives = 18.70), psychological functioning (male hypertensives = 18.74, female hypertensives = 16.72), social relationship (male hypertensives = 10.64, female hypertensives = 10.17), environment (male hypertensives = 17.96, female hypertensives = 20.11), general well being (male hypertensives = 6.60, female hypertensives = 6.86),  and total quality of life (male hypertensives = 74.32, female hypertensive = 72.56). Obtained mean value clearly indicate that male and female hypertensives have almost same quality of life before treatment but the mean value of male hypertensives is greater than female hypertensives on the bases of this result male hypertensives quality of life greater than female hypertensives. 

On the basis of the result table, obtained t-value is less than the table value at 0.05 level of confidence and the mean values show that there is no significance difference between male and female untreated hypertensive.

Since the null hypothesis 3 is not rejected.

 

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