Familiarity and Risk Factors Associated with Life Style Modification along with Low Blood Pressure– A Study of Medical University Larkana

1 Institute of Pharmacy, Shaheed Mohtarma Benazir Bhutto Medical University (SMBBMU), Larkana, Pakistan. Institute of Pharmaceutical Sciences, Peoples University of Medical and Health Sciences for Women (PUMHSW), Nawabshah, Pakistan. Department of Pathology, Liaquat University of Medical and Health Sciences (LUMHS), Jamshoro, Pakistan. 4 Department of Pharmacy, Shah Abdul Latif University (SALU), Khairpur, Pakistan. Department of Pharmaceutical Chemistry, Faculty of Pharmacy, University of Sindh, Jamshoro, Pakistan.


INTRODUCTION
In medical science the blood pressure can be described as the pressure that forces the blood to drive around the circulatory system by which the blood to be transported forward from the sides of the arteries when it comes from the heart. It is called as systolic blood pressure when the coronary arteries force the blood to flow and the diastolic blood pressure when the heart filled up between beats. The normal pressure of blood should not exceed 120 mmHg for systolic blood pressure and 80 mmHg for diastolic blood pressure, however the blood force does not always sustain at a normal range, it remains lower or higher than the optimal value. It undergoes modifications related to the psychological or physiological state of a patient. It can also appear when participant experience powerful emotional stimuli and collapse with some mental desperation. [1] The condition at which the systolic blood pressure exceeds to 120 mmHg and diastolic blood pressure exceeds to 80 mmHg is called as high blood pressure medically titled as hypertension. If elevated blood pressure persist for an extended period it can leads to several defects in body includes the chronic kidney diseases and heart failure. [2] Above said values of blood pressure are variable in men and women and if upper blood pressure or medically termed as systolic blood pressure is lower to 110 mmHg and lower blood pressure that means diastolic blood pressure below 60 mmHg in women are considered hypotensive, however, some studies in a few volumes consider that low blood pressure is beneficial because it supplements the mode of a man or a woman and makes it psychologically more powerful. Besides this some plenty of symptoms are related to low blood pressure such as sweating, loss of sleep, confusion, dizziness, hallucinations, fainting, and palpitations. [3] However certain situations may associate with holding an extra or ordinary regimen of antihypertensive pills or taking positive meals such as garlic, ginger, tea, freshly harvested oats, black chocolate, etc. Couple of medical conditions leading to a decrease in blood pressure, including myocardial infarction, adrenocortical insufficiency, high glucose level, loss of appetite, persistent cough and parkinson's disease. Behind this, there is couple of instances wherein low blood pressure constantly looked beyond indescribable symptoms and for this reason, lack of clinical management. [4] It becomes vital to study hypotensive patients with or without pathological disease, and more importantly, it must be managed or not. Many doctors treat hypotensive patients with unusual intravenous remedies followed by some nutrients.
This exercise become very commonplace in society and will cause the arrival of human immune deficiency virus such as (A.I.D.S) Acquired immunodeficiency syndrome, (H.B.V) hepatitis B and (H.C.V) hepatitis C due to risk of frequent reuse of needles. In addition, there is little pathology related to a multiplied blood pressure including cerebral, cardinal and kidney infections that disrupt the lives of multiple genders. [5][6][7][8][9][10] Most studies done on high blood pressure, however, statistics on hypotension could be much less that is the main reason for the low standard of knowledge of the medical technologist, medical students and doctors for the management to low blood pressure situations. Therefore, the purpose of our research is to show that it is important to draw attention to hypotension which is not an ordinary circumstance and on which certain undesirable symptoms manifest themselves, thus so want of appropriate therapeutic remedy or management to avoid any adverse conditions. S Clinical students (3rd and final Professionals) to analyze the familiarity regarding low blood pressure along with risk factors which may associated with life style modification after clinical exposure to hypotension illness. A distinctive interrogator used as an investigative tool which is designed with the aid of a researcher to summarize the applicable facts queried. The proforma comprises of demographics, lifestyle questions about hypotension, signs and symptoms, and corrective or management actions. After the revealed of the superior command, the consent is withdrawn to the persons during the elaboration of the field of the research observed. All enlisted students were asked to complete their research form as for as the analysis of blood pressure carried out by the principal researcher and record was maintained in corresponding form. Scanning of blood pressure was done by using a calibrated mercury sphygmomanometer. The records were analyzed using various statistical methods available in SPSS software Version 24.00.

DISCUSSION
Before this research study low blood pressure was not the interesting topic to medical technologists, medical students and physicians, as not much research had been conducted on this area. Since there has been no specific discussion in the literature, this is a critical issue for medical science students, medical technicians and physicians. The low blood pressure disorders considered as an ordinary condition since long time by a general public, medical technologists, medical students and doctors and not count this complication as an illness requiring treatment. This research has drawn the attention of many medical students towards hypotension illness, its complications and associated interventions. In current research  study it was observed that 49.1% of medical students in MBBS and BDS not bear in mind low blood pressure a sickness but as a normal physiological condition. This exceptional gap between the sentiment of non-clinical and clinical medical students provides irrefutable evidence of the clinical education of students. The results of our research are similar to the studies of various other scholars who concluded that hypotension without signs or symptoms not considered as an illness or disorder always. [11] In addition, Wesley et al observed that any individual assessed with low blood pressure had a longer life expectancy than an individual with hypertension. The author Qidwai W. along with his coworkers completed another close study conducted in a medical institution of Karachi, Sindh with the conclusion that hypotension is an illness characterized by complications of dizziness, tiredness and headache that can be medically managed with salt, liquids such as tea, espresso and fresh juices. [12] Infect correlating to another study carried at medical teaching institution of Karachi, Sindh most of the masses of Pakistan considered that low blood pressure sickness as an illness. This great distinction of research on the counting of low blood pressure is an illness that does not particularly depend on many breeds and varies according to needs and trusts. This current research is similar to the observation of Pemberton J., who also stated that fatigue was the most important symptom associated with "Systemic hypotension" [13]. The same types of manifestations were noted via Peter C. Rowe and his co researchers, who reported that persistent fatigue turned into the main symptom determined in hypotensive patients. [14] According to certain other studies it is expressed that hypotension related to fatigue can be because of low blood supply to the extremities of the body resulting in decreased delivery of oxygen to tissues and may leads to cardio de oxygenation . Now, because of the decrease in blood flow to the extremities, the accumulation of blood by means of which additional acidotic metabolites can also accumulate, causing a feeling of weakness and fatigue. The additional precision of this study is that couples of healthful individuals have blood pressure below the ordinary range, which does no longer trade their life-style or undesirable outcomes on their usual lives which have similarity with the observation of Wesley and John Pemberton et al. These scholars also determined that hypotension syndrome does not need any intervention. In Paradox, it was agreed by about 262 students that hypotension should be managed with medicines properly either with or without symptoms. [15] Intravenous sodium chloride (0.9 %) along with oral salts should be consumed regularly for the management of asymptomatic hypotension that is strongly resembled with observational studies conducted on the pupils of Karachi, Sindh by Qidwai W. and others, who also observed that the consumption of table salt was mainly used for the management of low blood pressure syndrome. Pemberton J. postulated that in various countries such as Italy, France and Germany the treatment of low blood pressure was regularized with couple of antihypotensive drugs, including ergotamine, amphetamines, and ephedrine by producing a pressor reaction and improve the role of the sympathetic nervous system. In addition, Barnett and Wagner distinguish phenylephrine and norepinephrine as vasocontractive, thereby increasing blood pressure, as amphetamines and ephedrine increase blood pressure by limiting the destruction of norepinephrine at the level of the sympathetic nerve endings. [16]

CONCLUSION
It was concluded that 55.1% of M.B.B.S and B.D.S students, belongs to the medical university, consider low blood pressure as a disease, disorder or an illness and 63.6% students agreed that it does required routine care and treatment. 64.6% students of both departments strongly analyze that they felt the complications of low blood pressure in their routine life whereas 59.2% candidates called low blood pressure as a symptomatic complication.

CONSENT
As per international standard or university standard, respondents' written consent has been collected and preserved by the author(s).

ETHICAL APPROVAL
SMBBMU Larkana Ethics Committee approved the study.

ACKNOWLEDGMENTS
Authors are thankful to all the participants of this study. Our gratitude is also extended to all the experts.

COMPETING INTERESTS
Authors have declared that no competing interests exist.