Alkem

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HTN INDIA

Exploring the burden and treatment pattern of hypertension in real world settings in India (HTN INDIA study)

BASIC DETAILS

Patient code (Do not write name here) *

Date *

Diagnosis (Newly Diagnosed HTN)*

Yes No

Parameter

Patient's Age (years) *

Gender *

Male Female

Height (in cm) *

Weight (in Kg) *

Presenting Complaint (tick as applicable) *

Asymptomatic Headache Nausea Vomiting Sudden blackout Giddiness Any Other

Risk factors

Obesity (BMI) *

Underweight (<18.5 kg/m²) Normal BMI (18.5-22.9 kg/m²) Over weight (23.0 -24.9 kg/m²) Obese (>25 kg/m²)

Active Smoker *

Yes No

Alcohol intake *

Yes No

Tobacco use *

Yes No

Family history of HTN *

Yes No

BP details

Baseline *

SBP (mmHg)
DBP (mmHg)

Post treatment *

SBP (mmHg)
DBP (mmHg)

Complications of HTN

CAD *

Yes No

Heart Failure *

Yes No

Stroke *

Yes No

Peripheral arterial disease *

Yes No

Prescribed antihypertensive drug *

	Frequency	Dose (mg/day)	Duration of therapy (weeks)
CCBs	OD BD TID
Diuretics	OD BD TID
ARBs	OD BD TID
ACE Inhibitors	OD BD TID
Beta blocker	OD BD TID
Any other	OD BD TID

Dietary advice *

Regular diet Intermittent Fasting Low-carb diets Weight Watchers The DASH Diet Any Other

Information not available

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