EFFECT OF DIETARY HABITS, DISEASE PATTERNS AND PSYCHOLOGICAL STRESS ON KNOWN ESSENTIAL HYPERTENSIVE IN RIVERS STATE.

            

ABSTRACT

Globally, uncontrolled hypertension is a health priority since it raises the risk for the onset of renal failure, heart disease and diabetes. Hypertension complications contribute to high rates of morbidity and mortality. Optimal blood pressure can be achieved by putting in place strategies that encourage routine physical activity engagement and intake of health diets among hypertensive patients. Patient related factors which include unhealthy dietary practices, poor nutrition status and physical inactivity have been identified to be main hindrances in hypertension management. Minimal information exists on the relationship between dietary practices, physical activity and nutrition status among hypertensive patients. These causes are researched and documented in developed countries but not in developing countries. This research aimed at determining the dietary practices, physical activity level and nutrition status of hypertensive patients in a developing country set up to fill this research gap. Cross-sectional analytical research design was adopted; the respondents were selected using systematic random sampling method. The study was conducted on a sample of 134 hypertensive patients attending Rivers State General Hospitals in Rivers State. Dietary practices were established by use of a 24-hour dietary recall and a seven day food frequency questionnaire. The World Health Organisation global physical activity questionnaire was used to measure the physical activity level. Anthropometric parameters were used to assess the nutrition status. A pretested questionnaire was used to collect demographic and socio-economic status data. Data analysis was done by use of statistical package for the social science. The respondent’s dietary practices, physical activity level, nutrition status, demographic and socio-economic characteristics of the study population were described by use of descriptive statistics. Chi-square test was used to determine the association between categorical variables like demographic, socioeconomic status and dietary practices and nutrition status. The relationship between non-categorical variables including physical activity level, dietary practices and nutrition status was determined by use of Pearson correlation test. A p-value of <0.05 was used as a criterion for statistical significance. The results were presented in the form of graphs and frequency tables. The study population had poor nutrition status as revealed by the high prevalence of overweight and obesity at 82.1%. Majority of the study participants had unhealthy dietary practices with intake of diets high in sugar, cholesterol, energy dense snacks and low in vitamins and minerals. Of the 134 respondent 79.1% had uncontrolled blood pressure. Low physical activity level was reported by most (63.0%) participants. Dietary practices were significantly associated with nutrition status. A positive significant relationship was found between dietary intake of carbohydrate (r=0.683, p<0.001) and cereals (r=0.229, p=0.008), and nutrition status. On the other hand a negative significant relationship was found between dietary intake of dark green vegetables (r=-0.210, p=0.015) and nutrition status. The predictors of being overweight or obese were determined to be dietary intake of carbohydrates, protein, meat, dark green vegetables and physical inactivity. Physical activity was significantly related with nutrition status at (p<0.001). The odds of being physical inactivity and obese in women was found to be 0.28 times while in men it was 3.50 times compared to physically active individuals. Based on these findings measures that would lead to better dietary practices and increased physical activity among hypertensive patients should be put in place for better hypertension management. The Ministry of Health and other agencies working in the sector for the control and management of hypertension may find the information collected in this study useful.

 

 

CHAPTER ONE: INTRODUCTION

1.1 Background to the Study

Uncontrolled hypertension is the primary cause of cardiovascular disease occurrence which in most cases lead to fatality worldwide (Kayima et al., 2013; Wang et al., 2013). According to WHO (2011), heart diseases are the second cause of death in Africa. Research data show 54% of stroke and 47% of coronary artery disease incidences globally are as a result of hypertension (Elperin et al., 2014; Musinguzi & Nuwaha, 2013). The management of hypertension in Africa remains a challenge due to limited resources. The prevalence of hypertension in Africa continues to increase while its control remains a challenge (Gaziano et al., 2009). According to Vijver (2014), most individuals in Nigeria are unaware that they have the disease with research statistics indicating that in every ten people one has hypertension. According to Mohan et al. (2013), hypertension prevalence is expected to rise in the coming years with projections showing that by 2025 in Africa almost three out of every four people will have hypertension. The rising hypertension prevalence trend is linked to urbanisation that has led to changes in lifestyle, and longer life expectancy (Opie

& Seedat, 2005).

 

Different factors have been identified as the main contributors of uncontrolled hypertension including sedentary lifestyle and poor dietary practices (Kayima et al., 2013; Nicol & Henein, 2010). Acharya & Chalise (2011) in their study on 100 hypertensive patients attending Tribhuvan University Teaching Hospital reported that most (89%) of hypertensive patients were non-vegetarians with 13% being alcoholic. The study also found that hypertensive patients never followed dietary advice and instead followed medication regimens. Antonio et al. (2006) observed that regular physical activity was beneficial to hypertensive patients since it decreased blood pressure. The risk of cardiovascular diseases is lowered with optimal blood pressure (Mutua et al., 2014).  For effective hypertension control understanding the factors that hinder achievement of optimal blood pressure levels is critical (Weber et al., 2014). Putting together this data, hypertension related complications may be avoided thus improving the quality of life for hypertensive patients and better intervention strategies being put in place.

 

Lifestyle modifications have been identified as preventive and management measures against hypertension (Gaziano et al., 2014; WHO, 2013). According to Alsairafi (2013), physical inactivity increases the risk of uncontrolled hypertension 8.34 times. Lifestyle modifications enhance antihypertensive drug efficacy and lower cardiovascular risk (Wilson et al., 2014). For individuals, health lifestyle modifications are beneficial in the control of blood pressure (Viera at al., 2008). Weight reduction, limited alcohol consumption, increased physical activity; dietary changes and reduction of salt intake have been identified as some of the lifestyle modification for optimal blood pressure (WHO, 2013). Hypertensive patients have challenges in including the lifestyle modifications in their day to day life (Hajjar et al., 2006). It is important to maintain optimal blood pressure levels in hypertensive patients to avoid damage of vital body organs. This can be achieved by lifestyle modification of improved diets, regular exercise for better nutrition status. However, there is paucity of data in Nigeria on the relationship between dietary practices, physical activity and nutrition status among hypertensive patients. This study therefore may provide baseline data for a future intervention study and an insight on the relationship between this lifestyle factors and blood pressure control.

Among hypertensive patients worldwide, only 31% have optimal blood pressure levels (Vijver, 2014). The Nigeria Stepwise Survey Report (2015) indicates the prevalence of uncontrolled hypertension among hypertensive patients in Nigeria is at 24%. Many hypertensive patients regularly attend hospital due to health complications caused by the disease (Mutua et al., 2014). In Rivers State rise in hypertension prevalence is observed.  According to Ministry of Health Nigeria, in 2012 Rivers State was leading in the Country with hypertension cases being 126,754. Rivers State Hospital records indicate that the disease is ranked seventh and fifth in causing fatality and hospital admission. From the hospital records uncontrolled hypertension contributed to 193 hospital admissions and 27 deaths in 2011, and 328 hospital admissions and 40 deaths in 2012.

 

1.2 Problem Statement

The prevalence of hypertension in Nigeria is expected to double by 2025; the disease remains a public concern with inadequate control (Vijver, 2014). The Government has put in place policies and strategies aimed at early screening and intervention for optimal blood pressure achievement among hypertensive patients. However, despite this efforts research findings have consistently revealed that uncontrolled hypertension prevalence is growing in Nigeria. This shows that there is a problem and a gap that exists in achievement of optimal blood pressure levels among hypertensive patients in Nigeria. This study therefore sought to fill this knowledge gap.

Intake of foods high in sugar, salt and physical inactivity has been linked to the growing hypertension prevalence in Nigeria. Their exist insufficient knowledge on how this factors affect blood pressure level among hypertensive patients in Nigeria. National Nutrition Action Plan of 2012-2017 attributes insufficient hypertension control in Nigeria to limited data & screening, lack of knowledge and financial handicaps to manage hypertension. In Nigeria many studies have been done examining medication adherence and blood pressure control but none has attempted to focus on how lifestyle factors affect hypertension control. It was on this strength that this study aimed at documenting physical activity, dietary practices and nutrition status of hypertensive patients.  The information generated in this study may contribute in the development of effective intervention strategies for optimal blood pressure achievement.

Hypertension has enormous effects on human life including significant morbidity and mortality in adult population (Mundan et al., 2013; Ogedegbe et al., 2013). According to Nigeria Health Policy of 2012-2030, heart diseases contribute to significant number of sickness and death. The policy reported that in 2009 CVDs led to 60% of hospital admissions in Nigeria.  Hypertension will be a leading contributor to high disease burden in the country by 2030 causing major disability and even death (Nigeria Health Policy of 20122030). Uncontrolled hypertension damages cells lining coronary vessels resulting in inflammation, vascular weakness and scarring, blood clots, blocked arteries and plaque formation (Ferdinard, 2008; Radhika et al., 2007). Prolonged periods of uncontrolled hypertension affect heart functions by weakening heart muscles and enlarging the heart which may lead to death (Farah et al., 2016; Low et al., 2015). Strategies to achieving optimal blood pressure will lower heart diseases occurrence (Mutua et al., 2014). However, trends in hypertension management do not show any reduction in hypertension related complications (Al-Ansary et al., 2013). To mitigate the current trends, continuous research to enhance an understanding of the factors affecting hypertension management is critical.

1.3 Purpose of the Study

This study sought to establish physical activity levels, dietary practices, nutrition status and their relationship to blood pressure among hypertensive patients attending Rivers State Hospital.

 

1.4 Objectives of the Study

The objectives of this study were to;

1. Establish the demographic and socio-economic characteristics of hypertensive patients attending Rivers State General Hospitals.
2. Determine the physical activity level of hypertensive patients attending Rivers State

District Hospital.

3. Establish the dietary practices of hypertensive patients attending Rivers State General Hospital.
4. Assess the nutrition status of hypertensive patients attending Rivers State General Hospital.
5. Determine blood pressure level of hypertensive patients attending Rivers State General

Hospital.

6. Determine the relationships among physical activity, dietary practices and nutrition status, and blood pressure level among hypertensive patients attending Rivers State General Hospital.

 

1.5 Hypotheses of the Study

H_01: There is no significant relationship between demographic and socio-economic factors, dietary practices and nutrition status among hypertensive patients attending Rivers State General Hospitals.

H₀₂: There is no significant relationship between physical activity and nutrition status among hypertensive patients attending Rivers State General Hospitals.

H₀₃: There is no significant relationship between dietary practices and nutrition status among hypertensive patients attending Rivers State General Hospitals.

H_04: There is no significant relationship between demographic and socio-economic factors, physical activity, dietary practices, nutrition status and blood pressure level among hypertensive patients attending Rivers State General Hospitals.

 

1.6 Significance of the Study

Documentation of information on hypertension and factors associated with hypertension is vital. The information generated from this study may aid in putting in place interventions for optimal blood pressure maintenance thus reducing time spent in hospital visits and consequently improving productivity, longevity and quality of life. The Ministry of Health and other agencies working in the sector for the control and management of hypertension may find the information generated in this study useful. Findings from this study may address the lifestyle challenges faced by hypertensive patients henceforth lowering hypertension complications thus reducing the financial cost of managing hypertension. The research findings of the study will also contribute to academic knowledge in the field of nutrition and add to ongoing research efforts on hypertension.

 

1.7 Delimitation of the Study

The study was carried out at Rivers State General Hospitals among hypertensive patients only.

Hence the findings may be applicable to settings with similar characteristics.

1.8 Limitations of the Study

The study was cross sectional hence data gathered did not reflect the contribution on long term effects of identified parameters on blood pressure level. The study relied on selfreported information from the respondents which may have caused recall and social desirability bias.

 

1.10 Conceptual Framework

The conceptual framework (Figure 1.1) identifies demographic and socio-economic status as influencers of dietary practices and physical activity level which when unhealthy result in poor nutritional status affecting hypertension control.

Demographic and socio-economic factors affect ones eating habits and physical activity engagement patterns. Physical inactivity and inappropriate dietary practices lead to obesity which increases the risk of uncontrolled hypertension (Yehia et al., 2015). Dietary intake of foods low in vitamins, minerals and high in sugar and fat affect nutrition status resulting in overweight and obesity hence increased blood pressure levels. Over consumption of processed foods that are energy dense with low dietary fiber has contributed to increased prevalence’s of uncontrolled hypertensive cases (Nguyen et al., 2013). Sedentary lifestyle has been directly linked to increased risk of hypertension (Kearney et al., 2005). Physical inactivity in hypertensive patients has been associated to lack of time, safe places for recreation activities and expensive gyms (Weber et al., 2007). Demographic and economic factors of age, gender, education and health seeking behavior are also known to influence nutrition status of an individual. In the study demographic and socio-economic characteristics directly affect physical activity level, dietary intake and practices. On the other hand unhealthy dietary intake, dietary practices and physical inactivity leads to onset of obesity and overweight a major contributor of uncontrolled hypertension.

 

EFFECT OF DIETARY HABITS, DISEASE PATTERNS AND PSYCHOLOGICAL STRESS ON KNOWN ESSENTIAL HYPERTENSIVE IN RIVERS STATE. PHYSIOLOGY PROJECT TOPICS AND MATERIALS; factors affecting food habits, factors that influence food habits and culture, what factors influence your eating habits most,social effects of unhealthy eating, factors affecting diet, factors affecting food availability and selection, how does cost affect food choices,factors that influence food choices.

 

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