Effect of Dietary Habits, Disease Patterns and Psychological Stress on Known Essential Hypertensive in Rivers State

Effect of Dietary Habits, Disease Patterns and Psychological Stress on Known Essential Hypertensive in Rivers State

CHAPTER ONE

Objectives of the Study

To determine socio-economic, demographic and medical characteristics of patients with secondary hypertension attending hypertension clinic in Rivers state Referral
To assess the dietary practices of patients with secondary hypertension attending hypertension clinic in Rivers state Referral Hospital.
To establish the physical activity levels of patients with secondary hypertension attending hypertension clinic in Rivers state Referral
To assess the nutrition status of patients with secondary hypertension attending the hypertension clinic in Rivers state Referral
To determine blood pressure levels of patients with secondary hypertension attending the hypertension clinic in Rivers state Referral Hospital.
To determine predictors of blood pressure levels among patients with secondary hypertension attending hypertension clinic in Rivers state Referral Hospital.

CHAPTER TWO

LITERATURE REVIEW

Hypertension

Hypertension is defined as systolic blood pressure level equal to or above 140 mm Hg and a diastolic blood pressure equal to or above 90 mm Hg (World Health Organization, 2016). The overall goal of hypertension management is to achieve controlled blood pressure of less than 140/90 mmhg (Ministry of Health, 2018c). It is reported that about 10% of hypertensive cases are alleviated by dietary and medical interventions. Investigations have shown that over 26.4% of the world adult population are suffering from hypertension and by 2025, it is estimated that the global prevalence of hypertension would rise to 29.2% (Lancet, 2014).

Dietary Practices and Secondary Hypertension

A cross-sectional study conducted in Asia among adults suggested that a vegetarian diet is more likely to decrease the probability of hypertension and obesity (Jaacks et al., 2016). A prospective study based in United states among hypertensives postulates that increased intake of dairy products and nuts and lower intake of meats were significantly and inversely related to hypertension (Weng et al., 2013). Cross- sectional studies conducted in settings such as Kathmandu, Nepal on hypertension, reported that 1 in every 10 participants consumed recommended fruits and vegetables with a representation of 11.4% (Dhungana et al., 2016). This suggests that hypertensive individuals are less likely to consume fruits daily. Reduction of sodium or salt intake and intake of more potassium has been recognized to reduce risk of hypertension among adults (Ministry of Health, 2018c). These studies have little information on diet and secondary hypertension thus need for this study.

CHAPTER THREE

RESEARCH METHODOLOGY

Research Design

This study adopted a cross-sectional analytical study design with mixed methods (quantitative and qualitative techniques) in data collection, analysis and presentation. The design was adopted because it allowed for testing of associations between variables during analysis (Bowling, 2014).

Study Variables

Dependent Variable

The dependent variable was blood pressure level and was determined by systolic and diastolic levels in mm Hg.

Independent Variable

The independent variables inlcuded: Dietary practices as determined by dietary intake in the previous twenty four hours and food frequency; Physical activity levels (PAL), which was determined by metabolic equivalence values (MET); Nutrition status as determined by body mass index (BMI), body composition and waist hip circumference ratio; Medical characteristics as determined by any other documented medical condition, socio-economic and demographic characteristics such as level of education, economic level, type of occupation, age and sex.

Target Population

The target population was secondary hypertensive patients attending hypertension clinic at Rivers state Refferal Hospital (TNCRH). Hypertensive individuals are referred to the clinic from community hospitals. According to the Ministry of Health, (2018), about 100 hypertensive individuals visited the clinic once per week and were on follow-up based on their blood pressure levels. Most individuals attending hypertension clinic have Type II diabetes (Mwanza, 2014).

CHAPTER FOUR

FINDINGS

Introduction

This chapter presents the results on demographic and socio-economic characteristics and medical characteristics of the study participants, their dietary practices, physical activity levels as well as nutrition status of the participants.

The chapter also includes a presentation of the predictors of blood pressure levels among patients with secondary hypertension attending hypertension clinic in Rivers state Referral Hospital.

Demographic, Socio-economic and Medical Characteristics of the Participants

Demographic Characteristics

The mean age of the participants was 52.51±11.08 years, with slightly more than a third, (38.5%) of the study participants being ages 41-50 years, while 26.1% were 51- 60 years of age. There were more females (68.4%) than males. The KII revealed that most were females and from 40 to 50 years. The KII 1, ‘‘Most of our patients are female in their 40s and 50s since female are more committed to appointments than male”. All the participants were Christians.

CHAPTERFIVE

SUMMARY, CONCLUSION AND RECOMMENDATIONS

Summary

This was a cross sectional analytical study that aimed to determine associations among dietary practices, nutrition status, physical activity level and blood pressure level of patients with secondary hypertension attending hypertension clinic in Rivers state Referral hospital.

The participants had an average of 53 years where 68.4% were female. Most (60.7%) participants were from middle economic level; 41% had secondary hypertension,42.7% had uncontrolled blood pressure, 56.3% of diseases were diagnosed before hypertension and diabetes mellitus contributed 50% of disease as among participants with secondary hypertension.

Dietary intake showed that only 21.4% consumed dark green leafy vegetables with less than half (41.5%) consuming vitamin A rich fruits. The medium dietary diversity score was achieved by 97% of participants, however, dietary energy was higher than recommended with frequent consumption of polished cereals. The average dietary consumption of SFA was higher than PUFA. The nutrition status was poor, characterized with 62.4% overweight and 88% of participants with increased risk of cardiovascular diseases based on BMI and waist hip ratio respectively. The physical activity level was high among 52.1% of participants and most (100%) spent their time in moderate work activity. The study established associations among dietary practices, nutrition status, physical activity level and blood pressure level of participants. Further, dietary practices, nutrition status and physical activity level were significant predictors of hypertension.

Conclusion

The study concluded that:

The participants; had mean age of 53 years, were from middle economic level and diabetes mellitus was common underlying condition.
The diet was suboptimal as it was generally low in fruits, fats, vegetables, nuts and whole grains with mean dietary diversity score of 5.64±1.27.
Most participants were overweight with increased risk of cardiovascular diseases.
Almost half of the participants had uncontrolled blood pressure.
The participants mostly engaged in moderate work related physical activity.
Dietary practices, demographics, medical characteristics, nutrition status and physical activity levels were the predictors of hypertension among the participants.

All the study hypotheses were rejected:

H_01: There is no significant association between dietary practices and blood pressure levels of patients with secondary hypertension attending the hypertension clinic in Rivers state Referral Hospital ; rejected.

H₀₂ _: There is no significant association between nutrition status and blood pressure levels of patients with secondary hypertension attending hypertension clinic in Rivers state Referral Hospital ; rejected.

H₀₃ _: There is no significant association between physical activity levels and blood pressure levels among patients with secondary hypertension attending hypertension clinic in Rivers state Referral Hospital ; rejected.

Recommendations

Recommendations for Policy

Ministry of Health both National and State level among other relevant stakeholders should strengthen disease diagnosis, physical activity, obesity and overweight reduction strategies among hypertensive patients to alleviate non communicable diseases.
Ministry of Health both National and State level among other relevant stakeholders should enhance blood pressure control strategies to reduce the prevalence of uncontrolled blood pressure among hypertensives to alleviate the burden of cardiovascular

Recommendations for Practice

Routine screening for overweight, diabetes type II, uncontrolled blood pressure levels and obesity among hypertensive patients should be strengthened by the Ministry of Health.

Consumption of fruits, nuts and vegetables to increase dietary PUFA, potassium, calcium, magnesium and fiber among other important nutrients in hypertension should be emphasized in management of hypertension by Ministry of Health.

Health and nutrition education on consumption of carbohydrates especially from whole grains and cereals to provide 60% limit of total energy among hypertensive patients by Ministry of Health and other stake holders working to alleviate hypertension and non-communicable diseases.

Sport related physical activities should be encouraged among hypertensive patients by Ministry of Health and other stake holders working to alleviate hypertension and non-communicable diseases.

Recommendation for Further Research

This study recommends further research in the following areas:

A similar study in other hospitals.
A comparative study on predictors of blood pressure among secondary hypertensive patients in private and public hospitals.
A study on identification of barriers to best pactices in nutrition and physical activity.

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