RIFT VALLEY COLLEGE

COLLEGE OF HEALTH SCIENCE

DEPARTMENT OF NURSING

A Research proposal submitted to Rift valley Health Science College Department of Nursing
Assessment of Prevalence of hypertension and its associated factors among adults in Adis –
Abeba Adis kifle ketema Town, Ethiopia

NAME TIZITA ALEMSHET DERES

ID NO 0027/2009

SUBIMITTED TO: TEFERA (PHD)

SUBMITTION DATE: MAY 2021

ADIS-ABEBA

ETHIOPIA

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 Abbreviations

AOR: adjusted odds ratio

CI: confidence interval; OR: crude odds ratio

BMI: body mass index

BP: blood pressure

BSC: Bachelor of Science

DBP: diastolic blood pressure

HBP: high blood pressure

HTN: hypertension

OPD: outpatient department

SBP: systolic blood pressure

OR: odds ratio

WHO: World Health Organization.

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 Abstract

Objective: To assess the prevalence and associated factors of hypertension among adults in
Adis Abeba Adis ketema kifle ketema, Ethiopia. A community based cross sectional study design
will be employed. Systematic random sampling will be used to select 456 study participants.
Analysis will be performed using SPSS version 20. Binary logistic regression will be fitted to show
the association between dependent variable and independent variables.

The prevalence of hypertension in Adis-Abeba Adis ketema kifle ketema town is a public health
problem. Being female sex,consuming animal source fat, family history of hypertension, excess
salt consumption age greater than 50 years and body mass index > 25 kg/m2 were significant
factors of hypertension. Therefore, health sectors take actions to tackle these modifiable risk
factors.

Keywords: Hypertension, Prevalence, Adis Abeba Adis ketema kifle ketema, Ethiopia

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 Introduction

High blood pressure is defined as a systolic blood pressure at or above 140 mmHg and/or a
diastolic blood pressure at or above 90 mmHg. High blood pressure causes the heart to have to
work harder to push blood throughout the body. Globally, nearly one billion adults had
hypertension in 2000 and this is estimated to increase to 1.56 billion by 2025. The prevalence of
hypertension is rapidly increasing in developing countries and is a major leading cause of death
and disability . Globally, 13% of premature deaths occur in developing and developed countries
due to hypertension. Today mean blood pressure has been high in many African countries and
some European countries. In Africa, hypertension (HTN) is the leading cause of heart failure.
Globally, hypertension is responsible for more than half of deaths from stroke. Hypertension is a
global public health issue currently. Globally, 40% adults were hypertensive with great regional
and residence variations. Similarly, 46% adults in Africa were hypertensive. It contributes to the
burden of heart disease, stroke, kidney failure and premature mortality and disability. From
cardiovascular disorders, complications of hypertension account for 9.4 million deaths
worldwide every year. Hypertension is responsible for at least 45% of deaths due to heart disease
and 51% of deaths due to stroke. It is mostly detected incidentally when they are admitted to
hospitals. There are risk factors that increase the chances of developing high blood pressure. Of
which, Smoking, Diabetes, Being obese or overweight, high cholesterol, unhealthy diet and
physical inactivity can be controlled. However, history of high blood pressure, ethnicity, age and
gender cannot be modified .

In Ethiopia, the prevalence of hypertension is increasing and most of the cases do not know
whether they are hypertensive or not before they are hospitalized. Even though studies were done
in Ethiopia, there is no documented research done in the study area. Therefore the aim of this
study was to assess the prevalence and associated factors of hypertension in Adis Abeba Adis
ketema kifle ketema town.

Definition
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Hypertension is another name for high blood pressure. It can lead to severe health complications
and increase the risk of heart disease, stroke, and sometimes death. Blood pressure is the force
that a person's blood exerts against the walls of their blood vessels.

Blood pressure is the force that a person’s blood exerts against the walls of their blood vessels.
This pressure depends on the resistance of the blood vessels and how hard the heart has to work.

Almost half of all adults in the United States have high blood pressure, but many are not aware
of this fact.

Hypertension is a primary risk factor for cardiovascular disease, including stroke, heart

attack, heart failure, and aneurysm. Keeping blood pressure under control is vital for preserving
health and reducing the risk of these dangerous conditions.

In this article, we explain why blood pressure can increase, how to monitor it, and ways to keep
it within a normal range.

Management and treatment

Lifestyle adjustments are the standard, first-line treatment for hypertension. We outline some
recommendations here:

Regular physical exercise

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Share on PinterestPeople can measure blood pressure using a sphygmomanometer.

Current guidelines recommend that all people, including those with hypertension, engage in at
least 150 minutes of moderate intensity, aerobic exercise every week, or 75 minutes a week of
high intensity exercise.

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People should exercise on at least 5 days of the week.

Examples of suitable activities are walking, jogging, cycling, or swimming.

Stress reduction

Avoiding or learning to manage stress can help a person control blood pressure.

Meditation, warm baths, yoga, and simply going on long walks are relaxation techniques that can
help relieve stress.

People should avoid consuming alcohol, recreational drugs, tobacco, and junk food to cope with
stress, as these can contribute to elevated blood pressure and the complications of hypertension.

Smoking can increase blood pressure. Avoiding or quitting smoking reduces the risk of
hypertension, serious heart conditions, and other health issues.

Medication

People can use specific medications to treat hypertension. Doctors will often recommend a low
dose at first. Antihypertensive medications will usually only have minor side effects.

Eventually, people with hypertension will need to combine two or more drugs to manage their
blood pressure.

Medications for hypertension include:

 diuretics, including thiazides, chlorthalidone, and indapamide

 beta-blockers and alpha-blockers
 calcium-channel blockers
 central agonists
 peripheral adrenergic inhibitor
 vasodilators
 angiotensin-converting enzyme (ACE) inhibitors

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  angiotensin receptor blockers

The choice of medication depends on the individual and any underlying medical conditions they
may experience.

Anyone on antihypertensive medications should carefully read the labels of any over-the-counter
(OTC) drugs they may also take, such as decongestants. These OTC drugs may interact with the
medications they are taking to lower their blood pressure.

Diet

People can prevent high blood pressure by following a heart-healthy diet.

Reducing salt intake

People’s average salt intake is between 9 grams (g) and 12 g per day in most countries around
the world.

The World Health Organization (WHO) recommend reducing intake to under 5 gTrusted
Source a day to help decrease the risk of hypertension and related health problems.

Lowering salt intake can benefit people both with and without hypertension.

Moderating alcohol consumption

Moderate to excessive alcohol consumption can increase blood pressure.

The American Heart Association (AHA) recommend a maximum of two alcoholic drinks a day
for men, and one for women.

The following would count as one drink:

 a 12-ounce (oz) bottle of beer

 4 oz of wine

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  1.5 oz of 80-proof spirits
 1 oz of 100-proof spirits

A healthcare provider can help people reduce consumption if they find it difficult to moderate
their alcohol intake.

Eating more fruit and vegetables and less fat

People who have high blood pressure or people at high risk of developing high blood pressure
should eat as little saturated and total fat as possible.

Instead, experts recommend:

 whole grain, high fiber foods

 a variety of fruit and vegetables
 beans, pulses, and nuts
 fish rich in omega-3 twice a week
 nontropical vegetable oils, for example, olive oil
 skinless poultry and fish
 low fat dairy products

It is important to avoid trans fats, hydrogenated vegetable oils, and animal fats, as well as large
portion sizes.

Some fats, such as those in oily fish and olive oil, have protective effects on the heart. However,
these are still fats. While they are typically healthful, people with a risk of hypertension should
still include them in their total fat intake.

Managing body weight

Excess body weight can contribute to hypertension. A fall in blood pressure usually follows

weight loss, as the heart does not have to work so hard to pump blood around the body.

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A balanced diet with a calorie intake that matches the individual’s size, sex, and activity level
will help.

The DASH diet

The U.S. National Heart, Lung, and Blood Institute (NHLBI) recommend the DASH dietTrusted
Source for people with high blood pressure. DASH stands for “Dietary Approaches to Stop
Hypertension.”

DASH is a flexible and balanced eating plan with a firm grounding in research by the NHLBI
who advise that the diet:

 lowers high blood pressure

 improves levels of fats in the bloodstream
 reduces the risk of cardiovascular disease

The NHLBI produce a cookbook called Keep the Beat Recipes that provides meal ideas to help
reduce blood pressure.

Research from 2014 suggests that using probiotic supplements for 8 weeks or more may benefit
people with hypertension.

For more research-backed information and resources for men’s health, please visit our
dedicated hub.
powered by Rubicon Project

Causes

Share on PinterestStress can increase the risk of high blood pressure.

The cause of hypertension is often not known. In many cases, it is the result of an underlying
condition.

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Doctors call high blood pressure that is not due to another condition or disease primary or
essential hypertension.

If an underlying condition is the cause of increasing blood pressure, doctors call this secondary
hypertension.

Primary hypertension can result from multiple factors, including:

 blood plasma volume

 hormone activity in people who manage blood volume and pressure using medication
 environmental factors, such as stress and lack of exercise

Secondary hypertension has specific causes and is a complication of another health problem.

Chronic kidney disease (CKD) is a common cause of high blood pressure, as the kidneys no
longer filter out fluid. This excess fluid leads to hypertension.

Conditions that can lead to hypertension include:

 diabetes, due to kidney problems and nerve damage

 kidney disease
 pheochromocytoma, a rare cancer of an adrenal gland
 Cushing syndrome that corticosteroid drugs can cause
 congenital adrenal hyperplasia, a disorder of the cortisol-secreting adrenal glands
 hyperthyroidism, or an overactive thyroid gland
 hyperparathyroidism, which affects calcium and phosphorous levels
 pregnancy
 sleep apnea
 obesity

Risk factors

A number of factors increase the risk of hypertension.

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  Age: Hypertension is more common in people who are more than 60 years of age. Blood
pressure can increase steadily with age as the arteries stiffen and narrow due to plaque
buildup.
 Ethnicity: Some ethnic groups are more prone to hypertension than others. African
Americans have a higher riskTrusted Source than other ethnic groups, for example. · Size
and weight: Being overweight or obese is a primary risk factor.
 Alcohol and tobacco use: Regularly consuming large quantities of alcohol or tobacco can
increase blood pressure.
 Sex: According to a 2018 reviewTrusted Source, males have a higher risk of developing
hypertension than females. However, this is only until after women reach menopause.
 Existing health conditions: Cardiovascular disease, diabetes, chronic kidney disease, and
high cholesterol levels can lead to hypertension, especially as people age.

Other risk factors include:

 sedentary lifestyle
 salt rich, high fat diet
 low potassium intake

Poorly managed stress and a family history of high blood pressure can also contribute to the risk
of developing hypertension.

Below is a 3-D model of hypertension, which is fully interactive.

Explore the model using your mouse pad or touchscreen to understand more about hypertension.

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Symptoms

Share on PinterestMost people experience no symptoms from hypertension and may not be
aware they have it.

A person with hypertension may not notice any symptoms, and so people often call it the “silent
killer.” Without detection, hypertension can damage the heart, blood vessels, and other organs,
such as the kidneys.

It is vital to check blood pressure regularly.

In rare and severe cases, high blood pressure causes sweating, anxiety, sleeping problems, and
blushing. However, most people with hypertension will experience no symptoms at all.

If high blood pressure becomes a hypertensive crisis, a person may experience headaches and

nosebleeds.

Complications

Long term hypertension can cause complications through atherosclerosis where plaque develops

on the walls of blood vessels, causing them to narrow.

This narrowing makes hypertension worse, as the heart must pump harder to circulate the blood.

Hypertension-related atherosclerosis can lead to:

 heart failure and heart attacks

 aneurysm, or abnormal bulge in the wall of an artery that can burst
 kidney failure
 stroke
 amputation
 hypertensive retinopathies in the eye, which can lead to blindness

Regular blood pressure monitoring can help people avoid these more severe complications.

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Learn more about atherosclerosis here.

Signs

A sphygmomanometer, or blood pressure monitor, can help people keep track of their blood
pressure.

A doctor’s visit is not always necessary for blood pressure monitoring. Home blood pressure
monitors are available for purchase online.

Having high blood pressure for a short time can be a normal response to many situations. Acute
stress and intense exercise, for example, can briefly elevate blood pressure in an otherwise
healthy person.

For this reason, a diagnosis of hypertension requires several readings that show sustained high
blood pressure over time.

The AHA issued guidelines in November 2017 that define hypertension as blood pressure that is
consistently higher than 130 over 80 millimeters of mercury (mmHg).

The systolic reading of 130 mmHg refers to the pressure as the heart pumps blood around the
body. The diastolic reading of 80 mmHg refers to the pressure as the heart relaxes and refills
with blood.

The AHA 2017 guidelines define the following ranges of blood pressure:

Systolic (mmHg) Diastolic (mmHg)

Normal blood
Less than 120 Less than 80
pressure

Elevated Between 120 and 129 Less than 80

Stage 1 hypertension Between 130 and 139 Between 80 and 89

Stage 2 hypertension At least 140 At least 90

Hypertensive crisis Over 180 Over 120

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If the reading indicates a hypertensive crisis, wait 2 or 3 minutes and then repeat the test.

If the reading is the same or higher, this indicates a medical emergency.

The person should seek immediate assistance at the nearest hospital.

Main texts Study design, setting and periods

A community based cross sectional study design was conducted at Adis Abeba . Adis Abeba
Adis ketema kifle ketema town had a total population of 107,129 of which 55,707 were females
(52%) and 51,422 were males (48%). It is located in Adis Abeba town.

Participants

All adults in Adis Abeba Adis ketema kifle ketem town will be the source population and
permanent resident adults older than 18 years old in three Adis Abeba Adis ketema kifle ketema
town all kebeles in Adis ketema kifle ketema will be included while pregnant female adults and
bed ridden patients were excluded.

Sample size determination and procedure

The sample size determination for first objective will be based on the prevalence of hypertension
among adults 25% will be taken from the study conducted in Adis Abeba in 2015, with 95%
confidence interval and 5% degree of freedom. The sample size will be determined by using
single population proportion formula and by adding 10% non-response rate and with design
effect of 1.5, the final sample size was 477. A multistage systematic random sampling technique
will be used to select the required sample households. The sample size will be allocated
proportionally for each selected Kebeles. The households were selected by using systematic
random sampling techniques using a K value of 11. The first household will be selected by using
the lottery method. Finally, if there will be two and above study units within the household, the
lottery method was used to select the participants.

Study variables

Hypertension will be the dependent variable and it’s defined as a systolic blood pressure at or
above 140  mmHg and/or a diastolic blood pressure at or above 90 mm Hg and known
hypertensive cases taken from adults’ age ≥ 18 years. Socio-demographic characteristics: Age,
sex, educational status, occupational status, income, ethnicity and religion; Behavioral factors:
Alcohol consumption, Cigarette, smoking, chewing chat, and physical exercise, drinking coffee,

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salt consumption, and animal source fat consumption; Other factors: diabetes mellitus, weight,
height, body mass index, family history of hypertension were the independent variables that were
used to explain the dependent variable.

Data collection procedures

Data will be collected using a pretested and structured interviewer administered questionnaire.
The questionnaire will be prepared in English and translated to Amharic, then back translate to
English to check the consistency. The questionnaire was adapted from a who stepwise survey for
developing countries and from different literatures . Blood pressure (BP) will be measured using
a manual sphygmomanometer with participants taking rest before measuring. Portable weight
and height measuring scales (PRESTIGE measuring instruments) will be used to measure the
weight and height of adults who were included in the study by following the standard procedures
of weight measurements. The weighing scales will be checked and adjusted at zero level between
each measurement and the instrument will be calibrated daily by known object. Height will be
measured by following the standard procedures. Two BP measurements weill be taken for
elevated pressures to check the variation and it will be taken the average measurement. To assure
the data quality, training regarding the study objectives and data collection process will be given
for data collectors and supervisor for 1 days. Additionally, Pretest was conducted in Adis Abeba
town by taking 5% of the total sample size and intensive supervision will be done by supervisor
and principal investigators throughout the data collection period. Participants who drank
caffeine, chat chewers and smokers were made stay for 30 min before BP measurement.

Data processing and analysis

The collected data were entered to Epi Data version 4.2 and exported to SPSS version 25 for
analysis. Descriptive statistics like, frequency and SD will be calculated. Binary logistic
regression will be fitted. Both the bi-variable and multivariable logistic regression analyses will
be performed to assess the association between dependent and independent variables.

Limitation of the study

Due to limitations time and money it is difficult to cover all the population, so the researcher
will use samples.

Availability of data and materials

The datasets used and/or analyzed during the current study are available from the corresponding
author. The data will not be shared in order to preserve participant anonymity.
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Ethics approval and consent to participate

We obtained ethical clearance from the Ethical review committee Adis Abeba College of Health
Science. Letter of permission was obtained from Adis abeba Adis ketema kifle ketema health
office. The aim of the study will be explained to study participants and their values, culture,
belief, religion and norms was respected. Written consent will be obtained from each participant.
Confidentiality will be strictly kept. Finally, those who had been hypertensive will be linked to
hospital.

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