Title Page

i|Page
Acceptance letter

ii | P a g e
 Table of Contents

Abstract........................................................................................................................iii

Acknowledgement.......................................................................................................iv

Chapter 1: Introduction...............................................................................................1

1.1 Background.........................................................................................................2

1.2 Operational Definitions......................................................................................6

1.2.1 Hypertension.................................................................................................6

1.2.2 Physical Activity...........................................................................................7

1.2.3 Nutritious Diet..............................................................................................7

1.3 Statement of Problem.........................................................................................7

1.4 Aims and Objectives...........................................................................................7

1.5 Research Questions.............................................................................................7

Chapter 2: Literature Review.....................................................................................8

2.1 Definition of hypertension..................................................................................9

2.2 Types of hypertensions.....................................................................................11

2.2.1 Mild hypertension......................................................................................11

2.2.2 Primary hypertension................................................................................11

2.2.3 Secondary hypertension............................................................................11

2.3 Causes of hypertension.....................................................................................11

2.3.1 Age...............................................................................................................11

i|Page
 2.3.2 Obesity.........................................................................................................12

2.3.3 High fat consumption.................................................................................12

2.3.4 High sodium intake....................................................................................12

2.3.5 Low potassium intake................................................................................12

2.3.6 Family history.............................................................................................13

2.3.7 Physical inactivity......................................................................................13

2.3.8 Stress...........................................................................................................13

2.3.9 Poor dietary habits.....................................................................................13

2.3.10 Lack of sleep.............................................................................................14

2.4 Classification of hypertension..........................................................................14

2.5 Diagnosis of hypertension................................................................................14

2.6 Prevalence of hypertension..............................................................................15

2.7 Risk factors associated with hypertension......................................................16

2.8 Relationship between diet and disease............................................................17

Chapter 3: Research Methodology...........................................................................19

3.1 Research Design................................................................................................20

3.2 Study Setting.....................................................................................................20

3.3 Study Population...............................................................................................20

3.4 Sample size estimation......................................................................................21

3.5 Duration of study..............................................................................................21

3.6 Collection of data..............................................................................................21

ii | P a g e
 3.7 Inclusion criteria...............................................................................................22

3.8 Exclusion criteria..............................................................................................22

3.9 Ethical consideration........................................................................................22

3.10 Data Collection Procedures...........................................................................22

3.10.1 Preparation Phase....................................................................................23

3.10.2 Implementation Phase.............................................................................23

3.11 Data Analysis...................................................................................................23

3.12 Instruments used for data collection.............................................................24

3.13 Statistical analysis...........................................................................................25

3.14 Flow chart of Research Methodology of Hypertension...............................26

Chapter 4: Results and Discussion............................................................................27

4.1 Analysis and interpretation.............................................................................28

4.1.1 Socio-Demographic characteristics..........................................................28

4.1.2 Health related characteristics...................................................................36

4.1.3 Behavioural Characteristics......................................................................44

4.1.4 Diet related characteristics........................................................................52

4.2 Discussion..........................................................................................................62

Chapter 5: Conclusion and recommendation..........................................................64

5.1 Conclusion.........................................................................................................65

5.2 Recommendations.......................................................................................68

References...................................................................................................................70

iii | P a g e
 List of tables

Table 2-1 Classification of hypertension..................................................................14

Table 4-1 Consumption of market processed food..................................................59

Table 4-2 Dairy products and nuts consumption....................................................60

Table 4-3 Consumption of meat and animal processed food..................................61

Table 5-1 The DASH diet plan..................................................................................68

iv | P a g e
 List of figures

Figure 1-1 Distribution of diseases among hypertensive patients............................4

Figure 1-2 Effect of hypertension on human heart...................................................6

Figure 2-1 Contraction of vessels during hypertension..........................................10

Figure 2-2 Prevalence of hypertension in Pakistan.................................................15

Figure 2-3 Association of hypertension with physical activity...............................18

Figure 3-1 Flow chart for methodology....................................................................27

Figure 4-1 Age of hypertensive respondents............................................................30

Figure 4-2 Gender of hypertensive patients.............................................................31

Figure 4-3 Education level of hypertensive patients...............................................32

Figure 4-4 Marital status of hypertensive patients..................................................33

Figure 4-5 Family size of hypertensive patients......................................................34

Figure 4-6 Occupation of hypertensive patients......................................................35

Figure 4-7 Income of hypertensive patients...............................................................36

Figure 4-8 BMI of male hypertensive patients........................................................37

Figure 4-9 BMI of female hypertensive patients.....................................................38

Figure 4-10 Hypertension checking behaviour in respondents..............................39

Figure 4-11 Frequency of hypertension in respondents..........................................40

Figure 4-12 Systolic blood pressure of respondents................................................41

Figure 4-13 Diastolic blood pressure of respondents..............................................42

Figure 4-14 Medicine intake behaviour of respondents..........................................43

Figure 4-15 History of chronic illness of respondents.............................................44

Figure 4-16 Intake of specific diet in respondents...................................................45

Figure 4-17 Smoking habits of hypertensive respondents......................................46

v|Page
Figure 4-18 Behaviour towards physical exercise...................................................47

Figure 4-19 Types of physical activities of respondents..........................................48

Figure 4-20 Duration of physical exercise in a week...............................................49

Figure 4-21 Behaviour towards watching screens.....................................................50

Figure 4-22. Attitude towards daily water intake...................................................51

Figure 4-23 Daily intake of food supplements.........................................................52

Figure 4-24 Attitude towards junk food consumption............................................53

Figure 4-25 Oil and Fats consumption.....................................................................54

Figure 4-26 Sodium intake of respondents................................................................55

Figure 4-27 Potassium intake of respondents..........................................................56

Figure 4-28 Behaviour towards fresh fruits consumption......................................57

Figure 4-29 Behaviour towards fresh vegetable consumption...............................58

Figure 4-30 Effect of exercise on hypertension........................................................62

Figure 4-31 Effect of diet on hypertension...............................................................63

vi | P a g e
 List of abbreviations

SBP Systolic Blood Pressure

DBP Diastolic Blood Pressure

PCH Polyclinic Hospital

HFH Holy Family Hospital

WHO World Health Organization

HPT Hypertension

BP Blood Pressure

SPSS Statistical Package for Social Sciences

HBP High Blood Pressure

RCT Randomized controlled trails

FFQ Food Frequency Questionnaire

vii | P a g e
Abstract

In this descriptive research, patients with hypertension at the Holy Family Hospital in

Rawalpindi and Polyclinic Hospital in Islamabad, Pakistan, were evaluated for their

level of hypertension and the characteristics that relate to it. A hundred subjects were

chosen from the pool of candidates. The study instrument was a questionnaire that

was created to collect information about hypertensive patients. It included three parts:

one evaluation form for demographic data, one for health-related data, and one for

behaviour toward food consumption to control hypertension. For data analysis,

frequencies, percentages, means, and standard deviations were used. Several critical

measurements for the investigation were also noted as BMI, weight, and height. 135

persons in all took part in the survey. 62.00% were women and 38.00% were males.

The prevalence of hypertension was 86.00% overall. In contrast, 30.00% of the

hypertension participants used anti-hypertensive medication. 39.29% of the total

individuals had a history of hypertension. A significant correlation between the

prevalence of hypertension and a positive history of hypertension was discovered

(p=0.02). If we take into account how often processed meat is consumed, it is

prevalent among subjects that consume a lot of meat and spends less time on physical

activities. Also, this correlation was statistically significant (p=0.044).

The findings showed that total consumption of diet and physical inactivity were not

according to need in hypertensive patients. This study provides evidence that people

with hypertension may still improve their dietary habits, especially if they are older,

male, recently diagnosed, or have had their diagnosis for a short period of time. It is

advised that training programs may improve patients’ dietary habits and physical

activities among this population.

viii | P a g e
Acknowledgement

ix | P a g e
Chapter 1: Introduction

1|Page
1.1 Background

Heart diseases are becoming more common as a result of the social

economy's quick expansion and rising standards of living. Hypertension is the most

significant risk factor for cardiovascular disease and should be given global

attention. According to the World Health Organization (WHO), 25% of adults

worldwide have hypertension (Mills, Stefanescu, & He, 2020). By 2025, 1.56 billion

will have hypertension, making up have hypertension, making about 29.2% of the

world's population (Salameh et al., 2022) (Basit, Tanveer, Fawwad, & Naeem,

2020). Serious conditions including coronary heart disease and heart failure can

develop as a result of high blood pressure.

Hypertension can cause raptured blood vessels which could be serious life

threat. That’s why there is a need to provide effective strategies and proper

healthcare to prevent antihypertensive drugs are working best to reduce the burden,

they are still increasing due to unhealthy diet, unawareness, sedentary lifestyle

awareness, sedentary lifestyle and inadequate treatment and control.

Exercise is a leisure-time activity that is planned, organised, and repeated in

order to maintain or enhance physical function. In addition to antihypertensive

medications, increased aerobic activity has play vital role as per the WHO

recommendations and guidelines for the diagnosis and treatment of hypertension in

China (2019). According to research, aerobic exercise at a specific intensity is

effective in treating hypertension (Esmailiyan et al., 2021). Exercise comes in a

number of forms and is one of the lifestyle therapies that are advised for people with

cardiovascular disease (Cao et al., 2019). The effects of aerobic or endurance

exercise on blood pressure in people with hypertension have been studied in a

2|Page
number of cohort studies, randomised controlled trials (RCTs), and meta-analyses

(de Barcelos et al., 2022). Patients with hypertension can benefit from modest

physical activity by strengthening their immune systems and improving their heart

health as well as immunity.

Considering the number of available studies for each exercise, we finally

determined different exercises like walking, running, yoga, sports, football etc,

affects hypertension along with the dietary habits. We evaluated the effects of each

intervention to identify meaningful physical activity interventions for this special

population.

Considering the number of available studies for each exercise, different

exercises like walking, running, yoga, sports, football etc, play vital role to reduce

many diseases. Hypertension is a state of high blood pressure for the long term

(Oparil et al., 2018). Hypertension is the most common and multifactorial disease

which is affecting people globally and normally occur in old age people but due to

varying factors hypertension is now common in adults as well (Unda Villafuerte et

al., 2020). It can be happened both from genetics as well as environmental factors. If

not controlled it can lead to many diseases such as stroke, aneurysm, vascular

dementia, kidney failure and heart failure (Kapoor, Dhar, Mirza, Saxena, &

Pathania, 2021).

Hypertension (HT) is not common only in under-developed countries instead

from several decades it has been increasing in developing and developed countries as

well. Hypertension is one of the leading causes of disability or death among young

people. According to World Health Organization (WHO) almost 1.28 billion people

from 30 years age are suffering from hypertension. On an estimation two third of

3|Page
these people are living in low- or middle-income countries. Many adults (almost

46%) are unaware from this condition that they have hypertension (Organization,

2013). There can be many reasons which are playing role in prevalence of

hypertension some of them are as follows (Aziz, 2015)

 Physical inactivity

 Unawareness

 Excessive intake of energy

 Unhealthy diet intake

 Sedentary lifestyle

 Obesity

 Inadequate measures and treatments.

On world hypertension day PharmaEvo Ltd, has stated that 1 in 2 people in

Pakistan has hypertension with a massive 42% is undiagnosed. Hypertension is

major risk factor leading to many cardio vascular, stroke and kidney diseases.

Death and paralysis due to blood pressure increase is also common in majority of

population (Wajngarten & Silva, 2019).

4|Page
 Figure 1-1 Distribution of diseases among hypertensive patients

Pakistan has an increasing rate of urbanization where mostly people consume

nutritionally imbalanced diet. According to National the Health Survey of Pakistan

18% of adults and 33% of individuals above 40 years are suffering from

hypertension (N. Shah, Q. Shah, & A. J. Shah, 2018). Each third person above 40

years of age becomes vulnerable to many diseases. It is observed that almost 50% of

patients with hypertension were diagnosed and only half of those were treated. 12.5

% of cases were controlled.

Obesity contributes to the development of hypertension via the interaction of

dietary, genetic, epigenetic and environmental factors. The current global obesity

epidemic has primarily been ascribed to excess consumption of energy-dense foods,

which are high in sugar, fat and sodium, in combination with an increasingly

sedentary lifestyle. Visceral adipocyte dysfunction leads directly to renal, cardiac

and vascular dysfunction, via an impaired immune or inflammatory response, and by

affecting neuroimmune interactions. Cardiac and/or renal abnormalities can lead to

vascular dysfunction and vice-versa. Obesity-related hypertension is associated with

structural and functional changes in the kidney, heart and vasculature (Shariq &

McKenzie, 2020).

The mechanism by which obesity can cause hypertension could be the

blocked or narrow passage of arteries by making them less elastic and causing less

flow of oxygen and red blood cells to the heart causing different heart diseases.

Figure 1-2 Effect of hypertension on human heart

5|Page
 Hypertension can damage blood vessels and the effect organ may not work

properly and cause different diseases. Additionally, there is a link between kidney

health and the sympathetic nervous system. SNS activity decreases blood flow to the

kidneys, releases renin, and increases the amount of salt that is reabsorbed. Obese

people are four times more prone to hypertension and cardiovascular disease

(Aronow, 2017). Although intake of healthy food and physical exercises are

recommended to control hypertension. To observe the prevalence of hypertension in

Pakistan many studies have been carried out. Therefore, the goal of the current study

is to find out the association of physical activity as well as dietary habits with

hypertension among adults.

1.2 Operational Definitions

1.2.1 Hypertension

Hypertension is known as high or raised blood pressure than normal (140/90

mmHg), the condition in which blood vessels bear persistent raised pressure.

1.2.2 Physical Activity

Regular and repeated movement of skeletal muscles that involve more energy

expenditure.

1.2.3 Nutritious Diet

Nutritional diet is any nourishing substance which involve taking in and

using it for growth, metabolism and repair of any individual.

6|Page
1.3 Statement of Problem

To assess the different levels of blood pressure and dietary habits among

adults as hypertension and physical inactivity are leading cause of cardiovascular

diseases.

1.4 Aims and Objectives

The aims and objectives of this study are:

 To assess the prevalence of hypertension among adults in hospitals of

Islamabad and Rawalpindi.

 To examine the impact of different dietary habits on hypertension.

 To analyse the association of physical activities and hypertension in adults.

1.5 Research Questions

1. What are the causes of high blood pressure in modern life style?

2. Does hypertension associates with dietary habits of individuals?

3. Hypertension in what manners can be related with physical activity?

7|Page
Chapter 2: Literature Review

2.1 Definition of hypertension

A phrase used to describe elevated blood pressure is hypertension (HTN). It

might be challenging to define hypertension because numerous meanings can be

found in different literature.

Blood pressure is the force or pressure that blood exerts against the walls of

the arteries as it circulates or passes through the body. The diastolic blood pressure

8|Page
range is defined as the second number, 60–80. When the heart is at rest and fills with

blood, it refers to the force that the blood applies on the artery walls (Li et al., 2021).

Regardless of age, the appropriate definition of hypertension for practical

reasons is "the level of blood pressure at which the advantages of action outweigh

the risks and costs of inaction" (Singh, Shankar, & Singh, 2017). A 90/60 to 120/80

mmHg blood pressure range is typical. It is primarily brought on by the heart muscle

contracting. The systolic blood pressure is the first number, which ranges from 90 to

120. It symbolises the force that the blood applies to the artery walls while the heart

contracts.

According to World health Organization ‘’Hypertension is diagnosed if,

when it is measured on two different days, the systolic blood pressure readings on

both days is ≥140 mmHg and/or the diastolic blood pressure readings on both days is

≥90 mmHg’’.

According to American Heart Association, high blood pressure (HBP or

Hypertension) is “when your blood pressures, the force of your blood pushing

against the walls of your blood vessels is consistently too high.’’

Iqra Saleem et al., have studied the effects of hypertension on different

groups. According to her study males are more prone to hypertension than females.

In another group she proposed that diabetic, physically inactive and smokers have

46%, 66%, 62% and 56% cases of hypertensions respectively. There is a need to

modify the community to improve health (Said et al., 2022).

9|Page
 Figure 2-3 Contraction of vessels during hypertension

High stress levels can cause a brief but significant rise in blood pressure. By

increasing your intake, smoking, or drinking alcohol while trying to unwind, you can

only make your high blood pressure issues worse. Effective blood pressure-lowering

methods include meditation and relaxation approaches.

According to another study, Darren ER Warburton have revealed that routine

physical activities play a vital role to supress the chronic heart diseases such as

stroke, hypertension, breast cancer and heart failure. He observed that physically

active individuals have 31% lower risk to get prone to severe chronic diseases.

Relationship of numerous health benefits are linearly related with physical activities

(Warburton, Charlesworth, Ivey, Nettlefold, & Bredin, 2010).

2.2 Types of hypertensions

For the purpose to know the severity of disease, hypertension is classified

into different types given below.

2.2.1 Mild hypertension

When blood pressure is elevated but not high enough to be classified as

hypertension, is called prehypertension. In this condition, blood exerts some more

10 | P a g e
pressure on walls of arteries than usual. Prehypertension is not considered as a

disease with no symptoms but it can lead towards risk for developing hypertension.

2.2.2 Primary hypertension

Primary hypertension, also known as essential hypertension (HTN), affects

95% of those who have the illness. Although the primary causes of hypertension are

still unknown, age, a high salt consumption, a low potassium diet, sedentary

lifestyle, stress, and genetics have all been identified as major risk factors.

2.2.3 Secondary hypertension

Secondary hypertension is high blood pressure that develops as a result of

another condition or as a negative drug side effect. Renal failure and renovascular

disorders may be examples of such an illness. In five to ten percent of instances, this

sort of blood pressure is noticeable (Giles, Materson, Cohn, & Kostis, 2009).

2.3 Causes of hypertension

2.3.1 Age

Hypertension in older age is common and serious health issue. The blood

vessels network commonly called vascular system alters with age. Vessels reduce

elasticity with age and get stiffer, therefore, blood exerts more force which results in

high blood pressure (Laurent & Boutouyrie, 2020).

2.3.2 Obesity

According to risk estimations, obesity is directly responsible for at least two-

thirds of the prevalence of hypertension. Obesity cause insulin resistance and

systematic inflammation that cause endothelial dysfunction and hypertension

(Leggio et al., 2017).

11 | P a g e
2.3.3 High fat consumption

Body requires certain amount of cholesterol, by eating too much saturated

fat, cholesterol level becomes high and starts to build up in walls of arteries, causing

them to become narrower and less able to carry blood. Recommended amount of

saturated fat is 30g per day for adult (Sabour et al., 2016).

2.3.4 High sodium intake

Blood pressure can be increased by consuming a lot of salt, which is a

significant risk factor for heart disease and stroke. High sodium intake can cause

expansion in circulating volume and kidneys also become incapable to excrete

sodium thus cause high blood pressure. Average sodium intake is less than 2300 mg

per day for adult (Grillo, Salvi, Coruzzi, Salvi, & Parati, 2019).

2.3.5 Low potassium intake

Low potassium intake can cause high blood pressure. As potassium reduces

the effect of sodium in body. It eases tension in blood vessels and smoothens the

blood pressure. The average potassium intake is 4700 mg per day for adult (Ellison

& Terker, 2015).

2.3.6 Family history

A significant, unchangeable risk factor for hypertension is family history.

Numerous studies have shown relationships between blood pressure among siblings

and between parents and offspring, supporting the genetic character of hypertension.

Genetic variables account for around 30% of the variation in blood pressure, with

findings varying from 25% in pedigree studies to 65% in twin studies (Ranasinghe,

Cooray, Jayawardena, & Katulanda, 2015).

12 | P a g e
2.3.7 Physical inactivity

A significant modifiable risk factor for the development of hypertension is a

person's lifestyle, which includes physical inactivity. Low physical activity directly

correlates with weight gain, which raises the risk of high blood pressure. Sedentary

behaviour leads towards the high prevalence of hypertension (Hegde & Solomon,

2015).

2.3.8 Stress

Stress can result in hypertension by repeatedly raising blood pressure and by

stimulating the neurological system to create a lot of vasoconstricting hormones

(cortisol and adrenaline), which raise blood pressure (Ayada, Toru, & Korkut, 2015)

2.3.9 Poor dietary habits

Inadequate or poor dietary habits also plays vital role in managing blood

pressure. It has been examined that excessive consumption of dietary sodium,

saturated fats, cholesterol, and alcohol increases the risk of hypertension, whereas

consumption of fruits and vegetables and foods high in magnesium, calcium,

potassium, and unsaturated fatty acids is said to lower blood pressure (Motamedi,

Ekramzadeh, Bahramali, Farjam, & Homayounfar, 2021).

2.3.10 Lack of sleep

Sleep modifies physiologic processes that affect blood pressure, including

autonomic nervous system activity. In addition, sleep problems change BP

responsiveness, and cause vascular inflammation which raise the risk of

hypertension (Aggarwal et al., 2018).

13 | P a g e
2.4 Classification of hypertension

High blood pressure for adult and elder patients can be classified into 3 categories

based on the level of systolic or diastolic blood pressure.

Table 2-1 Classification of hypertension

Categories of hypertension Systolic Pressure (mmHg) Diastolic Pressure (mmHg)

Normal 110-120 70-80

Pre-hypertension 140-159 90-99

Stage-I 160-179 100-109

Stage-II ≥180 ≥110

Hypertensive Crisis >210 >120

2.5 Diagnosis of hypertension

A person must rest for at least 5 minutes in order to diagnose hypertension

(HTN). Then, using the right cuff tools and techniques, they must monitor their

blood pressure independently for at least 2 minutes. Based on the average of two or

more measurements obtained at each of two or more visits following an initial test,

high blood pressure is diagnosed (Potter & Perry, 1999).

2.6 Prevalence of hypertension

14 | P a g e
 Figure 2-4 Prevalence of hypertension in Pakistan

Prevalence of hypertension is an increasing issue worldwide and will raise by

25% more by 2025 (Hunter, Chapman, & Dhaun, 2021). Therefore, prevention of

hypertension has become an important public health concern globally. Till date

many researchers have studied the causes for the high blood pressure in adults.

Relationship of physical activities and hypertension has been evaluated in many

research journals. First study about hypertension has been conducted in 1968 by

Paffenberger. In his study he observed that severe chronic diseases can be prevented

by daily physical activities. He finds out that people involved in physical activities

for at least 3-5 hr/week have delayed the chronic heart diseases up to 20 years. First

study to lower the hypertension was published in 1970 by Boyer and Kasch

(Saklayen & Deshpande, 2016).

2.7 Risk factors associated with hypertension

There are a number of factors that might cause hypertension. These elements

vary from nation to nation, and even within a single nation, there are differences

between urban and rural areas (Rani, Mengi, Gupta, & Sharma, 2015). The World

Health Organization has chosen "Urbanization and Health" as the topic for World

Health Day 2010 in recognition of the impact of urbanisation on our collective

health (City & Assessment, 2010).

15 | P a g e
 Nabi Shah et al., have conducted different surveys to examine the cases of

hypertension in different areas of Pakistan. The researchers reveal that prevalence of

hypertension in urban areas is higher and this prevalence may increase with time.

The main reason of such prevalence can be intake of imbalance diet which is high in

salt calories and fat and low in fruits, grains and vegetables (N. Shah, Q. Shah, & A.

J. J. A. o. p. h. Shah, 2018).

Risk variables that cannot be changed include race, gender, age, and genetics.

Modifiable risk factors include those that are connected to life style, such as obesity,

poor nutrition, physical inactivity, stress, the use of certain drugs, smoking, and

alcohol drinking. One of the greatest risk factors for a person's future development of

HTN is a family history of HBP. With age, risk of developing high blood pressure

rises, especially isolated systolic hypertension (Fang et al., 2017).

In rural regions, the usage of fat is directly linked to hypertension. In rural

regions, saturated fats are frequently consumed in the form of butter, beef, lard fat

or margarine, whole milk, etc. Animal fat, particularly from goat, lamb, cow and

denatured oils from fries are utilised again for household food preparation.

Obesity is another major cause of hypertension. The pressure inside the

arteries rises when more blood is pumped through the blood vessels. Obese people

require more blood flow to provide oxygen and nourishment to their tissues.

Exercise improves blood flow across all of the arteries, which triggers the production

of cytokines and natural hormones that relax blood vessels and reduce blood

pressure. Being overweight is also made more likely by inactivity (Granger et al.,

2017).

16 | P a g e
 According to (WHO, 1996), "Consistently higher levels of blood pressure

and high incidence of HTN have been identified among lower socio-economic

categories in countries that are in post-transitional stage of economic and

epidemiological transformation (Organization, 1996).

Dietary consumption and hypertension have a complicated connection. Many

researchers have studied that the effects of individual nutrients on hypertension.

People do not, however, consume isolated nutrients; rather, they often eat meals in

precise combinations or patterns, causing the intakes of some foods to be inversely

or positively linked with those of other foods. It is commonly acknowledged that a

decrease in sodium (Na) consumption and an increase in potassium (K) intake can

both independently lower blood pressure (Margerison, Riddell, McNaughton, &

Nowson, 2020).

2.8 Relationship between diet and disease

In order to analyse the relationship between diet and disease, dietary patterns

made up of a variety of foods are frequently utilised as an alternate way. A decreased

risk of getting hypertension has been linked to the vegetarian dietary pattern, which

includes foods rich in vegetables, fruits, grains, poultry, legumes, nuts, vegetable

oils, soya, and maybe dairy products and/or eggs. According to World Health

Organization (WHO), Pakistan has facing in increase of hypertension. According to

the research almost 38.7 million people in Pakistan are suffering from hypertension

in which almost 11.7 million people are aware of it. People who have systolic blood

pressure (SBP) and diastolic blood pressure (DBP) less than 140 mmHg and 90

mmHg respectively can overcome hypertension by simple medication (Basit et al.,

2020).

17 | P a g e
 Figure 2-5 Association of hypertension with physical activity

In another study Muhammad Riaz et al., have systematically reviewed the

different studies that dietary habits and life styles are directly corelate to risks of

hypertension. According to a report hypertension is associated with almost 47% of

ischemic heart diseases and can be reduced by lowering the intake of salt in regular

diet. Additionally, some other factors such as high intake of calcium, ghee/oil, meat,

improper dietary habits and depression can cause hypertension in adults (Riaz et al.,

2021).

Journal of the Pakistan Medical Association have published research in

which hypertension is directly related with obesity and improper dietary patterns.

According to Hina Ahmad et al., hypertension is a silent killer and one in four adults

is suffering from this. Hypertension is significantly high among people with

sedentary living styles and obesity (Ahmed & Thaver, 2020).

18 | P a g e
19 | P a g e
Chapter 3: Research Methodology

20 | P a g e
3.1 Research Design

This study is descriptive and questionnaire based, which is conducted in

different hospitals and clinics of Rawalpindi, Punjab, Pakistan. This study is aimed

to examine the different levels of hypertension among people of specific area and to

observe the corelation of hypertension with dietary habits and different physical

activities. Selection of patients was based on sex, age and disease history.

Diagnostic criteria: based on WHO criteria, a person was considered hypertensive if:

 SBP > 140mmHg or DBP > 90mmHg

 Patient is suffering from hypertension in the last 6 months.

 Patient is taking anti-hypertensive treatment.

3.2 Study Setting

The setting of study was conducted in Holy Family Hospital (HFH),

Rawalpindi, Punjab, Pakistan and near community. The city lies in north of Punjab

and southwest of Islamabad, the national capital. HFH is one of the major hospitals

under government. It is 850+ bedded hospital and almost a total of 1000 patients stay

here each day. This hospital has one male medical ward, female medical ward, male

female out patient department and coronary care ward. This hospital provide

treatment for more than 100 patients with medical problems a day.

3.3 Study Population

The targeted population was hypertensive patients of Rawalpindi, who were

admitted in patient ward or attended out patient departments. The subject composed

21 | P a g e
of both genders. Total 130 patients were admitted in patient ward each month. The

samples were the patients who were admitted in wards having following criteria

 Being diagnosed with hypertension for at least 6 months.

 Age above 20 years and below 70 years.

 Conscious patients

 Literate

 Able to communicate in national language Urdu.

3.4 Sample size estimation

The sample size of patients were estimated by the formula given below

(Adam, 2020)

N
n=
1+ Ne 2

n= 100, when

N= number of patients diagnosed with hypertension (135) in HFH

E= error estimation (0.05)

3.5 Duration of study

Study was carried out for the duration of 3 months from October 2022 to

December 2022.

22 | P a g e
3.6 Collection of data

All patients were contacted in male and female patient ward of Holy Family

Hospital, Rawalpindi and clinics. All patients were examined and interviewed using

the questionnaire.

3.7 Inclusion criteria

 Both genders were the study part.

 The age of patients over 20 were included in this study.

 Only Conscious patients were considered.

 Patients who were consenting to participate in the research study.

 Patients having hypertension more than 2 years.

3.8 Exclusion criteria

 Patients, less than 20 years were excluded.

 The patients over the age of 70 years were not considered.

 The patients who did not want to take part in the study.

 The women who were pregnant.

 Patients who have hypertension history less than previous 6 months.

3.9 Ethical consideration

This research study was conducted after taking written approval from the

concerned head of the department (HODs), Faculty of Nursing (FONs) of Holy

23 | P a g e
Family Hospital, Rawalpindi, Islamabad. Subjects were briefed about the study

objectives and their satisfaction were obtained. The participants were reassured that

they could refuse and could withdraw at any time. Patient’s consent was taken in

written format. The participants were free to ask any question about the study. The

confidentiality of the collected data was maintained throughout the study.

3.10 Data Collection Procedures

The data collection procedure was consisting of two phases (i) preparation

phase and (ii) implementation phase.

3.10.1 Preparation Phase

The researcher requested formal authorization from the head of clinics and

Director of Holy Family Hospital and the Faculty of Nursing before beginning to

gather data. After receiving approval from the Director, the researcher first spoke

with the head nurse (nursing superintendent) of the nursing department before being

introduced to the heads of the inpatient and outpatient departments. She then

requested permission to gather data and described the study's goal and pre-tests to

each head nurse.

3.10.2 Implementation Phase

1. The researcher made contact with the participants, introduced herself, and

distributed and described the study's information. The subjects were asked to sign an

informed consent form after hearing the explanations. But it was made clear to the

participants that they might leave at any time and pay nothing.

2. To make sure that patients had comprehended the questions, the researcher

explained the questionnaires. All of the individuals' queries were given time to be

24 | P a g e
answered, and the researcher provided clarification as needed. In roughly 30

minutes, all of the questions were answered. After ensuring that the questionnaires

were complete, the researcher requested the individuals to provide any missing

information.

3. The surveys were coded by the researcher to guarantee the individuals'

privacy. The replies were then graded and collated for data analysis by the

researcher.

3.11 Data Analysis

Data was collected by FFQ (food frequency questionnaire) to examine the

consumption of food and beverages in patients. The Statistical Package for the

Social Sciences (SPSS) Version 22 and Microsoft Excel spreadsheet were used to

check and analyse the study data in accordance with the study objectives.

Frequencies were reported for gender, financial status, language spoken, living

arrangements and the categorised blood pressure. Descriptive statistics including

mean (m), range and standard deviation (s.d) will be reported for age, weight and

BMI. An independent sample t-test will be used to compare mean blood pressure

score and age group. Chi-square tests will used to compare categorised BP score and

gender, financial status, education level. An alpha value of 0.05 will be chosen to

report levels of significance.

3.12 Instruments used for data collection

1. Age

The subject's reported age was recorded to the closest completed year.

2. Mercury sphygmomanometer

25 | P a g e
 Mercury sphygmomanometer was used to measure Blood pressure thorough

a similar instrument and standardize accordingly.

3. Weighing Machine

The weight was recorded using a portable scale with the zero error of ±1 kg,

that was regularly compared to standard weights and had a calibrated scale of 0.5 kg.

4. Measuring tape

A calibrated measuring tape marked in centimetres was used to determine

height. The measurement was made when the subject was standing straight.

5. Stethoscope

A standard stethoscope was used to measure the systolic and diastolic blood

pressure.

3.13 Statistical analysis

Data analysis was carried out using SPSS version 26. Simple proportions

were used to explain the results. Chi square test was used to evaluate the variation

between graphs for statistical significance. Odds were determined using logistic

regression analysis. P values less than 0.05 were judged to be significant.

1. I started by looking at the frequency distributions of the respondents'

sociodemographic and behavioural traits.

2. Information was summarised and presented using the described statistic in

the form of mean, median, percentages, and tables. Prevalence estimates with 95%

confidence intervals.

26 | P a g e
3. In order to analyse variables associated with adult-onset hypertension, binary

logistic regression models would be used.

3.14 Flow chart of Research Methodology of Hypertension

27 | P a g e
Figure 3-6 Flow chart for methodology

28 | P a g e
Chapter 4: Results and Discussion

29 | P a g e
4.1 Analysis and interpretation

The descriptive study aimed to identify the relation of hypertension with

dietary habits and physical activities in Rawalpindi, Punjab, Pakistan. The results

and discussions of the study are as follows

1. Socio-Demographic characteristics of the subjects

2. Health Related characteristics of the subjects

3. Behavioural characteristics of subjects toward hypertension

4. Diet related characteristics of the subjects

4.1.1 Socio-Demographic characteristics

The research was conducted on 135 residents of Rawalpindi, between the

ages of 20 and 70, including 54 men and 81 women. 100 out of 135 subjects had

complete data after the datasheet was reviewed; subjects who responded completely

were less than 90%, 62.00% women, and 38.00% men.

More than 29.00% of the subjects had completed their secondary education,

54.00% had completed their elementary education, and 14.00% had completed their

university education.

More than 36.00% of survey participants were employed whereas some were

jobless. 72.00% of the patients reported having a history of hypertension, whereas

28.00% said they had no such history.

30 | P a g e
 All individuals had their blood pressure measured to measure hypertension,

systolic and diastolic blood pressure values were 120.8 mmHg and 79.6 mmHg,

respectively.

By calculation, 30.00% of hypertension participants used anti-hypertensive

medication at the time of the data collection. On measurements, 14.00% have

normal BP. It is noticed that the prevalence of hypertension increased with age in

both males and females during this investigation, with a modest prevalence in

younger age categories and a substantial prevalence in high-age groups.

Figure 4-7 Age of hypertensive respondents

Figure 4.1 demonstrates the age-wise distribution of patients who willingly

participated in the research study. The above chart shows that 15.84% of

respondents were in the age group of 20-30 years, 21.78% were in the age group of

31-40 years, 31.68% were in the age group of 41-50 years, 18.81% were in the

age group of 51-60 years and 11.88% were in the age of 60 years and above. The

total mean and standard deviation are 2.89 and ±1.23 respectively. It is noted that

most patients who have hypertension problems were from the 41 to 50 years age

group.

31 | P a g e
 Figure 4-8 Gender of hypertensive patients

Figure 4.2 represents the gender of the respondents. The results showed that

62 (62.00%) patients out of 100 were female while 38 (38%) respondents were from

the male group and belong to the moderate age group. The total mean and standard

deviation S.D. are 1.3 and ±0.48 respectively. Most respondents belong to the urban

areas of Rawalpindi and Islamabad.

Figure 4-9 Education level of hypertensive patients

Figure 4.3 represents the education level of the respondents. The results

showed that 14.00% of patients were highly educated and belong to the young age

group. 29.00% of respondents passed matriculation 38% have passed their

middle-level education. While 16.00% were characterized as illiterate. The total

mean and standard deviation S.D. are 2.4 and ±0.93 respectively.

32 | P a g e
 Figure 4-10 Marital status of hypertensive patients

Figure 4.4 represents the marital status of hypertensive respondents. The

results showed that 56.44% of patients were married. 31.68% of respondents were

unmarried and belong to the young age group while 11.88% were divorced with

moderate family size. The total mean and standard deviation S.D. are 1.8 and

±0.63 respectively.

33 | P a g e
 Figure 4-11 Family size of hypertensive patients

Figure 4.5 represents the family sizes of hypertensive respondents. The

results showed that 20.00% of patients have families consisting of less than 5

persons. 33.00% of respondents have a family size of 7 persons and belong to the

moderate age group while 27.00% of respondents have families consisting of 8-10

persons. Only 20.00% of respondents who belonged to the old age group had a

family size greater than 10 persons. The total mean and standard deviation S.D.

are 2.5 and ±1.03 respectively.

Figure 4-12 Occupation of hypertensive patients

Figure 4.6 represents the job status of the respondents. The results showed

that 36.00% of patients were employed. 25.00% of respondents were homemakers

(HW) and belong to the female respondents’ group, 23.00% of respondents were

engaged in different businesses and around 9.00% of respondents were retired

34 | P a g e
belonging to the old age group respondents. 7.00% of patients were unemployed.

The total mean and standard deviation S.D. are 2.9 and ±1.9 respectively.

Figure 4-13 Income of hypertensive patients

Figure 4.7 represents the financial status of the respondents. The results

showed that 16.00% of patients earn 15,000-25,000 rupees per month. 30.00% of

respondents earn between 26,000 to 35,000 rupees, 28.00% of respondents earn

between 36,000-45,000 rupees per month and 28.00% earn between 36,000 to

45,000 rupees while 26.00% earn greater than 50,000 rupees. The total mean and

standard deviation S.D. are 2.6 and ±1.04 respectively.

4.1.2 Health related characteristics

Figure 4-14 BMI of male hypertensive patients

35 | P a g e
 As BMI screens the weight category and high BMI indicates high body

fatness. In figure 4.8, the body mass index of male participants has been represented.

According to this 7.00% of males were characterized as underweight. 23.00% have a

normal BMI while 29.00% have overweight and 41.00% of respondents have BMI

between 30-35 and are considered obese. The total mean and standard deviation S.D.

are 3.04 and ±0.96 respectively.

Figure 4-15 BMI of female hypertensive patients

In figure 4.9, the body mass index of female participants has been

represented. According to this only 4.00% of females were characterized as

underweight. 21.00% have a normal BMI while 33.00% of female respondents have

overweight and 42.00% of respondents have BMI between 30-35 and are considered

obese. The total mean and standard deviation S.D. are 3.13 and ±0.88 respectively.

36 | P a g e
 Figure 4-16 Hypertension checking behaviour in respondents

Figure 4.10 represents the hypertension-checking behaviour of respondents.

Only 37.00 % of respondents check their blood pressure daily while 63.00% of

respondents do not check their blood pressure regularly. The total mean and standard

deviation S.D. are 1.63 and ±0.48 respectively.

Figure 4-17 Frequency of hypertension in respondents

Figure 4.11 represents the frequency of hypertension in respondents. 23.00

% of respondents have hypertension problems once a week and belong to the young

age group. 38.00% of respondents have hypertension problems twice a week.

31.00% of patients have this problem thrice a week and 8.00% of respondents have

hypertension problems daily. The total mean and standard deviation S.D. are 2.2 and

±0.93 respectively.

37 | P a g e
 Figure 4-18 Systolic blood pressure of respondents

Figure 4.12 shows that the mean systolic blood pressure was 140.45 ± 12.35

mmHg. Most subjects 61.00% have systolic pressure above 140 mmHg. 25.00% of

respondents have blood pressure at borderline (140 mmHg). Only 14.00% of patients

have normal blood pressure between 120-139 mmHg. The total mean and standard

deviation S.D. are 2.44 and ±0.72 respectively.

Figure 4-19 Diastolic blood pressure of respondents

Figure 4.13 shows that the mean diastolic blood pressure was 92.30 ± 7.53

mmHg. Most subjects 51.00% have diastolic pressure above 90 mmHg. 40.00% of

38 | P a g e
respondents have blood pressure at borderline (90 mmHg). Only 9.00% of patients

have normal blood pressure between 80-89 mmHg. The total mean and standard

deviation S.D. are 2.4 and ±0.6 respectively.

Figure 4-20 Medicine intake behaviour of respondents

Figure 4.14 represents the behaviour of respondents toward taking

hypertension control medicine. Only 30.00 % of respondents take their blood

pressure control pills daily while 70.00% of respondents do not intake the medicine

regularly. The total mean and standard deviation S.D. are 1.7 and ±0.46 respectively.

Mostly patients do not take medicines to control their blood pressure and show

careless behaviour towards it.

39 | P a g e
 Figure 4-21 History of chronic illness of respondents

Figure 4.15 represents the history of chronic illness of respondents. Only

21.00 % of respondents have different chronic diseases like cardiovascular diseases

and belong to the old age group of respondents but 79.00% of respondents do not

have any chronic illness. The total mean and standard deviation S.D. are 1.79 and

±0.41 respectively.

40 | P a g e
4.1.3 Behavioural Characteristics

Figure 4-22 Intake of specific diet in respondents

Figure 4.16 represents the behaviour of respondents toward the intake of any

specific diet to control blood pressure. Only 12.00 % of respondents follow proper

diet plan to control their blood pressure while 88.00% of respondents do not follow

any specific diet. The total mean and standard deviation S.D. are 1.88 and ±0.33

respectively.

41 | P a g e
 Figure 4-23 Smoking habits of hypertensive respondents

Figure 4.17 represents the behaviour of respondents towards smoking. 34.00

% of respondents do not have a smoking habit. 46.00% of respondents have severe

smoking habits while 20.00% of respondents quit smoking to control hypertension.

The total mean and standard deviation S.D. are 1.86 and ± 0.72 respectively.

42 | P a g e
 Figure 4-24 Behaviour towards physical exercise

Figure 4.18 represents the behaviour of respondents toward physical

exercises to control blood pressure. Only 36.00 % of respondents follow proper

physical activities while 64.00% of respondents do not follow any physical activity.

The total mean and standard deviation S.D. are 1.64 and ±0.46 respectively.

Figure 4-25 Types of physical activities of respondents

43 | P a g e
 Figure 4.19 represents the engagement of different respondents in different

physical activities. 21.00% of respondents do simple exercises daily. 22.00% of

respondents walk daily. 17.00% of respondents do jogging or running and belong to

the young age group of respondents. 40.00% of respondents do different exercises

like swimming, cycling, etc. The total mean and standard deviation S.D. are 3.5 and

±2.17 respectively.

Figure 4-26 Duration of physical exercise in a week

Figure 4.20 represents the time of daily physical activities. 51.00% of

respondents walk less than 30 minutes daily. 31.00% of respondents walk almost 30

minutes daily. Only 18.00% of respondents walk more than 30 minutes daily to

control hypertension. The total mean and standard deviation S.D. are 1.67 and ±0.77

respectively.

44 | P a g e
 Figure 4-27 Behaviour towards watching screens

Figure 4.21 represents the behaviour of respondents toward watching screens

daily. Only 11.00% of respondents watch television for 1-2 hours. 45.00% of

respondents watch television or mobile for 3-4 hours daily. 34.00% of respondents

watch screens for 5-6 hours daily while 10.00% of respondents watch television for

more than 6 hours. The total mean and standard deviation S.D. are 2.4 and ±0.82

respectively.

Figure 4.4-28. Attitude towards daily water intake

Figure 4.22 represents the behaviour of respondents toward water intake

daily. Only 13.00% of respondents drink water more than 8 glasses a day. 37.00% of

respondents drink almost 8 glasses of water a day while 50.00% of patients do not

drink sufficient quantity water daily. The total mean and standard deviation S.D. are

1.63 and ±0.70 respectively.

45 | P a g e
 Figure 4-29 Daily intake of food supplements

Figure 4.23 represents the behaviour of respondents toward the daily intake

of food supplements. Only 7.00% of respondents take different food supplements,

minerals, or vitamins daily while 83% of respondents do not intake any food

supplements or vitamins. The total mean and standard deviation S.D. are 1.83 and

±0.34 respectively.

46 | P a g e
4.1.4 iet related characteristics
Figure 4-30 Attitude towards junk food consumption

Figure 4.24 represents the behaviour of respondents toward the consumption

of junk food. 30.00% of respondents eat junk food once a week. 35.00% of

respondents consume junk food twice a week. 29.00% of respondents eat junk food

thrice a week and 6.00% of respondents consume junk food daily. The total mean

and standard deviation S.D. are 2.11 and ±0.9 respectively.

Figure 4-31 Oil and Fats consumption

Figure 4.25 represents the behaviour of respondents toward oil and fat

consumption. 20.00% of respondents eat butter daily. 38.00% of respondents

consume margarine while 16.00% of respondents consume desi ghee daily. 26.00%

47 | P a g e
of respondents eat olive oil daily. The total mean and standard deviation S.D. are 2.4

and ±1.08 respectively.

Figure 4-32 Sodium intake of respondents

Figure 4.26 represents the behaviour of respondents toward sodium intake.

30.00% of respondents consume sodium less than 2300mg (normal) daily. 20.00% of

respondents consume sodium equal to 2300mg while 50% of respondents consume

more than 2300mg of sodium daily. The total mean and standard deviation S.D. are

2.2 and ±0.87 respectively.

48 | P a g e
 Figure 4-33 Potassium intake of respondents

Figure 4.27 represents the behaviour of respondents toward potassium

intake. 28.00% of respondents consume potassium less than 4700mg daily. 49.00%

of respondents consume potassium equal to 4700mg (normal) while 50% of

respondents consume more than 4700mg of potassium daily. The total mean and

standard deviation S.D. are 1.75 and ±0.72 respectively.

Figure 4-34 Behaviour towards fresh fruits consumption

Figure 4.28 represents the behaviour of respondents toward the consumption

of fresh fruits. 24.00% of respondents consume fresh fruits once a week. 42.00% of

respondents consume fruits twice a week. 25.00% of respondents eat fresh fruits

thrice a week and only 9.00% of respondents eat fruits daily. The total mean and

standard deviation S.D. are 2.1 and ±0.90 respectively.

49 | P a g e
 Figure 4-35 Behaviour towards fresh vegetable consumption

Figure 4.29 represents the behaviour of respondents toward the consumption

of fresh vegetables. 25.00% of respondents consume fresh vegetables once a week.

35.00% of respondents consume vegetables twice a week. 27.00% of respondents eat

fresh vegetables thrice a week and 13.00% of respondents consume vegetables daily.

The total mean and standard deviation S.D. are 1.8 and ±0.88 respectively.

Attitude towards consumption of market processed food

50 | P a g e
 Food Once a week Twice a week Thrice a week more

Pizza 23.00% 28.00% 21.00% 8.00%

Burger 17.00% 19.00% 4.00% 9.00%

French fries 13.00% 23.00% 15.00% 3.00%

Juice 35.00% 25.00% 35.00% 5.00%

Soft drink 25.00% 37.00% 17.00% 7.00%

Canned fruits 12.00% 21.00% 12.00% 1.00%

Canned juice 36.00% 32.00% 21.00% 2.00%

Chocolate 28.00% 12.00% 32.00% 2.00%

Pasta 7.00% 3.00% < 1.00% 3.00%

Bread 12.00% 9.00% 13.00% 1.00%

Cookies/ cakes 54.00% 32.00% 12.00% 2.00%

shawarma 21.00% 7.00% < 2.00% 1.00%

Table 4-2 Consumption of market processed food

Table 4.1. shows the bakery items or market-processed food consumption.

Pizza (21.00%), Burger (19.00%), Fries (23.00%), soft drinks (37.00%) and bread

(13.00%). Most of the respondents were belong to private or government job. Mostly

patients were avoiding market processed food and belong to older age group.

Attitude towards dairy product consumption

51 | P a g e
Table 4-3 Dairy products and nuts consumption

Food Once a week Twice week Thrice a week more

Milk 23.00% 42.00% 15.00% 20.00%

Yogurt 25.00% 12.00% 22.00% 40.00%

Pudding 27.00% 12.00% 29.00% 32.00%

Nuts 22.00% 14.00% 7.00% <2.00%

Table 4.2 shows the consumption of cow, goat, or buffalo milk. The daily

consumption of fresh milk is 23.00%. 42.00% consumption was noted twice a week.

The weekly consumption of milk was 5.00%. Similarly, 25.00% of respondents eat

yogurt daily in their diet. 22.00% of respondents take yogurt twice a week. 27.0% of

respondents take pudding daily in their diet. 12.00% consume once a week.

Attitude towards consumption of meat and animal processed food

52 | P a g e
Table 4-4 Consumption of meat and animal processed food

Food Once a week Twice a week Thrice a week more

Meat 12.00% 21.00% 9.00% 7.00%

Cured meat 3.00% 12.00% 5.00% 3.00%

Fish 32.00% 22.00% 11.00% 8.00%

Shrimps 3.00% 2.00% <2.00% <2.00%

eggs 43.00% 12.00% 21.00% 31.00%

chicken 21.00% 32.00% 14.00% 9.00%

Table 4.3 shows the consumption of meat and meat products. The daily

consumption of fresh meat products is 7.00%. 12.00% consumption was noted once

a week. The weekly consumption of chicken was 21.00%. Similarly, 32.00% of

respondents eat fish once a week. 32.00% of respondents eat eggs daily. <2.00% of

respondents eat shrimp daily and 3.00% of respondents eat shrimp once a week.

53 | P a g e
4.2 Discussion

Effect of diet and exercise on HPT

Many volunteer hypertensive patients are suggested to change their routine by

slightly changing their diet and physical activity. Patients were suggested to reduce

intake of fats, oils, junk food and repetitive eating habit. Instead of they were

suggested to involve in different activities such as walking, running, cycling and

aerobic and anaerobic exercises.

Primarily, regular aerobic exercise and weight training for a specific period

of time have both been analysed to reduce blood pressure. Hernelahti et al., conclude

that continuous vigorous exercises in healthy, young individuals had a negligible risk

of developing hypertension based on their cohort research from 1975 to 1990. They

claim that an activity has to be sustained for a longer period of time in order to be a

significant preventive component. They also assert that being overweight and

gaining a lot of weight are important risk factors for developing hypertension, as

well as drinking alcohol frequently.

Figure 4-36 Effect of exercise on hypertension

54 | P a g e
 Heavy drinking and weight gain can be explained by a change in lifestyle as

well as by a decrease in physical activity.

Figure 4-37 Effect of diet on hypertension

This secondary study of weight loss trial data revealed further information

about the effects of dietary modifications on blood pressure. Blood pressure can be

influenced by dietary patterns, important dietary items like nuts, and dietary amounts

of nutrients like sodium and potassium, but these effects are also interrelated. The

results of the current investigation demonstrated that extremely specific dietary

recommendations, supported by a daily dietary supplement of a healthy food (Fresh

fruits and vegetable, reduce intake of salt, nuts and dry fruit), led to a higher

decrease in SBP than broad recommendations that made use of the dietary standards.

The study discovered that, after adjusting for weight loss, a lower sodium-to-

potassium ratio and a corresponding rise in intakes of "nuts and fruits" and "seafood"

food categories were substantially related with lowered blood pressure, supporting

the impact of diet composition

55 | P a g e
Chapter 5: Conclusion and Recommendation

56 | P a g e
5.1 Conclusion

Most cardiovascular-related fatalities worldwide are directly related to

hypertension, a serious public health issue. The risk factors for hypertension

include an altered way of life, paying less attention to health-related behaviors,

eating a lot of processed food, and other things like using fatty and greasy foods,

eating a lot of salt, being stressed, etc. In order to develop precise and efficient

management strategies, reliable predictions of hypertension are also required.

This research was conducted to study the rise in the prevalence of

hypertension and investigate its risk factors and behaviors in the twin cities

of Pakistan. 135 participants from the cross-sectional research were chosen for

this study. The research was carried out between December 2022 to February

2023. Each individual was contacted directly and conducted a questionnaire

interview at clinics and in outdoor department of Holy Family Hospital

(HFH). Data from people 20 years of age and older was collected. Their blood

pressure measurements were taken, and the final value was taken as the

average of the last two.

Almost 38.00% of the study's participants were male, while about 62.00%

were female. The majority of responders who fit the educated description have

completed basic and secondary education. The majority of participants were

female and had been residing in the neighborhood for over two decades. The

findings indicate that the prevalence of hypertension steadily increased with age.

The majority of the study's participants were employees.

In this study, hypertension was prevalent. About half of the adult

population in the various twin cities regions were frequenters. This shows that the

57 | P a g e
prevalence of hypertension in twin cities increased significantly within a specific

time period (Mubarik & Aslam, 2018).

In addition to a number of demographic characteristics like age, gender,

socioeconomic status, obesity, a family history of the condition, alcohol and

cigarette use, stress, and many others, hypertension is also influenced by a number

of additional factors. The findings of this study show a direct correlation between

the occurrence of hypertension and smoking, obesity, physical inactivity, and

family history of hypertension.

When it comes to attitudes and knowledge about hypertension, the

respondents gave us a favorable reaction. Most people are aware that regular

checkups, exercise, and avoiding processed meat help regulate blood pressure.

According to these results, individuals who were more knowledgeable and had an

optimistic outlook did better than those who were less knowledgeable. A study

that looked at behaviors revealed that when people feel ill, they frequently check

their blood pressure. It's interesting to see that most individuals reduce their salt

intake to control their HBP. Most hypertension patients take their medicines on a

regular basis but still there are many people who show careless behavior towards

hypertension.

This study found that the prevalence of hypertension had increased in

Rawalpindi and Islamabad, a region in northern Pakistan. With the risk variables

included, the prevalence of 33.8% was concerning.

According to Pakistan's National Health Survey, hypertension affects 18%

of individuals overall and 33% of adults over the age of 45. To show the

prevalence of hypertension in Pakistan, however, only a small number of

58 | P a g e
population-based surveys have been conducted. It has been increasingly important

and will continue to become more necessary for high-quality research to be

conducted in Pakistan with a particular emphasis on the management and

treatment of hypertension.

According to the results of the current study, women are more likely than

males to have excessive blood pressure. The majority of women stay-at-home who

manage all elements of household upkeep, including cooking, cleaning, and caring

for young children and the elderly, and spend no time or little time in different

kind of physical activities.

Our results indicate that there is need to increase public knowledge about

HBP because lifestyle, dietary, and other factors influence how hypertension

manifests. Health care sessions are necessary to manage this growing medical

problem because hypertension is a serious medical problem in Pakistan. This

study found that educated people are more aware of high blood pressure than

uneducated or illiterate.

The DASH program (Dietary Approaches to Stop Hypertension)

demonstrates how dietary modifications can aid in blood pressure control. In order

to control hypertension, the DASH recommended healthy eating habits.

(Steinberg, Bennett, & Svetkey, 2017).

59 | P a g e
Table 5-5 The DASH diet plan

Food Group Recommended Serving Sizes

Serving (Example)
Grain product: whole 7-8 serving per day 1 slice whole wheat
grain
bread
breads and cereals
Fruits & Vegetables 8 - 10 serving 1/2 cup fruit or

per day vegetable

Dairy products: 2-3 8 oz milk

low fat (<1% M.F) serving

milk products and s per

low-fat cheeses day

Meat & 2-3 3 oz cooked meat

alternatives serving

lean s per

meat/fish/ day

poultry
Nuts, seeds and 4-5 servings 1/3 cup nuts

dry beans per week

60 | P a g e
5.2 Recommendations

1. Hypertension can be detected and treated most effectively through population

screening. Screening by private organisations should be encouraged because

underdeveloped countries like Pakistan cannot do this.

2. Youth should have unique opportunities at their colleges and institutions to

promote adopting a healthy lifestyle, and there should be designated channels of

communication.

3. Because canned meat, salted snakes, hot dogs, sausages, and other processed foods

are high in salt, it's best to stay away from them.

4. It should be encouraged to conduct more research on the primary prevention of

high blood pressure. Programs to address hypertension must be developed and

made available to the entire public.

5. Active hobbies like gardening, walking, and decent cardiovascular exercise can

help you manage stress, which is also a significant component in hobbies-related

hypertension.

6. Since that the prevalence of hypertension is increasing and becoming a global concern,

health services should carry out routine health screenings in many countries.

61 | P a g e
References

Adam, A. (2020). Sample Size Determination in Survey Research. Journal of Scientific

Research and Reports, 26, 90-97. doi:10.9734/JSRR/2020/v26i530263

Aggarwal, B., Makarem, N., Shah, R., Emin, M., Wei, Y., St‐Onge, M. P., & Jelic, S.

(2018). Effects of Inadequate Sleep on Blood Pressure and Endothelial Inflammation in

Women: Findings From the American Heart Association Go Red for Women

Strategically Focused Research Network. 7(12), e008590.

doi:doi:10.1161/JAHA.118.008590

Ahmed, H., & Thaver, I. H. (2020). Hypertension and obesity in community of Nain-Sukh.

J Pak Med Assoc, 70(4), 482-487. doi:10.5455/jpma.3318

Aronow, W. S. (2017). Association of obesity with hypertension. Ann Transl Med, 5(17),

350. doi:10.21037/atm.2017.06.69

Ayada, C., Toru, Ü., & Korkut, Y. (2015). The relationship of stress and blood pressure

effectors. Hippokratia, 19(2), 99-108.

Aziz, K. U. J. J. C. P. S. P. (2015). Evolution of systemic hypertension in Pakistani

population. 25(4), 286-291.

Basit, A., Tanveer, S., Fawwad, A., & Naeem, N. (2020). Prevalence and contributing risk

factors for hypertension in urban and rural areas of Pakistan; a study from second

National Diabetes Survey of Pakistan (NDSP) 2016–2017. Clinical and Experimental

Hypertension, 42(3), 218-224. doi:10.1080/10641963.2019.1619753

62 | P a g e
Cao, L., Li, X., Yan, P., Wang, X., Li, M., Li, R., . . . Yang, K. (2019). The effectiveness of

aerobic exercise for hypertensive population: A systematic review and meta-analysis. J

Clin Hypertens (Greenwich), 21(7), 868-876. doi:10.1111/jch.13583

City, B. L., & Assessment, E. J. B. W. H. O. (2010). Urbanization and health. 88(4), 245-

246.

de Barcelos, G. T., Heberle, I., Coneglian, J. C., Vieira, B. A., Delevatti, R. S., & Gerage, A.

M. (2022). Effects of Aerobic Training Progression on Blood Pressure in Individuals

With Hypertension: A Systematic Review With Meta-Analysis and Meta-Regression.

Front Sports Act Living, 4, 719063. doi:10.3389/fspor.2022.719063

Diaz, K. M., & Shimbo, D. (2013). Physical activity and the prevention of hypertension.

Curr Hypertens Rep, 15(6), 659-668. doi:10.1007/s11906-013-0386-8

Ellison, D. H., & Terker, A. S. (2015). Why Your Mother Was Right: How Potassium

Intake Reduces Blood Pressure. Trans Am Clin Climatol Assoc, 126, 46-55.

Esmailiyan, M., Amerizadeh, A., Vahdat, S., Ghodsi, M., Doewes, R. I., & Sundram, Y.

(2021). Effect of Different Types of Aerobic Exercise on Individuals With and Without

Hypertension: An Updated Systematic Review. Current Problems in Cardiology,

101034. doi:https://doi.org/10.1016/j.cpcardiol.2021.101034

Fang, H., Quan, M., Zhou, T., Sun, S., Zhang, J., Zhang, H., . . . Chen, P. (2017).

Relationship between Physical Activity and Physical Fitness in Preschool Children: A

Cross-Sectional Study. BioMed Research International, 2017, 9314026.

doi:10.1155/2017/9314026

63 | P a g e
Giles, T. D., Materson, B. J., Cohn, J. N., & Kostis, J. B. (2009). Definition and

classification of hypertension: an update. J Clin Hypertens (Greenwich), 11(11), 611-

614. doi:10.1111/j.1751-7176.2009.00179.x

Granger, E., Di Nardo, F., Harrison, A., Patterson, L., Holmes, R., & Verma, A. (2017). A

systematic review of the relationship of physical activity and health status in

adolescents. European Journal of Public Health, 27(suppl_2), 100-106.

doi:10.1093/eurpub/ckw187 %J European Journal of Public Health

Grillo, A., Salvi, L., Coruzzi, P., Salvi, P., & Parati, G. (2019). Sodium Intake and

Hypertension. Nutrients, 11(9). doi:10.3390/nu11091970

Hegde, S. M., & Solomon, S. D. (2015). Influence of Physical Activity on Hypertension and

Cardiac Structure and Function. Curr Hypertens Rep, 17(10), 77. doi:10.1007/s11906-

015-0588-3

Hunter, P. G., Chapman, F. A., & Dhaun, N. (2021). Hypertension: Current trends and

future perspectives. British Journal of Clinical Pharmacology, 87(10), 3721-3736.

doi:https://doi.org/10.1111/bcp.14825

Kapoor, M., Dhar, M., Mirza, A., Saxena, V., & Pathania, M. (2021). Factors responsible

for Uncontrolled Hypertension in the Adults over 50 years of age: A pilot study from

Northern India. Indian Heart Journal, 73(5), 644-646.

doi:https://doi.org/10.1016/j.ihj.2021.07.003

Laurent, S., & Boutouyrie, P. (2020). Arterial Stiffness and Hypertension in the Elderly.

Front Cardiovasc Med, 7, 544302. doi:10.3389/fcvm.2020.544302

Leggio, M., Lombardi, M., Caldarone, E., Severi, P., D'Emidio, S., Armeni, M., . . . Mazza,

A. (2017). The relationship between obesity and hypertension: an updated

64 | P a g e
 comprehensive overview on vicious twins. Hypertension Research, 40(12), 947-963.

doi:10.1038/hr.2017.75

Li, J., Somers, V. K., Gao, X., Chen, Z., Ju, J., Lin, Q., . . . Zhang, L. (2021). Evaluation of

Optimal Diastolic Blood Pressure Range Among Adults With Treated Systolic Blood

Pressure Less Than 130 mm Hg. JAMA Netw Open, 4(2), e2037554.

doi:10.1001/jamanetworkopen.2020.37554

Margerison, C., Riddell, L. J., McNaughton, S. A., & Nowson, C. A. (2020). Associations

between dietary patterns and blood pressure in a sample of Australian adults. Nutrition

Journal, 19(1), 5. doi:10.1186/s12937-019-0519-2

Mills, K. T., Stefanescu, A., & He, J. (2020). The global epidemiology of hypertension. Nat

Rev Nephrol, 16(4), 223-237. doi:10.1038/s41581-019-0244-2

Motamedi, A., Ekramzadeh, M., Bahramali, E., Farjam, M., & Homayounfar, R. (2021).

Diet quality in relation to the risk of hypertension among Iranian adults: cross-sectional

analysis of Fasa PERSIAN cohort study. Nutrition Journal, 20(1), 57.

doi:10.1186/s12937-021-00717-1

Mubarik, S., & Aslam, M. (2018). Measuring central percentiles of blood pressure levels

among adults in Pakistan: A case study of Rawalpindi. Pakistan journal of

pharmaceutical sciences, 31, 907-912.

Oparil, S., Acelajado, M. C., Bakris, G. L., Berlowitz, D. R., Cífková, R., Dominiczak, A.

F., . . . Whelton, P. K. (2018). Hypertension. Nat Rev Dis Primers, 4, 18014.

doi:10.1038/nrdp.2018.14

Organization, W. H. (1996). Hypertension control: report of a WHO Expert Committee:

World Health Organization.

65 | P a g e
Organization, W. H. (2013). A global brief on hypertension: silent killer, global public

health crisis: World Health Day 2013. Retrieved from

Potter, P. A., & Perry, A. G. (1999). Basic Nursing: A Critical Thinking Approach: Mosby.

Ranasinghe, P., Cooray, D. N., Jayawardena, R., & Katulanda, P. (2015). The influence of

family history of hypertension on disease prevalence and associated metabolic risk

factors among Sri Lankan adults. BMC Public Health, 15, 576. doi:10.1186/s12889-015-

1927-7

Rani, R., Mengi, V., Gupta, R. K., & Sharma, H. J. P. H. R. (2015). Hypertension and its

risk factors–a cross sectional study in an urban population of a north Indian District.

5(3), 67-72.

Riaz, M., Shah, G., Asif, M., Shah, A., Adhikari, K., & Abu-Shaheen, A. J. P. o. (2021).

Factors associated with hypertension in Pakistan: A systematic review and meta-

analysis. 16(1), e0246085.

Sabour, H., Norouzi-Javidan, A., Soltani, Z., Mousavifar, S. A., Latifi, S., Emami-Razavi, S.

H., & Ghodsi, S. M. (2016). The correlation between dietary fat intake and blood

pressure among people with spinal cord injury. Iran J Neurol, 15(3), 121-127.

Said, M. S., Hashmi, A. M., Hussain, A., ur Rehman, S., Suliman, N. J. I. J. o. N. M., &

Sciences, H. (2022). Clinical evaluation and prevalence of hypertension in different

areas of Pakistan. 1(4).

Saklayen, M. G., & Deshpande, N. V. (2016). Timeline of History of Hypertension

Treatment. Front Cardiovasc Med, 3, 3. doi:10.3389/fcvm.2016.00003

Salameh, A. B., Hyassat, D., Suhail, A., Makahleh, Z., Khader, Y., El-Khateeb, M., &

Ajlouni, K. (2022). The prevalence of hypertension and its progression among patients

66 | P a g e
 with type 2 diabetes in Jordan. Ann Med Surg (Lond), 73, 103162.

doi:10.1016/j.amsu.2021.103162

Shah, N., Shah, Q., & Shah, A. J. (2018). The burden and high prevalence of hypertension

in Pakistani adolescents: a meta-analysis of the published studies. Archives of Public

Health, 76(1), 20. doi:10.1186/s13690-018-0265-5

Shah, N., Shah, Q., & Shah, A. J. J. A. o. p. h. (2018). The burden and high prevalence of

hypertension in Pakistani adolescents: a meta-analysis of the published studies. 76(1), 1-

10.

Shariq, O. A., & McKenzie, T. J. (2020). Obesity-related hypertension: a review of

pathophysiology, management, and the role of metabolic surgery. Gland Surg, 9(1), 80-

93. doi:10.21037/gs.2019.12.03

Singh, S., Shankar, R., & Singh, G. P. (2017). Prevalence and Associated Risk Factors of

Hypertension: A Cross-Sectional Study in Urban Varanasi. Int J Hypertens, 2017,

5491838. doi:10.1155/2017/5491838

Steinberg, D., Bennett, G. G., & Svetkey, L. (2017). The DASH Diet, 20 Years Later. Jama,

317(15), 1529-1530. doi:10.1001/jama.2017.1628

Unda Villafuerte, F., Llobera Cànaves, J., Lorente Montalvo, P., Moreno Sancho, M. L.,

Oliver Oliver, B., Bassante Flores, P., . . . Rigo Carratalà, F. (2020). Effectiveness of a

multifactorial intervention, consisting of self-management of antihypertensive

medication, self-measurement of blood pressure, hypocaloric and low sodium diet, and

physical exercise, in patients with uncontrolled hypertension taking 2 or more

antihypertensive drugs: The MEDICHY study. Medicine (Baltimore), 99(17), e19769.

doi:10.1097/md.0000000000019769

67 | P a g e
Wajngarten, M., & Silva, G. S. (2019). Hypertension and Stroke: Update on Treatment. Eur

Cardiol, 14(2), 111-115. doi:10.15420/ecr.2019.11.1

Warburton, D. E. R., Charlesworth, S., Ivey, A., Nettlefold, L., & Bredin, S. S. D. (2010). A

systematic review of the evidence for Canada's Physical Activity Guidelines for Adults.

International Journal of Behavioral Nutrition and Physical Activity, 7(1), 39.

doi:10.1186/1479-5868-7-39

68 | P a g e