LOW CARDIOVASCULAR RISK REDUCTION BEHAVIORS AMONG HYPERTENSIVES ATTENDING FOLLOW-UP CARE AT A TERTIARY-LEVEL HOSPITAL IN ADDIS ABABA, ETHIOPIA
DOI:
https://doi.org/10.53555/hsn.v8i11.2146Keywords:
Comorbidity, Body mass index, Hypertension, CVD, Risk reduction behavior, EthiopiaAbstract
Introduction: Cardiovascular disease (CVD) outcomes in hypertensives are substantially influenced by risk-reduction behaviors. Even though hypertensives in Ethiopia have a high prevalence of behavioral risks for negative CVD outcomes, little is known about risk-reduction behaviors in this population. Therefore, this study aimed to investigate the CVD risk reduction behaviors among adult hypertensives in Addis Ababa, Ethiopia.
Method: A cross-sectional design was used. A sample of 384 hypertensives was selected using a systematic random sampling technique from the hypertension clinic registry. Epi data version 3.10 was used to clean the data, and SPSS version 25.0 was used for analysis. Descriptive statistic was used to determine participants’ CVD risk reduction behavioral status. Bivariate chi-square test and ordinal logistic regression analyses were run to identify variables associated with participants' ranked CVD risk reduction behavioral status at the p-value < .05 cutoff for statistical significance.
Results: The mean (± standard deviation) age of participants was 53.61 (± 12.34) years, (range, 30-82 years), and 51.2% were males. The majority (56.5%) of them were at low CV risk reduction practices. Only 45.1% were at target BP control. The absence of comorbidities (p < .001), clinic visits every 3 months for hypertension (p = .041), normal body mass index (p = .008), hypertension duration of 5–9 years (p = .034), and young age adults (p = .041) were the characteristics significantly associated with the high CVD risk reduction practice.
Conclusion: Hypertensives' adoption of CVD risk reduction behaviors was low, with a variety of unmanaged risk factors and a few cardioprotective behaviors. Healthcare providers may improve patients’ CV risk-reduction behavior through teaching lifestyle changes and more frequent clinic visits.
Downloads
References
Bromfield, S., & Mounter P. High Blood Pressure: The Leading Global Burden of Disease Risk Factor and the Need for Worldwide Prevention Programs.NIH Public Access. 2013;15(3):134–6.
Lim SS, Theo Vos, Abraham D Flaxman, Goodarz Danaei KS, Heather Adair-Rohani, Markus Amann, H Ross Anderson KGA, Martin Aryee, Charles Atkinson, Loraine J Bacchus, Adil N Bahalim* K, Balakrishnan*, John Balmes* SB-C, Lim SS, et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380(9859):2224–60.
Lawes CM, Hoorn S Vander, Rodgers A, International Society of Hypertension. Global burden of blood-pressure-related disease, 2001. Lancet [Internet]. 2008;371(9623):1513–8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/18456100%0Ahttp://linkinghub.elsevier.com/retrieve/pii/S0140673608606558
WHO. A global brief on Hypertension: Silent killer, global public health crisis World Health Day 2013. www.who.int. World Heal Organ. 2013;1–40.
Yau JA, Karaye KM, Okeahialam BN. Profile of Cardiovascular Risk Factors in Nigerians with Stroke. 2016;125–37.
Watila MM, Nyandaiti YW, Ibrahim A, Balarabe SA, Gezawa ID, Bakki B, et al. Risk factor profile among black stroke patients in Northeastern Nigeria. 2012;4(May):50–8.
Mensah G, Roth G, Sampson U, Moran A, Feigin V, Forouzanfar M, et al. Mortality from cardiovascular diseases in sub-Saharan Africa, 1990–2013: a systematic analysis of data from the Global Burden of Disease Study 2013: cardiovascular topic. Cardiovasc J Afr [Internet]. 2015;26(2):S6–10. Available from: http://www.cvja.co.za/onlinejournal/vol26/vol26_issue2_supplement/#8/z
Cappuccio FP, Miller MA. Cardiovascular disease and hypertension in sub-Saharan Africa: burden, risk and interventions. Intern Emerg Med. 2016;11(3):299–305.
BeLue R, Okoror TA, Iwelunmor J, Taylor KD, Degboe AN, Agyemang C, et al. An overview of cardiovascular risk factor burden in sub-Saharan African countries: A socio-cultural perspective. Global Health. 2009;5:1–12.
WHO. Non communicable Diseases Country Profiles. WHO Press [Internet]. 2014;1–210. Available from: http://www.who.int/nmh/countries/ben_en.pdf?ua=1
Hailemariam T. Prevalence of Cardiovascular Emergencies in Specialized Hospital, Addis Ababa Ethiopia. Emerg Med Open Access [Internet]. 2014;04(04):8–12. Available from: http://www.omicsgroup.org/journals/prevalence-of-cardiovascular-emergencies-in-specialized-hospital-addis-ababa-ethiopia-2165-7548.1000198.php?aid=30357
Mendis S, Puska P, Norrving B. Global Atlas on cardiovascular disease prevention and control. WHO, Geneva [Internet]. 2011;1–54. Available from: http://whqlibdoc.who.int/publications/2011
Gaziano, TA., Bitton, A., Anand, S., Gessel, SA., & Adrianna Murphy, A. (2010). Growing Epidemic of Coronary Heart Disease in Low- and Middle- Income Countries. 2011;35(2):1–34.
Tibebu A, Mengistu D, Negesa L. Adherence to recommended lifestyle modifications and factors associated for hypertensive patients attending chronic follow-up units of selected public hospitals in Addis Ababa, Ethiopia. Patient Prefer Adherence. 2017;11:323–30.
Stuart-Shor EM, Berra KA, Kamau MW, Kumanyika SK. Behavioral strategies for cardiovascular risk reduction in diverse and underserved racial/ethnic groups. Circulation. 2012;125(1):171–84.
Brainy Quote. Bra [Internet]. 2014. Available from: http://www.brainyquote.com/quotes/quotes/n/napoleonbo106371.html
Fuster V, Kelly BB. Committee on Preventing the Global Epidemic of Cardiovascular Disease : Meeting the Challenges in Developing Countries Board on Global Health Valentín Fuster and Bridget B . Kelly , Editors. 2010.
Stuart-Shor, E.M., Berra, K., Kamau, M.W., & Kumanyika S. Behavioral Strategies for Cardiovascular Risk Reduction in Diverse and Underserved Racial/Ethnic Groups. NIH Public Access. Circulation. 2012;125(1):171–84.
AbdEl-hay SA, Mezayen SE El. Knowledge and Perceptions Related to Hypertension , Lifestyle Behavior Modifications and Challenges That Facing Hypertensive Patients Abstract : 2015;4(6):15–26.
Barreto M da S, Cremonese IZ, Janeiro V, Matsuda LM, Marcon SS. Prevalence of non-adherence to antihypertensive pharmacotherapy and associated factors. Rev Bras Enferm. 2015;68(1):54-60,60-67.
Bilal M, Haseeb A, Lashkerwala SS, Zahid I, Siddiq K, Dar MI, et al. Knowledge , Awareness and Self-Care Practices of Hypertension Among Cardiac Hypertensive Patients. Glob J Heal Sci. 2016;8(2):9–19.
Adebolu F, Naidoo M. Blood pressure control amongst patients living with hypertension presenting to an urban district hospital outpatient clinic in Kwazulu-Natal. African J Prim Heal Care Fam Med [Internet]. 2014;6(1):6–11. Available from: http://phcfm.org/index.php/phcfm/article/view/572
Gebrihet TA, Mesgna KH, Gebregiorgis YS, Kahsay AB, Weldehaweria NB, Weldu MG. Awareness, treatment, and control of hypertension is low among adults in Aksum town, northern Ethiopia: A sequential quantitative-qualitative study. PLoS One. 2017;12(5):1–16.
Berhe DF, Taxis K, Haaijer-Ruskamp FM, Mulugeta A, Mengistu YT, Mol PGM. Hypertension treatment practices and its determinants among ambulatory patients: retrospective cohort study in Ethiopia. BMJ Open [Internet]. 2017;7(8):e015743. Available from: http://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2016-015743
Nalin S, Luiza M, Rosa G, Lugon JR, Ramos S. Dietary habits and inadequate control of blood pressure in hypertensive adults assisted by a Brazilian Family Doctor Program. Public Health Nutr. 2011;14(12):2176–84.
Tesfaye F. Epidemiology of Cardiovascular Disease Risk Factors in Ethiopia : The rural-urban gradient. Epidemiology & Public Health Sciences, Department of Public Health and Clinical Medicine Umeå University, Sweden. http://www.diva-portal.org/smash/get/diva2:141340. 2008.
MOH E. National noncommunicable diseases management protocols. 2021;(November).
Mancia G, Fagard R, Narkiewicz K, Redán J, Zanchetti A, Böhm M, et al. 2013 Practice guidelines for the management of arterial hypertension of the European Society of Hypertension (ESH) and the European Society of Cardiology (ESC). J Hypertens [Internet]. 2013;31(10):1925–38. Available from: http://content.wkhealth.com/linkback/openurl?sid=WKPTLP:landingpage&an=00004872-201310000-00002
CDC. Body mass index: Considerations for practitioners. Cdc [Internet]. 2011;4. Available from: http://scholar.google.com/scholar?hl=en&btnG=Search&q=intitle:Body+Mass+Index+:+Considerations+for+Practitioners#3%5Cnhttp://scholar.google.com/scholar?hl=en&btnG=Search&q=intitle:Body+mass+index:+Considerations+for+practitioners%233
Gelaye B, Williams MA, Lemma S, Deyessa N, Bahretibeb Y, Shibre T, et al. Validity of the Patient Health Questionnaire-9 for Depression Screening and Diagnosis in East Africa. Psychiatry Res. 15;210(2):dio:10.1016/j.psychres.2013.07.015. 2013;210(2).
Woringer M, Nielsen JJ, Zibarras L, Evason J, Kassianos AP, Harris M, et al. Development of a questionnaire to evaluate patients’ awareness of cardiovascular disease risk in England’s National Health Service Health Check preventive cardiovascular programme. BMJ. 2017;7(9):1–10.
Ministry of Health; Kenyan National Bureau of Statistics; World Health Organization. STEPwise Survey for Non CommuniKenyacable Diseases Risk Factors 2015 Report. Public Health [Internet]. 2015;5(7):8–210. Available from: http://aphrc.org/wp-content/uploads/2016/04/Steps-Report-NCD-2015.pdf
Ramirez FD, Chen Y, Di Santo P, Simard T, Motazedian P, Hibbert B. Association between self-reported potentially modifiable cardiac risk factors and perceived need to improve physical health: A population-based study. J Am Heart Assoc. 2017;6(5):13–5.
Cohen S, Kamarck T, Mermelstein R. A Global Measure of Perceived Stress. J Health Soc Behav. 1983;24(4):385–96.
Gelaw S, Yenit MK, Nigatu SG. Self-Care Practice and Associated Factors among Hypertensive Patients in Debre Tabor Referral Hospital, Northwest Ethiopia, 2020. Int J Hypertens. 2021;
Buda ES, Hanfore LK, Fite RO, Buda AS. Lifestyle modification practice and associated factors among diagnosed hypertensive patients in selected hospitals, South Ethiopia. Clin Hypertens. 2017;23(1):1–9.
Roman WP, Martin HD, Sauli E. Assessment of risk factors for cardiovascular diseases among patients attending cardiac clinic at a referral hospital in Tanzania. 2019;1–14.
Satyal GK, Rai L, Gautam R, Dangol BK, Shakya R. Knowledge and Self-Care Practice on Hypertension among Hypertensive Patients in a Tertiary Level Hospital of Kathmandu. J Inst Med Nepal. 2020;42(2):10–5.
Chacko S, Jeemon P. Role of family support and self-care practices in blood pressure control in individuals with hypertension: Results from a cross-sectional study in Kollam District, Kerala. Wellcome Open Res. 2020;5:1–15.
Ajani K, Gowani A, Gul R, Petrucka P. Levels and predictors of self-care among patients with hypertension in Pakistan. Int J Gen Med. 2021;14:1023–32.
Dasgupta A, Sembiah S, Paul B, Ghosh A, Biswas B, Mallick N. Assessment of self-care practices among hypertensive patients: a clinic based study in rural area of Singur, West Bengal. Int J Community Med Public Heal [Internet]. 2018;5(1):262–7. Available from: http://www.ijcmph.com
Tibebu A, Bekele DM, Negesa L. Adherence to recommended lifestyle modifications and factors associated for hypertensive patients attending chronic follow-up units of selected public hospitals in Addis Ababa, Ethiopia. Patient Prefer Adherence [Internet]. 2017;Volume 11:323–30. Available from: https://www.dovepress.com/adherence-to-recommended-lifestyle-modifications-and-factors-associate-peer-reviewed-article-PPA
Tadesse DB, Gerensea H. Self-care practice among hypertensive patients in Ethiopia: Systematic review and meta-analysis. Open Hear. 2021;8(1):1–11.
Piepoli MF, Hoes AW, Agewall S, Albus C, Brotons C, Catapano AL, et al. 2016 European Guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J. 2016;37(29):2315–81.
Yadeta D, Walelgne W, Fourie JM, Scholtz W, Scarlatescu O, Nel G. PASCAR and WHF Cardiovascular Diseases Scorecard project: Ethiopia Country Report. 2021;32(1):37–46.
Sorato MM, Davari M, Kebriaeezadeh A, Sarrafzadegan N, Shibru T. Reasons for poor blood pressure control in Eastern Sub ‑ Saharan Africa : looking into 4P ’ s ( primary care , professional , patient , and public health policy ) for improving blood pressure control : a scoping review. BMC Cardiovasc Disord [Internet]. 2021;21(123):1–15. Available from: https://doi.org/10.1186/s12872-021-01934-6
Hareri H, Gedefaw M, Simeng B. Assessment of prevalence and associated factors of adherence to anti-hypertensive agents among adults on follow up in Adama Referal hospital, East Shoa,. Int J Curr Microbiol App Sci [Internet]. 2014;3(1):760–70. Available from: http://www.ijcmas.com/vol-3-1/Habtamu Abera Hareri, et al.pdf
Kendir C, Akker M Van Den, Vos R, Metsemakers J. Cardiovascular disease patients have increased risk for comorbidity : A cross-sectional study in the Netherlands. Eur J Gen Pract [Internet]. 2018;0(0):45–50. Available from: https://doi.org/10.1080/13814788.2017.1398318
Davidson KW, Alcántara C, Miller GE. Disease : Challenges and Grand Opportunities. 2019;73(8):1019–30.
Elbur AI. Level of adherence to lifestyle changes and medications among male hypertensive patients in two hospitals in taif; kingdom of Saudi Arabia. Int J Pharm Pharm Sci. 2015;7(4):168–72.
Bhagavathula AS, Shah SM, Suliman A, Oulhaj A, Aburawi EH. Hypertension control and guideline-recommended target blood pressure goal achievement at an early stage of hypertension in the UAE. J Clin Med. 2022;11(1).
Fekadu G, Adamu A, Gebre M, Gamachu B, Bekele F, Abadiga M, et al. Magnitude and determinants of uncontrolled blood pressure among adult hypertensive patients on follow-up at nekemte referral hospital, western ethiopia. Integr Blood Press Control. 2020;13:49–61.
Amare F, Nedi T, Berhe DF. Blood pressure control practice and determinants among ambulatory hypertensive patients attending primary health care facilities in Addis Ababa. SAGE Open Med. 2020;8:205031212094652.
Hussen FM, Adem HA, Roba HS, Mengistie B, Assefa N. Self-care practice and associated factors among hypertensive patients in public health facilities in Harar Town, Eastern Ethiopia: A cross-sectional study. SAGE Open Med. 2020;8:205031212097414.
Labata BG, Ahmed MB, Mekonen GF, Daba FB. Prevalence and predictors of self care practices among hypertensive patients at Jimma University Specialized Hospital , Southwest Ethiopia : cross ‑ sectional study. BMC Res Notes [Internet]. 2019;1–8. Available from: https://doi.org/10.1186/s13104-019-4125-3
Gadde KM, Martin CK, Berthoud H, Steven B, Biomedical P, Rouge B. Obesity : Pathophysiology and Management. J Am Coll Cardiol. 2021;71(1):69–84.
Haregu TN, Oti S, Egondi T, Kyobutungi C. Measurement of overweight and obesity an urban slum setting in sub-Saharan Africa : a comparison of four anthropometric indices. BMC Obes [Internet]. 2016;1–8. Available from: http://dx.doi.org/10.1186/s40608-016-0126-0
Ukoha-kalu BO, Adibe MO, Anosike C, Ukwe CV. Knowledge, attitude and practice towards hypertension among patients receiving care in a Nigerian Hospital. Ann Clin Hypertens. 2020;4(1):016–9.
Gilardini L, Redaelli G, Croci M, Conti A, Pasqualinotto L, Invitti C. Effect of a modest weight loss in normalizing blood pressure in obese subjects on antihypertensive drugs. Obes Facts. 2016;9(4):251–8.
Levy D, Larson MG, Vasan RS, Kannel WB, Ho KKL. The progression from hypertension to congestive heart failure. J Am Med Assoc. 1996;275(20):1557–62.
Feyissa M, Shibeshi W, Mahammedsied W. Assessment of Drug Therapy Problems and Contributing Factors among Adult Ambulatory Hypertensive Patients in Ayder Referral Hospital, Mekelle Northern Ethiopia Evaluation of medicinal plants for their Pharmacologic effect View project Cardiovascular disea. J Pharma Care Heal Sys JPCHS [Internet]. 2020;7:218. Available from: https://www.researchgate.net/publication/347888842
Hill MN, Miller NH, DeGeest S. ASH position paper: Adherence and persistence with taking medication to control high blood pressure. J Clin Hypertens. 2010;12(10):757–64.
WHO. Guideline: Sodium intake for adults and children. World Heal Organ [Internet]. 2012;1–56. Available from: http://apps.who.int/iris/handle/10665/77985%5Cnhttp://www.ncbi.nlm.nih.gov/pubmed?term=Sodium%5BTitle%5D AND intake%5BTitle%5D AND adults%5BTitle%5D AND children%5BTitle%5D AND WHO%5BTitle%5D%5Cnhttp://www.ncbi.nlm.nih.gov/pubmed?term=Sodium%255BTitle%255
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2022 International Journal For Research In Health Sciences And Nursing
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
In consideration of the journal, Green Publication taking action in reviewing and editing our manuscript, the authors undersigned hereby transfer, assign, or otherwise convey all copyright ownership to the Editorial Office of the Green Publication in the event that such work is published in the journal. Such conveyance covers any product that may derive from the published journal, whether print or electronic. Green Publication shall have the right to register copyright to the Article in its name as claimant, whether separately
or as part of the journal issue or other medium in which the Article is included.
By signing this Agreement, the author(s), and in the case of a Work Made For Hire, the employer, jointly and severally represent and warrant that the Article is original with the author(s) and does not infringe any copyright or violate any other right of any third parties, and that the Article has not been published elsewhere, and is not being considered for publication elsewhere in any form, except as provided herein. Each author’s signature should appear below. The signing author(s) (and, in
