Prevalence and Risk Factors of Hypertension Among Middle-Aged Adults in Ahiazu Mbaise Local Government Area, Imo State, Nigeria

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1 International Journal of Basic & Applied Sciences IJBAS-IJENS Vol:13 No:1 26 Prevalence and Risk Factors of Hypertension Among Middle-Aged Adults in Ahiazu Mbaise Local Government Area, Imo State, Nigeria Mbah, B.O., Eme, P.E., Ezeji J. Department of Home Science, Nutrition and Dietetics, University of Nigeria, Nsukka. Abstract-- The thrust of the study was to determine the prevalence and the risk factors of hypertension among middleaged persons in Ahiazu Mbaise Local Government Area, Imo State. A total of subjects aged 4-6 were selected and used for the study. Anthropometric measurements (weight and height) were taken. Body Mass Index (BMI) of the subjects was also calculated. The blood pressure measurements of the subjects were also collected using a sphygmomanometer and then classified using standard methods. A structured interviewer administered questionnaires were used to obtain information on the socio-economic characteristics, personal data and risk factors associated with hypertension among the subjects. The Statistical Package for social sciences was used for data analyses. The prevalence of hypertension (32.%) was found among the subjects with a higher proportion in female subjects (.%) than males (12.%). A quarter of the subjects (.%) were either overweight or obese. Less than half (.%) of the subjects had a frequent consumption of alcoholic beverages and 23.% had a frequent intake of salty foods. These were all implicated as the risk factors of high blood pressure. There is need for preventive strategies on hypertension control and enlightening the public on the risk factors of hypertension especially high BMI and wrong eating habit and lifestyle should be encouraged Index Term-- Prevalence, risk factors, hypertension, middleaged, Imo State. I. INTRODUCTION Cardiovascular diseases (CVDs) are important causes of worldwide preventable health problems [1]. CVDs have become a leading cause of mortality and morbidity in developing countries and rates are expected to rise further over the next few decades [2]. Relative to white subjects, Afro- Caribbean and people of African descent have high incidence of stroke and end stage renal failure whereas coronary heart disease is less common [3]. According to Chobanian [4], hypertension is defined as a transitory or sustained elevation of systemic arterial blood pressure to induce cardiovascular damage or other adverse consequences. This has become a chronic condition and a major public health problem that adversely affects health status of individuals, families and communities. A study done in Portland, USA, states that males over 16 of age had higher blood pressure values than female subjects until the ages of 46- when women had values equal to or greater than those for men []. Most of the Indian studies have found increasing levels of blood pressure with increasing age. A study done among elderly population of the desert region of Rajasthan ( 6 ) showed a higher prevalence rate with 4.3% among urban and 32.6% among rural subjects []. Once considered a problem only in highincome countries, the prevalence of CVD risk factors is dramatically increasing in low- and middle-income African countries, particularly in urban areas [6]. Studies in Tanzania have reported high rates of hypertension in both urban and rural areas, particularly among the obese and elderly [6]. In Ghana, earlier studies revealed hypertension prevalence to be 4.% among rural dwellers and 8% to 13% in the urban dwellers [6]. The estimated prevalence of diabetes mellitus in Sub-Saharan Africa is about 1% in rural areas and 7% in urban areas, and between 8% and 13% in countries like Uganda and South Africa [7]. Overweight and obesity are leading risk factors for a number of chronic diseases, including CVD, diabetes mellitus, and cancer. Obesity is a leading determinant of hypertension, dyslipidaemia, and diabetes mellitus [8]. In Ghana, earlier studies revealed a hypertension prevalence of 4.% among rural dwellers while in Nigeria the prevalence of hypertension was found to be % in rural areas [7] Nigeria is a multi ethnic nation organized into six geo-political zones inhabited by people with diverse cultures. Most of the rural communities are inhabited by children, men, and women who belong more to the low socioeconomic strata. Most of the men and women are elderly people who have retired from active service. Most of the active youths and middle-aged individuals reside in the urban and semi-urban cities characterized by better social amenities and job opportunities. Cardiovascular risk factors have been thought to be less common in these rural communities due to the traditional lifestyle the inhabitants are thought to adopt. The aim of this study was to ascertain the prevalence and risk factors of hypertension in Ahiazu Mbaise Local Government Area, Imo State, Nigeria. II. MATERIALS AND METHODS Study Area The survey was carried out in Nnarambia and Ogbe communities in Ahiazu Mbaise L.G.A. in Imo State. About 6% of food consumed in the two communities is produced in the surrounding village and are mainly staple foods which include yam, cocoyam, cassava, maize, fluted pumpkin, bitter leaf, orange, pawpaw, mango, palm oil etc. They are mainly traders and civil servants February 13 IJENS

2 International Journal of Basic & Applied Sciences IJBAS-IJENS Vol:13 No:1 27 Study Design. The design was a cross sectional survey. Study Population The subjects were males and females (4-6 ) who were randomly selected from the two communities. Informed Consent Prior to the administration of the questionnaire, each participant was given information on the aim and objectives of the study and allowed to decide about participation in the study. The informed consent form was then signed by each participant. Data Collection: The pretested questionnaire was interviewer-administered. It was used to obtain information on personal data, the sociodemographic characteristics, alcoholic beverage consumption, frequency of salt consumption and anthropometric (weight, height) measurement. Participants stood and dressed in light clothing without shoes for the anthropometric measurements. A calibrated stadiometer beam scale with height rod graduated in centimetres) was used to obtain the weight and height. Weight was measured to the nearest.1kg and height was measured to the nearest. cm. The scale was calibrated each time for each participant. A sphygmomanometer was used to obtain the blood pressure of the subjects. The subjects were asked to sit down for at least minutes and the cuff was put around their arms and start pumping. Three readings were taken one minute apart. The first was discarded and the mean of the last 2 reading was used in the analysis. Data Analysis Data was exported into Excel Spreadsheet and exported into SPSS version 17 and analysed using descriptive statistics: frequency distribution and percentages. Mean scores of the readings from the sphygmomanometer was also calculated. III. RESULTS Fig. 1 shows the age range of the respondents. About 3% was within the age range of 46-, 37.% were within 1-6 and 28.% were within Fig. 2. Marital status of the respondents Fig. 2 shows the marital status of the respondents. Majority of the respondents (8.%) were married and a few (7.%) were divorced. Married Single Divorced FLSC WAEC B.Sc/HND Fig. 3. Educational status of the respondents Keys: FSLC: First School Leaving Certificate WAEC:West African Examination Certificate HND: Higher National Diploma B.Sc: Bachelor of Science Fig. 3 shows the educational status of the respondents. Half of the respondents had Bachelor of Science or its equivalent, 4.% had WAEC while.% had only First School Leaving certificate. Fig. 1. Age range of the respondents February 13 IJENS

3 International Journal of Basic & Applied Sciences IJBAS-IJENS Vol:13 No:1 28 Fig. 4. Occupation status of the respondents Fig. 4 shows the occupation status of the respondents. More than half of the respondents (1.%) were traders, 37.% were civil servants while only 11.% were farmers. 17. Civil servant Trading Farming Fig.. Income level of the respondents Fig. shows the income level of the respondents. About 3% of the respondents earned from N21, and above, 3.% earned between N11, and N, while 12.% earned less than N, T ABLE I ALCOHOLIC BEVERAGE/DRINK CONSUMPTION OF THE RESPONDENTS Frequency Percentage Alcoholic consumption Yes No 27. Total. Type of alcohol consumption Beer Whisky. Brandy 4. Others. Total Alcohol consumption pattern Once daily 6. Twice daily 4. Three times daily Above three times daily Total Table I shows the alcoholic beverage consumption of the respondents. More than half (72.%) consumes alcoholic beverages/drink. About 33% consumes beer,.% consumes whisky,.% consumes brandy while only.% consumes other alcoholic brands such as spirit. T ABLE II FREQUENCY OF SALT CONSUMPTION OF RESPONDENTS Frequency Percentage Like salty foods Yes No Total. Spread table salt on food Yes No Total. Table II shows the frequency of salt consumption of the respondents. More than three-quarters (76.%) of the respondents like salty foods and about 71% of them spread table salt on their foods. T ABLE III T HE RELATIONSHIP OF SYSTOLIC BLOOD PRESSURE OF RESPONDENT AND BODY MASS INDEX (BMI) BMI(kg/m 2 ) Systolic blood pressure (mm Hg) < >16 Total 18. 3(1.) (2.) 2(1.) - (.) (22.) 73(36.) (.) 3(1.) 14(7.) (.) (12.) - 3(17.) (7.) - (7.) Total 47(23.) 88(44.) 62(31.) 3(1.) (.) February 13 IJENS

4 International Journal of Basic & Applied Sciences IJBAS-IJENS Vol:13 No:1 29 Table III shows the relationship of systolic blood pressure of respondents and their body mass index. A greater percentage of those who were overweight (12.%) had more prevalence T ABLE IV SYSTOLIC BLOOD PRESSURE RECORDS BASED ON SEX AND AGE GROUP Systolic blood pressure (mm Hg) < of hypertension than the other categories and about 8% of those who were obese and morbidly obese had hypertension >16 Total 4-4 (7.) (.) 8 (4.) 2 (1.) 3 (17.) 46- (.) 9 (4.) 4 (2.) 3 (1.) 26 (13.) > (2.) 7 (3.) 2 (1.) (2.) 19 (9.) Total (.) (12.) 14 (7.) (.) 8(4.) 4-4 (.) 12 (6.) 9 (4.) 2 (1.) 43 (21.) (6.) 9 (4.) 7 (3.) (2.) 34 (17.) > 12 (6.) 8 (4.) (7.) 8 (4.) 43 (21.) Total 4 (22.) 39 (19.) 31 (.) (7.) 1 (6.) Table IV shows systolic blood pressure records of the respondents based on sex and age group. The prevalence of hypertension in males was 12.% and it was higher among those aged 4-4 while the prevalence of hypertension in females was 23.% and it was higher among those above. IV. DISCUSSION The result showed that a greater percentage of the respondents (37.%) were within the age range of 1-6. This was in agreement with the findings of Omotala [9] in a similar work done in Imezi-Owa, a rural community in South-East Nigeria where majority of their respondents were within the same age range. The preponderance of elderly people in our study may be explained by the effect of rural-urban drift. Several of our rural communities have over the witnessed rural-urban migration due to concentration of better social amenities in such urban cities and/or in search of better jobs by the younger people thus leaving the elderly ones behind. Nearly all the respondents were Igbo. This might be as a result of the location where the study was carried out. More than half of the respondents (1.%) were traders and about 38.% of them were civil servants. This was reflected in their income as 2.% of the respondents had an income level of above N,. Majority of the respondents (72.%) consume alcohol and about.% of them consume it daily. A study reported that blood pressure levels were higher in subjects who drank alcohol []. Another study showed that acute alcohol consumption raises blood pressure by increasing the discharge rate of the sympathetic vasocensticter nerve in the skeletal muscle vasculature [11]. Excess salt intake was another risk factor for hypertension in this study as majority of the respondents (76.% and 71.%) like salty food and spreads table salt on food respectively. This may be traceable to transition to the Western feeding habit which was more likely to be adopted by the study population. The high prevalence of overweight and obesity among the hypertensive adults might be explained because hypertension is more prevalent in the older obese population than in normal weight control [12]. There is also a direct positive relationship between Body Mass Index and blood pressure [12]. As generally observed globally, though the prevalence of CVD risk factors has been shown to be on the increase both in Western and African countries, particularly in urban areas, the rural areas which have suffered from rural-urban migration are becoming affected too [3]. While most reports have emanated from hospital-based studies, community-based studies which truly describe the population are few. Compared to earlier reports from rural communities in Ghana and Nigeria [13] rising trend in the prevalence of hypertension are thus well demonstrated. The prevalence of hypertension in this study was 32.% as against % earlier observed. This may be explained by both the age structure of our population and the cutoff used to define hypertension. Over time the cutoff value for hypertension has been lowered from 16/9 mmhg to 14/9 mmhg. This inadvertently is bound to identify more people as having hypertension. Scope and limitation of the study The scope of this study covers behavioural and physical measurements of the subject and does not include biochemical measurements such as determination blood glucose or cholesterol level. Similarly, we did not collect data on menopausal status among the women, and thus we did not controll the potential effect of menopausal status on the risk of blood pressure in women. Our study had certain limitations. Subjects for the study were chosen from a single locality and thus may not be representative of affluent subjects throughout Nigeria. However, we carefully chose a colony which had a representative mix of subjects with all different professions, age groups and religions. Blood pressure measurements were taken on a single day and were not repeated again for practical reasons. Hence, we may have over-diagnosed both prehypertension and hypertension. CONCLUSION February 13 IJENS

5 International Journal of Basic & Applied Sciences IJBAS-IJENS Vol:13 No:1 The prevalence of hypertension was quite high in this study and it was more prevalent in females than males. The risk factors that may have exposed the respondents in this study include frequent consumption of alcoholic beverages and consumption of salty foods. Overweight and obesity was another risk factor of hypertension identified in this study. There is need to enlighten the public especially the middleaged adults and the elderly on preventive and control measures of hypertension. Further work should be done on the management of hypertension among middle-aged people in that area. REFERENCES [1] M. Ahmad, The health farm concept in the primary prevention of coronary artery disease, Singapore Medical Journal, 199, vol. 36, no. 6, pp [2] K. Whelton, P. Reynolds, P. Muntner, K. Whelton, and J. He, Global burden of hypertension: analysis of worldwide data, The Lancet,, vol. 36, no. 94, pp [3] E. Sobngwi, J-C. N. Mbanya, N. C. Unwin et al., Physical activity and its relationship with obesity, hypertension and diabetes in urban and rural Cameroon, International Journal of Obesity, 2, vol. 26, no. 7, pp [4] A. V. Chobanian, G.L. Bakeries, H.R. Black, W.C. Cushman and J.L. Izzo. The Seventh report of National Committee on prevention, detection, evaluation and treatment of high blood pressure: the JNC of report (published arratum in JAMA, 3, 289: [] H.L. Prashanth. Prevalence of hypertension in an urban and rural area of Gulbarga district- A Comparative Study, 6 (unpublished work). [6] D. L. Christensen, J. Eis, A. W. Hansen et al., Obesity and regional fat distribution in Kenyan populations: impact of ethnicity and urbanization, Annals of Human Biology, 8, vol. 3, no. 2, pp [7] M. Njelekela, H. Negishi, Y. Nara et al., Cardiovascular risk factors in Tanzania: a revisit, Acta Tropica, 1, vol. 79, no. 3, pp [8] D. Lasky, E. Becerra, W. Boto, M. Otim, and J. Ntambi, Obesity and gender differences in the risk of type 2 diabetes mellitus in Uganda, Nutrition, 2, vol. 18, no., pp [9] A. A. Motala, M. A. K. Omar, and F. J. Pirie, Epidemiology of type 1 and type 2 diabetes in africa, Journal of Cardiovascular Risk, 3, vol., no. 2, pp [] A.B. Okesina, D.B. Oparinde, K.A. Akindoyiri, B.T. Eramus. Prevalence of some risk factors of coronary health diseases in rural Nigeria, [11] A.L. Klatsky, C.S. Delca and F.C. Barrtter. The effect of high sodium and low sodium intake on blood pressure and other related variables in human subjects with idiopathic. HTNJ, [12] Y.A. Al-Turki. The prevalence of overweight and obesity amongst hypertensive and diabetic adult patients in primary health care. Saudi Medical Journal,, 21(4), [13] T. J. Aspray, F. Mugusi, S. Rashid et al., Rural and urban differences in diabetes prevalence in Tanzania: the role of obesity, physical inactivity and urban living, Transactions of the Royal Society of Tropical Medicine and Hygiene, vol. 94, no. 6, pp February 13 IJENS