CHAPTER ONE

INTRODUCTION

Background of the Study

Hypertension remains a major global public health challenge that has been identified as the leading risk factor for cardiovascular morbidity and mortality (Reynolds, 2014). It increases hardening of the arteries, thus predisposing individuals to heart diseases, peripheral vascular diseases, stroke, heart failure and kidney failure. Hypertension is the commonest non-communicable disease in the world and all races are affected with variable prevalence.

Castelli (2012) explained that its prevalence is on the increase in developing countries where adoption of western lifestyle and stress of urbanization, both of which are expected to increase morbidity associated with unhealthy lifestyle are not on the decline.

Grigs (2013) were of the opinion that hypertension produces disruptions in health, disability and death in the adult population worldwide. Ejike and Ugwu (2011) stated that hypertension causes one in every eight deaths worldwide, making it the third leading killer disease in the world. They also estimated that about one billion adults, the world over, had hypertension in the year 2010 and the number is expected to rise to 1.56 billion in the year 2025 if positive intervention programme is not made. George (2013) indicated that fifty million Americans have high blood pressure, approximately one in three adults. In United States of America, approximately twenty eight (28) to thirty one per cent of adults have hypertension. Of this population, 90 to 95 per cent have primary hypertension (high blood pressure related to unidentified cause). The remaining five to ten per cent of this group have secondary hypertension (high blood pressure related to identified cause). In China, almost 130 million people aged 35-74 years are estimated to be hypertensive (Camel & Delene, 2006).

Similarly in Ghana, studies revealed a hypertension prevalence of forty per cent among rural dwellers and eight per cent to thirteen per cent in the urban areas. In sub-Saharan Africa, it is the most rapidly rising cardiovascular disease and affecting over 20 million people (Kadiri, 2015). He also stated that in Nigeria, hypertension is the commonest non-communicable disease with over 4.3 million Nigerians above the age of fifteen years classified as being hypertensive. Hypertension, also known as high blood pressure is the persistent blood pressure in the arteries above ninety millimeters of mercury (mmHg) between the heart beats (diastolic) or over 140 millimeters of mercury (mmHg) at the beats (systolic) (Aquilla, 2008).

According to Hyman and Parlik (2013), hypertension is the persistent raised levels of blood pressure in which the systolic pressure is above 140 mmHg and diastolic pressure above 90 mmHg. The normal blood pressure is below 120/80 mmHg; blood pressure between 120/80 and 139/89 is called Pre-hypertension, and a pressure of 140/90 or above is considered high (abnormal) blood pressure. According to Expert Committee on Non-Communicable Diseases (2013), blood pressure of 120/80 mmHg is considered normal for a 30 year old person, while blood pressure of 140 mmHg is considered high for such a person. Similarly, blood pressure of 150/90 mmHg is considered normal for a 60-year old person, while blood pressure of 160/100 mmHg is high for such a person.

Hypertension is sometimes called “the silent killer” because people who have it are often symptom-free. In this study, hypertension is perceived as a systolic blood pressure greater than 140 mmHg and a diastolic blood pressure greater than 90 mmHg among adults. The top number which is the systolic pressure corresponds to the pressure in the arteries as the heart contracts and pumps blood forward into the arteries. The bottom number which is the diastolic pressure represents the pressure in the arteries as the heart relaxes after contraction. The diastolic pressure reflects the lowest pressure to which the arteries are exposed. Blood pressure is normally measured at the brachial artery with a sphygmomanometer (pressure cuff) in millimeters of mercury (mmhg) and given as systolic over diastolic pressure. Hypertension is classified into two namely; primary and secondary hypertension.

According to Stanler (2014), hypertension is categorized into primary and secondary hypertension. Primary hypertension has an unknown cause and accounts for ninety per cent to ninety five per cent of all hypertension cases (Chris, 2009). This type of hypertension is strongly associated with lifestyle. Usually, the patients do not have many signs and symptoms but may experience frequent headache, tiredness, dizziness or nose bleeds. Although the cause is not known, obesity, smoking, alcohol, diet and heredity play a role in essential or primary hypertension. Secondary hypertension has a known cause and accounts for five per cent to ten per cent of all hypertension cases. Chris (2009) maintained that the most common cause of secondary hypertension is an abnormality in the arteries supplying blood to the kidneys. Other causes include airway obstruction during sleep, stress, diseases and tumors of the adrenal glands, lifestyle, spinal cord injury, hormone abnormalities (oral contraceptive estrogen replacement), thyroid disease, toxemia of pregnancy, renal problems such as vascular lesion of renal arteries, diabetic neuropathy, pains as well as anxiety and hypoglycemia.

There are some factors which predispose adults to hypertension. The risk factors of hypertension are genetic factor which can be inherited from parents, age which when the body does not retain the amount of elasticity as it used to in the early years of life, obesity which is an increase in weight of over ten per cent above normal body index due to generalized deposition of fat in the body, excessive salt intake which increases blood pressure, stress which produces chemical substances that cause generalized vasoconstriction, oral contraceptive which contains estrogen that causes salt retention that increases the volume of blood, sedentary lifestyle which has the tendency of increasing body weight and directly raises blood pressure, elevated levels of plasma lipids particularly cholesterol, excessive alcohol consumption which increases blood pressure and tobacco use (cigarette smoking) that contains nicotine which causes constriction of the blood vessels. The signs and symptoms of hypertension recognized by Thatch and Schultz (2011) include occipital headache, dizziness, restlessness, failing vision, shortness of breath, and rapid increased heartbeat. Adults should possess the knowledge of risk factors in order to prevent hypertension. This will help them recognize and prevent or treat hypertension when these signs occur.

Knowledge is used to cover such related terms as facts, information, understanding, awareness, insight, wisdom, reasons, comprehension, meaning, concept and experience (Albelum, 2007). It is an organized body of knowledge shared by people. Nnachi (2007) conceptualized knowledge as the ability to understand or comprehend phenomena, the acquisition of positive information by the exercise of some capacity which humans presumably have in common. Health knowledge could be said to mean putting into reality the art of mobilization of resources by an individual, intellectually, physically and emotionally.

Hamburg and Russell (2009) opined that health knowledge and understanding of related factors have a favourable effect on quality of overall well-being. They went further to state that one’s exposure to proper health knowledge will influence positively the person’ss health attitude and practice, and thus, one could rightly say that knowledge is the key to optimum well-being. Umaru (2003) pointed out that knowledge comes about as a result of learning through cognitive, affective and psychomotor domains. In this study, knowledge is referred to as all understanding and familiarity gained by learning and experience that will enable adults to recognize risk factors as well as recognizing and use of preventive measures of hypertension. Knowledge of hypertension is an important prerequisite for an individual to implement desirable behavioural practices towards its prevention. Lack of such knowledge will lead to aggravated health problems. Adults should therefore, possess adequate knowledge of risk factors of hypertension in order to prevent the disease.

Risk factors are defined by Lothar, Gottfried and Heide (2011) as individual characteristics which affect the person’s chances of developing a particular disease or group of diseases within a defined future time period. According to Lucas and Gilles (2003), risk factor is anything that has been identified as increasing an individual’s chances of getting a disease or developing a condition. They will be considered to be at risk of developing hypertension, those with habits or characteristics which increase the likelihood of developing hypertension. Risk factors in this study, refers to the characteristics, conditions or behaviors such as excess salt intake and smoking which increase the probability of hypertension to occur. When risk factors are related to hypertension, they are known as risk factors of hypertension. Risk factors of hypertension are of two types: those ones that can be changed and those that cannot be changed. The risk factors that can be changed are obesity, excess salt intake, smoking, environmental stress, oral contraceptives, sedentary lifestyle, elevated levels of plasma lipids and unregulated secretion of aldosterone. Risk factors that cannot be changed are genetic predisposition, age and gender. Adults should have adequate knowledge of the risk factors to be able to prevent hypertension. Preventive measures are interventions directed to avert the emergence of specific disease, reducing their incidence and prevalence in population. Starfield, Hyde, and Gervas (2007) defined preventive measures as all measures that limit the progression of a disease at any stage of its course. In this study, preventive measures is referred to as all the activities whose primary purpose is to promote, restore and maintain health, and those practices which are directed towards preventing hypertension among adults. There are two types of preventive measures; primary and secondary. Primary prevention is the intervention that averts the occurrence of a disease or actions taken prior to the onset of disease which removes the possibility that a disease will occur. It signifies intervention in the pre-pathogenesis phase of a disease or health problem. It may be accomplished by measures designed to promote general health and well-being, and quality of life of adults (health promotion) or by specific protective measures (specific protection). Secondary prevention is action which slows the progression of a disease at its incipient stage and prevents complication. Salama (2011) opined that the specific intervention in secondary prevention is early detection of hypertension which involves screening test. It attempts to arrest the disease process, restore health by seeking out unrecognized disease and treating it before irreversible pathological changes take place especially among adults.

Statement of the Problem

It is expected that adults should practice healthy lifestyles such as regular exercise, maintaining weight at 15 per cent or less of desirable weight, management of stress, moderation of alcohol consumption, avoidance of tobacco smoking, increase intake of fruits and vegetables, increase intake of low-fat diary products and reduction of excessive salt intake to prevent hypertension and improve optimum wellbeing. Adults should have basic knowledge of these healthy lifestyle behaviours while growing up through health education to be able to prevent cardiovascular diseases such as hypertension.

Regrettably, most adults due to ignorance of risk factors and preventive measures of hypertension engage in unhealthy lifestyles such as excessive consumption of alcohol, sedentary lifestyle, excess consumption of sodium intake, tobacco and cigarette smoking, obesity, reduced intake of fruits and vegetables, stress and consumption of foods rich in cholesterol. These unhealthy lifestyle practices have increased the prevalence of hypertension in the world including Nigeria, which culminates into high cases of deaths. Hypertension is one of the problems affecting especially a great portion of the adult population and currently causes one in every eight deaths worldwide, making it the third leading killer disease in the world. Ejike, Ezeanyika and Ugwu (2010) estimated that about one billion adults had hypertension in the year 2010, and the number is expected to rise to 1.56 billion in the year 2025. In addition, hypertension is the commonest non-communicable disease in Nigeria with over 4.3 million Nigerians classified as being hypertensive. In Nigeria, many people lose their lives to hypertension. This is not an acceptable situation, considering the fact that hypertension is preventable and manageable to reduce its impact on the health and lives of people in Nigeria.

Purpose of the Study

The purpose of the study is to determine the Social Factors Influencing the occurrence of Hypertension in Gboko Local Government of Benue state. Specifically, the study was set to determine:

i.                   The level of knowledge of hypertension.

ii.                 The social factors influencing the occurrence of hypertension.

iii.              The strategies that could curb the problems of hypertension.

Significance of the Study

The results of this study may be useful to health educators, medical and paramedical officers, public health officers, counselors, media educators, researchers, curriculum planners, government and adults in many ways.

The study may help to develop a positive regard towards hypertension. The Ministry of Health may benefit from the study by discovering a gap in knowledge of the population, and emphasize strategies to teach the adult population on how to prevent the risk factors.

It may also be useful to other researchers to carry out this study in areas where disease prevention measures and health promotion are needed with regards to hypertension.

The anticipated results from the study of knowledge of signs and symptoms of hypertension will generate new knowledge relating to the effectiveness of health education and intervention programmes to improve the knowledge of signs and symptoms associated with hypertension for adults. It may likely be useful to health educators on the need to create awareness on the signs and symptoms of hypertension.

The results generated from the study on knowledge of risk factors of hypertension revealed those risk factors that have been in existence over the years, which have been predisposing people to hypertension. The results may be useful to health educators, media educators and medical officers in sensitizing community members through awareness campaigns in the form of seminar to alert people on the risk factors of hypertension.

The results generated from the study on knowledge of preventive measures of hypertension revealed the preventive measures that may promote health and well-being. The results may be useful to health educators, medical and paramedical officers and centre for disease control agencies in organizing orientation endeavours to raise level of awareness of the masses on measures of preventing hypertension.

The health and allied educators may use the results of the study to educate adults and encourage them to practice healthy lifestyles that will promote their health and be conscious of their health.

The results may be useful to health care providers and health educators who may want to embark on further enlightenment campaigns on preventive measures of hypertension and also plan hypertension intervention programmes.

The results generated from the study on the knowledge of hypertension according to age revealed those measures that will help in the prevention of hypertension for various age groups. It may be useful to health educators, individuals, media and administrators in creating awareness on the preventive measures of hypertension to the various age groups that will be mostly affected.

The health educators may direct their teachings to the age group that is negatively affected by risk factors of hypertension. The results of the study may also provide useful information needed by health administrators in planning appropriate intervention against the increasing trend of the disease in the society.

 It may serve as a reminder to individuals on the possible measures for the prevention of hypertension. Health and allied educators may find the results of this study beneficial, and they will be armed with adequate information on how to prevent hypertension for different segments of the population.

Research Questions

The following research questions were posed to guide the study.

i.                   What is the level of knowledge of hypertension in the study area?.

ii.                 What are the social factors influencing the occurrence of hypertension?

iii.     What strategies could be adopted to curb the problems of hypertension?

Scope of the Study

The study covered the Factors Influencing the occurrence of Hypertension in Gboko Local Government of Benue state. It is hoped that the social factors influencing the hypertension would have been known in the study area in the course of this research work.

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