Prevalence of Undiagnosed Hypertension and its risk factors among health care workers of some selected hospitals in Dutse, Jigawa State, North western Nigeria.

Abstract

Abstract
Hypertension remains a major global public health challenge as the leading risk factor for cardiovascular morbidity and mortality Annually, it accounts for 7.1 million (one-third) of global preventable premature death. The study was carried out to determine the prevalence of undiagnosed hypertension and associated risk factors among healthcare workers in Dutse, Jigawa state.
The study is a cross sectional in which 107 participants were recruited using convenient sampling technique. All the participants’ blood pressure was measured using mercury sphygmomanometer and a stethoscope. Height and weight was measured and was used to calculate BMI. A data sheet was used to assess other risk factors of hypertension (age, gender, obesity, occupational stress, family history, physical activity level, dietary habits and smoking). The data obtained was analyzed using both descriptive and interferential statistics. The descriptive (mean, standard deviation & percentage) and inferential (Pearson &Spearman) statistics were used to summarize the data. Alpha level was set at <0.05. All statistical analyses were performed using the Statistical Package for Social Science (SPSS) version 16.0.
Out of 107 participants, 69(64.5%) were male and 38(35.5%) were female. the mean age of the participants was 32.8 ±7.54 years, SBP was 124 ±12.50 mm Hg, DBP was 79 ±10.54 mm Hg and BMI was 22.3 ±4.09 kg/m2. About 30(28.0%) nurses participated, 25 (23.3%) of the participant where medical doctors, 16 (14.9%) are from medical laboratory scientist, 12(11.2%) are from radiographers, pharmacist and physiotherapist each. Prevalence of undiagnosed HTN was found to be 26.2% in the participants. Age, BMI, and physical activity level were found to be significantly associated with HTN (p ? 0.05). On the other hand, occupational stress, family history of HTN, dietary habits and smoking showed no significant relationship p ? 0.05).
A moderate prevalence of undiagnosed hypertension was found and hypertension is associated with age, BMI, and physical activity level. Therefore, physical activity and weight reduction programmes should be encouraged among health care workers, the need for services to detect and manage undiagnosed cases through regular blood pressure measurements is recommended.
Keywords: Undiagnosed Hypertension, Health care Workers, Hypertension

Full text

ORIGINAL PAPER Adv Sci Med 2016; 1(2): 19-23
© 2016 HIST-MED Lublin
19
Prevalence of undiagnosed hypertension and its associated risk factors
among healthcare workers of some selected hospitals in dutse , jigawa
state, north western Nigeria
Farida Garba Sumaila
1A-F
, Aishat Shittu
1DEF
, Abbas Sufiyan Idris
2AB,
Muhammad Aliyu Abba
1
EF
1.
Department of Physiotherapy, Bayero University Kano, Kano, Nigeria.
2.
Department of Physiotherapy, Rasheed Shekoni Specialist Hospital Dutse, Jigawa State, Nigeria
Received: June 18.2016; Accepted: June 27.2016
Abstract
Hypertension remains a major global public health challenge as the leading risk factor for cardiovascular morbidity and mortality
Annually, it accounts for 7.1 million (one-third) of global preventable premature death. The study was carried out to determine the
prevalence of undiagnosed hypertension and associated risk factors among healthcare workers in Dutse, Jigawa state.
The study is a cross sectional in which 107 participants were recruited using convenient sampling technique. All the participants’ blood
pressure was measured using mercury sphygmomanometer and a stethoscope. Height and weight was measured and was used to
calculate BMI. A data sheet was used to assess other risk factors of hypertension (age, gender, obesity, occupational stress, family history,
physical activity level, dietary habits and smoking). The data obtained was analyzed using both descriptive and interferential statistics.
The descriptive (mean, standard deviation & percentage) and inferential (Pearson &Spearman) statistics were used to summarize the
data. Alpha level was set at <0.05. All statistical analyses were performed using the Statistical Package for Social Science (SPSS) version
16.0.
Out of 107 participants, 69(64.5%) were male and 38(35.5%) were female. the mean age of the participants was 32.8 ±7.54 years, SBP
was 124 ±12.50 mm Hg, DBP was 79 ±10.54 mm Hg and BMI was 22.3 ±4.09 kg/m2. About 30(28.0%) nurses participated, 25 (23.3%)
of the participant where medical doctors, 16 (14.9%) are from medical laboratory scientist, 12(11.2%) are from radiographers,
pharmacist and physiotherapist each. Prevalence of undiagnosed HTN was found to be 26.2% in the participants. Age, BMI, and physical
activity level were found to be significantly associated with HTN (p ? 0.05). On the other hand, occupational stress, family history of
HTN, dietary habits and smoking showed no significant relationship p ? 0.05). A moderate prevalence of undiagnosed hypertension was
found and hypertension is associated with age, BMI, and physical activity level. Therefore, physical activity and weight reduction
programmes should be encouraged among health care workers, the need for services to detect and manage undiagnosed cases through
regular blood pressure measurements is recommended.
Keywords: Undiagnosed Hypertension, Health care Workers, Hypertension
Introduction
Hypertension remains a major global public
health challenge as the leading risk factor for
cardiovascular morbidity and mortality [1] [2]. Annually, it
accounts for 7.1 million (one-third) of global preventable
premature deaths [2] [3] [4].
An elevation of the systolic and/or diastolic blood
pressure increases the risk of developing heart disease,
kidney disease, arteriosclerosis, eye damage, and stroke
[5]. These complications of hypertension are often
referred to as end-organ damage because damage to these
organs is the end result of chronic high blood pressure [6].
Diagnosis of hypertension is made by the
observation of persistently high blood pressure, this needs
accurate measurement of blood pressure on at least two
different occasions, in each time the individual is given
enough time to relax [5]. In very high blood pressure levels
(SBP?160 mmHg and/or DBP ?100 mmHg) with evidence
of target-organ damage only one reading is necessary to
start on treatment [6].
In the United States, essential hypertension has
been associated with Family history of hypertension,
advanced age, African-American race, obesity, inactivity,
cigarette smoking, excessive salt intake and excessive
alcohol intake [6].A number of physical and psychological
factors associated with individuals occupation can
increase their risk of developing cardiovascular diseases,
numerous studies carried out mainly in Europe and USA
have shown a higher incidence of cardiovascular disease
(CVD) in certain occupations such as swing shift, bus,

FG Sumaila, A Shittu, A Idris
,
MA Abba
© 2016 HIST-MED Lublin
20
tractors and taxi drivers [6] [7].
A large numbers of people with hypertension are not
aware they have this condition and highlight the need for
targeted case finding to help manage undiagnosed
hypertension and reduce future health damage. The
national RoI data suggest that there are approximately five
adults aged 45+ years with undiagnosed hypertension for
every three adults aged 45+ years with clinically
diagnosed hypertension [7].
Specifically on health care workers, various
studies were conducted in different part of the world on
general inclination of CVD risk factors among this
occupational category[1] [3] [4] [5] [7] [8] [9]. In Havana,
Cuba, cardiovascular disorders were found to be a
significant health problem among health care workers,
with hypertension having the highest incidence. It is
unknown whether the several CVD risk factors especially
hypertension that where observed among healthcare
workers in certain parts of the world are also common
among health care workers in Jigawa state, though
healthcare workers are very critical, and effective in
primary prevention of undiagnosed hypertension and its
risk factors, there is tendency for them to ignore
themselves.
This therefore, informed the formulation of the study
which was aimed at determining the prevalence of
undiagnosed hypertension and its risk factors among
health care workers in Dutse, Jigawa state.
METHODOLOGY
The research was a cross sectional study, which was
conducted to estimate the prevalence of the result of the
interest for a given inhabitants that was conducted in
Jigawa state, Nigeria. The population of this study
comprised of all nurses, medical doctors, physiotherapist,
pharmacist, Radiographers and medical laboratory
scientist working in the Rasheed Shekoni Specialist
Hospital(RSSH) and General Hospital Dutse (GHD) of
Jigawa state.
Participants
A total of 107 participants were recruited for the study
using convenient sampling technique. All serving
healthcare worker in RSSH and GHD that have no history
of hypertension were included in the study and pregnant
women were excluded.
Procedure
Ethical approval was sought from ministry of health
Dutse and RSSH, informed consent was given to the
participants, and only those that signed participated in the
study. The measurement of Blood pressure, weight and
stature was taken, Body Mass index (BMI) was calculated.
In addition Stress measuring Questionnaire (international
stress management Association ISMA QUESTIONNAIRE)
was used to measure the occupational stress while Global
physical activity questionnaire was used to assess the
physical activity level.
Risk factors of Hypertension were categorized and
assessed:
(a) Age: - The age of participants was recorded in
years. The age associated risk grouped as follows: [8].
(1) 19-49yrs = at no risk
(2) ?50yrs = at risk
(b) Obesity: - This was assessed using BMI values.
BMI outcomes from 25 to 29 is considered overweight,
with BMI outcomes equal to and greater than 30
indicative of obesity [9].The obesity associated risk was
coded as:
0 = at no risk
1 = at risk
(c) Family history of HTN: - An individual having a
family history of HTN was considered at “at risk” [10] and
was coded as:
0 = at no risk
1 = at risk
(d) Smoking: - An individual who is currently a
smoker or have ever smoked in his lifetime was
considered at risk of HTN [11]. It was coded as:
0 = at no risk
1 = at risk
(e) Dietary habits: an individual with poor dietary
habits was considered at risk of HTN [3]. And was coded
as:
0 = at no risk
1 = at risk
(f) Occupational stress:- Occupational stress
participant was considered at risk of developing HTN
using ISMA questionnaire
0 = at no risk
1 = at risk
(g) Physical inactivity using Global physical activity
questionnaire
1 = low physical activity = at risk
2= moderate at no risk
3= high at no risk
Data Analysis Procedure
The data obtained was analyzed using both descriptive
and inferential statistics. The descriptive statistics was
used to summarize data using mean, median, standard
deviation and percentage. Inferential statistics of
Spearman and Pearson was used to determine
relationship between BP and risk factors of HTN. P value
of <0.05 was use to show significance relationship. All
statistical analyses were performed using the Statistical
Package for Social Science (SPSS) version 16.0
Results
The study sample consisted of 107 healthcare workers
69(64.5%) were male and 38(35.5%) were female. The
mean age of the participants was 32.8 years,this study
found that majority of the participants fall within the
middle age category and they are averagely normal weight
individuals. The result also showed that the BP of the
participants is in the safer range as shown in the table 1
below.

Prevalence of undiagnosed hypertension and its associated risk factors among healthcare workers of some selected hospitals in dutse ,
jigawa state, north western Nigeria
© 2016 HIST-MED Lublin
21
Table 1: Physical/anthropometric characteristics of participants
Variables Mean± SD
Age (years) 32.28±7.54
W (Kg) 59.45±11.30
H (m) 1.64±.099
BMI (Kg/m2) 22.31±4.09
SBP (mmHg) 123.89±12.50
DBP (mmHg) 78.29±10.54
Key: W= weight kg=kilogram H= height m=meters BMI= Body mass index SBP=systolic blood pressure DBP= diastolic blood pressure
About 30(28.0%) nurses participated, 25 (23.3%) of the participant are medical doctors,12 (11.2%) participants are
physiotherapist,16(14.9%) are medical lab scientist,12(11.2%) are radiographers and 12(11.2%) are pharmacist the result are
illustrated in the table 2 below.
Table: 2 frequency distribution of the occupational status of participants
Variables n %
NURSING 30 28.0
MEDICAL DOCTORS 25 23.3
PHYSIOTHERAPIST 12 11.2
MEDICAL LAB SCI 16 14.9
RADIOGRAPHERS 12 11.2
PHARMACISTS 12 11.2
TOTAL 107 100
Key: n= frequency %= percentage
Table: 3 Frequency distribution of Physical activity level of the participants
Variables n %
LOW 53 49.5
MODERATE 37 34.6
HIGH 17 15.9
TOTAL 107 100.0
Key: n= frequency %= percentage
The above table shows that 49.5% have low physical activity level, 34.6% moderate and 15% presented with high physical activity level
Table 4: Descriptive statistics of risk f actors of HTN
Variables n (%)
At no risk At risk
FHXDM 92(86.0) 15(14)
FHXHTN 79 (73.8) 28 (26.2)
DIETARY HABITS 75 (70.1) 32 (29.9)
SMOKING 94 (87.9) 13
Key: Hx=history HTN=Hypertension DM =Diabetes
The table above describes some risk factors of hypertension with dietary habits being the highest followed by family history of hypertension.
Table 5: Hypertension status categories of the participants
Variables n (%)
Hypertension status
NORMAL 79 (73.8)
HYPERTENSIVE 28 (26.2)
Key: n= frequency %= percentage
As shown in the table above, moderate numbers of the participants were newly diagnosed as hypertensive.
The table 6 below draws correlation between physical/anthropometric characteristics, some risk factors and the undiagnosed
hypertension.
Table 6: Pearson and Spearman correlation summary showing relationship between undiagnosed HTN and risk factors of HTN
Variables R P-value
GENDER 0.113 0.032
AGE 0.251 0.024
BMI 0.208 0.001
OCCUPATIONAL STRESS -0.079 0.133
PHYSICAL ACTIVITY LEVEL -0.193 0.001
FAMILY HISTORY OF DM 0.039 0.460
FAMILY HISTORY OF HTN -0.040 0.441
DIETARY HABITS 0.074 0.158
SMOKING 0.070 0.182
Key: BMI=Body mass index R=correlation coefficient P-value at 0.05

FG Sumaila, A Shittu, A Idris
,
MA Abba
© 2016 HIST-MED Lublin
22
Discussion
The prevalence of undiagnosed hypertension among
health care workers in Dutse was found to be 35.4% which is
higher than the 27% prevalence reported in Zimbabwe
general population [10]. Similar report was documented in an
attempt to determine the prevalence of undiagnosed HTN in
an emergency department of Imam Hossein Medical and
Educational center, Teheren, Iran. The prevalence was found
to be 28.6%. Barron et al, conducted a similar study among
adults aged 45+ years, and found the prevalence of
undiagnosed hypertension to be 62% [11] [12].
Das et al, reported 24.9% of undiagnosed hypertension in
West Bengal, Yadav et al, reported 32.2% hypertension from
Lucknow in the rural Central India, Kannan et al, From
eastern India, Hazarika et al, reported a prevalence of 33.3%
in the age group of 30 years and above among the native
population of Assam[13] [14] [15]. While hypertension was
13% in rural adults more than 30 years of age in Jammu,
Chow et al, reported 27% hypertension in rural adults > 30
years of Andhra Pradesh. This was similar to that reported
from industrialized economies [16].
In this study, the prevalence of hypertension was found to
increase significantly with increasing age. Similar findings
were reported by different researchers in various parts of
India. In a north Indian study, they noted that hypertension
was highest in the age group 60-69 years (64%). Comparable
reports were found from many other countries, Erem et al.
from Turkey, Wang et al. from US and Lim et al. from
Malaysia noted similar trends [17] [18] [19].
This study shows no significant relationship between dietary
habits and HTN. It is in consistent with a report by [10]. In
contrast, Reddy et al, showed a significant relationship
between the prevalence of hypertension and dietary habit
[20].
Physical activity level was significantly correlated with
hypertension in this study. But it was noted that hypertension
is significantly associated with sedentary life style Prevalence
of hypertension was significantly more in people who lead a
sedentary life style [14] [21] [22] [23] [24] [25]. There was no
significant relationship between occupational stress and
hypertension, similar finding was reported [26]. Occupational
stress, or job strain, resulting from a lack of balance between
job demands and job control, is considered one of the
frequent factors in the etiology of hypertension in modern
society. Stress, with its multifactorial causes, is complex and
difficult to analyze at the physiological and psychosocial
levels [25] [26].
Family history of hypertension was not significantly
associated with hypertension in the current study. Similar
finding was reported [14] [26]. But positive association of
hypertension with family history was reported [17] [27] [28]
[29].
Smoking habit was not significantly associated with
hypertension. Divan et al. and Yadav et al, showed similar
findings [14][28]. Others reported no association [21][23][26]
[29] [30].
It was noted from this study that hypertension is significantly
associated with Body Mass Index. Similar findings were
reported [14][17] [21] [22][29] [30] [31].
Conclusion
A moderate prevalence (35.4%) of undiagnosed
hypertension was found among health care workers in Dutse,
Northwestern Nigeria. Hypertension was found to be
associated with Age, BMI, and Physical Activity level.
Recommendation
Health care workers should be encouraged to have
routine check-up of their blood pressure so as not to neglect
themselves. Awareness should be promoted among
healthcare workers on the need for them to participate in
more physical activity and weight reduction so as to reduce
the impact of the relationship between physical activity, BMI
and Hypertension.
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Correspondence address
Farida Garba Sumaila
Address: Department of Physiotherapy, Bayero University
Kano, Kano, Nigeria.
Email: fareedat2006@gmail.com
Conflict of interest:
The authors have declared no conflict of interest.