An investigation into the effects of sociodemographic characteristics and lifestyle factors on

hypertension
Introduction

Hypertension is defined as the systolic blood pressure (SBP) of ≥140 millimetres of mercury

(mmHg) and/or diastolic blood pressure (DBP) ≥90 mmHg, self-reported physician

diagnosis, or the use of anti-hypertensive medication (Chobanian et al. 2003). Many

researcher/ scientists argue that an individual is said to express the issue of hypertension,

their blood pressure tends to exceed levels of 140/90mmHg. The normal and the standard

blood pressure is said to be around 120/80 mm/Hg. Scientists claim that some individual

tends to express high blood resting pressure naturally when compared to others. Therefore, it

is advisable for people in different situations has comparative tests. However, getting one's

blood tested at a doctor’s room might be one of the worst things ever in the process of getting

an accurate reading since many individuals are said to be quite stressed out while they are

there. According to research studies, high blood pressure is said to be one of the major risk

factors that are associated to mortality as well as one of the most leading causative agents of

disability-adjusted life-years (DALYs) in the global world (Ezzati et al., 2002; Hendricks et

al., 2012). Hypertension which is also referred to high blood pressure has been a very

fundamental and a critical issue of public health concern in which the World Health

Organization has recently rated hypertension and its global mortality rate as 14%. It is very

critical to mention that hypertension has been greatly involved in contributing to 27% of the

Americans and European myocardial infections.

Literature review

It is a fact that World Health Organization has been giving high blood pressure the highest

priority in the process of trying its level best in tackling the issue of its epidemic as well as

trying to reducing its prevalence and incidence rates. It is a fact that hypertension can be

controlled as well as being prevented because high blood pressure is commonly associated

with lifestyles such as tobacco habits, it is also associated with individuals would do not do

practice physical exercises as well as excessive consumption of alcohol. Blood pressure is

critically how blood presses against the wall of the blood vessels walls. In addition,

individuals who have been detected to have hypertension, their blood tend to push against the

walls of the blood vessels too strongly and excessively. People with high blood pressure may

express the following symptoms; fatigue which can be either physical or mental where the

victims may tend to feel confused for no reason. Individuals may also have an aspect of blood

in urine, ruthless heart beating through their chest, blurred vision and so many other

symptoms.

Additionally, hypertension contributes to the global incidence of cardiovascular disease,

because it is highly contributing to heart related diseases in the world (Lawes et al., 2008).

Epidemiological studies have explored the relationship between hypertension and life

expectancy in adults. For instance, Franco et al. (2005) life expectancy that has been explored

at 50 years of about 3000 individuals suspected to have high blood pressure compared to

healthy men and women from the Study by Framingham Heart. The results of the study

indicated that those healthy individuals lived 0.2 years more that the hypertensive. Similarly,

lifestyle factors such as unhealthy diets, tobacco use, lack of physical activity, as well as

excessive consumption of alcohol increase the risk of developing hypertension (WHO, 2013).

Lifestyle factors are also related to the aging thus leading to higher explore for individuals to

contract hypertension.
Furthermore, social determinants of health are a complex term that combines several numbers

of variables that include wealth, education, occupation, and household income as well as the

place of residence are known to be associated with increased blood pressure levels (Clark et

al. 2009; Havranek et al. 2015). These social economic factors have well been established as

the cardiovascular-related risk factors as well as the means predicting behaviour. Disparities

in social determinants lead to health inequalities (Arcaya et al. 2015). These disparities are

influenced by the socioeconomic status (SES) of individuals. Socioeconomic is always in

respective with how individuals in the society are educated, their working condition and their

level of wealth. Thus, a person of low SES is said to be an individual with little or no formal

education, belonging to a lower wealth class, not employed as well as working on a very low

paying job. Education level is said to establish itself as the major maker of socioeconomic

status since it is said to offer the most influential measure in terms of individual-level thus

not having the issue of reverse causation like wealth and income status. Most often,

individuals with high socioeconomic status tend to enjoy healthier life which is contrary to

individuals of low socioeconomic status (Marmot, 2005).

This study aims to investigate the effects of lifestyle factors (smoking), demographic

characteristics (age and gender), socioeconomic factors (employment), and comorbidities

(cardiovascular conditions, overweight/obesity) on hypertension. High blood pressure as

adopted in this research I is defined by SBP of ≥140 mmHg as well as the DBP of ≥90

mmHg.

Methods
Study Design and Data Collection

The study entailed a secondary analysis of previously gathered data in a cross-sectional

design study using a self-completed questionnaire. The data used in the survey were obtained

from randomly selected primary care practices. The survey captured elements of

socioeconomic status, age, gender, lifestyle habits, education and occupation among others.

Sample Size

The sample size was computed using an online calculator with a power set at 0.8, significant

level at 0.05, as well as effect size at 0.5. The required sample size for this research is 128

people (64 in each group). The study included a random sample of 998 participants aged 16-

97 years.

Outcome Variables

Hypertension

SBP and DBP were measured. The mean of the 2nd and 3rd readings was obtained. The

variable for hypertension was derived from the two variables ‘newsyst’ and ‘newdiast’

respectively. Thus, the definition of high blood pressure is stated as SBP of ≥140 mmHg as

well as the DBP of ≥90 mmHg. High blood pressure was classified into two categories as

follows:

• Normotensive is indicated by (SBP <140 mmHg / DBP <90 mmHg)

• Hypertensive is indicated by (SBP ≥140 mmHg / DBP ≥90 mmHg)

Other Covariates

Age in years

The age of participants was obtained as a continuous variable.

Age categories

Age was classified into five different categories as follows: 15-30, 31-45, 46-60, 60-75 and

75 years and above.

Gender

Information on gender was obtained where participants identified whether they were ‘Male’

or ‘Female’.

BMI Status

Weight (in kilograms) is divided by the square of height (in meters).

Overweight and obesity classification was based on the following categories:

• Normal body weight (BMI ≤ 25.0 kg/m²)

• Overweight and Obesity (BMI ≥25.0 kg/m²)

Cardiovascular Condition

Participants were asked to report whether the currently had cardiovascular condition.

Health Status

Self-reported health status of the participants was recorded on a Likert scale ranging from 1-5

with 1= “Very Good” and 5= “Very Bad”.

Working Status

Reported working status of the participants was recorded on

Smoking Status
Participants were asked whether they had smoked for the last six months and if so they were

classified into ‘noncurrent smokers’ or ‘current smokers’

Marital Status

Participants were asked about their marital status. Responses obtained were ‘married’,

‘cohabiting’, ‘single’, ‘widowed’, ‘divorced’, and ‘separated’. For the purpose of this

research, marital status has been classified into three different categories as such:

• cohabiting as well as married

• single

• Divorce/Separated or widowed

Hypotheses

There are five proposed hypotheses for this research:

a) There is no difference in hypertension status between males and females

b) Hypertension status does not vary between current smokers and noncurrent smokers

c) Hypertension status does not vary between employed and unemployed participants

d) There is no difference in hypertension status between normal weight participants and

participants that are overweight or obese

e) Hypertension status does not vary by cardiovascular disease status.

Data Analysis

Test for Normality

The Shapiro-Wilk test (Coin, 2008) was used to evaluate the shape and distribution of the

variables. The normality test was conducted to help the author determine whether to carry out

parametric or non-parametric tests during analysis.

Descriptive Statistics

The descriptive statistics involved exploring the characteristics of the study participants and

stratifying the study participants by hypertension status. The means of the continuous

variables (age) was explored by the use of independent samples t-test (Kirkwood and Sterne,

2003). In addition, the proportions of determining the categorical variables (gender, age

group, employment, physical activities, health status, and cardiovascular diseases) were

compared across strata by adopting use of Pearson’s chi-square (X2) test (Kirkwood and

Sterne, 2003).

Regression Analysis

We also adopted the use of logistic regression models in order to explore the relation between

the dependent variable (hypertension) and all independent variables included in the analysis.

This analysis was conducted to control for confounders and obtain adjusted measures of

hypertension (Kirkwood and Sterne, 2003).

The first step of the regression analysis entailed a bivariate logistic regression analysis where

the regression model had to include the independent variable and the dependent variable

(Kirkwood and Sterne, 2003). The measures of effect were then presented by the use of odds

ratios (OR) with the case of 95% of the confidence intervals (CI) as well as the p values. P

values < 0.05 indicated statistical significance.

The second step entailed a multivariable logistic regression where all variables included in

the bivariate regression analysis were included in the final multivariable model (Kirkwood

and Sterne, 2003). The measure of effect was presented using adjusted odds ratios (AOR)

with 95% of the confidence intervals as well as the P values.

Goodness-of-fit of the Final Model

The Hosmer-Lemeshow test is a fact that it was used to assess goodness-of-fit of the final

regression model (Hosmer and Lemeshow, 1980). Hosmer-Lemeshow goodness-of-fit test

statistic above 0.05 has indicated that the model's estimates has palyed a major role in fitting

the data at an acceptable level.

Results

Participants

The number of participants that were surveyed in this research was 998. Of these, about

46.5% were males, 37.3 were hypertensive, about 26.0% were aged 60 years and above,

57.7% were overweight/obese. In addition, 40.6% were unemployed, 23.8% reported having

the cardiovascular condition, 22.6% reported having poor health, 55.4% were current

smokers, about 65.2% are either married or cohabiting. In addition, female on the other hand

contributed to 52.6% of the total population surveyed. Among them, females who were

hypertensive accounted for 34% of the total population of the women surveyed. The general

statistics indicated that the total number of hypertensive population was 370 both male and

female combined which accounted for 37.45% of the total population surveyed.

On the part of the age group stratification, there is a high prevalence rate of hypertension of

the population of the increasing age in the 31 to 45- year bracket when compared to other age

groups. The research statistics of multivariant analyses indicate that the more the increase in

age as well as the body mass index, physical activity, the male gender were more likely to be

associated with the cases of high blood pressure. The prevalence of hypertension according to
the statistics was not significant to the individuals who reported to have been involved in

moderate-intensity as well as vigorous-intensity activities that were said to increase the

heartbeat rates. The results of the statistics indicated that many of the alcohol consumers were

not able to estimate the number of alcoholic drinks they did consume within the course of the

week as well as for the length of their lifetime alcohol consumption. On the part of the

reported tobacco use among the population of study, 55.4% accounted for the current tobacco

smokers of the total of the population (Barber et al 2015) Therefore, it is a clear fact that the

hypertension prevalence on the current smokers did not show any significant difference to

that of the non-current smokers. In the case of Body Mass Index status, 57.7% of the

population was obese which indicated that the study population was at risk of contracting

hypertension cases.

Variables N %

Hypertension
Normotensive 625 62.6

Hypertensive 372 37.3

Gender

Male 464 46.5

Female 525 52.6

Age group

15-30 220 22.0

31-45 308 30.9

46-60 210 21.0

60-75 192 19.4

75> 66 6.6

BMI status

Normal 391 39.2

Overweight/Obese 576 57.7

Economic activity status

Not working 405 40.6

Working 593 59.4

Cardiovascular condition

No 747 74.8

Yes 238 23.8

State of general health

Not healthy 226 22.6

Healthy 769 77.1

Smoking status

Noncurrent smokers 443 44.4

Current smokers 553 55.4

Marital status

Single 185 18.5

Married/Cohabiting 651 65.2

Divorced/Widowed/Separated 159 15.9

Table 1: Baseline Socio-demographic characteristics and lifestyle factors

Variables Hypertensive

n (%) Normotensive

n (%) P value

Mean Age in years (SD) 58.1 (16.9) 39.6 (15.0) <0.0001

Gender (%)

Male 192 (41.4) 272 (58.6)

Female 178 (34.0) 346 (66.0) 0.02

Age group (%)

15-30 30 (13.6) 190 (86.4)

31-45 57 (18.5) 251 (81.5)

46-60 90 (42.9) 120 (57.1)

60-75 146 (75.3) 48 (24.7)

>75 49 (75.4) 16 (24.6) <0.0001

BMI status (%)

Normal 110 (28.1) 281 (71.9)

Overweight/Obese 251 (43.7) 324 (56.3) <0.0001

Economic activity status (%)

Not working 218 (53.9) 186 (46.0)

Working 154 (26.0) 439 (74.0) <0.0001

Cardiovascular condition (%)

No 227 (30.4) 519 (70.0)

Yes 138 (58.0) 100 (42.0) <0.0001

State of general health (%)

Not healthy 112 (49.8) 113 (50.2)

Healthy 258 (33.6) 511 (66.4) <0.0001

Smoking status (%)

Noncurrent smokers 158 (35.7) 285 (64.3)

Current smokers 213 (38.6) 339 (614) 0.344

Marital status (%)

Single 46 (24.9) 139 (75.1)

Married/Cohabiting 235 (36.2) 415 (63.8)

Divorced/Widowed/Separated 90 (56.6) 69 (43.4) <0.0001

Table 2: Characteristics of the study population that was stratified by smoking status

Hypothesis 1

When you look at table 2, it clearly shows that hypertension is significantly higher in males

than females (p-value 0.02). The analysis of the data revealed that there is a significant

difference in hypertension between males and females, thus rejecting the null hypothesis.

Hypothesis 2
It is very critical to argue that the current smokers also had the higher rate of hypertension,

although this was not statistically significant (p-value 0.344). Besides, Hypertension was also

higher among participants that were divorced/widowed/separated (p-value <0.0001). The

analysis of the data revealed that hypertension status did not vary between current smokers

and non-current smokers, thus accepting the null hypothesis.

Hypothesis 3

Unemployed participants also had the higher proportion of hypertension than their employed

counterparts (p-value <0.0001). The analysis of the data revealed that there is a significant

difference in hypertension between employed and unemployed participants, thus rejecting the

null hypothesis.

Hypothesis 4

Overweight/obese participants had the higher proportion of hypertension than participants

with normal weight (p-value <0.0001). The analysis of the data revealed that hypertension

status did not vary between BMI status, thus accepting the null hypothesis.

Hypothesis 5

The proportion of hypertension was also higher among participants with cardiovascular

conditions and those that reported not having good health (p-value <0.0001). The analysis of

the data revealed that hypertension status did not vary between cardiovascular disease status,

thus accepting the null hypothesis.

Variables (OR (95% CI) AOR (95% CI)

Gender

Male 1.00 1.00

Female 1.37 (1.06, 1.78)* 1.86 (1.33, 2.60)*

Age group

15-30 1.00 1.00

31-45 0.05 (0.03, 0.10)* 0.07 (0.03, 0.15)*

46-60 0.07 (0.04, 0.14)* 0.09 (0.04, 0.20)*

60-75 0.25 (0.13, 0.46)* 0.30 (0.15, 0.63)*

>75 0.99 (0.52, 1.91) 1.08 (0.54, 2.18)

BMI status

Normal 1.00 1.00

Overweight/Obese 0.51 (0.38, 0.67)* 0.74 (0.53, 1.03)

Economic activity status

Employed 1.00 1.00

Unemployed 3.34 (2.56, 4.37)* 1.25 (0.84, 1.86)

Cardiovascular condition

No 1.00 1.00

Yes 0.32 (0.24, 0.43)* 1.19 (0.56, 1.22)

State of general health

Not healthy 1.00 1.00

Healthy 1.96 (1.45, 2.65)* 0.81 (0.71, 1.54)

Status of smoking

Noncurrent smokers 1.00 1.00

The current smokers 0.88 (0.68, 1.14) 0.18 (0.91, 1.74)

Marital status

Single 1.00 1.00

Married 0.25 (0.16, 0.40)* 0.97 (0.53, 1.92)

Divorced/Widowed/Separated 0.43 (0.31, 0.62)* 0.44 (0.51, 1.34)

Table 3: Unadjusted and Adjusted Odds Ratio of Hypertension

Table 3 shows the presents the results of the bivariate and multivariate regression analysis

presented an odds ratio (OR) and adjusted odds ratio (AOR) respectivelywith 95%

confidence intervals. From the bivariate analysis, the odds that were used to develop

hypertension were significantly higher among female participants and healthy participants.

However, the likelihood of developing hypertension was lower among overweight/obese

participants, and those with cardiovascular conditions. From the multivariate analysis, the

likelihood of developing was significantly higher among females, participants with the

cardiovascular condition, and those in employment (p-value <0.0001). The Hosmer-

Lemeshow goodness-of-fit test revealed a p-value of 0.38, suggesting that that the final

model fits the data at an acceptable level.

Discussion

The hypertension frequency according to the statistics increased with an increase with age.

High prevalence rates of high blood pressure were seen in the individuals of the age between

31 to 45. The reason for the prompt rise of hypertension in this groups was commonly

associated with multiple factors like the aspect of shrinking and hardening of the arteries, the

issue of increased social stress, obesity as well as a failure of the individuals to be conversant

with the practices of the healthy lifestyle. The analysis of the data revealed that there is a

significant difference in hypertension between males and females and between employed and

unemployed participants, thus rejecting the null hypotheses (a) and (c).

The results of the study indicate that the rate of prevalence of high blood pressure was higher

in unemployed individuals compared to the employed. This analysis corresponds with the

research findings of (Peterson et al 2010) authors who argued on several factors that led to

increased rates of hypertension cases among the unemployed individuals. Joblessness has

been contributing to increased risks of contracting heart attacks when compared to the
individuals who were still working (Cheng et al 2017). These cardiologists argued that the

jobless individuals compared to the working individuals is directly proportional to smokers

and non-smokers when it comes to the related issues related to heart problems. There are

several factors that are behind unemployed challenges and their relation to hypertension such

as stress which is said to be a certain factor. The issue of budget constraints may also

contribute to issues of high blood pressure among unemployed individuals since most of

them tend to give up on purchasing healthy foods, failing to pay gym membership fee etc.

Unemployed individuals may also fail or lose their health insurance thus failing to access

treatment on existing heart problems.

The statistics of the research analysis indicates that there is a significant difference in the

cases of high blood pressure between males and females although the difference varies from

an age group to another. This analysis may be supported by the fact there exist sex steroids

that play a fundamental role in blood pressure regulation as well as cardiovascular disease.

Research findings have shown that women are somewhat protected from the most of the

cardiovascular diseases compared when they are compared to men. Analysis indicates that

the rate of hypertension prevalence in women who are at the reproductive age (up to 39

years) is less compared to men of the same ages (Cheng et al 2017). After menopause the rate

of prevalence of high blood pressure on women increases. Many investigators have argued

that the reduction of androgen in males may result in the increase in the rate of cases of

cardiovascular diseases. Furthermore, according to investigators males are more involved in

risk factors that contribute to the cases of hypertension. These risk factors include smoking,

drug abuse, alcoholism, violence etc.

However, hypertension status did not vary between current smokers and noncurrent smokers,

by BMI status, and by cardiovascular disease status, thus accepting the null hypotheses (b),

(d), and (e).

These results have implication for health because, in several epidemiological studies,

hypertension is known to be associated with smokers, participants with higher BMI, and

participants with cardiovascular diseases (Karishe et al. 2015). However, other factors could

have mediated the association between hypertension and BMI, smoking status, and

cardiovascular diseases. These factors could have been understood through a mediation

analysis, however, due to time constraint, this will be considered as one of the limitations in

the analyses of this data.

Conclusion

In conclusion, our main objective of our research study was to produce credible, reliable and

effective findings. However, there existed challenges in our study like the major limitation

which was the cross-sectional design. It is very critical to argue that the ability to obtain

quality and credible data was somewhat challenged such complications. It is a fact this design

tended to limit inferences that showed the relationship between high blood pressure and the

risking factors. Furthermore, it limited our determination on the association between

hypertension and the risky lifestyle behavioural activities (Larsen et al 2017). The study

could effective if it was studied in more regions to make an efficient and reliable conclusion

on our findings on our research study.

Our research came to conclude that hypertension was commonly associated with overweight

and obesity (anthropometric measures) as well as the aspects of unemployment cases. It is

very important for the scientists, researchers and learners to emphasise on factors that can

control the rate of blood pressure in both men and women. There is need to call upon and

create awareness to the society on the early screening to detect the presence of hypertension
among individuals (Baldisserotto et al 2016). Health care professionals should emphasise on

the best treatment strategies like the activation of SNS (Sympathetic Nervous System) as well

as activating the RAS for the purpose of increasing Ang 11 which contribute and enhance the

process of balancing the rate of blood pressure in our bodies. There is the need for further

analyses of the data so as to obtain better explanations regarding the significant and non-

significant findings of this study. Furthermore, if this exercise is to be done next time, it will

be done differently (by testing other hypotheses), although, the author has learnt a lot about

applying statistical analyses to datasets.