INTRODUCTION

1.1 BACKGROUND OF THE STUDY

Hypertension which is also known as high blood pressure is a chronic medical
condition in which there is a sustained elevation in the blood pressure in the
arteries of an individual above levels considered normal for the individual’s age,
sex, race, body size etc. It implies that there has to be a reference value for an
individual which is set arbitrarily based on the above mentioned biosocial indices,
in other words there are various classifications for the diagnosis of hypertension
which actually erupted as a result of different studies by various research groups
and which became adopted by the World Health Organization (W.H.O).
Hypertension is a blood pressure of 140/90mmhg or more based on at least two
separate readings on separate occasions (Mlunde, 2007). The American Heart
Association, (2003) graded blood pressure as follows; normal, high normal, grade
1, grade 2, and grade 3, high blood pressure (hypertension).
In the 18th century, the health burden was on communicable diseases, and
hypertension was not of interest then. Now with the epidemiological transition
from communicable to non communicable diseases, hypertension has been
recorded as the major type of cardiovascular disease with attendant
complications. Hypertension rarely has symptoms therefore one-third of the
people affected do not know they have the disease; as such it is called “The silent
Killer”. Pathophysiology of high blood pressure reveals that the blood pressure at
any time is determined by the cardiac output and the peripheral resistance (Blood
Pressure = Cardiac Output x Peripheral resistance) (Uzoma, 2010). Hypertension is
therefore associated with conditions affecting these two factors such as increased

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peripheral resistance, fluid and water retention and high rennin secretion in some
cases (Uzoma, 2010).
The works of Bharati et al, (2012), indicated that in India, hypertension is the
commonest cardiovascular disease, posing a major public health issue, and more
prevalent in urban areas due to urbanization, lifestyle, diet, stress and the overall
socio-economic and epidemiological transition than those in the rural areas.

Although the exact cause of hypertension is yet unknown, but it is believed that
age, genetic factors and lifestyles such as dietary salt, adiposity, cigarette
smoking, alcohol consumption, sedentary lifestyle and mental stress are possible
risk factors that predisposes people to hypertension. Hypertension is a chronic
medical condition that often leads to complications such as coronary and renal
failure, peripheral vascular disease, retinal hemorrhage and visual impairment
amongst others.

The prevalence of hypertension is high in both men and women, and it is not only
a concern of the urban population alone but also an issue for rural populations.
Furthermore, in other to reduce this burden in Nigeria at large, it is important to
have detailed up to date information on the prevalence of hypertension in order
to match this with available resources.

It is in view of the foregoing development, the researcher is interested in carrying

out this work in other to explore the magnitude of the problem of hypertension
and to obtain specific knowledge on the level of prevalence of hypertension
among adults in kpansia community of Bayelsa State.

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1.2 Statement of the problem.
Hypertension affects over 1.3 billion people worldwide. It is the most common
cardiovascular disease in black Africans and a major cause of morbidity and
mortality among Nigerians. Hypertension is no longer a problem of only the
developed nations; it is present here with us. Considering its ‘silent’ nature, few
persons are usually aware of their hypertensive status and also fewer persons
seek treatment. This has led to unacceptably high morbidity and mortality from
potentially preventable complications such as coronary heart disease, heart
failure, strokes and chronic renal failure (Delacroix et al, 2014).
The reported prevalence of hypertension varies widely in the various parts of the
world, as low as 3.4% in rural Indian men and as high as 72.5% in Polish women
(Kearney, et al 2004). In North America, two national surveys in the United States
during the last two decades put the overall prevalence amongst American adults
at 28% (Wolf-Maier, et al 2003 and Kearney, et al 2004), while in Canada the
prevalence is 27.4% (Wolf-Maier K et al 2003). The awareness level was about
70% and 58% in the United States and Canada respectively (Wolf-Maier, et al,
2003 and Chobanian, 2003). In Europe, the average prevalence rate is estimated
to be 44.2%; 37.7% for Italy, 38.4% for Sweden, 41.7% for England, 46.8% for
Spain, 48.7% for Finland and 55.3% for Germany (Wolf-Maier, et al 2003).

Data published from Nigeria, Ghana, Cameroon and The Gambia have shown a
higher prevalence of hypertension generally and a consistently higher prevalence
in urban than in rural areas. Akinkugbe, (1992) revealed that in Nigeria,
hypertension is the most common non-communicable disease, also less than one-
third of people in Nigeria undergo medications and less than one-third of those

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undergoing treatment have their problem being absolutely managed (Kadiri,
2005). Currently, the population specific prevalence of hypertension in Nigeria is
not known with certainty.
Little is known about the magnitude and determinants of hypertension in
Yenagoa particularly in the study area (kpansia Community). Therefore, this
research work “The prevalence of hypertension among adults in Kpansia Yenagoa
Bayelsa State” is having hypertension as dependent variable and independent
variables of systolic and diastolic blood pressures through their measurement
with blood pressure estimation apparatus.
1.3 Aim
To determine the prevalence of hypertension, and level of awareness of
hypertension among adults in kpnasia community.
1.4 Objectives
 To determine the level of prevalence of hypertension among adult living in
kpansia community
 To determine if there is difference in prevalence of hypertension among
male and female adults in Kpansia Community during the study.
 To determine the level of awareness on risk factors associated with
hypertension among adults living in Kpansia Community.

RESEARCH QUESTIONS

1. What is the prevalence of hypertension among adults living in Kpansia

community of Yenagoa Metropolis?

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 2. What is the difference in prevalence of hypertension among male and
female adults in Kpansia Community during the study?
3. What is the level of awareness on risk factors of hypertension among adults
living in Kpansia Community of Yenagoa metropolis?

1.5 SIGNIFICANCE OF THE STUDY

 This study would serve as a medium to know the number of individuals that
are hypertensive in kpansia community
 It would serve as a medium to encourage individuals in the community to
go for routine hypertension screening
 It would also serve as a reference materials for further studies.
1.6 SCOPE OF THE STUDY
This study is limited to adults aged between 18years and above living in kpansia
community, Yenagoa, Bayelsa State from April to May, 2018.

1.7 DEFINITION OF TERMS

AWARENESS: this is the concern about and well-informed interest in a particular
situation or development.
BIOSOCIAL: concerning the interaction of biological and social factors or with
reference to social phenomena that are affected by biological factors.
CARDIAC OUTPUT: this refers to the amount of blood pumped by the heart per
minute
HYPERTENSION: this is defined as systolic blood pressure > 140 mmHg or diastolic
blood pressure > 90 mmHg based on at least two separate readings on separate
occasions.
MAGNITUDE: this refers to the extent of something.
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MORBIDITY: this refers to the rate of disease or proportion of diseased people in
a geographical location.
PERIPHERAL RESISTANCE: this refers to the sum total of resistance to blood flow
in the systemic circulation in the arterioles, dependent on the
constriction/relaxation of the smooth muscle in their walls.
PREDISPOSE: this is to make someone liable to a specific condition.
PREVALENCE: this refers to the number of cases of a disease that are present in a
particular location at a given time (old and new cases of a disease).
SEDENTARY LIFESTYLE: this is a type of lifestyle with little or no physical activity.
URBANIZATION: this refers to the population shift from rural to urban areas or
the gradual increase in the population of people living in urban areas, and the
ways in which each society adapts to the change

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 CHAPTER TWO
LITERATURE REVIEW
2.0 INTRODUCTION
This chapter attempts to review the following areas:
Conceptual frame work
- Classification of blood pressure
- Physiology of blood pressure regulation
- Hypertension
- Types of hypertension
- Pathophysiology of hypertension
- Signs and symptoms of hypertension
- Risk factors of hypertension
Empirical review
- Prevalence of hypertension
- Difference in prevalence among male and female
- Level of awareness on the risk factors of hypertension

2.1 CONCEPTUAL FRAMEWORK

Blood pressure is the pressure within the arteries of the body due to the blood
pumping action of the heart. This means that contraction of the left ventricle of
the heart forces blood out into the aorta and travels through the large arteries to
the smaller vessels (Foëx & Sear, 2004). The maximum arterial pressure during
contraction of the left ventricle of the heart which is measured in millimeter of
mercury is known as the systolic blood pressure and the lowest arterial pressure
during relaxation or dilatation of the heart and measured in millimeter of mercury

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is the diastolic blood pressure (Foëx & Sear, 2004). The World Health Organization
(2013) made it clear that blood pressure is created by the force of blood pushing
against the walls of the blood vessels as it is been pumped by the heart.
2.1.1 CLASSIFICATION OF BLOOD PRESSURE
Blood pressure has been grouped into the following grades:
 Normal blood pressure or optimal blood pressure (Systolic Blood Pressure
<130mmHg and Diastolic Blood Pressure of < 85mmHg).
 High normal blood pressure or prehypertension (Systolic Blood Pressure
130mmHg –139mmHg and Diastolic Blood Pressure of 85mmHg –
90mmHg).
 Grade 1 or Mild hypertension (Systolic Blood Pressure 140mmHg –
150mmHg and Diastolic Blood Pressure of 90mmHg – 99mmHg).
 Grade 2 or Moderate hypertension (Systolic Blood Pressure 160mmHg –
175mmHg and Diastolic Blood Pressure of 100mmHg – 109mmHg).
 Grade 3 or severe hypertension (Systolic Blood Pressure ≥180mmHg and
Diastolic Blood Pressure of ≥110mmHg).
(Source: Seventh report of the Joint National Committee on Prevention, Detection,
Evaluation, and Treatment of High Blood Pressure) 2004

2.1.2 PHYSIOLOGY OF BLOOD PRESSURE REGULATION

Blood pressure at any time is been regulated through several mechanisms which
works together to maintain a particular blood pressure in an individual (Foëx &
Sear, 2004). There are two mechanisms of blood pressure regulation namely; the
neurogenic regulation mechanism and the humoral regulation mechanism.

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2.1.2.1 Neurogenic regulation
The autonomic nervous system regulates blood pressure through the vasomotor
centre located in the pons and midbrain. Increase in the afferent impulse activity
causes the arterial baroreceptors to respond and thereby, cause vascular wall
distension. This in effect decreases the efferent sympathetic activity and increases
vagal tone and causes decrease in heart rate (bradycardia) and widening of the
blood vessels (vasodilatation) (Joyner et al, 2010). Increased sympathetic activity
increases vascular tone through the effect of noradrenaline on vascular alpha
adrenoreceptors. Adrenaline activates both vascular beta-2 and alpha
adrenoreceptors with resultant vasodilatation and vasoconstriction respectively
(Kirkman & Sawdon, 2010).
2.1.2.2. Humoral regulation
Humoral regulation of blood pressure involves many interactive systems,
hormones and factors such as the renin-angiotensin-aldosterone system, the
renomedullary system, the kallikrein-kinin system, atrial natriuretic peptides,
eicosanoids, endothelial mechanisms, and adrenal steroids.

The renin-angiotensin-aldosterone system

Renin is a protein molecule produced mainly by the juxtaglomerular apparatus of
the kidneys. The juxtaglomerular apparatus is sensitive to changes in renal
perfusion pressure and the sodium concentration in the distal tubular fluid. Renin
binds to angiotensinogen (which is produced by the liver) to form an inactive
peptide (angiotensin I). Angiotensin I is then converted into an active peptide
(angiotensin II) through the action of the enzyme angiotensin converting enzyme
(Widmaier et al, 2014). Angiotensin II acts on specific angiotensin II type 1

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receptors and angiotensin II type 2 receptors causing smooth muscle contraction
and the release of aldosterone, prostacyclin, and catecholamines which cause an
increase in blood pressure (Yvan-Charvet & Quignard-Boulange, 2011). High
angiotensin II concentrations suppress renin secretion via a negative feedback
effect.
The renomedullary system
Renomedullary interstitial cells found in the renal papilla secrete an inactive
substance called medullipin I. Medullipin I is transformed into medullipin II in the
liver. Medullipin has prolonged hypotensive effect through vasodilatation,
inhibition of sympathetic drive and a diuretic action. The activity of the
renomedullary system is controlled by renal medullary blood flow (Foëx & Sear,
2004).
The adrenal steroids system
Another important mechanism of control of blood pressure involves the adrenal
corticosteroids; mineralocorticoids and glucocorticoids. Cortisol is the most
important glucocorticoid. Aldosterone is the primary mineralocorticoid involved
in electrolyte balance. Corticosteroids increase blood pressure.
Mineralocorticoids cause sodium and water retention while glucocorticoids cause
increased vascular reactivity. Both of them increase vascular tone by up regulating
the receptors of pressor hormones such as angiotensin II. Sodium and water
retention are associated with an increase in blood pressure while sodium
depletion is associated with hypotension. It is postulated that through the
sodium–calcium exchange mechanism, sodium causes an increase in intracellular
calcium within vascular smooth muscles with a resultant increase in vascular tone
(Foëx & Sear, 2004).

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The atrial natriuretic peptide system
One important factor in the regulation of blood pressure is the atrial natriuretic
peptide (ANP). ANP is released from atrial granules and it is a potent vasodilator.
It produces natriuresis, diuresis and decreases blood pressure. It decreases
plasma renin and aldosterone concentrations. There are three types of ANP and
their concentrations are increased by raised filling pressures in the atria in
persons with arterial hypertension and left ventricular hypertrophy as the wall of
the left ventricle participates in the secretion of ANP (Widmaier et al, 2008).
The Eicosanoids system
Eicosanoids play an important role in blood pressure regulation. Examples of
eicosanoids include prostaglandins, leukotrienes, thromboxanes, lipoxins. Some
eicosanoids are vasodilators while others are vasoconstrictors. They are known to
cause changes in blood pressure by their direct effects on vascular smooth muscle
tone and interactions with other vasoregulatory systems such as the autonomic
nervous system, renin–angiotensin–aldosterone system, and other humoral
pathways.
The kallikrein-kinin system
The kallikrein-kinin system plays an important interactive role in the regulation of
blood pressure. Tissue kallikreins activate kininogens to produce vasoactive
kinins. The most important of these vasoactive kinins is a vasodilator called
bradykinin which regulates renal blood flow, water and sodium excretion.

The endothelium system

The endothelium plays an important role in blood pressure regulation through the
production of a number of vasodilator and vasoconstrictor substances which

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regulate vasomotor tone (Galley & Webster, 2004). The endothelium synthesises
nitric oxide and endothelins. Nitric oxide is a known vasodilator while endothelins
are known to be the most powerful vasoconstrictors (Flammer et al, 2012).

Sodium and water excretion

Sodium and water retention are associated with an increase in blood pressure. It
is postulated that sodium, via the sodium–calcium exchange mechanism, causes
an increase in intracellular calcium in vascular smooth muscle resulting in
increased vascular tone (Foëx & Sear, 2004). The primary cause of sodium and
water retention may be an abnormal relationship between pressure and sodium
excretion resulting from reduced renal blood flow, reduced nephron mass, and
increased angiotensin or mineralocorticoids (Foëx & Sear, 2004).

2.1.3 HYPERTENSION
According to WHO (2013), hypertension was defined as a systolic blood pressure
equal to or above 140 mmHg and/ or diastolic Blood Pressure equal to or above
90 mmHg. Wilson and Waugh, (2001) also defined hypertension as a term used to
describe blood pressure that is sustained at a higher than the generally accepted
normal maximum level for a particular age group. Onuzulike (2006) also described
it as the consistent elevation of blood pressure of above normal for a particular
age. Hyman and Parlik (2003) defined hypertension as the persistent raised levels
of blood pressure in which the systolic pressure is 140 mmHg and diastolic above
90 mmHg. Therefore, Hypertension is a chronic medical condition in which the
systemic arterial blood pressure is elevated which measured systolic as 140mmhg
or more and diastolic of 90mmhg or more.

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Abanobi (2005) stressed that hypertension is characterized by excessive load on
the blood pumping function of the heart as it works to send oxygen and nutrients
to the various tissues of the body. Under the conditions of excess load, the
arteries metabolic efficiency is being compromised. In this study, hypertension is
referred to as a systolic blood pressure greater than 140 mmHg and a diastolic
blood pressure greater than 90 mmHg.

Hypertension is a major risk factor for cardiovascular diseases which results in

hardening of the arteries, thus predisposing individuals to heart diseases,
peripheral vascular diseases, stroke, heart failure, and kidney failure (Whelton et
al 2017). Bovet et al, (2003) explained that hypertension is affected by peripheral
resistance, cardiac output and total blood volume. When the diameter of an
artery decreases, there is vasoconstriction, which causes a rise in blood pressure.
TYPES OF HYPERTENSION
There are basically two types of hypertension namely:
1. PRIMARY OR ESSENTIAL HYPERTENSION
Essential hypertension also known as primary hypertension or idiopathic
hypertension is the most common type of hypertension affecting 95% of
hypertensive patients (Carretero & Oparil, 2009), it tends to be familiar and
is likely to be the consequence of an interaction between environmental
and genetic factors. Prevalence of essential hypertension increases with
age and individuals with relatively high blood pressure at younger ages.
Hypertension increases the risk of cerebral, cardiac and renal events
(Carretero & Oparil, 2009). Essential hypertension is four times more

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 common in blacks than whites and it accelerates more rapidly and is often
more severe with higher mortality in black patients (Lescalzo, 2008).
2. SECONDARY HYPERTENSION
This is a type of hypertension with an underlying potentially correctable
cause it is a High blood pressure occurring as a result to a consequence of
another disorder or a side effect of medication is referred to as secondary
high blood pressure. Such disorders may include renal failure or
renovascular disease. This type of blood pressure is evident in about five to
10% of cases (Cunha et al. 2011). Treatment of secondary hypertension
involves controlling the underlying medical condition or disease in addition
to prescribing antihypertensive drugs.
2.1.4 PATHOPHYSIOLOGY OF HYPERTENSION
Blood pressure is the product of cardiac output and systemic vascular resistance
(Foëx & Sear, 2004). In arterial hypertension there may be an increase in cardiac
output, an increase in systemic vascular resistance, or both. Increased systemic
vascular resistance and increased stiffness of the vasculature with ageing play a
dominant role in the pathophysiology of hypertension. Vascular tone may be
raised as a result of increased α-adrenoceptor stimulation or increased release of
peptides such as angiotensin or endothelins (Richard, 2012)

An increase in cytosolic calcium in vascular smooth muscles causes

vasoconstriction. Several growth factors, including angiotensin and endothelins,
cause an increase in vascular smooth muscle mass. Endothelial dysfunction causes
a decline in nitric oxide production. In hypertensive persons, endothelial-derived
relaxation is inhibited. The harmful vascular effects of endogenous endothelin-1

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may be heightened by a decrease in nitric oxide production caused by endothelial
dysfunction (Flammer et al., 2012).

An increase in systemic vascular resistance and vascular stiffness increases the

load imposed on the left ventricle. This induces left ventricular hypertrophy and
left ventricular diastolic dysfunction. The pulse pressure generated by the left
ventricle is relatively low in young people. The waves reflected by the peripheral
vasculature occur mainly after the end of systole; hence pressure is increased
during the early part of diastole and improves coronary perfusion (Foëx & Sear,
2004).

However, with ageing, stiffening of the aorta and elastic arteries increases the
pulse pressure, reflected waves move from early diastole to late systole. These
results in an increase in left ventricular after load, and left ventricular
hypertrophy. The widening of the pulse pressure with ageing is a strong predictor
of coronary heart disease (Foëx & Sear, 2004).

The autonomic nervous system plays an important role in the control of blood
pressure. In hypertension, there is an increased release of norepinephrine and
enhanced peripheral sensitivity to it. In addition; there is increased
responsiveness to stressful stimuli. Another feature of arterial hypertension is a
resetting of the baroreflexes and decreased baroreceptor sensitivity. The renin–
angiotensin system is involved at least in some forms of hypertension such as
renovascular hypertension and is suppressed in the presence of primary
hyperaldosteronism (Foëx & Sear, 2004).

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SIGNS AND SYMPTOMS OF HYPERTENSION
Hypertension is often referred to as “the silent killer” because people who have it
are often symptom-free that is, It is asymptomatic but a person with
hypertensive crisis (very high blood pressure) may experience Frequent
Headache, Anxiety, Fatigue, Dizziness, Palpitations, Tachycardia (rapid heart
rate), Nosebleeds, Blurred vision, shortness of breath amongst others. Ironically,
despite its deadly nature, victims of hypertension are rarely aware that they have
this disease (Foëx & Sear, 2004).
2.1.5 RISK FACTORS OF HYPERTENSION
Hypertension is a non-communicable disease in which it cannot be transferred
from person to person or from an agent to a susceptible host directly rather,
various factors contribute to the development of hypertension. Lothar, Gottfried
and Heide, (2011) conceptualized risk factor as individual characteristics which
affect the person’s chances of developing a particular disease or group of diseases
within a defined period of time. Risk factor according to Last, (2001), is an
environmental, behavioural or biological factor confirmed by temporal sequence,
usually in longitudinal studies, which if present directly increases the probability
of a disease occurring, and if absent or removed reduces the probability. Donna
(2006) posited that a risk factor is something that increases an individual’s
chances of getting a disease. Risk pertaining to hypertension is therefore referred
to as the environment and behavioral characteristics a person indulge in that
increases the probability or chances of hypertension to occur. Risk factors of
hypertension are identified factors, characteristics or behaviors which exposes
adults to the risk of developing hypertension such as obesity, tobacco smoking,

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sedentary lifestyle or physical inactivity, excessive alcohol consumption, high salt
and high fiber diet, age and genetic factor which increase the chance of
hypertension to occur in adults.
The cause of hypertension is not yet known unless it is secondary high blood
pressure. However, there are mainly two categories of risk factors associated with
the occurrence of hypertension and they are the modifiable and non-modifiable
risk factors.
1. Modifiable risk factors
These are risk factors that can be reduced or controlled by intervention thereby
reducing the probability of hypertension occurring. This risk factor includes
obesity, cigarette smoking, excessive alcohol drinking, high salt intake, physical
inactivity, stress and oral contraceptives use.
Obesity is an increase in weight of over 10 per cent above normal body mass
index due to generalized deposition of fat in the body. Onuzulike, (2006) asserted
that excess weight promotes hypertension and lipid abnormalities. It predisposes
the individual to diabetics which in turn accelerates to coronary artery disease in
which, hypertension is complicated and increases the risk of stroke. Dischuneit,
Flechner, Johnson & Adler, (2006) asserted that physical inactivity coupled with
obesity seem to have more implication in hypertension than obesity alone.
Erhum, Olayiwola, Agbani & Omtoso, (2005) stressed that cigarette and tobacco
smoking as an unhealthy social habit has short-circuited millions of lives for many
countries, and is one of the root causes of chronic diseases of which hypertension
is one of them. According to them, cigarette is a suicide bomber seeking for a
person whose health and life will blow away with its smoke. Cigarette contains
nicotine, which causes contraction of the blood vessels (vasoconstriction) that can

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lead to hypertension, stroke and cardiac output. Blood pressure rises and the
heart also has to work harder to pump increased volumes of blood through
damaged lungs. Onuzulike, (2006) contributed that smoking nicotine and carbon
monoxide from tobacco have been found to provoke increased level of adrenalin
and this causes narrowing of the arterioles leading to increase in blood pressure.

Excess salt intake has been implicated in hypertension. Chhabra, Lal and Sharma
(2002) observed in a study that a high salt intake of about 7-8gram (1-2 teaspoon)
a day increases blood pressure proportionately. Sacks, Svetkey and Vollmer
(2006) declared that low sodium intake have been found to lower blood pressure.
Chemically, salt is made of sodium and chloride. Sodium is of higher
concentration than water, thus, can easily draw water from the surroundings to
dilute itself. They further explained that if the salt concentration of blood is high,
water from the surrounding cells move into the blood vessels to dilute the salt.
When this happens, the volume of the blood increase with corresponding
increase in volume of blood in the heart which increase the pressure with which
blood flows through the blood vessels (hypertension). Org, Cheung, Man, Lau &
Lam, (2007) acknowledged that diets high in salt and saturated fats have been
shown to be etiologically related to hypertension. Foods that fit into this category
include canned foods, bacon, frozen foods, hot dogs, ham, salted nuts, sausages,
seasoning salt, salted cheese and potato chips. Other foods that contribute to risk
of hypertension include fat sources of all kinds namely, butter, eggs, red fatty
meat, ice cream and cheese. Furthermore, it is not advisable to add table salt to
ones food.

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Sedentary lifestyle or physical inactivity as a risk factor of hypertension elevates
blood pressure. Org, Cheung, Man, Lau & Lam (2007) explained that lack of
physical fitness especially cardiovascular fitness derived from aerobic exercise is
known to be related to elevated blood pressure. The role of exercise in the
sustenance of the natural supple condition of the arteriole cells and influencing
favorable ratios of low density lipoproteins to the high-density variety is critical in
the development and progression of hypertension. Regular exercise lowers blood
stimulating metric oxide (helps keep blood vessels open).

High alcohol consumption is associated with an increased risk of hypertension.

Onuzulike, (2006) explained that risk of hypertension has been raised among
heavy alcohol drinkers.
Stress is a risk factor of hypertension which activates the autonomic nervous
system and of the central nervous-pituitary adrenalin system. Carpenter, Griggs
and Loscalzo, (2004) explained that during stress or emotional disturbances, the
body system produces chemical substances called catecholamine and adrenalin.
These substances when released cause generalized vasoconstriction (contraction)
and narrowing of the blood vessels, which can produce transient hypertensive
state.
There are some contraceptive pills which prevent pregnancy, and are associated
with the risk of developing hypertension. Castelli, (2004) stated that the main
ingredient of these contraceptive pills (oestrogen) cause increased hepatic
secretion of rennin substance, which in turn increases the formation of
anquitensine. This substance enhances re-absorption of sodium (salt) from the

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kidney which means that estrogen causes salt retention thereby, being a risk
factor to hypertension.
2. Non modifiable risk factors
These are risk factors that cannot be controlled or reduced by intervention in
reducing the probability of the occurrence of hypertension and they include: age,
sex/gender, race and genetic factors/family history (Ibekwe, 2015).
The incidence of hypertension has been said to rise with age (non modifiable risk
factor). Mandal et al, (2010) supported this by stating that the level of intimacy
for blood pressure varies according to age. As the body gets older naturally, it
does not retain the amount of elasticity as it used to during early years of life. The
arteries become hard and this increases the resistance to blood flow. In addition,
morbidity and mortality rates of hypertension increase steadily with advancing
age. The World Health Organization WHO (1990) reported that the morbidity and
mortality rates of hypertension increase steadily with advancing age and the older
a person becomes, the more he or she is likely to be hypertensive. This is because
hypertension becomes prevalent with increasing age, most likely because of
reduced arterial compliance or blood flow. When both parents are involved, the
risk is especially great. However, if the onset of hypertension occurs during the
younger ages, life expectancy of the individual decreases and even a modest
elevation of blood pressure are associated with a great increased risk of death
(Gaudemaris et al, 2002). These risk factors are modified by lifestyle changes.
Furthermore, as the heart develops over the years, adults need to be aware of the
modifiable risk factors in order to follow healthy lifestyle practices and reduce
their chances of morbidity.

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2.2 EMPERICAL REVIEW
2.2.1 PREVALENCE OF HYPERTENSION
Sarry El-Din et al, (2012) stated that hypertension is the commonest non
communicable disease affecting both sexes in all races and the most prevalent
cardiovascular disease risk factor globally. Worldwide, hypertension is common
and now regarded as a major public health problem. Hypertension is a global
health problem affecting almost 1 billion adults of the world’s population in the
year 2000 (Baliga, & Narula, 2009) and more than 1.3 billion representing 31% of
the world’s population in 2010 (Michael, 2016).
However, hypertension is not only a problem of developed nations on the
contrary, It is common in both developed (333 million) and developing (639
million) countries; Worldwide, hypertension is the cause of 30% of deaths (wolf-
Maier, 2003). Kearney P.M et al (2005) sated that hypertension causes 7.5 million
deaths worldwide and over 57 million disability adjusted life years (DALYs) and
the 4th leading cause of premature deaths in developed countries and 7 th in
developing countries.
In Africa, the prevalence of hypertension is 30.8% of the total adult’s population
in 2010 (Adeloye, et al, 2014). Ayhen, (2017) stated that hypertension is the
second leading cause of death in sub-Saharan Africa. However, with sub-Saharan
African above the age of 30, cardiovascular disease rises to the top as the leading
cause of deaths in Sub-Saharan Africa. In 2014, the prevalence of hypertension in
Mozambique increased significantly from 33.1% to 38.9%. In South Africa, Steyn
(2008) conducted a national survey on hypertension and reported a prevalence of
21%. In his study, gender, age and family history of hypertension were considered
non modifiable. Longo-Mbenza (2007) also conducted a cross-sectional survey of

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workers in Kinshasa, (Republic of Congo) and reported a prevalence of 21.3%
while that in a community based survey in Uganda was 30.4% (Wamala, 2009). A
community based survey in Gambia had a prevalence of 7.1% (using blood
pressure threshold of ≥160/95mmHg) and 18.4% (using Bp ≥140/90mmHg) (Van
de Sande, 2000). In Ghana, a study in semi-urban and rural areas of Ashanti region
gave an overall prevalence rate of 28.7%, being higher in the semi-urban (32.9%)
compared to the rural (24.1%) areas and an overall awareness level of 22%
(Cappuccio, 2004).
In Nigeria, the prevalence of hypertension is believed to be 25.8% (Guwatudde et
al, 2015). A previous national survey on non-communicable diseases (NCDs) gave
an overall crude prevalence of 11.2% (using blood pressure [BP] threshold of
≥160/95mmHg) and awareness level of 33.8 % (Akinkugbe, 1997). Various studies
have tried to give a picture of hypertension prevalence amongst different
population groups and regions in the country. In Katsina, a study in a tertiary
health institution found the prevalence to be 25.7% (Sani, et al 2010). Lawoyin, et
al (2007) had prevalence of 12.4% (Bp threshold of ≥160/95mmHg) in an Ibadan
community thereby making hypertension not only a risk factor for cardiovascular
diseases but also a major factor in a large number of chronic disorders having
significant mortality and morbidity impact. While Olatunbosun, et al (2000) (also
using a Bp threshold of ≥160/95mmH) had a prevalence of 10.3% in a civil service
population in Ibadan. In Ile-Ife, Adedoyin et al had a prevalence of 13.3% (Bp
threshold of≥160/95mmHg) and 36.6% (using Bp threshold ≥ 140/90mmHg)
(Adedoyin, et al, 2008). Amongst workers in Ilorin, Oghagbon et al (2008) found a
prevalence of 27.1%. They were predominantly males with age and body mass
index (BMI) identified as important correlates to blood pressure. This is higher

22 | P a g e
than what was found in an Indian urban population. Omuemu, et al (2007) in a
study in a rural community in Edo state south-south Nigeria had a prevalence of
20.2%.

2.3 DIFFERENCE IN PREVALENCE AMONG MALE AND FEMALE

Hypertension affects both sex however, rates vary in different regions as low as
3.4% (men) and 6.8% (women) in rural India and as high as 68.9% (men) and
72.5% (women) in Poland (Kearney P.M et al 2004). Study done in Vietnam
reported that the prevalence of hypertension was 14.1%. Men had high
prevalence of hypertension than women and age was positively associated with
hypertension (Van, 2006). Another study reported that an overall of 26.4% of the
adult population in 2000 had hypertension (26.6% men and 26.1% women),
(Patricia, 2005). In Cameroon, the prevalence of hypertension showed a
difference in sex variations as 16.4% in urban men and 12.1% in urban women,
and 5.4% in rural men and 5.9% in women (Mbanya, 1998). In Accra, Amoah
(2003) studied 4733 subjects with age ranging from 25 to 102 years and found
overall crude and age-standardized prevalence rates of hypertension (BP >140/90
mm Hg) to be 28.3% and 27.3%, respectively. Hypertension was more common in
women than men (Amoah, 2003). South Africa‘s Demographic and Health Survey
in 1998 studied 12 952 participants and described the national prevalence of
hypertension. Using a cut-off point of 140/90 mmHg and age adjusting, 25% of
men and 26% of women had hypertension (Krisela et al, 2008). Edwards et al
(2000) did two concurrent studies at Ilala (770 participants) and Shari (928) all
above 15 years and found age-standardized hypertension (to the New World
Population) prevalence was 37.3% (32.2-42.5%) among men and 39.1% (34.2-

23 | P a g e
44.0%) in women in Illala, and 26.3% (22.4-30.4%) in men and 27.4% (24.4-30.4%)
in women in Shari. In Zimbabwe a study by Mufunda et al (2000) they found the
age-adjusted prevalence of hypertension in Marondera were 30% for women and
21% for men. In a study done in Cameroon by Kamadjeu et al (2003) found the
prevalence of hypertension in male was 25.6% and 23.1% in females and an
overall of 24.6%.

THE LEVEL OF AWARNESS ON THE RISK FACTORS ASSOCIATED WITH

HYPERTENSION
In developing countries, hypertension is regarded as a major risk factor for
cardiovascular diseases and the fourth contributing factor to pre-mature deaths
in developed countries and seventh in developing countries (Indian Guidelines on
Hypertension, 2013). Due to its silent nature, it has no detectable symptoms
while causing continuous and progressive damage to vital target organs in the
body thereby, leading to various life threatening complications and the cause of
about nine million deaths worldwide (WHO, 2013).
Prevention of hypertension is achievable if people are aware and have the
knowledge of its risk factors thereby leading to the prevention of its complications
such as stroke, coronary heart disease and heart failure.
Studies have shown that many people are not aware of the importance of utilizing
the opportunity of regular clinical check-ups. In most cases the affected person
may remain undiagnosed of hypertension until the damages are done (Ajewole,
2017).
According to the 2010 Global status report, World Health Organization (WHO)
projects that in the next 10 years, Africa will experience the largest increase in

24 | P a g e
death rates from cardiovascular diseases (WHO, 2011). In developed countries,
the improved control of hypertension has led to considerable reduction in overall
morbidity and mortality over the last fifty years.
Although, prevention of hypertension which should be cheaper and easier is
however, difficult where there is poor awareness of it. For instance, in Africa,
Adeloye & Basquill (2014) who carried out a systematic analysis on the prevalence
and awareness rate of hypertension in Africa reported that the level of awareness
rate of hypertension is Low as only 33% of the respondents are aware of
hypertension. Despite the fact that hypertension is the most common
cardiovascular disease in Nigeria, a study carried out in Nigeria revealed that only
17.4% are aware of hypertension in the country showing a low level of awareness
of hypertension in the country (Adeloye et al, 2014).
The rates of awareness of hypertension vary in various regions of the country
(Nigeria). In Maiduguri, of the north-eastern Nigeria, it was revealed by Dr.
Ibrahim (2012) that 21.6% of the respondents are not aware of the risk factors of
hypertension. Whereas a more recent study done in Sokoto state of Nigeria by
Abdulaziz et al, (2017) recorded a high awareness rate of hypertension as 87.7%
(rural group) and 91.3% (urban group) are aware of the risk factors of
hypertension. Whereas, in south-west of the country (lagos), Olusoji et a,l (2015)
revealed that of those hypertensive, only 18.9% are aware of hypertension. The
result gotten in south-south Nigeria which was carried out in Bayelsa state shows
that 65.3% were not aware they had hypertension (Egbi, 2015). Therefore,
despite the high prevalence of hypertension in the country, awareness of it still
continues to low thereby causing prevention of hypertension even more difficult
(Olusoji et al, 2015)

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 CHAPTER THREE
METHODOLOGY
3.0 INTRODUCTION
This chapter concentrates on the various methods and procedures of this
research work. It includes the description of the research design and location,
population of the study, sample and sampling technique, instrument for data
collection, methods of data collection, methods of data analysis and ethical
consideration.
3.1 RESEARCH DESIGN
The research design adopted in this study will be a descriptive cross sectional
design. Descriptive cross sectional design is one in which the primary aim of
the research is to asses a sample at one specific point in time without trying to
make inference or casual statements (NEDARC, 2012)
3.2 STUDY LOCATION
This study was carried out in Kpansia Community, Yenagoa LGA of Bayelsa
State. Kpansia Community is one of the communities in Epie Kingdom of
Yenagoa LGA and politically in ward 5. It has 10 compounds and occupies a
town landscape of about 18 square/kilometers and located at latitude 4.9340°
N - longitude 6.3129° E (GPS coordinates). It is bounded at the north by
Yenizuegene-Epie community, at the south by Okaka-Epie community, at the
west by Otuasega, Elebele in Ogbia Communities and Kolo Creek respectively
and at the east by Yenizue-Gene Epie Community.
Fish farming, crop cultivation are common occupations of the people and
these occupational practices are at subsistence level. They love traditional
wrestling and cultural dance; their dances are usually displayed during

26 | P a g e
 festivals, Christmas season and other great ceremonial occasions. Kpansia
Community has a total population of 7,362 both male and female according to
the National Population Commissions as at 2006.
3.3 POPILATION OF THE STUDY
Comprises of all adults between 18 – 59 years living in Kpansia Community.
This group forms 41.36% of the entire population of kpansia community which
is approximately 3,045 adults. This approximate population forms the
sampling frame from which the sample size was drawn.
3.4 SAMPLE SIZE
The sample size of the study was determined using sample size determination
formula for simple random sampling method. The proportion (previous
prevalence) used 0.183 (18.3) which was gotten from a previous study done in
Kegbare, Niger Delta Region of Nigeria (Onwuchekwa et al, 2016). Using the
formula for systematic sampling, we have:
Z2(pq)
N=
d2
where:
N= sample size
P= proportion from previous study (0.183)
d= degree of accuracy (0.05)
Z= Level of significance (1.96)
N= 1.962 X 0.183(1-0.183)
0.052

3.6864 X 0.1495
0.0025
N= 220.47

27 | P a g e
For the avoidance of coverage error, the sample size was rounded up to 230 by
addition of 9 representing 4.1%. Therefore, total sample size used for this study
was 230 representing 7.5% of the study population and this is quite significant for
generalization of findings of this work.
SAMPLE PROCEDURE

A multi stage sampling technique was used. First stage, four compounds were
selected out of the ten compounds into cluster using a simple random sampling.
Second stage, for each compound, the first house is randomly selected from the
left hand side of the main road. Third stage, the next house was determined with
a systematic sample of every third house in a compound. Fourth stage, at each
house, using simple random sampling by way of balloting to pick participants and
using the instrument of data collection the interviewer obtain information related
to the variables of the study. Health personnel’s who have been trained according
to the research methodology measured blood pressure of the participants at
convenient time. A mercury sphygmomanometer and a stethoscope were used.
The mercury sphygmomanometer was held at the level of the heart, on the left
arm of the participants over the brachial artery in a sitting position and the
stethoscope was placed over the brachial pulse (Ibama, 2011). The systolic blood
pressure was taken as the first Korotkoff sound and the diastolic blood pressure
was recorded at the disappearance of the sounds. Measurements were recorded
to the nearest mmHg.
3.5 INSTRUMENT FOR DATA COLLECTION
The instrument for data collection was a self developed semi-structured
questionnaire which was in four sections. Section A consists of demographic
characteristics of respondents and section B consists of related questions that

28 | P a g e
deal with the risk factors of hypertension section C will consisted of related
questions on the level of awareness of hypertension and section D was the
systolic and diastolic blood pressure of the respondent after dully measured by
the researcher using a sphygmomanometer and a stethoscope.
The semi-structured questionnaire was given to the researcher’s supervisor in the
department of community medicine, University of Port Harcourt Teaching
Hospital, Rivers State for validity in terms of content and face validity of the
instrument.
Pretest was carried out among 30 adults in Opolo-Epie community, Yenagoa
Bayelsa State, who did noform part of the respondents used for the study.
3.6 METHOD OF DATA ANALYSIS
The data collected was collated, coded and analyzed using simple frequency
tables and percentages and descriptive directed at major responses.
3.7 ETHICAL CONSIDERATION
Permission was obtained from the informed consent and ethical committee. In
addition, the training institution (Community Health Officer Training Programme)
in the department of Community medicine, University of Port Harcourt Teaching
Hospital was issued a recognition letter to the researcher which was sent to the
leaders of Kpansia community in Yenagoa, Bayelsa State whose subjects were
used for this research. This allowed the researcher into the community and
solicited corporation and assistance of the respondents.

29 | P a g e
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 APPENDIX 1

QUESTIONNAIRE ON THE PREVALENCE OF HYPERTENSION AMONG ADULTS IN

KPANSIA COMMUNITY OF BAYELSA STATE

Pleas tick ( √ ) to the correct choice that is most applicable to you

SECTION A (SOCIO-DEMOGRAPHI DATA)

1. How old are you?.......................................................................

2. What is your sex? …………………………………………………..

3. Religion: Christian Muslim Traditionalist

4. Educational level: No formal education , Primary education ,

Secondary education , Tertiary education

5. Occupation: Employed (formal) , Employed (self) , Retired

, Unemployed , Skilled worker , Student .

6. Marital status: Single , Married , Divorced , Separated

, Widowed .

SECTION B (RISK FACTORS OF HYPERTENSION)

7. How often do you take alcohol in a day? Once in a day , Regularly

, Rarely , Never .

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 8. How often do you smoke in a day? Once in a day , Regularly ,

Rarely , Never .

9. How often do you add table salt to your food in a day? Once in a day

, Regularly , Rarely , Never .

10.How often do you perform physical exercise? Once in a week ,

Regularly , Rarely , Never .

11.How often do you eat fried food (yam, potatoes, rice), fried fish/meat, fast

food (snacks and other ready to eat food in a day)? Once in a week ,

Regularly , Rarely , Never .

12.How often do you drink/eat chocolate, sweets, ice-cream, butter and meat

organs? Once in a week , Regularly , Rarely , Never

. Once in 2 weeks

13.Does anyone in your family have history of hypertension? Yes , No

14.How often do you measure your blood pressure? Once in a year ,

Regularly , Rarely , Never .

15.How often do you check your body weight? Once in a year , Regularly

, Rarely , Never .

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SECTION C: AWARNESS ON THE RISK FACTORS OF HYPERTENSION

16.Have you ever heard of hypertension before? Yes , No

17.If yes, where did you hear it from? Health campaign , health worker

media family neighbors friends others

(please specify) ……………………

18.What are the symptoms of hypertension? Nervousness/anxiety

sweating sleeping difficulty dizziness palpitation

rapid heart rate nose bleeding blurred vision

shortness of breath all of the above no visible symptoms

I don’t know

19.Can hypertension be inherited? Yes , No I don’t know

20.Can cigarette smoking cause hypertension? Yes , No I don’t

know

21.Can excessive alcohol intake cause hypertension? Yes , No I

don’t know

22.Can excessive intake of salt cause hypertension? Yes , No I

don’t know

39 | P a g e
 23.Can lack of exercise cause hypertension? Yes , No I don’t

know

24.Can sitting down for a long time cause hypertension? Yes , No

I don’t know

SECTION D PREVALENCE OF HYPERTENSION (MEASUREMENT OF BLOOD

PRESSURE, WEIGHT AND HEIGHT)

SYSTOLI DYSTOLIC WEIGHT HEIGHT BODY MASS INDEX

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 APPENDIX 2

INFORMED CONSENT

Prevalence of hypertension among adults in Kpansia community in Yenagoa Local

Government of Bayelsa State

I PRAISE UZONDU, a student of community health officers training programme

UPTH is conducting the above named study for my partial fulfillment for the
award of Higher Diploma in community Health.

This study is aimed at determining the prevalence of hypertension among adults

living in Kpansia community of Bayelsa State which will be a base line data for
further studies.

Questionnaire involving your biodata and your lifestyle will be asked. This would
take few minutes (15-20 minutes).

I assure you of utmost confidentiality, you may choose to withdraw from the
study at any time and this will not be used against you

Thank you

I hereby accept to participate in this study freely and voluntarily.

Participant …………………………………………………………………………………

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Withness …………………………………………………………………………………….

APPENDIX 3

Community Health Officers

Training Programme,
University of Port Harcourt
Teaching Hospital
Date: 25th May, 2018
The Chairman,
UPTH Medical ETHIC Committee
University Of Port Harcourt
Teaching Hospital

sir,

REQUEST FOR APROVAL OF MY PROJECT PROPOSAL

I, PRAISE UZONDU, a student of community health officers training programme

UPTH is conducting the above named study for my partial fulfillment for the
award of Higher Diploma in community Health.

My topic Prevalence of hypertension among adults in Kpansia community of

Bayelsa State

This study is expected to be ethically carried out among adults living in kpansia
community of Bayelsa State.

Your approval is thereby requested for this project to commence. This study is for
my partial fulfillment for the award of Higher Diploma in community Health.

Your kind assessment of this request is anticipated

42 | P a g e
PRAISE UZONDU

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