Of the 136 hypertensive patients, 77(56.6%) were male. The principal characteristics of the study population are described in Table 1. They had a mean (SD) age of 56.74 (+12.58) years; the majority (26.5%) were in the age range of 30-40 years. The majority (95; 69.9%) of the hypertensive patients were Hindus and very fewer (1; 0.7%) were of other religions like Shikh. Regarding ethnicity, upper caste patients were predominant (40; 29.4%) and only 6 (4.4%) patients belonged to religious minorities. Similarly, a higher proportion (95; 69.9%) of patients were married and very few (4; 2.9%) were divorced.
Most of the patients (30; 22.1%) were illiterate and only 11(8.1%) of themhad a bachelor and above level of education. Twenty-two(16.2%) of the patients had a family income of less than 7000 and 66(48.5%) of them had an income range of 21,000 and above. Thirty-seven(27.2%) were homemakers, 20(14.7%) were involved in agriculture, 26(19.1%) were self-employed, 14(10.3%) were employed in the government sector, 10(7.4%) were employed in the private sector, 22(16.2%) were unemployed, and 7(%.1%) were retired.
Likewise, sixty-nine (50.7%) patients had reported afamily history of hypertension, whereas 67(49.3%) hadreported not having any such history. Among the 69, 29(42.03%) told that their father or mother had hypertension, 16(23.18) told their son or daughter had hypertension, 7(10.15%) told their grandparents had hypertension, and 17(24.64%) complained that their husband or wife had hypertension. Among 136 patients, 56(41.2%)had no any comorbid condition, but 32(23.5%) complained of having diabetes mellitus. The majority (107; 78.7%) were nonvegetarian, whereas 29(21.3%) of them were vegetarian. Moreover, 134(98.5%) of the patients had easy access to healthcare services, and only 2(1.5%) of them complained of nonavailability of health service facilitieswithin 30 minutesof walking distance.
Table 1: Socio-demographic determinants of patients (n=136)
Characteristics
|
Categories
|
n (%)
|
Age
|
30-80
|
136 (100.0)
|
Sex
|
Male
|
77 (56.6)
|
Religion
|
Hindu
|
95 (69.9)
|
|
Buddhist
|
28 (20.6)
|
|
Christian
|
2 (1.5)
|
|
Muslim
|
10 (7.4)
|
|
Others
|
1 (0.7)
|
Ethnicity
|
Dalit
|
26 (19.1)
|
|
Disadvantaged non-dalit tarai caste
|
11 (8.1)
|
|
Religious minorities
|
6 (4.4)
|
|
Relatively disadvantaged janajati
|
22 (16.2)
|
|
Relatively advantaged janajati
|
31 (22.8)
|
|
Upper caste people
|
40 (29.4)
|
Marital status
|
Unmarried
|
9 (6.6)
|
|
Married
|
95 (69.9)
|
|
Divorced
|
4 (2.9)
|
|
Widow/Widower
|
28 (20.6)
|
Educational status
|
Illiterate
|
30 (22.1)
|
|
Informal schooling
|
24 (17.6)
|
|
Primary
|
25 (18.4)
|
|
Secondary
|
25 (18.4)
|
|
Higher secondary
|
21 (15.4)
|
|
Bachelor and above
|
11 (8.1)
|
Monthly family income
|
Less than 7,000
|
22 (16.2)
|
|
7,000-14,000
|
23 (16.9)
|
|
14,000-21,000
|
25 (18.4)
|
|
21,000 and above
|
66 (48.5)
|
Occupation
|
House maker
|
37 (27.2)
|
|
Agriculture
|
20 (14.7)
|
|
Self employed
|
26 (19.1)
|
|
Government sector
|
14 (10.3)
|
|
Private sector
|
10 (7.4)
|
|
Unemployed
|
22 (16.2)
|
|
Retired
|
7 (5.1)
|
Family history of hypertension
|
Present
|
69 (50.7)
|
|
Absent
|
67 (49.3)
|
Family member having hypertension(n=69)
|
Parents
|
29 (42.03)
|
|
Offspring
|
1 (23.18)
|
|
Grandparents
|
7 (10.15)
|
|
Partner
|
17 (24.64)
|
Presence of comorbidities
|
No any
|
56 (41.2)
|
|
Diabetes mellitus
|
32 (23.5)
|
|
Kidney diseases
|
10 (7.4)
|
|
Asthma
|
21 (15.4)
|
|
Other diseases
|
17 (12.5)
|
Dietary pattern
|
Vegetarian
|
29 (21.3)
|
|
Non-vegetarian
|
107 (78.7)
|
Availability of health services at 30 minutes walking distance
|
Available
|
134 (98.5)
|
|
Not available
|
2 (1.5)
|
Others: Shikh, Other diseases: Skin problems, psychological disorders, gastritis, reproductive problems
The majority (69; 50.7%) of the hypertensive patients were found to havea positive attitude regarding hypertension, whereas 67(49.3%) had a negative attitude. Likewise, 71 (52.2%) patients were found to perform adequate self-care practice and only 65(47.8%) were found to perform inadequate self-care practice, as depicted in Table 2.
Table 2: Attitude and self-care practice scoring of hypertensive patients (n=136)
Variables
|
Category
|
n (%)
|
Attitude
|
Negative (<40)
|
67 (49.3)
|
|
Positive ( >40)
|
69 (50.7)
|
Practice
|
Inadequate (<16)
|
65 (47.8)
|
|
Adequate ( >16)
|
71 (52.2)
|
Table 3 reveals the attitude of hypertensive patients toward each statement. The majority (86; 63.2%) of the patients had a positive attitude towards the positive statement, i.e., hypertension is a major cardiovascular diseases. Sixty-three (34.3%) patients strongly agreed that smoking and alcohol consumption increase the risk of hypertension and no respondent disagreed on that statement. Fifty (36.8%) patients strongly disagreed that a balanced diet and healthy lifestyle play an important role in the causation of hypertension, but also 11 (8.1%) patients agreed to the same statement. Nineteen (14%) patients strongly agreed that only salt intake reduction is sufficient for prevention of hypertension and 41(30.1%) showed strong disagreement in this statement. Similarly, 74 (54.4%) patients strongly agreed that regular physical exercise is essential for maintaining a healthy lifestyleand 11(8.1%) disagreed on it.
Likewise, 59 (43.4%) and 50 (36.8%) patients, respectively,showed strong disagreement and disagreement that regular blood pressure level checking is not necessary for hypertensive patients. Most of the patients (72; 52.9%) strongly agreed and 8(5.9%) strongly disagreed that regular follow-up for hypertensive patients is important. In the negative statement, hypertension usually does not cause any symptoms, only 16(11.8%) patients strongly agreed and 56 (41.2%) disagreed. Fifty-eight (42.6%) disagreed and only 9(6.6%) agreed that regular intake of medication is not necessary for hypertensive patients. In the last positive statement, hypertension may lead to various life-threatening complications if not managed in time, 107 (78.7%) patients showed strong agreement, as shown in Table 3.
Table 3: Attitude of hypertensive patients (n=136)
Statements
|
Response
|
Strongly agree n (%)
|
Agree n (%)
|
Undecided n (%)
|
Disagree n (%)
|
Strongly disagree n (%)
|
Hypertension is common cardiovascular disease in adult.
|
86 (63.2)
|
34 (25.0)
|
8 (5.9)
|
8 (5.9)
|
0 (0.0)
|
Habit of smoking and alcohol consumption increases risk for hypertension.
|
63 (46.3)
|
60 (44.1)
|
1 (0.7)
|
12 (8.8)
|
0 (0.0)
|
Balanced diet and healthy lifestyle plays an important role in causation of hypertension.
|
18 (13.2)
|
11 (8.1)
|
13 (9.6)
|
44 (32.4)
|
50 (36.8)
|
Only salt intake reduction is sufficient for prevention of hypertension.
|
19 (14.0)
|
23 (16.9)
|
18 (13.2)
|
35 (25.7)
|
41 (30.1)
|
Regular exercise is essential for maintaining healthy lifestyle.
|
74 (54.4)
|
36 (26.5)
|
15 (11.0)
|
11 (8.1)
|
0 (0.0)
|
Regular blood pressure level checking is not necessary for hypertensive patient.
|
6 (4.4)
|
7 (5.1)
|
14 (10.3)
|
50 (36.8)
|
59 (43.4)
|
Regular follow up for hypertensive patient is important.
|
72 (52.9)
|
34 (25.0)
|
10 (7.4)
|
12 (8.8)
|
8 (5.9)
|
Hypertension usually does not cause any symptoms.
|
16 (11.8)
|
9 (6.6)
|
14 (10.3)
|
56 (41.2)
|
41 (30.1)
|
Regular intake of medication is not necessary for hypertensive patient.
|
10 (7.4)
|
8 (5.9)
|
5 (3.7)
|
58 (42.6)
|
55 (40.4)
|
Hypertension may lead to various life threatening complication if not managed in time.
|
107 (78.7)
|
25 (18.4)
|
1 (0.7)
|
0 (0.0)
|
3 (2.2)
|
Among 136 patients, the majority (130; 95.6%) were found to follow a healthy dietary pattern. One hundred and six (77.9%) patients did not regularly take fried goods. One hundred and sixteen (85.3%) added extra salt to their diet and only 20 (14.7%) did not add extra salt to their diet. Most of them (97; 71.3%) did not take red or smoked meat. One hundred and thirty (95.6%) and 105 (77.2%) patients reported taking more than 5 servings of green leafy vegetables and fruits, respectively.
Similarly, only 34 (25%) patients were found to have a habit of smoking and drinking alcohol, 94 (69.1%) patients had confessed that they performedphysical exercise for more than 30 minutes daily, among which 44 patients exercised six or more days in a week. Forty-two (44.68%) patientsused to exercise with the purpose of reducing hypertension, while 52(53.32%) used to exercise with the intention of reducingweight. Most of the study patients (112; 82.4%) had reported taking hypertensive medication. About 96(70.58%) of the patientstold that that theyvisited for follow-up as per physician advice, and 124 (91.2%) of them regularly checked their blood pressure, and 54 (43.54%) of them had the habit of checking it weekly, as illustrated in Table 4.
Table 4: Self-care practice of Hypertensive patients (n=136)
Variables
|
Categories
|
n (%)
|
1. Follow a healthy eating pattern
|
Yes
|
6 (4.4)
|
2. Take fried food regularly
|
Yes
|
30 (22.1)
|
3. Adding extra salt in regular diet
|
Yes
|
20 (14.7)
|
4. Take red meat and smoked meat
|
Yes
|
39 (28.7)
|
5. Take>5 green leafy vegetable servings
|
Yes
|
130 (95.6)
|
6. Take> 5 fruits servings
|
Yes
|
105 (77.2)
|
7. Smoking habit
|
Yes
|
34 (25.0)
|
8. Alcohol consumption habit
|
Yes
|
34 (25.0)
|
8.1. How often (n=34)
|
Daily
|
17 (50.0)
|
|
Weekly
|
4 (11.76)
|
|
Occasionally
|
13 (38.24)
|
|
As eye opener
|
0 (0.0)
|
8.2. Amount of alcohol (n=34)
|
Quarter(180 ml)
|
26 (76.48)
|
|
Half bottle (375ml)
|
3 (8.82)
|
|
Bottle (750ml)
|
5 (14.7)
|
9. Physical exercise ofat least 30 minutes
|
Yes
|
94 (69.1)
|
10. Specific exercise
|
Yes
|
93 (68.4)
|
11. Days of exercise in a week (n=94)
|
< 3 days
|
11 (11.71)
|
|
4 days
|
13 (13.83)
|
|
5 days
|
26 (27.66)
|
|
>6 days
|
44 (46.8)
|
12. Purpose of exercise (n=94)
|
Hypertension reduction
|
42 (44.68)
|
|
Weight management
|
52 (53.32)
|
13. Taking any anti-hypertensive medication
|
Yes
|
112 (82.4)
|
13.1. Take blood pressure medicine regularly (n=112)
|
Yes
|
111 (99.1)
|
13.2. Habit of increasing/decreasing doses (n=112)
|
Yes
|
2 (1.79)
|
13.3. Take blood pressure medicine at same time every day (n=112)
|
Yes
|
106 (94.65)
|
13.4. Take recommended number of blood pressure medicine (n=112)
|
Yes
|
109 (97.32)
|
14. Visit for follow up
|
As physician advice
|
96 (70.58)
|
|
6 monthly
|
20 (14.7)
|
|
When symptoms worsen
|
14 (10.3)
|
|
Rarely
|
6 (4.42)
|
15. Habit of checking blood pressure regularly
|
Yes
|
124 (91.2)
|
15.1. If yes, how often(n=124)
|
Daily
|
16 (12.90)
|
|
Weekly
|
54 (43.54)
|
|
Monthly
|
37 (29.83)
|
|
When symptoms worsen
|
17 (13.73)
|
The attitude of hypertensive patients was high with a mean (±SD) of 40.78 (+4.37) and a mean percentage of 81.56. Similarly,the self-care practice of the patients was adequate with a mean (±SD) value of 14.66 (+ 3.48) and a mean percentage of 73.3, as shown in Table 5.
Table 5: Attitude and self-care practice of hypertensive patients
Response
|
Maximum score
|
Median
|
Mean+SD
|
Mean percentage (%)
|
Attitude
|
50
|
41
|
40.78+4.37
|
81.56
|
Self-care practice
|
20
|
16
|
14.66+3.48
|
73.3
|
A significant association was found between selected variables such as educational status, dietary pattern, and attitude of hypertensive patients, whereas there was no significant association with other variables like age, gender, religion, ethnicity, occupation, monthly income,and family history, as illustrated in Table 6. In contrast, no significant association was found between sociodemographic variablesand self-care practice, as depicted in Table 7. As a whole, a significant association was found between attitude and self-care practice, as shown in Table 8.
Table 6: Association of attitude of hypertensive patients with demographic variables (n=136)
Variables
|
Categories
|
Total scores
|
p-value
|
Median
<41 n (%)
|
Median
>41 n (%)
|
Age
|
< 54
>54
|
27 (46.6)
40 (51.3)
|
31 (53.4)
38 (48.7)
|
0.585
|
Sex
|
Male
Female
|
37 (48.1)
30 (50.8)
|
40 (51.9)
29 (49.2)
|
0.747
|
Ethnicity
|
Upper caste
Others
|
24 (60.0)
42(44.2)
|
16 (40.0)
53 (55.8)
|
0.094
|
Educational status
|
Illiterate
Others
|
21 (70.0)
46 (43.4)
|
9 (30.0)
60(56.6)
|
0.010*
|
Monthly family income
|
Less than 7,000
7,000-14,000
14,000-21,000
21,000 and above
|
12 (54.5)
9 (39.1)
13 (52.0)
33 (50.0)
|
10 (45.5)
14 (60.9)
12 (48.0)
33 (50.0)
|
0.734
|
Occupation
|
Home maker
Others
|
22 (59.5)
45 (45.5)
|
15 (40.5)
54 (54.5)
|
0.146
|
Family history of hypertension
|
Present
Absent
|
33 (47.8)
34 (50.7)
|
36 (52.2)
33 (49.3)
|
0.733
|
Dietary pattern
|
Vegetarian
Non vegetarian
|
22 (75.9)
45(42.1)
|
7 (24.1)
62 (57.9)
|
0.001***
|
(***) Highly significant (*) Significant
Table 7: Association of self-care practice of hypertensive patients with demographic variables (n=136)
Variables
|
Categories
|
Total scores
|
p-value
|
Median
<16 n (%)
|
Median
>16 n (%)
|
Age
|
< 54
>54
|
30 (51.7)
35 (44.9)
|
28 (48.3)
43 (55.1)
|
0.429
|
Sex
|
Male
Female
|
39 (50.6)
26 (44.1)
|
38 (49.4)
33 (55.9)
|
0.446
|
Ethnicity
|
Upper caste
Other caste
|
24 (60.0)
42 (44.2)
|
16 (40.0)
53 (55.8)
|
0.094
|
Educational status
|
Illiterate
Others
|
14 (46.7)
51 (48.1)
|
16 (53.3)
55 (51.9)
|
0.889
|
Monthly family income
|
Less than 7,000
7,000-14,000
14,000-21,000
21,000 and above
|
12 (54.5)
9 (39.1)
13 (52.0)
33 (50.0)
|
10 (45.5)
14 (60.9)
12 (48.0)
33 (50.0)
|
0.734
|
Occupation
|
Home maker
Others
|
18 (48.6)
47 (47.5)
|
19 (51.4)
52 (52.5)
|
0.903
|
Family history of hypertension
|
Present
Absent
|
32 (46.4)
33 (49.3)
|
37 (53.6)
34 (50.7)
|
0.737
|
Dietary pattern
|
Vegetarian
Non vegetarian
|
15 (51.7)
50 (46.7)
|
14 (48.3)
57 (53.3)
|
0.633
|
Table 8:Association between attitude and self-care practice of hypertensive clients (n=136)
Attitude
|
Total scores of practice
|
p-value
|
Median
<16 n (%)
|
Median
>16 n (%)
|
Negative
Positive
|
41 (61.2)
24 (34.8)
|
26 (38.8)
45 (65.2)
|
0.002***
|
(***) Highly significant (*) Significant