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Prevalence and associated factors of hypertension complications among hypertensive patients at University of Gondar Comprehensive Specialized Referral Hospital

Open AccessPublished:December 30, 2021DOI:https://doi.org/10.1016/j.cegh.2021.100951

      Abstract

      Background

      Cardiovascular diseases (CVDs) were non-communicable diseases that remain the leading cause of disability and death in the world. Therefore, this study aimed to assess the prevalence and associated factors of hypertension complications among hypertensive patients at University of Gondar comprehensive specialized referral hospital.

      Method

      A cross-sectional study was conducted to assess the prevalence and associated factors of hypertension complications, from 1st June 2020 to 30th August 2020. Interview-guided self-administered questionnaire and a chart review were used for data collection. Statistical significance was set at a 95% confidence interval using a P-value of ≤0.05 as a cutoff point.

      Results

      Out of 428 hypertensive patients, 261 (61.0%) were males. They were from 19 to 84 years age group and the mean age of participants was 53.55 ± 16.65 years. Participants with a family history of hypertension were 5 times more likely to develop complications than those with no family history of hypertension (AOR = 5.372, 95% CI = 2.378, 12.134, p = 0.001). Participants who had sedentary physical activity were 4 times more likely to develop complications than those who had vigorous physical activity (AOR = 4.049, 95% CI = 1.463, 11.206, p = 0.007). Participants who had high waist circumference were 7 times (AOR = 7.229, 95% CI = 1.436, 36.394, p = 0.016) more likely to develop complications than those who had low waist circumference.

      Conclusion

      In this study, being female, illiterate participants, having a family history of hypertension, doing sedentary exercise and obesity are factors associated with hypertension complications.

      Keywords

      1. Background

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      Hypertension is a chronic medical condition characterized by elevated blood pressure (BP) where systolic blood pressure (SBP) is ≥ 140 mmHg or diastolic blood pressure (DBP) is ≥ 90 mmHg in the arteries. It makes the heart work harder to circulate blood through the blood vessels.
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      In some age groups, the risk of CVDs doubles for each increase of 20 mmHg in SBP and 10 mmHg in DBP starting from 115/75 mmHg. Treating SBP and DBP until they are less than 140/90 mmHg is associated with a reduction in cardiovascular complications.
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      and 48.3% in Malaysia. Controlling BP is a difficult experience in Africa too; BP control was accomplished for only 47.7% of the hypertensive patients on follow-up in Tanzania,
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      As the available evidence showed that HTN is a public health problem in Ethiopia, mortality is high indicating that increased complications of the disease such as stroke, heart failure, and renal failure.
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      It is evident in previous study that in spite of accessible therapeutic alternatives, blood pressure remained above 140/90 in a large number of hypertensive patients in Ethiopia.
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      The aim of this study asses prevalence and associated factors of hypertension complications among hypertensive patients at university of gondar comprehensive specialized hospital.

      2. Methods

      2.1 Study design, study area, and period

      A cross-sectional study was conducted to identify the major risk factors inducing hypertensive complications at the University of Gondar Comprehensive Specialized Referral Hospital, Northwest Ethiopia. The study was conducted at the University of Gondar Comprehensive Specialized Hospital, Chronic ambulatory care clinic from 1st June 2020 to 30th August 2020. University of Gondar Comprehensive Specialized Hospital is found in the historical town of Gondar located 750 km Northwest of Addis Ababa in the North Gondar zone of the Amhara National Regional State.

      2.2 Study participants and sampling

      All adult hypertensive patients (age ≥18 years) who visited the hypertension care services of University of Gondar Comprehensive Specialized Hospital through the study period were included. Hypertensive patients with a duration of hypertension of less than one year, pregnant women, and participants with mental problems were excluded from the study. Single population proportion formula was used with the assumption of 95% CI, 5% margin of error, the prevalence (p) of (50%), and 5% for possible non-response to determine a final adjusted sample size of 372. Then, a systematic random sampling method was used to recruit the final participants. However, to increase the power of the study, the sample size was extended to 428.

      2.3 Data collection process

      The data collectors were appropriately skilled in the data collection tool before data collection. Several published articles were reviewed to prepare the data collection tool.
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      Risk factors for hypertension and its complications—a hospital based case control study.
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      • et al.
      Major inducing factors of hypertensive complications and the interventions required to reduce their prevalence: an epidemiological study of hypertension in a rural population in China.
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      Prevalence and associated risk factors of hypertension: a cross-sectional study in urban Varanasi.
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      • Kanniammal C.
      Identification of risk factors for hypertension and its complications among hypertensive adults attending medical OPD–A hospital based case control study.
      Interview-directed self-administered questionnaires and a chart review were employed for data collection. Patients with hypertension who were unable to write and read were interviewed. The questionnaire includes both the sociodemographic characteristics and clinical status of the patients.
      The presence of complications was diagnosed by the physician, the laboratory findings and complications were obtained from the patient charts. The collected data were checked and cleared every day for consistency and completeness before processing. During data gathering, two trained health professionals were recruited and supervised by two MSc graduate health professionals. Finally, the fulfillment and completeness of all questions were checked by the data collectors and principal investigator.

      2.4 Operational definitions

      • Hypertension: A sustained high blood pressure (SBP ≥140 or DBP ≥90 mmHg).
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        • Adekola B.
        Blood pressure and the new ACC/AHA hypertension guidelines.
      • Pre-hypertension: SBP is 120–139 mmHg or DBP 80–89 mmHg.
        • Flack J.M.
        • Adekola B.
        Blood pressure and the new ACC/AHA hypertension guidelines.
      • Normal: SBP is 90–119 mmHg and DBP 60–79 mmHg.
        • Flack J.M.
        • Adekola B.
        Blood pressure and the new ACC/AHA hypertension guidelines.
      • Complications of hypertension: are clinical outcomes that result from persistent elevation of blood pressure. Hypertension is a risk factor for all clinical manifestations of atherosclerosis since it is a risk factor for atherosclerosis itself.
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        • Ishaq M.
        Awareness of the risk factors, presenting features and complications of hypertension amongst hypertensives and normotensives.
      • Body Mass Index: Calculated as weight in kilograms divided by height in square meters and interpreted as underweight (BMI <18.5), normal (18.5–24.9), overweight (25.0–29.9), and obese (≥30.0).
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        • et al.
        Body mass index and outcomes in ischaemic versus non-ischaemic heart failure across the spectrum of ejection fraction.
      • Vigorous physical activity: Intensity activity on at least 3 days achieving a minimum of at least 1500 MET minutes/week OR 7 or more days of any combination of walking, moderate- or vigorous intensity activities achieving a minimum of at least 3000 MET-minutes per week.
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        • et al.
        Relationship between metabolic syndrome and rheumatoid arthritis.
      • Moderate physical activity: Three or more days of vigorous-intensity activity of a least 20 min per day or, 5 or more days of moderate-intensity activity or walking of at least 30 min per day OR 5 or more days of any combination of walking, moderate- or vigorous intensity activities achieving a minimum of at least 600 MET-minutes per week.
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        • Choi H.
        • Cho B.-L.
        • et al.
        Relationship between metabolic syndrome and rheumatoid arthritis.
      • Sedentary physical activity: A person not meeting any of the above-mentioned criteria falls in this category.
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        • Choi H.
        • Cho B.-L.
        • et al.
        Relationship between metabolic syndrome and rheumatoid arthritis.

      2.5 Data management and statistical analysis

      Data were entered using the Epi-info version 7.2.2.6 and analyzed using the SPSS version 26. Descriptive statistics, like frequency distribution, mean, and percentage were employed for most variables. A forward stepwise binary logistic regression analysis was done to assess the relative importance of the explanatory variables on the dependent variable (hypertension and its complications). Statistical significance was set at a 95% confidence interval using a P-value of ≤0.05 as a cutoff point.

      3. Results

      Out of 428 hypertensive patients, 261 (61.0%) were males. They were from 19 to 84 years age group and the mean age of participants was 53.55 ± 16.65 years. Nearly two-half of the participants (61.0%) were urban residence and 73.4% had orthodox religion with near to half participants were self-employed. (91.3%) were living with extended family. Of the participants, 123 (28.7%) had hypertension for a duration of greater than 20 years (Table 1).
      Table 1Sociodemographic characteristics of participants.
      VariableCategoryFrequencyPercent
      Mean age 53.55 + 16.65
      Age group<30429.8
      30–458118.9
      >4530571.3
      SexMale26161.0
      Female16739.0
      ResidenceUrban26161.0
      Rural16739.0
      Marital statusSingle5813.6
      Married25659.8
      Divorced6014.0
      Widowed5412.6
      ReligionOrthodox31473.4
      Muslim8319.4
      Protestant317.2
      OccupationGovernment9822.9
      Non-government5011.7
      Self-employed17340.4
      Farmer9221.5
      Student153.5
      Educational statusIlliterate19345.1
      Elementary school7517.5
      Secondary school6715.7
      High school diploma5212.1
      Higher education419.6
      Income<100012128.3
      1000–300013932.5
      3000–50007417.3
      >500017.322.0
      Family historyYes21850.9
      No21049.1
      SmokingYes7417.3
      No35482.7
      AlcoholYes17641.1
      No25258.9
      Physical activitySedentary16839.3
      Moderate18242.5
      Vigorous7818.2
      BMIUnder weight429.8
      Normal22151.6
      Over weight12829.9
      Obesity378.6
      Weekly fruit consumptionYes12429.0
      No30471.0
      Blood pressureNormal6715.7
      Prehypertension7517.5
      Stage I hypertension15135.3
      Stage II hypertension13531.5
      Duration of hypertension<511727.3
      5–107918.5
      10–146815.9
      15–20419.6
      >2012328.7
      From the sociodemographic characteristics sex was significantly associated; female participants with hypertension were 3 times more likely to develop complication compared to males (AOR = 2.865, 95% CI = 1.169, 7.021, p = 0.021). Divorced participants were about 80% less likely to have complication compared to those who were single (AOR = 0.200, 95% CI = 0.059, 0.678, p = 0.010). Muslim participants were about 80% less likely to have complication whereas protestant with hypertension were 4 times more likely to develop complication compared to orthodox (AOR = 0.184, 95% CI = 0.067, 0.508, p = 0.001 and AOR = 24.271, 95% CI = 5.059, 116.450, p = 0.001 respectively). Compared to government employed participants, farmers were 5 times more likely to develop complication (AOR = 5.135, 95% CI = 1.064, 24.773, p = 0.042). Illiterate participants were 7 times more likely to develop complication than those who attained higher education (AOR = 6.772, 95% CI = 1.415, 32.404, p = 0.017). Participants with family history of hypertension were 5 times more likely to develop complication compared to those with no family history of hypertension (AOR = 5.372, 95% CI = 2.378, 12.134, p = 0.001). Participants who had sedentary physical activity were 4 times more likely to develop complication than those who had vigorous physical activity (AOR = 4.049, 95% CI = 1.463, 11.206, p = 0.007). Participants who had high waist circumference (obesity) were 7 times ((AOR = 7.229, 95% CI = 1.436, 36.394, p = 0.016) more likely to develop complications than those who had low waist circumference (underweight). Participants with normal and prehypertension 90% and 97% less likely develop complication compared to stage II hypertension (AOR = 0.099, 95% CI = 0.027, 0.363, p = 0.001 and AOR = 0.028, 95% CI = 0.010, 0.080, p = 0.001, respectively). Participants with less than 5 years duration of hypertension were 3 times more likely to develop complication than those with greater than 20 years duration of hypertension (AOR = 3.091, 95% CI = 3.349, 12.349, p = 0.001) (Table 2).
      Table 2Associated risk factors of hypertension complications.
      VariablesCategoriesComplication/sAOR (95% CI)P-value
      YesNo
      Age in years<3015 (6.1)27 (14.7)1
      30–4548 (19.7)33 (17.9)1.012 (0.242,4.234)0.987
      >45181 (74.2)124 (67.4)1.437 (0.335,6.154)0.626
      SexMale156 (63.9)105 (57.1)1
      Female88 (36.1)79 (42.9)2.865 (1.169,7.021)0.021*
      ResidenceUrban155 (63.5)106 (57.6)1.409 (0.606,3.276)0.426
      Rural89 (36.5)78 (42.4)1
      Marital statusSingle29 (11.9)29 (15.8)1
      Married143 (58.6)113 (61.4)2.562 (0.958,6.855)0.061
      Divorced43 (17.6)17 (9.2)0.200 (0.059,0.678)0.010*
      Widowed29 (11.9)25 (13.6)2.307 (0.625,8.513)0.210
      ReligionOrthodox173 (70.9)141 (76.6)1
      Muslim61 (25.0)22 (12.0)0.184 (0.067,0.508)0.001*
      Protestant10 (4.1)21 (11.4)4.271 (5.059,16.450)0.001*
      OccupationGovernment56 (23.0)42 (22.8)1
      Non-government31 (12.7)19 (10.3)0.950 (0.267,3.380)0.936
      Self-employed113 (46.3)60 (32.6)1.160 (0.329,4.080)0.818
      Farmer38 (15.6)54 (29.3)5.135 (1.064,24.773)0.042*
      Student6 (2.5)9 (4.9)5.210 (0.547,49.623)0.151
      Educational statusIlliterate118 (61.1)75 (38.9)6.772 (1.415,32.404)0.017*
      Elementary school44 (58.7)31 (41.3)0.865 (0.188,3.973)0.852
      Secondary school24 (35.8)43 (64.2)3.119 (0.776,12.533)0.109
      High school34 (65.4)18 (34.6)0.689 (0.191,2.478)0.568
      Higher education24 (58.5)17 (41.5)1
      Income<100060 (49.6)61 (50.4)1
      1000–300087 (62.6)52 (37.4)0.450 (0.178,1.139)0.092
      3000–500041 (55.4)33 (44.6)1.565 (0.491,4.985)0.449
      >500056 (59.6)38 (40.4)1.208 (0.333,12.134)0.774
      Family history of HTNYes118 (54.1)100 (45.9)5.372 (2.378,12.134)0.001*
      No126 (60.0)84 (40.0)1
      SmokingYes44 (59.5)30 (40.5)1.839 (0.606,5.576)0.282
      No200 (56.5)154 (43.5)1
      AlcoholYes102 (58.0)74 (42.0)1
      No142 (56.3)110 (43.7)1.736 (0.785,3.838)0.173
      Physical activitySedentary126 (75.0)42 (25.0)4.049 (1.463,11.206)0.007*
      Moderate75 (41.2)107 (58.8)1.002 (0.350,2.863)0.998
      Vigorous43 (55.1)35 (44.9)1
      BMIUnder weight26 (61.9)16 (38.1)1
      Normal124 (56.1)97 (43.9)3.506 (0.707,17.374)0.125
      Over weight62 (48.4)66 (51.6)3.973 (0.678,23.264)0.126
      Obesity32 (86.5)5 (13.5)7.229 (1.436,36.394)0.016*
      Weekly fruit consumptionYes62 (50.0)62 (50.0)1
      No106 (34.9)198 (65.1)1.475 (0.640,3.399)0.361
      Blood pressureNormal38 (50.7)37 (49.3)0.099 (0.027,0.363)0.001*
      Prehypertension133 (88.1)18 (11.9)0.028 (0.010,0.080)0.001*
      Stage I26 (38.8)41 (61.2)1.046 (0.310,3.534)0.942
      Stage II hypertension47 (34.8)88 (65.2)1
      Duration of hypertension<595 (77.2)28 (22.8)3.091 (3.349,12.349)0.001*
      5–944 (55.7)35 (44.3)1.296 (2.116,5.156)0.032*
      10–1425 (36.8)43 (63.2)3.217 (0.870,7.663)0.241
      15–2021 (51.2)20 (48.8)1.678 (0.177,9.588)0.128
      >2059 (50.4)58 (49.6)1
      *significant at p < 0.05.
      In this study, the overall prevalence of hypertension complications was 203 (52.7%). Diabetic mellitus 151 (35.3%) was the most reported complication by hypertensive patients, followed by dyslipidemia 135 (31.5%), kidney disease 123 (28.7%), Stroke 99 (23.1%), eye problem 48 (11.2%), and heart disease 45 (10.5%) (Table 3).
      Table 3Complication of hypertension.
      ComplicationFrequency (n = 428)Percent
      Diabetic mellitus15135.3
      Dyslipidemia13531.5
      Heart disease4510.5
      Eye problem4811.2
      Kidney disease12328.7
      Stroke9923.1

      4. Discussion

      Raised blood pressure is a major risk factor for CVDs, moreover elevated BP is also positively correlated with the risk of CVDs, and so CVDs include stroke, coronary heart disease, chronic heart disease, peripheral vascular disease, retinal hemorrhage, renal impairment, visual impairment, and heart failure.
      • Ombada M.
      • Ombada M.
      Diagnosing hypertension among adults; A study based on prevention-management of primary and secondary hypertension.
      The most common complications of hypertension in this study include diabetes mellitus, dyslipidemia, kidney disease, stroke, eye problem, and heart disease. Among these, diabetes mellitus was the most common complication followed by dyslipidemia, kidney disease, and stroke. Being female, farmers, illiteracy, family history, sedentary activity, and obesity were significantly associated risk factors for hypertension and its complications, whereas divorced and Muslims were protective risk factors for hypertension and its complications. Moreover, alcohol and smoking were not associated risk factors for complications of hypertension in this study due to low prevalence as a result of health education. Health education is important in this concern.
      Several studies have revealed that good control of blood pressure is vital to avoid risky complications.
      • Adler A.I.
      • Stratton I.M.
      • Neil H.A.W.
      • et al.
      Association of systolic blood pressure with macrovascular and microvascular complications of type 2 diabetes (UKPDS 36): prospective observational study.
      • Collins R.
      • MacMahon S.
      Blood pressure, antihypertensive drug treatment and the risks of stroke and of coronary heart disease.
      • Ruilope L.M.
      • Campo C.
      • Rodriguez-Artalejo F.
      • Lahera V.
      • Garcia-Robles R.
      • Rodicio J.L.
      Blood pressure and renal function: therapeutic implications.
      In this study, participants with normal and prehypertension were less likely to develop complications when compared to stage II hypertension. Furthermore, the development of complications was a significantly associated risk factor with a duration of hypertension. This result is consistent with the finding of studies conducted in Ethiopia and Nigeria which suggested the possible reason might be an increase in awareness and adherence to antihypertensive treatment as the patient stays on treatment for longer years.
      • Tesfaye A.
      • Kumela K.
      • Wolde M.
      Blood pressure control associates and antihypertensive pharmacotherapy patterns in Tikur Anbessa general specialized hospital chronic care department, Addis Ababa, Ethiopia.
      ,
      • Iloh G.U.
      • Ofoedu J.N.
      • Njoku P.U.
      • Godswill-Uko E.U.
      • Amadi A.N.
      Medication adherence and blood pressure control amongst adults with primary hypertension attending a tertiary hospital primary care clinic in Eastern Nigeria.
      Illiterate participants developed more complications than those participants with higher education levels. This is consistent with the studies which reported lower control on hypertension among individuals with lower education and that low rates of control and treatment of hypertension have been considered as a major risk to increase CVDs and stroke.
      • Azizi A.
      • Abasi M.
      • Abdoli G.
      The prevalence of hypertension and its association with age, sex and BMI in a population being educated using community-based medicine in Kermanshah: 2003.
      • Xu T.
      • Wang Y.
      • Li W.
      • et al.
      Survey of prevalence, awareness, treatment, and control of hypertension among Chinese governmental and institutional employees in Beijing.
      • Joffres M.
      • Falaschetti E.
      • Gillespie C.
      • et al.
      Hypertension prevalence, awareness, treatment and control in national surveys from England, the USA and Canada, and correlation with stroke and ischaemic heart disease mortality: a cross-sectional study.
      • Wu Y.
      • Tai E.S.
      • Heng D.
      • Tan C.E.
      • Low L.P.
      • Lee J.
      Risk factors associated with hypertension awareness, treatment, and control in a multi-ethnic Asian population.
      In this study, age was not an associated risk factor for hypertension and its complication, unlike other studies that reported age was independently associated with hypertension that hypertension-related morbidity increases with increased age along with subsequent complications.
      • Abebe S.M.
      • Berhane Y.
      • Worku A.
      • Getachew A.
      Prevalence and associated factors of hypertension: a crossectional community based study in Northwest Ethiopia.
      • Anteneh Z.A.
      • Yalew W.A.
      • Abitew D.B.
      Prevalence and correlation of hypertension among adult population in Bahir Dar city, northwest Ethiopia: a community based cross-sectional study.
      • Awoke A.
      • Awoke T.
      • Alemu S.
      • Megabiaw B.
      Prevalence and associated factors of hypertension among adults in Gondar, Northwest Ethiopia: a community based cross-sectional study.
      • Demisse A.G.
      • Greffie E.S.
      • Abebe S.M.
      • et al.
      High burden of hypertension across the age groups among residents of Gondar city in Ethiopia: a population based cross sectional study.
      • Angaw K.
      • Dadi A.F.
      • Alene K.A.
      Prevalence of hypertension among federal ministry civil servants in Addis Ababa, Ethiopia: a call for a workplace-screening program.
      • Abebe S.M.
      • Andargie G.
      • Shimeka A.
      • et al.
      The prevalence of non-communicable diseases in northwest Ethiopia: survey of Dabat Health and Demographic Surveillance System.
      • Giday A.
      • Tadesse B.
      Prevalence and determinants of hypertension in rural and urban areas of southern Ethiopia.
      Participants with a family history of hypertension developed more complications than those participants having no family history. This is in line with other findings and reported that the association was due to family history increases the risk of developing hypertension.
      • Jaddou H.
      • Batiehah A.
      • Ajlouni K.
      Prevalence and associated factors of hypertension: results from a three community-based survey, Jordan.
      ,
      • Devadason P.
      • Sabarinath M.
      • Reshma Dass R.
      • et al.
      Risk factors for hypertension and its complications—a hospital based case control study.
      ,
      • Giday A.
      • Tadesse B.
      Prevalence and determinants of hypertension in rural and urban areas of southern Ethiopia.
      ,
      • Mandago K.
      • Mghanga F.P.
      Awareness of risk factors and complications of hypertension in southern Tanzania.
      Because it exposed the patient to high blood pressure, heart disease, and stroke or their family had the same lifestyle habit.
      • Corvol P.
      • Jeunemaitre X.
      • Charru A.
      • Soubrier F.
      Can the genetic factors influence the treatment of systemic hypertension? The case of the renin-angiotensin-aldosterone system.
      ,
      • Carmelli D.
      • Robinette D.
      • Fabsitz R.
      Concordance, discordance and prevalence of hypertension in World War II male veteran twins.
      The present study also revealed that family history and obesity were associated risk factors for hypertension and its complications. This is consistent with the finding reported that a family history of hypertension, diabetes, and being obese was strongly associated with high blood pressure and a strong association between elevated blood pressure and complications.
      • Gudina E.K.
      • Michael Y.
      • Assegid S.
      Prevalence of hypertension and its risk factors in southwest Ethiopia: a hospital-based cross-sectional survey.
      ,
      • Vasantha J.P.J.
      • Kanniammal C.
      Identification of risk factors for hypertension and its complications among hypertensive adults attending medical OPD–A hospital based case control study.
      This finding is also consistent with the study conducted in Saudi Arabia,
      • Bani I.A.
      Prevalence and related risk factors of essential hypertension in Jazan region, Saudi Arabia.
      and India.
      • Devadason P.
      • Sabarinath M.
      • Reshma Dass R.
      • et al.
      Risk factors for hypertension and its complications—a hospital based case control study.
      Participants with sedentary activity developed more complications than participants doing vigorous activity. This is in agreement with other studies and such association was because of the decreased activity in less than 10 min daily increased risk of hypertension,
      • Awoke A.
      • Awoke T.
      • Alemu S.
      • Megabiaw B.
      Prevalence and associated factors of hypertension among adults in Gondar, Northwest Ethiopia: a community based cross-sectional study.
      ,
      • Giday A.
      • Tadesse B.
      Prevalence and determinants of hypertension in rural and urban areas of southern Ethiopia.
      ,
      • Tesfaye F.
      • Byass P.
      • Wall S.
      Population based prevalence of high blood pressure among adults in Addis Ababa: uncovering a silent epidemic.
      and also it was as a result of increased peripheral vascular resistance due to an increase in neuro-hormonal and structural responses with enhancement in sympathetic nerve activity and a decrease in arterial lumen diameters.
      • Hamer M.
      The anti-hypertensive effects of exercise.
      Similarly, a study in India showed lack of physical exercise was the major risk factor for the development of complications of hypertension.
      • Kumar C.
      • Sasi Sekhar T.
      • Sahithi B.
      Hypertension–the silent killer, awareness of the risk factors and complications of hypertension among hypertensives.
      Moreover, a Canadian study showed that excess body weight and living a sedentary lifestyle predispose an individual to hypertension and its complications.
      • Kirkland S.A.
      • MacLean D.R.
      • Langille D.B.
      • Joffres M.R.
      • MacPherson K.M.
      • Andreou P.
      Knowledge and awareness of risk factors for cardiovascular disease among Canadians 55 to 74 years of age: results from the Canadian Heart Health Surveys, 1986-1992.
      In this study, participants with obesity were 7 times more likely to have complications than those underweight participants (AOR = 7.229, 95% CI = 1.436, 36.394, p = 0.016), similar to the current finding other studies reported that obesity was a significant risk for developing hypertension than those with normal or overweight subjects,
      • Almobarak A.O.
      • Badi S.
      • Siddiq S.B.
      • et al.
      The prevalence and risk factors for systemic hypertension among Sudanese patients with diabetes mellitus: a survey in diabetes healthcare facility.
      Besides another study found that overweight subjects had a two-fold risk of being hypertensive and obese had more than the three-fold risk for the same in comparison to underweight subjects.
      • Singh S.
      • Shankar R.
      • Singh G.P.
      Prevalence and associated risk factors of hypertension: a cross-sectional study in urban Varanasi.
      Furthermore, other studies showed that obesity (BMI >25) is 2.62 times more risk for developing hypertension as compared to those not having BMI < 25.
      • Mizumoto K.
      • Pancharuniti N.
      • Pradipasen M.
      • Smitasiri S.
      Hypertension and its risk factors among middle aged women in central Thailand.
      • Hu G.
      • Barengo N.C.
      • Tuomilehto J.
      • Lakka T.A.
      • Nissinen A.
      • Jousilahti P.
      Relationship of physical activity and body mass index to the risk of hypertension: a prospective study in Finland.
      • Jonas J.B.
      • Nangia V.
      • Matin A.
      • Joshi P.P.
      • Ughade S.N.
      Prevalence, awareness, control, and associations of arterial hypertension in a rural central India population: the Central India Eye and Medical Study.
      So obesity is not only linked to the risk of hypertension, but it can also predict uncontrolled hypertension,
      • Sakboonyarat B.
      • Rangsin R.
      • Kantiwong A.
      • Mungthin M.
      Prevalence and associated factors of uncontrolled hypertension among hypertensive patients: a nation-wide survey in Thailand.
      and other studies also revealed that overweight and obese patients have a less chance of controlled BP.
      • Animut Y.
      • Assefa A.T.
      • Lemma D.G.
      Blood pressure control status and associated factors among adult hypertensive patients on outpatient follow-up at University of Gondar Referral Hospital, northwest Ethiopia: a retrospective follow-up study.
      Studies reported that the possible reasons between overweight and complication of hypertension could be that increased weight increases cardiac output and peripheral resistance of arterioles which causes elevated arterial pressure and structural changes in the kidney.
      • Abebe S.M.
      • Berhane Y.
      • Worku A.
      • Getachew A.
      Prevalence and associated factors of hypertension: a crossectional community based study in Northwest Ethiopia.
      ,
      • Re R.N.
      Obesity-related hypertension.
      It may also be due to obesity inducing a state of chronic volume overload as a result of increased requirements to circulate blood through large and relatively low resistance adipose tissue.
      • Animut Y.
      • Assefa A.T.
      • Lemma D.G.
      Blood pressure control status and associated factors among adult hypertensive patients on outpatient follow-up at University of Gondar Referral Hospital, northwest Ethiopia: a retrospective follow-up study.

      5. Conclusion

      In this study Being female, illiterate participants, having a family history of hypertension, doing sedentary exercise, and obesity are strongly associated risk factors for hypertension and its complication. Health education should be given to hypertensive patients on the risk factors for hypertension and complications as well as prevention. Implementation of proper training programs and offering essential services to health care services by health professionals is necessary. The other approach to control hypertension and its complications by patients includes taking prescribed medicines, maintaining regular physical activities, weight control, and good nutrition. It is also important to note that all patients taking regular medicines are the best way of preventing complications of hypertension.

      Ethical consideration

      The school of Pharmacy on behalf of the University of Gondar institutional ethical review committee provided ethical clearance. Upon this clearance, additional written informed consent was taken with included study subjects before the interview. Confidentiality of information was maintained by avoiding the recording of patients’ names and keeping the data anonymous. Finally, personal identifiers were excluded during the data presentation.

      Availability of data and materials

      Most of the data is included in the manuscript. Additional can be found from the corresponding author based on reasonable request.

      Funding

      No funding to report.

      Declaration of competing interest

      The authors declare that he has no competing interests.

      Acknowledgment

      We would like to acknowledge University of Gondar for material supports.

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