Ijipsrmnr 47 PDF

Assefa B.Zikru et.
al / IJIPSR / 2 (3), 2014, 653-668

ISSN (online) 2347-2154
RESEARCH ARTICLE
Department of Pharmacology
International Journal of Innovative

Pharmaceutical Sciences and Research
www.ijipsr.com
PREVALENCE AND ASSOCIATED FACTORS OF HYPERTENSION
AMONG ADULT POPULATION IN MEKELLE CITY, NORTHRN
ETHIOPIA
1
Assefa B.Zikru*, 2Haftu B.Gebru, 3Alemayehu B.Kahsay

1
2,3
Tigray Teachers Association, ETHIOPIA

Mekelle university Department of Nursing, ETHIOPIA
Abstract
The objective of this study was to assess the prevalence and associated factors of hypertension among adult
population in Mekelle city, Tigray, Ethiopia. A population based cross-sectional study, employing a multistage
cluster sampling technique, was conducted on March 2013 on adult population (age of 18years and above) in
Mekelle. Data, using a world health organization instrument for STEPS wise surveillance of chronic disease risk
factors and interviewer-administrated questionnaire technique, were collected from subjects. Data were analyzed
using the statistical package for social sciences (SPSS, version 16.0). Percentages, Means and odds ratios (ORs)
were calculated. Multiple logistic regressions were also performed to identify the independently significantly
associated factors with hypertension. Results of this study showed that Total of 709 subjects, in which 228 males
and 481 females participated in the study. The overall prevalence of hypertension was 11%. About 60% of the
respondents reported they had never checked their blood pressure within the past 12 months. Factors found to be
associated with hypertension included: older age (AOR=7.18, 95% CI; 3.12-16.53), obesity (AOR=4.43, 95%
CI; 1.54-2.76) and having attained higher tertiary education (AOR=5.26, 95% CI; 1.44-19.21). Conclusion: The
prevalence of hypertension, which was associated with age, nutritional status and education, was found to be not
higher. However, public health education and public blood pressure screening are needed for its prevention and
halt of the disease.
Key words: Hypertension, Prevalence, Associated Factors, Mekelle, Ethiopia
Corresponding Author:
Assefa B. Zikru
Tigray teachers association,
Tigray Regional state Education Beauru,, Tigray Ethiopia
P.O. Box C/o MU-CHS 1781
Mekelle City, Tigray, ETHIOPIA
E-Mail: tiatron@gmail.com Mobile: 0914700210
Available online: www.ijipsr.com
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Assefa B.Zikru et.al / IJIPSR / 2 (3), 2014, 653-668

INTRODUCTION
Hypertension is a common health problem in developed countries and is now becoming
increasingly important as causes of mortality and morbidity in the developing countries.
Hypertension, usually known as the silent killer, disease of affluence, increases the risk of
ischemic heart disease, strokes, peripheral vascular disease and other cardiovascular diseases,
and is also a risk factor for cognitive impairment and dementia and chronic kidney disease. By
the year 2025, 1.5 billion people are expected to have hypertension which is to be 29% of
worlds adult population. One in three adults worldwide, however, has hypertension, today
[1,2,3,4,5]. In the year 2000, hypertension was estimated to have affected approximately 1
billion people globally and accounted for approximately 7.1 million Deaths, where most of the
morbidity and mortality were in developing countries. In 2001, it also caused 7.6 million
premature deaths and contributed 92 million disability adjusted life years Worldwide.
Hypertension is the most frequently observed risk factor for CVD in both urban and rural
communities of Africa. According to the world health report 2002, cardiovascular disease
accounted for 9.2% of the total deaths in the African region in 2001. It has been suggested that
the prevalence of hypertension is increasing rapidly in this region. Analysis on hypertension in
Sub-Saharan Africa population, likewise, indicated that hypertension has changed from a relative
rarity to major problem. 10 to 20 million may be affected in Sub-Saharan Africa: the African
Union has called hypertension one of the continents greatest health challenges after AIDS [6,
7,8,9]. Hypertension, like other Non-communicable diseases, is associated with identifiable
behavioral and biological risk factors. The major risk factors include races, obesity, diabetes,
age, sex, alcoholism, sedentary life style, diet, and family history of hypertension. Some of these
risk factors for hypertension are modifiable through lifestyle interventions or at least their effects
could be made less sever by lifestyle modifications and medical management. Although
hypertension is one of the most modifiable risk factors of cardiovascular diseases, its prevention
and control has not received due attention in many developing countries including Ethiopia.
Awareness, treatment, and control of hypertension are still low in these countries [10, 11,12, 13].
In a recent study conducted in adult population of Addis Ababa, Ethiopia the prevalence of
hypertension was found to be as high as 30%. According to 2012 of Mekelle Hospital annual
report on NCD also indicated hypertensives which were less than 500 in number, in 2011 raised
to about above 600 in 2012. However, very little, except in Addis Ababa and some parts of
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Ethiopia, has been done to determine the magnitude and associated factors of the disease in the
country. Hypertension prevalence data are crucial for understanding the magnitude of the
problem, identifying groups at high risk for cardio vascular (CVD), and evaluating the effects of
policy and practice interventions [13,14, 15]. Though several studies revealed an increment of
non communicable diseases like hypertension priority is given to control communicable disease
in many developing countries including Ethiopia. More over little is known about hypertension
in Ethiopia, specifically in Tigray. Data that describes current population health status of concern
is necessary for effective intervention. Hence, the current study is intended to contribute to data
on prevalence and associated factors of hypertension. Thus, findings of this study will be helpful
in raising the awareness of the public about the magnitude and potential risk factors of
hypertension as well serve as the base line observation in the distribution of the potential risk
factors of hypertension in the adult population of Mekelle city.
Objectives
General objective: To assess the magnitude and associated factors of hypertension among adults
of Mekelle, Tigray, Ethiopia
Specific objectives
To determine the magnitude of hypertension among adults.
To identify associated factors of hypertension among adults.
METHODS AND MATERIALS

Study area: The study was conducted in Mekelle, capital city of Tigray administrative region. It
is an administrative zone which comprises seven sub cities, each is with four or five smaller
administrative units known as Tabias. Mekelle, located 783 kms north of Addis Ababa, is one
of the Ethiopian cities with rapid growth of development. Its population size is 215,546 among
which 104,758 are males, 110,788 females, and about 129,000 are adults. Several governmental
and nongovernmental health organizations render services to the community. In the city, there
are nine governmental health centers and four hospitals of which one is a referral and teaching
hospital [16,17].
Study design: A community based cross-sectional survey was conducted to assess the
prevalence and associated factors of hypertension among adults of Mekelle, Tigray, Ethiopia.
Source Population: All adult men and women of Mekelle whose age were 18 years and older
were the source of this study.
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Study Population: The study population consisted of all adult members households of selected
tabias in sub-cities.
Study unit: A household selected using sampling procedure.
Eligibility Criteria: Inclusion Criteria: All Adults in the households who were 18 years old and
above were included in this study. Those who were already on treatment for hypertension were
also included. Exclusion Criteria: Adults with known physiological abnormalities (such as
pregnancy), gross anatomical deformities of the arms were excluded from the study.
Variables: Dependent variable was Hypertension and Independent variables were Socio
demographic factors: Education status, Sex, Age, Ethnicity and Marital status. Life style :
Alcohol intake, Diet and Physical activity. Nutritional status: Weight, height and Body mass
index.
Sample size and sampling procedure
Sample size determination: The sample size for the study was calculated using the single
proportion formula: n=( Z
2
/2/e) .p.(1-p),
design effect, 2, and a 10% non-response rate with a CI:
95%, tolerable error (e) =5%,(47) and p=30%, [13 ]. The total sample size was therefore 711.
Sampling procedures
Subjects were selected by a multi-stage cluster sampling technique from the seven sub cities. In
the first stage, one Tabia (one administrative unit) from each sub city was selected at random and
Sample size was distributed to each Tabia in accordance to probability proportional to size. In
the second stage first household was selected from each tabia, by spinning a pen, where the tip of
the pen pointed. Thereafter, subsequent households were selected on the basis of proximity to the
first and the preceding household. All adult members in the households were then invited and
interviewed; blood pressure, height and weight measurements were measured. Households
whose members were absent during the study period were replaced by adjacent households.
Operational definition
Hypertension: A Subject was considered as hypertensive if the blood pressure 140 mmHg
systolic and 90 mmHg diastolic after 3 measurements were taken and the average of the last
two are determined or self-reported use of drug treatment for hypertension irrespective of
measured blood pressure.
Alcohol intake: Alcohol consumption intake was considered as excessive intake if it is either
more than 2 bottles of beer or 3 Ounces of liquor for men (1 bottle of beer or 1.5 Ounces of
liquor for women) per day.
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Physical Activity: level of physical activity was classified in to vigorous or moderate. And
activity that involves walking briskly, bicycling, swimming for recreation, dancing, or mowing a
lawn for at least 30 minutes for at least 5 days per week was considered as moderate physical
activity whereas an activity that involves running, fast cycling, fast swimming or
carrying/moving heavy loads greater than 20kg/ for at least 10 minutes continuously was
considered as vigorous physical activity.
Body mass index: weight (in kilogram) divided by height (in meters) squared. A subject whose
BMI is between 18.5 and 24.9 kg/m2 is assumed to be normal.
Dietary Intake: Consuming 8-10 servings/d of fruits and vegetables, 2-3 serving/d of low fat
dairy products, and reduced in standard fat and cholesterol was considered as healthy dietary
intake.
Cigarette Smoking: Subjects who smoked at least 1 cigarette per day at the time of the study
was classified as current smokers and those who have smoked for at least 3 years in the past but
had stopped by the time of the study was classified as habitual smokers.
Data collection procedures: Data on selected socio-demographic characteristics and life style
behaviors including physical activity, using interviewer administrated questionnaire and
physical measurements of weight, height, and blood pressure were collected using the WHO
STEPS Instrument [18]. Weight and height were measured with subjects standing with slippers
and light clothing. Weight was measured using bath room scale. For the height measurement,
subjects were to stand upright with the head in Frankfort plane. Height was recorded to the
nearest 0.5cm, and weight, to the nearest 100g. To assess the physical activity, global physical
activity questionnaire (GPAQ) section of the STEPS instrument were used.
The standard
mercury sphygmomanometer was used to measure blood pressure in a sitting position after the
study subjects rest for at least five minutes. Measurements were taken before and afternoon, 9 to
12 AM in the morning and 2 to 5 PM in the afternoon. Three consecutive measurements were
made in an interval of at least 3 minutes. Then mean systolic and diastolic blood pressures were
determined from the second and third measurements. Measurements were made after subjects
had avoided smoking and intake of caffeine during the last an hour. The questionnaire was
modified to local settings and was translated to local language (Tigrigna). Sixteen nurses were
trained for half a day for the data collection by the principal investigator. The data collection
process was supervised by the investigator, and supervisor who similarly trained for one day.
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Reviewing of the field questionnaire was done by the supervisor and investigator. The study
instrument was checked using a pretest of 5% of invited adult members of households in one
Tabia other than the study area. Result of pretest was used in modifying the questionnaire. The
data collection took three consecutive Sundays and two other days of a typical week (March
2013).
Data processing and analysis: The data entry and analysis were performed using SPSS version
16 statistical program after the questionnaire was coded. Percentages were calculated for the
categorized part while means for the continuous part of the study. Cross tabulations, bivariate
and multivariate logistic regressions were further used for the analysis part. All factors with a pvalue less than 0.2 in the bivariate logistic regression analysis were checked further confounding
effect control. Crude odds ratios (Ors) and their 95% confidence interval (CI) and adjusted odds
ratio (AOR) and their 95% CI are presented. Body mass index (BMI) was categorized as < 18.5
Kg/m2 (under weight), 18.5-24.9 kg/m2
(normal) 25.0-29.9kg/m2 (overweight), and > 30kg/m2
(obese).
Ethical considerations: Ethical clearance letter was obtained from college of health sciences
(CHS), Research and Community Service Council of Mekelle University (MU). Letter of
permission was secured from city administration and sub cities. Individual verbal informed
consent was solicited to the participants at the time of data collection and was briefed about the
purpose of the study. Subjects who had high BP during data collection were counseled to go to
health institutions as soon as possible. Documents were kept confidential and subjects had the
right to refuse to participate totally at any occasions if they were not comfortable.
RESULT
Socio Demographic Description
A total of 709 adults aged 18years and older from all sub cities of Mekelle, with a response rate
of 99.7%, participated in the study. Age of the participants ranged from 18-83 years. About 72%
were between the age of 18-40 while 11.8% were of age 60 and above. Majority 67.2% of the
study participants were females. About 30% of the participants were primary education complete
where as 3% were post graduate and above. Married were 44.7% and widowed 6.2%. The
Tigray ethnic group constituted 96.3% of the participants. [Table -1].
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TABLE 1: SOCIO-DEMOGRAPHIC CHARACTERISTICS OF STUDY PARTICIPANTS

(N=709), MEKELLE 2013
Socio-demographic characteristics
Sex
Male
Female
Age
18-40
41-59
60 and above
Educational level
No formal education
Primary education
Secondary education
College/university
Post graduate and above
Marital status
Single
Married
Divorced
Widowed
Others
Ethnicity
Tigray
Amhara
Frequency
Percent
228
481
32.8
67.2
506
119
84
71.4
16.8
11.8
94
213
198
182
21
13.3
30.1
28
25,7
3
288
317
29
44
31
40.5
44.7
4.1
6.2
4.4
683
26
96.3
3.7
Behavioral and dietary related risk factors

Those who responded they consumed alcohol daily were 3.2%, while more than half of 57.4%
participants reported that they never took alcohol. About 64% of the participants were low fruit
consumers and 54.4%, low vegetable consumers. [Table 2]
TABLE 2: BEHAVIOURAL RISK FACTORS OF STUDY PARTICIPANTS (N=709 , MEKELLE, 2013
Behavioural risk factors
Alcohol consumption
Daily
5-6 days per week
1-4 weeks per week
1-3 days per month
Less than once a month
Didnt drink at all
Fruit intake
0-2 days per week
3-4 days per week
5-7 days per week
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Frequency
Percent
23
21
80
119
59
407
3.2
3.0
11.3
16.8
8.3
57.4
454
82
43
64.0
11.6
6.1
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Did not know how much he/she took fruit per week
Vegetable intake
0-2 days per week
3-4 days per week
5-7 days per week
Did not know how much he/she took fruit per week
130
18.3
386
181
108
34
54.4
25.5
15.2
4.8
Physical Activity
The study indicated that one from every seven participants 15% was involved in vigorous
activities such as lifting heavy loads while most 92.5% were involved in moderate activities.
[Figure 1]
Body Mass Index
The majority had normal BMI 63.2% while 3.2% were obese. Overweight were 18.2% and were
about 31% among males and 69% among females. [Figure 1]
Fig.1: Physical Activity of Study Participants (N=709), Mekelle, 2013
Figure 2: Body Mass Index Of Study Participants (N=709), Mekelle, 2013
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Prevalence of Hypertension: Blood pressure measurements were taken in 3 minutes interval,

consecutively, three times from all participants except two, (one refused, one incomplete). The
average of the second and third measurements of each participant was, however, considered in
all analyses. About 40% of the participants had never checked their blood pressure for the last
five years and above. The participants mean systolic blood pressure (SBP) was 111.15 (95% CI:
109.6, 112.6 ) and the mean diastolic blood pressure (DBP) was 72.19 (95% CI: 71.33, 73.04).
Mean systolic blood pressure (SPB) was also 117.6 ( 95% CI: 116.3 ,118.8) for males and 108
(95% CI:106.5,109.6) for females. Similarly Mean diastolic blood pressure (DPB) was 76.5
(95% CI: 75.73, 77.27) for males, 70.2 ( 95% CI :69.35, 71.05) for females. The overall
prevalence of Hypertension was 11% (95% CI; 10.9, 11.1). The disease was seen in 4.9% of the
age group 18-40 and in 32.1% of the age group 60 years and above. More over the disease was
observed in (28.6%) of the post graduated respondents, (31.8%) and (20.7%) of the divorced.
Risk Factors associated with hypertension
Factors associated with hypertension are shown in table 6. Among the factors considered in
bivariate analyses to be associated with hypertension, age, education, marital status, alcohol
consumption, obesity and overweight were significantly associated with hypertension.Table 3:
Bivariate and Multivariate logistic regression analysis of factors associated with hypertension
among study participants (n=709), Mekelle, 2013
Multivariate logistic regression analysis indicated that age, education and nutritional status were
the factors to be associated with hypertension. Respondents with age group 60 and above years
were almost seven times more likely to have hypertension as compared with 18-40 years of age
(AOR= 7.18,95% CI; 3.12-16.53) provided other variables kept controlled. Also respondents
within the age group 41 to 59 years were also more likely to have hypertension as compared to
18 to 40 years old (AOR= 3.10,95%CI;1.53-6.28) other variables being controlled. Moreover,
the odds of developing hypertension is 5.26 times higher among the respondents with
educational levels of post graduate and above than those who had no formal education. (AOR=
5.26,95% CI; 1.44-19.21).
The study also revealed that respondents with obesity and
Overweight were over four fold, and more than twice, more likely to have hypertension as
compared to the normal body mass index (18.5-24.9kg/m2), (AOR= 4.43, 95% CI;1.54-12.67)
and (AOR=2.05,95%CI;1.12-3.77) respectively, again adjusted to other variables. This study
indicated that there was no association observed between hypertension and sex, marital status,
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ethnicity and the different categories of physical activity, alcohol, fruits and vegetables
consumption.
Table3: Multivariate Logistic Regression Analysis Of Factors Associated With Hypertension
Among Study Participants (N=709), Mekelle, 2013
Hypertension
Variable categories
COR 95% CI
AOR 95% CI
Yes
n (%)
No
n (%)
Age
18-40
41-59
60 and above
25(4.9)
26(21.8)
27(32.1)
481(95.1)
93(78.2)
57(67.9)
1.00
5.32(2.97,9.72 )***
9.11(4.95, 16.76)***
1.00
3.1 (1.53, 6.28)**
7.18 (3.12, 16.53)***
Educational level
No formal education
Primary education
Secondary education
College/university
Post graduate & above
20(21.3)
25(11.7)
13(6.6)
14(7.7)
6(28.6)
74(78.7)
188(88.3)
185(93.4)
168(92.3)
15(71.4)
1.0
0.49( .25,.93)**
0.6( .12,.55)***
0.30( .14, .64) ***
1.48(.50, 4.30)
1.00
0.78 (0.37, 1.67)
0.86 (0.33, 2.19)
0.81 (0.32, 2.05)
5.26 (1.44, 19.21)*
Marital status
Single
Married
Divorced
Widowed
Others
13(4.5)
44(13.9)
6(20.7)
14(31.8)
1(3.2)
275(95.5)
273(86.1)
23(79.3)
30(68.2)
30(96.8)
1.00
3.4 (1.79, 6.47)***
5.51 (1.91, 15.87)**
9.87 (4.26, 22.95)***
0.70 (0.08, 5.58)
1.00
1.86 (0.91, 3.82)
1.94 (0.58, 6.47)
2.29 (0.79, 6.59)
0.90 (0.10, 7.53)
Alcohol consumption
Daily
5-6 days per week
1-4 weeks per week
1-3 days per month
Less than once a month
Didnt d rink at all
5(21.7)
1(4.8)
9(11.2)
16(13.4)
11(18.6)
36(8.8)
18(78.3)
20(95.2)
71(88.8)
103(86.6)
48(81.4)
371(91.2)
4(3.7)
105(96.3)
40(8.9)
27(20.9)
409(91.1)
102(79.1)
7(30.4)
16(69.6)
Body mass index

Underweight <18.5kg/m2
Normal 18.5-24.9kg/m2
Overweight 25.0- 29.9kg/m2
Obese >30kg/m2
1.00
0.18 ( 0.01 ,
0.46 ( 0.13 ,
0.46 ( 0.18 ,
0.83 ( 0.25 ,
0.35 ( 0.12 ,
1.69)
1.52)
1.71)
2.70)
.99)*
.39 ( .13 , 1.11)

1.00
2.70 ( 1.58 , 4.61)***
4.47 ( 1.73 , 11.51)***
1.00
0.14 (0.01, 1.64)
0.65 (0.16, 2.50)
0.66 (0.18, 2.34)
1,44 (0.37, 5.58)
0.55 (0.17, 1.79)
.33 ( .11 , 1.02)

1.00
2.05 ( 1.12 , 3.77)*
4.43 ( 1.54, 2.76)**
*Significant at P<0.05, ** Significant at P<0.01, *** Significant at P<0.001, CI=confidence interval
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DISCUSSION
The study employed community based cross-sectional study to measure prevalence of
hypertension and associated risk factors. The study revealed that the prevalence of Hypertension
among the study subjects was 11% (10.5% in males and 11.2% in females). The prevalence
estimate in this study is much lower than those reported from Zambia, 34% (38% in males and
33.3% in females), Addis Ababa (30%) Gondar (28.3%), and most urban communities of SubSaharan Africa (23.7-33.3%), but slightly higher than the least prevalence estimate reported in
Nigeria (8%) and southern Ethiopia (10.1%) and almost the same with the national estimate of
Ethiopia for 2008 Difference in age composition and variability in definition of hypertension
(cut-off level) could account for much of the differences in the estimates among the studies. In
this study age was found to have association with hypertension. Hypertension was seen of a 4%
increase among the age group 41- 59 and 8% increase among the age group 60 and above when
compared to the age group 18- 40. This finding is consistent with the population based study
conducted in Addis Ababa in which significant linear association was exhibited between age and
SBP as well as DBP [13,19,20,21,22,23,24].
Similar findings on association of hypertension with age were reported by the population based
surveys in Zambia, Rukunfiri district Uganda, South India, South Africa and Turkish. Finding of
this study was also supported by Beevers et al who reported that blood pressure increases with
age (28) stress, obesity , life style ,narrowing of the arteries and family history can attribute to the
risk of blood pressure with age [25,26 ,27,28,29].
This study failed to show association between hypertension and sex (10.5% in males and 11.2%
in females), P=0.837. The finding was supported by Tesfaye et al and by the adult population
study of Kang, Botswana in 2010 who reported that there was no significant difference between
males and females in the prevalence of high blood pressure (P>0.05). Dissimilar findings were
also reported in the population based surveys of Lusaka, Zambia, Uganda and Turkish adults,
Trabzon. Some of those studies found that hypertension was significantly associated with male
gender while others with female [25, 28, 26].
This study observed relatively higher prevalence of hypertension among those who completed
post graduate level (28.6%) and those who attended the non formal education (21.3%). low
prevalence of hypertension was also seen among secondary education. However, an association
between hypertension and higher tertiary education (post graduate level) was only observed in
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this study. This finding was consistent with the study in Rukungiri, Uganda that revealed the
association between hypertension and tertiary education(25) Unlikely an association between
low educational level and hypertension was reported in the studies of Turkish and Addis Ababa
adults (13, 28). In this study, higher prevalence of hypertension was also observed among the
widowed (31.8%) and divorced (20.7%) respondents, but low prevalence (4.5%) among the
single. Nevertheless no association was seen between hypertension and marital status .This
finding was in line with the study conducted in Gondar (20). In contrast a positive association
was observed between hypertension and marital status in the study of Turkish adults [13,
20,25,28, 30)]..
No association was observed between hypertension and the different categories of alcohol
consumption. Although, this finding was supported by the study in Kang, Botswana, which
failed to show an association between hypertension and alcohol consumption (P=0.73), some
other studies on adults of Turkish, Nepal, Uganda , Zambia and Southern Ethiopia, however,
reported significant association of alcohol use and hypertension (25,28,26). An analysis of a
major study on causes, diagnosis and treatment of high blood pressure found that those who
drunken more than three alcoholic drinks a day had higher blood pressure than those who did
not. Reviews of research evidence, however, report that moderate drinkers tend to have better
health and live longer than those who are either abstainers or heavy drunker. Moderate
consumers of alcoholic beverage (beer, wine ) are less likely to suffer strokes [ 31, 32].
Findings of this study showed 1.00 & 1.40 servings per week of fruits and vegetables among
participants. When compared this amount with the minimum five portions/ servings/ of fruits and
vegetables per day recommended by the world health organization, it was found to be low.
This study found no association between hypertension and different categories of fruits and
vegetables consumption. The finding was in line with the study conducted in Gondar that
revealed the no association between hypertension and the different categories of fruits and
vegetables (20). Similar finding was also reported by Stephen T, in Kang, Botswana which
revealed that except in the groups of participants who took fruits and vegetables 0-2 days per
week (P = 0.009) no association was observed between hypertension and different categories of
fruits and vegetables consumption. However, an inverse relationship between fruits and
vegetables intake and blood pressure was exhibited in the epidemiologic studies and randomize
controlled trials conducted by Conlin et al: 2000, John et a1 2002 and Nowson et al: 2005. The
studies suggested that factors likely to contribute to the blood pressure-lowering effect are the
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high potassium content of most fruits and vegetables and their increased antioxidant activity
[33].
This study found that being obese or over weight was associated with hypertension .This finding
was supported by the studies conducted in Sub-Saharan Africa, Addis Ababa as well as in
Turkey which demonstrated the significant association between BMI and hypertension. This
study was also consistent with the findings reported in Gondar and Nepal. A prospective study in
Finland also supports the finding of this study. It revealed that overweight and obese subjects
were associated with an increased risk of hypertension [ 13, 20, 28,34,35].
The study found no association between hypertension and subjects involved in vigorous intensity
activity or moderate-intensity activity. ( P = 0.37 and p = 0.59). Similar finding was reported in
the study of adults in Kang, Botswana. In contrast several epidemiological studies demonstrated
a strong relationship between physical activity and hypertension. Ishikawa K.et al in their study
of influence of age and gender on exercise training-induced blood pressure reduction in
systematic hypertension, reported that regular physical exercise lowers blood pressure in adult
with hypertension. A recent study in Nepal also reported the positive association of lower
physical activity with hypertension .Several studies reveal participation in regular physical
activity on at least 30 minutes of moderate activity on at least five days per week or 20 minutes
of vigorous physical activity at least 3 times per week is critical to sustaining good health
[34,36,37,38]. This study was found inconsistent with the reports of Ishikawa et al, Baster T and
the study in Nepal. Self-report may be accountable for the failure of this study to support inverse
association between vigorous intensity activity or moderate intensity activity and hypertension.
Limitations of The Study
Some of the major limitations of the study were:
The study might be prone to selection bias as all adults were invited in a household.
Some subject were probably misclassified as they could not recall how much fruits and
vegetables and alcohol they were taking per week, for how long they were involved in the
vigorous intensity activity or moderate intensity activity.
CONCLUSION
This study found that hypertension prevalence among participants was 11%, relatively not higher
compared with the findings of other studies. It also showed increased hypertension with age,
significant association between hypertension and body mass index (overweight and obesity) and
an association between tertiary education and hypertension. However, no association was seen
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665

RESEARCH ARTICLE
between hypertension and different categories of alcohol consumption, fruits and vegetables,
physical activity, Sex, marital status and ethnicity in this study.
RECOMMENDATIONS
1. Public health education to improve awareness of hypertension is needed.
2. Public blood pressure screening is required so that the public could be aware of its blood
pressure status.
3. Adults should maintain their normal weight.
4. Further research on prevalence and associated factors of hypertension is needed.
ACKNOWLEDGMENT
This research paper would not have been possible without the support of many people. First and
for most we would like to thank to the study participants, interviewers and supervisors for
devoting their time. Special thanks go to Mekelle University college of Health Sciences for its
financial and material support.
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Assefa B.Zikru et.

al / IJIPSR / 2 (3), 2014, 653-668

International Journal of Innovative

Assefa B.Zikru*, 2Haftu B.Gebru, 3Alemayehu B.Kahsay

Tigray Teachers Association, ETHIOPIA

Key words: Hypertension, Prevalence, Associated Factors, Mekelle, Ethiopia

Assefa B.Zikru et.al / IJIPSR / 2 (3), 2014, 653-668

Assefa B.Zikru et.al / IJIPSR / 2 (3), 2014, 653-668

METHODS AND MATERIALS

Assefa B.Zikru et.al / IJIPSR / 2 (3), 2014, 653-668

design effect, 2, and a 10% non-response rate with a CI:

Assefa B.Zikru et.al / IJIPSR / 2 (3), 2014, 653-668

Assefa B.Zikru et.al / IJIPSR / 2 (3), 2014, 653-668

(normal) 25.0-29.9kg/m2 (overweight), and > 30kg/m2

Available online: www.ijipsr.com

Assefa B.Zikru et.al / IJIPSR / 2 (3), 2014, 653-668

TABLE 1: SOCIO-DEMOGRAPHIC CHARACTERISTICS OF STUDY PARTICIPANTS

Behavioral and dietary related risk factors

Available online: www.ijipsr.com

Assefa B.Zikru et.al / IJIPSR / 2 (3), 2014, 653-668

Fig.1: Physical Activity of Study Participants (N=709), Mekelle, 2013

Figure 2: Body Mass Index Of Study Participants (N=709), Mekelle, 2013

Available online: www.ijipsr.com

Assefa B.Zikru et.al / IJIPSR / 2 (3), 2014, 653-668

Prevalence of Hypertension: Blood pressure measurements were taken in 3 minutes interval,

The study also revealed that respondents with obesity and

Assefa B.Zikru et.al / IJIPSR / 2 (3), 2014, 653-668

Body mass index

.39 ( .13 , 1.11)

.33 ( .11 , 1.02)

*Significant at P<0.05, ** Significant at P<0.01, *** Significant at P<0.001, CI=confidence interval

Available online: www.ijipsr.com

Assefa B.Zikru et.al / IJIPSR / 2 (3), 2014, 653-668

Assefa B.Zikru et.al / IJIPSR / 2 (3), 2014, 653-668

Assefa B.Zikru et.al / IJIPSR / 2 (3), 2014, 653-668

Assefa B.Zikru et.al / IJIPSR / 2 (3), 2014, 653-668

Kearney PM, Whelton

hypertension: analysis of worldwide data. Lancet 2005

World health statistics 2012

Available online: www.ijipsr.com

Assefa B.Zikru et.al / IJIPSR / 2 (3), 2014, 653-668

Available online: www.ijipsr.com

Assefa B.Zikru et.al / IJIPSR / 2 (3), 2014, 653-668

Available online: www.ijipsr.com

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Significant at P<0.05, Significant at P<0.01, Significant at P<0.001, CI=confidence interval