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UNIVERSITY FOR DEVELOPMENT STUDIES
ASSESSING THE KNOWLEDGE, AWARENES, ATTITUDES AND
PERCEPTIONS OF HYPERTENSION AMONG ADULTS (19 - 60 YEARS) IN
THE SUNYANI MUNICIPALITY, BRONG AHAFO REGION, GHANA
JOSHUA NYARKO
2018
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www.udsspace.uds.edu.gh
UNIVERSITY FOR DEVELOPMENT STUDIES
ASSESSING THE KNOWLEDGE, AWARENES, ATTITUDES AND
PERCEPTIONS OF HYPERTENSION AMONG ADULTS (19-60YEARS) IN
THE SUNYANI MUNICIPALITY, BRONG AHAFO REGION, GHANA
BY
JOSHUA NYARKO (BSc. PUBLIC HEALTH)
(UDS/CHD/0227/15)
THESIS SUBMITTED TO THE DEPARTMENT OF PUBLIC HEALTH
SCHOOL OF MEDICINE AND HEALTH SCIENCES, UNIVERSITY FOR
DEVELOPMENT STUDIES, IN PARTIAL FULFILLMENT OF THE
REQUIREMENTS FOR THE AWARD OF MASTER OF PHILOSOPHY
DEGREE IN COMMUNITY HEALTH AND DEVELOPMENT
OCTOBER, 2018
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DECLARATION
Student’s Declaration
I hereby declare that this dissertation is the result of my own original work and that no
part of it has been presented for another degree in this University or elsewhere:
Candidate’s Signature:……………...…………… Date:………………….………
Name: ……………………………………………………………………...………
Supervisors’ Declaration
I hereby declare that the preparation and presentation of the dissertation was
supervised in accordance with the guidelines on supervision of dissertation laid down
by the University for Development Studies.
Supervisor’s Signature:………………………… Date:…………………………
Name: ………………………………...………………………………………..…..
Head of Department’s Signature..………………….……… Date:……..…………
Name: …………………………………………………..…………………………
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ABSTRACT
The study investigated the knowledge, awareness, attitudes and perception of hypertension
among adults (19-60 years). The study was conducted in the Sunyani Municipality, Brong
Ahafo Region, Ghana. A descriptive cross section research survey design with a multi-
stage comprising cluster sampling, systematic sampling, and purposive sampling
techniques was used with a sample size of 343 respondents. The following are the major
findings; out of 343 respondents 78 were hypertensive. Prevalence for the entire study
respondent was 22.7%. There were 221 females and 53 of them were hypertensive. The
prevalence for the female respondent was 24.0%. There were 122 males and 25 of them
were hypertensive. So the prevalence of the male respondent was 20.5%. The findings of
this study showed that hypertension is highly prevalent among adults (19-60 years). Out of
the 343 respondent, (62.1%) of them in the present study had heard of hypertension with
majority (70.5%) being males. Most of the respondents did not know their current blood
pressure status. It was shown that there was significant association between awareness of
hypertension and demographic profile (no formal education (p<0.0001; x2 = 22.52),
tertiary education (p<0.0001; x2 = 19.3), cigarette smoking (p = 0.0414; x2 = 4.16), shisha
smoking (p =0.0009; x2 = 11) and exercise (p < 0.0001; x2 = 36.09). Furthermore, the
finding suggests that individuals who had no form of formal education (p<0.0001; x2 =
22.52) are more likely to become hypertensive than those who are educated. This may be
attributed to the fact that persons who are educated stand the chance of being enlightened
on hypertension and therefore adopt healthy lifestyles to avoid the condition. The study
found a significant (p<0.0500) association between the perception that changing lifestyle
(such as low salt intake, quit smoking and engaging in exercise) lowers hypertension.
Finally, it was shown that there was a higher proportion between the perception that
hypertension is an avoidable part of aging and socio-demographic characteristics.
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ACKNOWLEDGEMENT
First and foremost, I would like to thank the Almighty God for giving me wisdom and
knowledge to put this study together. Without his mercies, this work would not have
been possible.
I owe my deepest gratitude to my supervisor, Professor Nafiu Amidu for his expertise
which he brought to bear on this work. I am also grateful to Dr. Michael Wombeogo,
Mr. Akwasi Boakye -Yiadom and all the lecturers in the Department of Public Health
for their invaluable contributions in my academic development.
I am also very thankful to Adams Yussif for his detailed comments, suggestions and
constructive criticisms during the execution of this project. Without them this work
would not have been such a masterpiece.
Last and not the least are my colleagues Peter Paul and Daniel Owusu for their
support towards the achievement of this study.
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DEDICATION
To my family and friends
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TABLE OF CONTENTS
ABSTRACT...............................................................................................................................ii
ACKNOWLEDGEMENT ....................................................................................................... iii
DEDICATION..........................................................................................................................iv
TABLE OF CONTENTS...........................................................................................................v
LIST OF TABLES....................................................................................................................ix
LIST OF FIGURES ...................................................................................................................x
CHAPTER ONE ........................................................................................................................1
INTRODUCTION .....................................................................................................................1
1.1 Background to the Study......................................................................................................1
1.2 Statement of the Problem.....................................................................................................3
1.3 Significance of the Study .....................................................................................................5
1.4 Conceptual Framework........................................................................................................6
1.5 Justification of the Study ...................................................................................................10
1.6 Research Question .............................................................................................................11
1. 7 Research Objectives..........................................................................................................11
1.7.1 Main Objective................................................................................................................11
1.7.2 Specific objectives ..........................................................................................................12
1.8 Organisation of the Study ..................................................................................................12
CHAPTER TWO .....................................................................................................................13
LITERATURE REVIEW ........................................................................................................13
2.0 Introduction........................................................................................................................13
2.1 Overview of Hypertension.................................................................................................13
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2.1.1 Determinants of Hypertension ........................................................................................18
2.2 Knowledge on Hypertension..............................................................................................25
2.3 Awareness on Hypertension ..............................................................................................28
2.5 Consequence of Hypertension ...........................................................................................36
2.6 Epidemiological Trend and Distribution of Hypertension.................................................41
2.6.1 Worldwide Distribution of Hypertension .......................................................................43
2.6.2 Age Distribution of Hypertension...................................................................................43
2.6.3 Sex Distribution of Hypertension ...................................................................................44
2.6.4 Race or Ethnicity Distribution ........................................................................................45
CHAPTER THREE .................................................................................................................47
METHODOLOGY ..................................................................................................................47
3.0 Introduction........................................................................................................................47
3.1 Study Setting......................................................................................................................47
3.2 Study Design......................................................................................................................49
3.3 Sample Size........................................................................................................................49
3.4 Population ..........................................................................................................................50
3.5 Sample and Sampling Techniques .....................................................................................51
3.6 Data Collection Method.....................................................................................................52
3.7 Measurement procedures ...................................................................................................53
3.8 Data Analysis and Processing............................................................................................55
3.9 Quality Control ..................................................................................................................55
3.10 Ethical Consideration.......................................................................................................56
CHAPTER FOUR....................................................................................................................57
RESULTS ................................................................................................................................57
4.0 Introduction........................................................................................................................57
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4.1: Sociodemographic characteristics of the study population...............................................57
4.2: Prevalence of Hypertension among study participants.....................................................59
Figure 4. 2: Prevalence of hypertension among study participants stratified by age ..............61
4.3 Hypertension Knowledge...................................................................................................61
4.4: Knowledge on Risk Factors of Hypertension ...................................................................64
Figure 4. 3: Knowledge on Risk Factors of Hypertension.......................................................65
4.5: Knowledge on Symptoms of Hypertension ......................................................................65
Figure 4. 4: Knowledge on Symptoms of Hypertension..........................................................66
4.6: Association between knowledge on the danger of hypertension and Socio-
demographics .....................................................................................................................66
4.7: The knowledge of respondents on normal blood pressure range and the socio-
demographic characteristics...............................................................................................69
4.8: Association between Knowledge on Risk Factors of hypertension and Socio-
Demographics ....................................................................................................................72
4.9: Association between Knowledge on Symptoms of Hypertension and Socio-
Demographics Characteristics ...........................................................................................75
4.10: Hypertension Awareness ................................................................................................78
4.11: Association between Awareness of Hypertension and Socio- Demographic
Characteristics....................................................................................................................80
4.12: Association between Hypertension Status and Demographic Characteristics................82
4.13: Awareness of Personal Blood Pressure Level and Socio-demographic
Characterisstics ..................................................................................................................86
4.14: Attitudes and Perceptions Related to Hypertension .......................................................89
4.15: Perceive severity of hypertension as a personal health concern and socio-
demographic characteristics of respondents ......................................................................91
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4.16: Association between perceptions of hypertension as a lifelong Disease and
Socio- demographic Variables...........................................................................................94
4.17: Perception that Hypertension has a Cure and Socio- Demographic
Characteristics....................................................................................................................96
4.18: Association between the attitude and perception that changing lifestyle lowers
blood pressure (BP) and Socio- Demographic Characteristics..........................................98
4.19: Perceptions that hypertension is an avoidable part of aging and socio-
demographic Characteristics of Respondents ..................................................................102
CHAPTER FIVE ...................................................................................................................105
DISCUSSIONS......................................................................................................................105
5.0 Introduction......................................................................................................................105
5.1 Socio demographic characteristics of the study population stratified by gender.............105
5.2 Hypertension Knowledge.................................................................................................107
5.3 Awareness of Hypertension .............................................................................................109
5.4 Attitudes and Perceptions Related to Hypertension.........................................................111
CHAPTER SIX......................................................................................................................115
CONCLUSION AND RECOMMENDATIONS ..................................................................115
6.1 Conclusion .......................................................................................................................115
6.2 Recommendations............................................................................................................116
6.3: Limitations ......................................................................................................................117
REFERENCES ......................................................................................................................118
APPENDIX............................................................................................................................131
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LIST OF TABLES
Table 4. 1: Sociodemographic characteristics of the study population stratified by

gender.......................................................................................................................................58
Table 4. 2: Respondents Knowledge of Hypertension stratified by gender ............................63
Table 4. 3: Association between knowledge on the danger of hypertension and Socio-
demographics Characteristics ..................................................................................................68
Table 4. 4: Knowledge on Normal BP and Socio- Demographics characteristics ..................71
Table 4. 5: Association between Knowledge on Risk Factors of Hypertension and
Socio- Demographics Characteristics ......................................................................................74
Table 4. 6: Association between Knowledge on Symptoms of Hypertension and
Socio- Demographics Characteristics ......................................................................................76
Table 4. 7: Hypertension Awareness among Respondents stratified by gender......................79
Table 4. 8: Association between Awareness of Hypertension and Socio- Demographic
Characteristics..........................................................................................................................81
Table 4. 9: Association between Hypertension Status and Demographic
Table 4. 10: Awareness of Personal Blood Pressure Level and Socio-demographic
Table 4. 11: Association between Respondents Attitude and Perceptions Related to
Hypertension ............................................................................................................................90
Table 4. 12: Perceive Severity of Hypertension as a Personal Health Concern and
Socio- Demographic Characteristics of Respondents..............................................................92
Table 4. 13: Association between Perceptions of Hypertension as a Lifelong Disease
and Socio- Demographic Characteristics.................................................................................94
Table 4. 14: The Perception that Hypertension has a Cure and Socio- Demographic
Table 4. 15: Association between the Attitude and Perception that Changing Lifestyle
Lowers BP and Socio- Demographic Characteristics............................................................100
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Table 4. 16: Perceptions That Hypertension is an Avoidable Part of Aging and Socio-
Demographic Characteristics .................................................................................................103
LIST OF FIGURES
Figure1.1: Conceptual framework of the study showing an overview of knowledge,
awareness, attitudes and perception of hypertension among adults (19-60
years)…………………………………..………………………………………………6
Figure 4. 1: Prevalence of hypertension among study participants stratified by gender .........60
Figure 4. 2: Prevalence of hypertension among study participants stratified by age ..............61
Figure 4. 3: Knowledge on Risk Factors of Hypertension.......................................................65
Figure 4. 4: Knowledge on Symptoms of Hypertension..........................................................66
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ABBREVIATIONS AND ACRONYMS
ACE Angiotensin-Converting Enzyme
ADRB1 Adrenergic receptor
BP Blood pressure
BMI Body Mass Index
BTT Benefit-based Tailored Treatment
CDC Centre for Disease Control
CHF Congestive Heart Failure
CKD Chronic Kidney Disease
CTP11B2 Mineralocorticoid Receptor, Chimeric
CVDs Cardio-Vascular Diseases
DALYS Disability Adjusted Life Years
DBP Diastolic Blood Pressure
ENaC Epithelial Sodium Channel
ESRD End-Stage Renal Disease
GFR Glomerular Filtration Rate
GHS Ghana Health Service
GNA Ghana News Agency
GSS Ghana Statistical Service
GWAS Genome-Wide Association Studies
GYTS Global Youth Tobacco Survey
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HP Hypertension
HTN Hypertension
JHS Junior High School
JNC-7 Joint National Committee
LVH Left Ventricular hypertrophy
MHD Municipal Health Directorate
NaCl Sodium Chloride
NCDs Non-communicable Diseases
OPD Out Patient Department
QA Quality Assurance
SBP Systolic Blood Pressure
SPSS Statistical package for Social Sciences Version 22.0
UK United Kingdom
US United States
US$ United States Dollar
WHO World Health Organization
WHR Waist Hip Ratio
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CHAPTER ONE
INTRODUCTION
1.1 Background to the Study
The incidence and prevalence of hypertension is a challenge for public health bodies
all over the world (Jones & Hall, 2014). Hypertension is the leading and most
important modifiable risk factor for coronary heart disease, congestive heart failure,
stroke, renal diseases and retinopathy. Hypertension is cardiovascular disorder
affecting approximately one billion people globally and accounts for approximately
7.1 million deaths annually (Brundtland, 2013). Until recently, hypertension has been
given low priority in Africa. The condition is now being widely reported in many
parts of Africa and is the most common cause of cardiovascular disease on the
continent (Brundtland, 2013). Studies conducted in Africa as reported by Addo et al.
(2013) revealed prevalence ranging from 7.5% in Sudan to as high as 37.7% in
Tanzania.
According to statistical reports from medical education and the Ministry of Health,
the prevalence rate of hypertension in Iran is 45% (27% for 69 years and 42% for 70
years). The prevalence rate of arterial hypertension in Isfahan is 17.5% (18.6% for
women and 16.4% for men). Among them, 46.2% of patients are informed of their
condition, while 33.9% are on treatment and 12% have controlled hypertension (Pour
et al., 2004). In early study, the prevalence in Tehran and Isfahan is estimated at about
18% (Khosravi et al., 2006).
Hypertension is defined as the level of blood pressure (BP) at which detection and
treatments do more good than harm. The current definition of hypertension is a
systolic BP 140 mm Hg or diastolic BP 90 mm Hg or both (Joint, 2013).
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Hypertension is classified into primary hypertension, which accounts for the majority
of adulthood hypertension with no identifiable cause, although there are usually
recognisable risk factors; and secondary hypertension, which accounts for the
majority of childhood hypertension (Haslett et al., 2013). Some of the known risk
factors for primary hypertension like age, heredity, and gender are non-modifiable.
However, the majority of the other risk factors like tobacco use, alcohol use,
unhealthy diet, physical inactivity, overweight and obesity can be effectively
prevented (WHO, 2013).
Over the past decade, Ghana, especially the urban areas have witnessed major
socioeconomic development leading to significant changes in its standard of living
and lifestyle. The transformation of the society has also resulted in changes in dietary
habits and related social practices, many of which are not necessarily healthy ones.
This has been compounded by a lack of exercise among large segments of the society.
These factors and others have contributed to the emergence of degenerative diseases
of adult life such as obesity, diabetes mellitus and hypertension. These have
essentially replaced communicable diseases as the principal causes for morbidity and
mortality (WHO, 2013).
In the Brong Ahafo Region, hypertension is estimated to affect 20%-26% of the
population above 35 years of age (Addo et al., 2013). They estimated its prevalence
among adults to range from 4% to 15%. However, a nationwide study by the Ghana
Demographic and Health Survey (2014) using a blood pressure (BP) of 140/90 as the
definition of hypertension estimated that among adults aged 30-50 years, the
prevalence of hypertension was 26.1%. Male subjects had a higher prevalence of
hypertension 28.6%, while for females the prevalence was significantly lower at 23.9
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Hypertension which was considered to be nonexistent or extremely rare in most
communities, particularly in rural is now emerging as a public health problem
affecting both the young and the age in society (WHO, 2012). With a sharp increase
of 1,895 cases in 2008 in the Sunyani Municipality (Annual Report of Sunyani
Municipal Health Directorate, 2015), the problem cannot be left unattended. There is
therefore, the need to investigate the prevalence of hypertension and its contributing
factors in Sunyani Municipality, hence this study.
1.2 Statement of the Problem
The problem of hypertension remains an area of public health focus globally (WHO,
2013). It is estimated that globally, 25 million or one half of all deaths and most of the
physical disabilities are attributable to non-communicable diseases (NCDs), and this
is still on the increase year after year. The highest rated among them is hypertension.
WHO (2013) estimated that in 2000, hypertension and mental disorders caused 59%
of deaths and 46% of the global burden of disease.
According to the GNA (2015), available statistics indicate that hypertension cases are
on the increase in the Sunyani Municipality with women being the worst affected. Dr.
David A. Opare, Municipal Director of Health Services who disclosed this at an end
of year meeting said the disease, which had increased by 54% continued to be among
the top ten out-patient cases reported at health facilities in the municipality. He said
out of the 4,982 cases recorded in 2006, women contributed 3,015, adding, the figures
far exceeded that of 2005 in which 2,697 cases were recorded for both males and
females.
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Recently, hypertension has gained popularity in the Sunyani Municipality due to its
overwhelming burden in the Region. According to the 2014 Annual Report of
Sunyani Municipal Health Directorate, ‘hypertension had increased compared to the
previous years and is a source of worry for the municipality’. There is therefore the
likelihood of future increase on hypertension burden in the municipality if no
intervention is implemented. The annual health reports also present that hypertension
cases show an increase trend with time. In 2003, 793 cases of hypertension were
recorded in the municipality. This increased to 1,259 cases in 2004, 1,713 in 2005,
with a slight decrease to 1,701 in 2006, 1,698 in 2007 with a sharp increase to 1,895
in 2008. The data available for hypertension cases for only persons aged 30-50 years
indicated that in 2010, 589 cases were recorded, in 2011, 716 cases were recorded, in
2012, 682, and in 2013, 1,023 (Annual Report of Municipal Health Directorate,
2013).
This same hypertension accounted for 2.1%, 2.8%, 4% and 2.1% of cases of
morbidity in 2004, 2005, 2006 and 2007 respectively, as well as 2.9 % of causes of
institutional admission in both 2004 and 2005. Among the top-10 causes of
institutional death in the municipality, Cardio-Vascular Diseases (CVDs) mainly
hypertension, diabetes and stroke ranked first in 2004 representing 11.3% of total
causes of deaths in that year and 2.9 % in 2005, ranking 7th. In 2006 and 2007, CVD
still accounted for 8.94 % and 7.4 % of causes of death respectively (Annual Report
of Sunyani Municipal Health Directorate, 2013). The picture of hypertension in the
municipality from the previous years to date makes this study so critical for the
documentation of the distribution of risk factors among the urban population.
In assessing the factors that contribute to the problem, hypertension has been
associated with various factors, including age, sex, family history, alcohol
4
consumption, smoking, obesity, dietary intake, level of education, and occupation,
among others (Olatunbosun et al., 2012). Agyemang (2012) identified the following
as major factors contributing to hypertension in the Ashanti Region of Ghana: (i)
Sedentary lifestyles such as smoking, drinking, physical inactivity among individuals
are strong risk factors for developing hypertension;(ii) Low consumption of fresh
fruits and vegetables and their nutrient biomarkers are associated with increased risk
of hypertension;(iii) Poor dietary/nutritional behaviours contribute to increased risk of
hypertension; (iv) Socio-economic factors are key determinants of hypertension; (v)
Hypertension and their risk factors are equally associated with males and females; and
(vi) Advanced age is a risk factor for developing hypertension.
The increase in hypertension in the Sunyani Municipality is likely to cause coronary
heart disease and loss of lives. It is against this background that the study is conducted
to investigate the prevalence of hypertension and its contributing factors in the
Sunyani Municipality and to make appropriate recommendations to address those
factors if any.
1.3 Significance of the Study
This study will be of much benefit to the Municipal Health Directorate and all the
major stakeholders in the health sector. The results will reveal the factors associated
with hypertension in the municipality and how best they can be addressed.
The study will be of more importance to the Ministry of Health as well as the Ghana
Health Services and other policy planners who aimed at reducing the prevalence of
hypertension in Ghana.
5
This research is for academic purposes hence will be significant to the researchers as a
source of academic requirement and experience that will help in future works as a
public health professional. Besides, the study also serves as a source of information
for future researchers since it better documented for literature review.
1.4 Conceptual Framework
The conceptual framework represents the main study variables which serve as the
backbone on which the entire study rests. The conceptual framework outlines the
various risk factors of hypertension as well as the indicators of hypertension among
individuals. The framework indicates the prevalence of hypertension, consequences,
and the distribution. The study, therefore, based on four core variables namely;
knowledge, awareness, attitude and perception of hypertension, prevalence of
hypertension, consequences of hypertension, and the distribution of hypertension as
shown in Figure 1.1 below.
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Demographic Factors
 Sex
 Age
 Education
 Occupation
Attitude / Perception
 Life long HP Indicators
 Severity
 Weight
 Cure
 Height HYPERTENSIO
 Waist Size N
 Hip Ratio
Knowledge /Awareness  Heart beat Rae
 Awareness of HP  Blood Pressure
 Awareness of Risk
Factors
 Awareness of Symptoms
Prevalence of HP Consequences of HP
Trend & Distribution
 Number with HP
 Coronary heart diseases
 Number with severe  Time series
 Kidney damage
HP  Brain damage  Distribution by age
 Number with mild  Loss of productive  Distribution by sex
HP hours  Dist. by ethnicity
 Number reported at  Financial burden  Genetic distribution
the hospital  Visual impairment
 Number of non-  Cerebral infarction
 Angina pectoris
reported cases
Figure 1. 1: Conceptual Framework of the Study Showing an Overview of

knowledge, awareness, attitudes and perception of hypertension among adults
(19-60 years) (Author’s Construct, 2017)
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Explanation of Conceptual Framework
There are several contributing factors associated with hypertension among persons
aged 30-54 years. Hypertension is influence by demographic (age, sex, education and
occupation), physical factors, environmental factors, and knowledge on the risk
factors and prevention of the condition. In a study conducted, Abed & Abu-Haddaf
(2013) applied multiple logistic analysis on the data that they collected through
questionnaire based survey to predict the hypertension’s risk factors for residents of
Gaza strip, Palestine. They inferred that hypertension was strongly linked with
physical inactivity, education, obesity, low income and family history of high blood
pressure.
Demographic Factors: The demographic factors such as age, sex, education and
occupation are reported as risk factors that influence hypertension among individual.
The sex of respondents is measured in terms of sex organ, age is measured at last
birthday, highest educational level is measured in terms qualification while the main
work of respondents defines the occupation. Educational status is also linked with the
knowledge of the individuals regarding hypertension.
Knowledge/Awareness of HP: Individuals with a higher educational status will have
greater knowledge on the risk factors of hypertension which will influence them to
adopt preventive measures. Adequate knowledge on the various physical and
environmental risk factors will all influence them to develop more favorable attitudes
towards the adoption of hypertension free measures. The environmental factors that
are associated with hypertension include risky lifestyles such as frequency of
smoking, number of times of smoking per day, frequent alcohol consumption, and
vegetable intake per daily, meat taken containing fat, type of physical activities
8
perform, level of quantity of salt taken per meal, among others. Lack of awareness
and practice of physical activity among individual is associated with hypertension.
This include such as depression, lack of exercise, and type of exercise (jogging, gym,
riding and walking), and the rate of exercising.
Prevalence of HP: the prevalence in the study is defined as the number of people
within the study sample who have hypertension. It includes those reported to any
health facility and those who do not report to any health facility. The prevalence also
includes those with severe and mild hypertension.
Consequences of HP: the consequence of hypertension is defined as the various health
and economic burden that occurred as a result of the condition. Hypertension can lead
to health complications and diseases such as coronary heart diseases (stroke, heart
failure, peripheral vascular disease, angina pectoris etc.), renal impairment, retinal
hemorrhage and visual impairment, kidney damage, brain damage, and cerebral
infarction. It also has economic consequences which include cost of treatment, loss of
productive time in seeking treatment, low productivity at work, and family burden.
Trend and Distribution of HP: the trend in the study depicts the occurrence of
hypertension in the Sunyani municipality for a particular length of time (2011-2016)
whereas the distribution of HP looks at the spread of the condition among individuals
with respect of sex orientation, age, ethnicity, and family history.
In summary, the various demographic (age, sex, education and occupation), physical
factors, environmental factors, and knowledge factors have the potential to trigger
hypertension indicators such as overweight, height, waist size, rate of heart beat, and
blood pressure. These indicators further influence hypertension among individuals.
People awareness of the risk factors of hypertension could contribute to health
9
practices and lifestyles that can minimize the occurrence of hypertension. However,
hypertension when it occurs, could lead to both health and economic consequences
1.5 Justification of the Study
Hypertension remains an area of high public health concern to the health services
providers. Until recently, hypertension was not given much attention as the disease
was noted to be confined to the wealthy people. With the current increase in trend of
the disease among all the different social categories of people, attention has begun to
rise about major determinants of the diseases and risk factors for hypertension
(Olatunbosun et al., 2013). However, much have not been done in the area of research
in the Brong Ahafo Region of Ghana to determine the state of hypertension with
particular emphasis on knowledge/awareness, prevalence, consequences and the
distribution.
Also, in a study of two urban communities and one urban community in Ghana,
hypertension prevalence was 28.4% (Amoah, 2013). The annual municipal health
report continues to show hypertension ranking among the top 10 diseases over the
past five years, indicating that contrary to what is believed, hypertension does not
only occur in urban areas (Annual Report of Sunyani Municipal Health Directorate,
2013). With the rapid increase in the number of hypertension cases in recent annual
reports of the Ghana Health Service (GHS), there is the need for a current research to
be conducted to examine the recent trend and distribution of the condition among
adults.
Last but more importantly, in the Sunyani Municipality, hypertension is ranked 4th
among the first ten leading causes of deaths (Annual Report of Sunyani Municipal
Health Directorate, 2016). This and others necessitate this study into assessing the
10
level of awareness/knowledge, determinants, prevalence, consequences and the
distribution of the disease such that tentative interventions can be put in place at a
minimum cost before the situation gets out of control. In order to take effective
prevention measures, identification of the risk factors is an essential prerequisite.
Little is known about the prevalence of the risk factor coupled with little data
available on the dietary habits, physical activity and other life-style associated factors
in urban centres in the municipality.
1.6 Research Question
1. What is the level of knowledge of hypertension among adults (19-60 years) in
the Sunyani Municipality?
2. What is the level of awareness of hypertension among adults (19-60 years) in
the Sunyani Municipality?
3. What is the level of attitude and perception related to hypertension in the
Sunyani Municipality?
1. 7 Research Objectives
1.7.1 Main Objective
The main objective is to assess the knowledge and attitudes of hypertension among
adults (19-60 years) in the Sunyani Municipality, Brong Ahafo Region, Ghana.
11
1.7.2 Specific objectives
The specific objectives are to:
1. Assess the level of knowledge of hypertension among adults (19-60 years) in
the Sunyani municipality
2. Assess the level of awareness of hypertension among adults (19-60 years) in
the Sunyani Municipality.
3. Assess the level of attitudes and perceptions related to hypertension in the
Sunyani Municipality.
1.8 Organisation of the Study
The study is organised into six chapters. The chapter one presents the overview of the
general introduction to the study. It covers the general background, statement of the
problem, justification of the study, research questions, general and specific objectives
of the study, significance of the study, scope of the study, and organisation of
chapters. The chapter two deals with the review of existing literature on the subject
matter mainly, theoretical and empirical evidence. The chapter three considers the
methodology of the study. It consists of sections such as profile of the study area,
study design and type, study population, sampling techniques and sample size, data
collection techniques and tools, measurement procedures, data handling and analysis,
ethical consideration, and limitations of the study. The chapter four presents a detailed
outcome of the research results and findings. The chapter five deals with discussion of
the results. It is organised around the specific objectives of the study. Finally, the
chapter six of the study draws the conclusion and recommendations based on
findings.
12
CHAPTER TWO
LITERATURE REVIEW
2.0 Introduction
The literature review was based on previous works done by others on factors
contributing to hypertension. This was done by considering the level of
awareness/knowledge on hypertension, determinants of hypertension, and trend and
distribution of hypertension.
2.1 Overview of Hypertension
Worldwide prevalence of hypertension exceeds 1.3 billion in 2016. The global
hypertension is estimated to cause 7.5 million deaths, about 12.8% of the total of all
deaths. This accounts for 57 million disability adjusted life years (DALYS) or 3.7%
of total DALYS. Globally, the overall prevalence of hypertension in adults aged 25
and over was around 44% in 2016. The proportion of the world’s population with
high blood pressure, or uncontrolled hypertension, fell modestly between 1980 and
2008. However, because of population growth and ageing, the number of people with
uncontrolled hypertension rose from 600 million in 1980 to nearly 1.4 billion in 2016
(WHO, 2017).
High blood pressure has become a major problem in many developing countries
experiencing an epidemiological transition from communicable to non-communicable
chronic diseases (WHO, 1993). The development of hypertension and other
cardiovascular diseases in these countries is associated with the aging of the
population. Urbanization and socio-economic changes favor, among other things,
sedentary habits, obesity, alcohol consumption and salt consumption (Omran, 1971;
13
Akinkugbe, 1987). The cost-effective use of health services to combat these emerging
chronic diseases is particularly needed in developing countries, as resources are
limited and must generally be shared with the burden of persistent communicable
diseases. In this context, hypertension is an important area of intervention because it
is common and can be controlled by non-pharmacological lifestyle factors and
pharmacological treatment. Pharmacological treatment of hypertension has been
shown to be effective in reducing BP and subsequent cardiovascular events (Collins et
al., 1990), although BP levels may be significantly higher in treated patients than in
truly normotensive patients. Lifestyle measures to lower BP include reduced alcohol
consumption, reduced consumption of sodium chloride, increased physical activity,
and over-control (Cutler, 1993; Stevens et al., 1993). Lifestyle interventions also have
the potential to reduce the need for BP in non-hypersensitive people. In addition,
lifestyle interventions help control other concomitant cardiovascular risk factors that
are not related to hypertension, such as smoking, high cholesterol or diabetes, hence
the importance of multifactorial approach effective risk reduction in hypertensives
(WHO, 1996; Strasser, 1992). Several models have been proposed for health
behaviors and sustained behavioral changes (Becker, 1974; Prochaska, &
DiClemente, 1986). Although they may differ in content and point of view, behavioral
change models emphasize the importance of assessing individuals' perceptions,
attitudes, beliefs and expectations as a crucial means of understanding observed
behaviors and guiding behavioral changes. An adequate assessment and
understanding of KAP factors is particularly useful in the area of chronic diseases
such as hypertension, for which prevention and control require the adoption of healthy
lifestyles throughout life.
14
The literature shows that pharmacists in Jos have a low prevalence of hypertension.
Although knowledge about hypertension was appropriate, the awareness of
hypertension was very low. Hypertension was significantly associated with married
respondents and patients with insufficient hypertension. The prevalence of
hypertension among pharmacists in Jos was low relative to the national prevalence in
Nigeria (Whitworth, 2003, Ogah et al., 2012) and the prevalence of hypertension in
other Glenn workers' health studies, (Glenn, 2013; Aguirre, et al., 1999) the majority
had pre-hypertension. The prevalence of pre-hypertension with risk factors for
overweight hypertension, such as: Low level of physical activity, obesity and alcohol
consumption at our participants indicate that BP intervention programs are necessary
for pharmacists and should focus on regular monitoring of BP. The JNC-7 director
(Chobanian et al., 2003) recommends screening annual lifestyle changes, such as
increased exercise levels, reduced alcohol consumption, weight reduction strategies
and changes in food should be part of the lifestyle control measures BP among
pharmacists.
Hypertension is recorded as a major type of cardiovascular disease which affects one
billion people worldwide and claims the life of seven million (American Heart
Association, 2006). It accounts for 13% of global mortality (Khatib, 2005) with 25%
prevalence in Nigeria (Danbauchi et al., 2007). A current trend in management is
lifestyle modification (Simeon & Zieve, 2008).
Across the WHO regions, the prevalence of hypertension was highest in Africa, where
it was 46% for both sexes combined in 2016. Both men and women have high rates of
hypertension in the Africa region, with prevalence rates over 40%. The lowest
prevalence of raised hypertension was in the WHO Region of the Americas at 35%
for both sexes in 2016. Men in this region had higher prevalence than women (39%
15
for men and 32% for women). In all WHO regions, men have slightly higher
prevalence of hypertension than women. This difference was only statistically
significant in the Americas and Europe (WHO, 2017).
In Ghana, the prevalence of hypertension among urban population is pegged at 54.6
% against rural prevalence of 19.3%. In Ghana, hypertension was rated fourth among
the first ten causes of admission in 2015 and 2016 with 33,154 cases recorded (GHS,
2017). The disease affects nearly one out of every five Ghanaian adults. This statistic
was contained in a review of population-based studies on hypertension in Ghana by a
team of researchers (Okertchiri, 2016).
The prevalence of hypertension was higher in urban than rural areas in studies that
covered both types of area and increased with increasing age. They also found out that
hypertension is associated with high blood pressure included increasing body mass
index, increased salt consumption, family history of hypertension and excessive
alcohol intake. The levels of hypertension detection, treatment and control were
generally low (control rates ranged from 1.7 % to 12.7 %),” the research showed
(Okertchiri, 2016). The research concluded that an increased burden of hypertension
should be expected in Ghana as life expectancy increases with rapid urbanization.
Prevention and control of hypertension in Ghana is, thus, imperative and any delays in
instituting preventive measures would most likely pose a greater challenge on the
already overburdened health system,” the findings concluded (Okertchiri, 2016).
In the Brong Ahafo Region, hypertension was rated fourth among the first ten causes
of admission in 2015 and 2016 with 3,230 cases recorded (GHS, 2017). Hypertension
was also rated the seventh cause of mortality within the same period with 588 deaths
record with the period. The prevalence of adult hypertension in the region appears to
16
be increasing and ranges from 19% to 48%. Current reports have identified that, up to
70% of persons identified to have hypertension are not on treatment and only 13% of
those with hypertension have their blood pressures well controlled.
According to a survey in Portugal (Macedo et al., 2005), the awareness and treatment
of hypertension increased between 2003 and 2012 despite a similar prevalence of
hypertension. Hypertension increases by 3.8 times. Other studies have shown
improved treatment and control of hypertension for decades (Kastarinen et al., 2009;
Guo et al., 2012; Gao et al., 2013). In particular, the proportion of hypertensive
patients undergoing controlled treatment almost doubled between 2003 and 2012.
This progress may be related to increased use of antihypertensive drugs, new
therapeutic approaches and overall improvement in blood pressure in patients and of
the health system.
In the past decade, several campaigns have been launched in Portugal to alert the
public to the importance of high blood pressure as the cause of the disease. In
addition, it is generally believed that access to primary care has improved
significantly in recent years. In terms of treatment, a study indicated that patients with
adequate control of hypertension were more often treated with a combination of
antihypertensive drugs (65% are fixed combinations) than those with an uncontrolled
BP. In addition, this is consistent with other studies that have described a combination
of more frequent drug combinations with a progressive increase in adequate control of
hypertension.
Once again, it is in good agreement with the European directives, Mancia et al.,
(2013) and American (Chobanian et al., 2003). Over the last ten years, the control of
hypertension in 10 years despite the adverse changes in obesity is improving. It is
17
important to improve the control of hypertension from 2003 to 2012 which caused
Portugal with a significant reduction of systolic and diastolic blood pressure in
hypertensive patients in the range of 12.4 / 8.0 mmHg average. The Portuguese
population to be reduced by more than 20% reduction in stroke mortality in 10 years
(Lewington et al., 2002).
2.1.1 Determinants of Hypertension
High Blood Pressure and Age
Blood pressure is considerably lower in children than in adults and increases steadily
throughout the first two decades of life. In adults, cross-sectional and longitudinal
surveys have shown that systolic and diastolic blood pressure increase progressively
with age. For example, in the WHO survey, systolic blood pressure increased by
about 0.29 to 0.91 mm Hg per year in men and 0.6–1.31 per year in women. This
increase remains stable and possibly declines after age 50 for diastolic but not for
systolic blood pressure, leading to a steep increase in pulse pressure; a key risk factor
for cardiovascular outcome. These trends have been demonstrated in both genders and
most ethnic groups. Similarly, many studies document an increase in hypertension
prevalence with age (Hajjar et al., 2013).
In the United States, hypertension prevalence increased from 6.7% in persons within
the ages 20 to 39 years to 65.2% in persons 60 years or older. The greatest increase in
hypertension prevalence between 1988–1991 (57.9%) and 1999–2000 (65.4%)
occurred in individuals who are 60 years or older (Hajjar et al., 2013). On
hypertension in the Ashanti Region, West Africa: an opportunity for early prevention
of Clinical Hypertension; documented 40% and 29% as a prevalence of both
hypertensive and hypertensive respectively with hypertension being more in non-
18
hypertensive males than non-hypertensive females particularly people aged around 35
years (Addo et al., 2013).
In population-based sample studies of the United States, the mean systolic blood
pressure is higher for men than for women during early adulthood, although among
older individuals the age-related rate of rise is steeper for women. Consequently,
among individuals aged 60 or older, mean systolic blood pressure of women is higher
than that of men (Stamler et al., 2013). A family history of hypertension is associated
with an increase in the prevalence and incidence of hypertension. Both genetic and
environmental factors appear to contribute to this association (Fava et al., 2004). In a
nationwide screening program, a family history of hypertension was associated with
hypertension prevalence double that in persons with a negative family history,
independent of Body Mass Index, gender, and ethnicity (Stamler et al., 2013). In a
population-based ascertainment of families in Utah, a family history of hypertension
was associated with a 3.5-fold increased risk of hypertension. Young children of
parents with hypertension are at increased risk of hypertension, and they show higher
levels of systolic blood pressure than those of parents with no hypertension. In a study
of 745 subjects followed for 10 years (baseline mean age = 12 years), subjects with a
family history of hypertension in one or both biological parents were associated with
higher systolic blood pressure, and a higher rate of increase of systolic blood pressure
over time (Stamler et al., 2013).
Anthropometric Indexes
Body mass index (BMI) is an important correlate of blood pressure and hypertension
prevalence. By the current World Health Organization (WHO, 2016) criteria, a BMI
<18.5kg/m2 is considered underweight, 18.5–24.9 kg/m2 ideal weight and 25–
19
29.9kg/m2 overweight or pre-obese. The obese category is sub-divided into obese
class I (30–34.9kg/m2), obese class II (35–39.9kg/m2) and obese class III (≥40kg/m2).
A BMI greater than 28kg/m2 in adults was associated with a three to four-fold greater
risk of morbidity due to CVDs than in the general population.
The recent increase in overweight and obesity in the United States both in adults and
children may explain, in part, the associated increase in hypertension prevalence over
the past decade. In the NHANES-III data, obese men and women had a hypertension
prevalence ranging from 49% to 64% with increasing degrees of obesity in men and
from 39% to 63% with increasing obesity in women versus 27% in normal-weight
men and 23% in normal-weight women. According to Han et al. (2014), weight gain
is also associated with an increase in hypertension incidence and the age-related rise
in systolic blood pressure. In an analysis of four Chicago epidemiological studies,
weight gain was associated with an increase in pulse pressure. In the Framingham
Heart Study, a 5% weight gain was associated with a 20% to 30% increase in
hypertension incidence (Han et al., 2014).
Obesity which is defined as a condition of abnormal or excessive fat accumulation in
adipose tissue, to the extent that health is impaired in absolute terms, and its
distribution in the body - either around the waist and trunk (abdominal, central or
android obesity) or peripherally around the body (gynoid obesity) - has important
health implications. A central distribution of body fat is associated with a higher risk
of morbidity and mortality than a more peripheral distribution (Kissebah et al., 2016).
Measurement of the waist circumference, measured at the midpoint between the lower
border of the rib cage and the iliac crest, or the waist: hip ratio (WHR) provide useful
indices of abdominal fat accumulation and a better correlation with an increased risk
of ill health and mortality than BMI alone (Kissebah et al., 2016).
20
An abdominal girth in excess of 108 cm (40 inches) for men and 98 cm (35 inches)
for women or a WHR > 1.0 and 0.85 in men and women, respectively, are the
currently accepted indicators of excessive abdominal fat accumulation which correlate
with a substantially increased risk of metabolic complications (WHO, 2016). In both
national studies, Greater Accra Region had the highest overweight and obesity rates
and women constituted a high-risk group.
Nutritional/Dietary Behaviour Measures
Results of observational studies and clinical trials document an association between
sodium chloride (NaCl) intake and blood pressure. The effect of NaCl on blood
pressure increases with age, with the height of the blood pressure, and in persons with
a family history of hypertension. Among population groups, age-related increments of
blood pressure and the prevalence of hypertension are related to NaCl intake (Elliott
et al., 2016).
In societies with high potassium intakes, both mean blood pressure levels and the
prevalence of hypertension tend to be lower than in societies with low potassium
intakes. Meta-analyses of clinical trials have concluded that oral potassium
supplements significantly lower both systolic and diastolic blood pressures
(Cappuccio et al., 2013). Within and among populations, as with potassium, there is
an inverse association between dietary calcium intake and blood pressure, and low
calcium intake is associated with an increased prevalence of hypertension (Cutler et
al., 2013). A study by Maham et al. (2013), in India indicates that majority (93.2%) of
the subjects (190) incorporated into a study of risk factor profile of non-
communicable diseases in an industrial productive had low daily intake of vegetables
and fruits.
21
Sedentary lifestyle
Sedentary life style and low educational attainment have each been linked to the rise
in blood pressure with age, low socio-economic status, low occupational class,
psycho-social factors such as hostility and time urgency/impatience, job strain,
depression (Davidson et al., 2014).
Tobacco Smoking
Smoking, which is believed to be the number one major single known cause of non-
communicable diseases such as hypertension, is widespread around the world.
Estimate of the World Health Organization (WHO) indicates that roughly about 30%
of the global adult male populations are smokers (WHO, 2013).
It is estimated that tobacco-related deaths exceed 4 million annually. It has been
estimated that by 2030, diarrhoeal diseases and lower respiratory infections will have
been surpassed by chronic obstructive airways diseases as causes of mortality
(Murray & Lopez 2014). While the prevalence of tobacco use in many industrialized
nations is reducing, there is a growing epidemic of smoking in the developing world.
In many African countries, there is paucity of data on the epidemiology of tobacco
and smoking. Based on the available data however, in African countries, it appears
smoking among adults is more common among males and the poor. An estimated 4.8
million deaths case worldwide in 2000 was believed to have occurred due tobacco
smoking, particularly occurring in developing countries (Ezzati et al., 2013).
In Ghana specific, little is known about prevalence of smoking. Before the year 2013,
no National data was available on prevalence of smoking among adults. The 2013
Ghana Demographic and Health Survey estimated smoking prevalence in men aged
15 to 19 to be only 0.7%. Global Youth Tobacco Survey (GYTS) also documented
22
smoking prevalence rate of 4.8% among 1,917 Ghanaian school children between the
ages of 11-16 years in 2010. Males smoker were more than females (5.3% versus 3.8
%) (Ghana Demographic and Health Survey, 2014).
On smoking patterns in Ghanaian civil servants, changes over three decades, it was
revealed high rates of smoking prevalence in men and women. The age-standardised
prevalence of cigarette smoking among the 1,015 participants was also high. Among
the participants, men with age-standardised prevalence of 7.3% and 0.5% for women
were considered to be ex-smokers. The study also obtained an average number of
cigarettes smoked per day among the proportion of respondent being current male
smokers to be 4.3 sticks. About 82% of men reported smoking 5 or less cigarettes in a
day while 18% reported smoking 6 to 10 sticks of cigarettes per day (Ghana
Demographic and Health Survey, 2014).
Physical Inactivity
Physical inactivity is known to be a major public health problem of concern in 2010
as physical activity levels of people of all ages tended to decrease. The Centres for
Disease Control (CDC, 2014) reported that among the youth in America aged 12 and
13 years, 69% were regularly active. However, the number dropped to 38% for young
people between the ages of 18-21 years. A physically inactive child is more likely to
become a physically inactive adult, which could lead to chronic diseases including
hypertension of lifestyle. Patterns of inactivity, also known as sedentism, begin early
in life, making the promotion of physical activity among children imperative. The
prevalence of physical inactivity among youth worldwide has increased. In the
international level, 67% of young children in Canada did not meet the average
physical activity guidelines to achieve optimal growth and development (CDC, 2014).
23
Among the United Kingdom, London Health Observatory reported that both adults
and children in Britain are less active and less fit than previously. The Allied Dunbar
National Fitness Survey identified United Kingdom adult population groups who were
sedentary as women aged 16-24 years, middle-aged men and people aged 50 years
and over. Girls are reported as being physically inactive between age 10 and 15. In the
16-24 years age group, 39% of the males are reported as inactive and 62% of the
females are reported as inactive. In some Sub-Saharan countries, prevalence of
physical inactivity has been recorded. A study in South Africa report indicates that
more than 40% of young people do not participate in regular physical activity. A
study found that physical activity was less common among girls than boys and among
those with lower income and less education (WHO, 2013).
Environmental Factors
Urbanization is an important factor in the aetiology of obesity, and a major risk factor
for hypertension. It accelerates the changes in diet, physical inactivity and increases
access to tobacco products and high fat foods which are all risk factors of
hypertension. Diet and physical inactivity are modifiable risk factors associated with
changes in lifestyle. Diets of the African population tend to differ between rural and
urban dwellers. Studies have shown that rural dwellers diets are low in fat and sugar
but high in carbohydrates and fibre (Steyn et al., 2013), while their urban counterparts
show high fat and low fibre and carbohydrate intake (Bourne et al., 2014) which is
typical of a Western diet.
24
2.2 Knowledge on Hypertension
Hypertension is one of the most common chronic health problems in the world and a
major risk factor for mortality and morbidity (Kearney et al., 2004). Controlling
hypertension by changing lifestyle habits could reduce the cost of health care by
reducing the use of pharmacological and invasive cardiovascular treatments. Disease
prevention and control should be the primary means of ensuring public health and
disease treatment (Connor et al., 2005).
For knowledge about risk factors for hypertension, the results of the study showed
that more than half of hypertensive patients were aware of this; family history,
smoking, and excessive salt intake have increased the risk of high blood pressure.
While most of them did not know; aging, overweight, inactivity, stress, alcohol
consumption, high cholesterol levels and some medications are associated with an
increased risk of hypertension. This may be due to the low level of education of
patients and the fact that patients have other concerns than the time to monitor their
disease in clinics. The most common risk factors for hypertension in volunteers were
excessive salt intake (77.4%), followed by family history (73.4%) and the lowest
alcohol consumption (47.6%) (Demaio, et al., 2013).
Knowledge of hypertension is very essential because it contributes enormously to the
prevention and management of the condition and also drug adherence (Saleem et al.,
2013). A study conducted in 2012 to assess the knowledge level and management
practices of hypertension in pregnancy among health care workers in Moshi urban in
Tanzania found out that the level of knowledge of hypertension during pregnancy is
too low (Liljevik & Lohre, 2012). A recent study by Siddiqua et al. (2017) in Saudi
Arabia in 2017 concluded that a significant proportion of hypertensive patients have
25
good knowledge and attitude towards hypertension but they show moderate levels of
practice which can lead to worsening their health condition in time being and
resulting in severe complications and damaging of other vital organs also. A
descriptive cross - sectional study conducted in China on the topic “health literacy in
rural areas of China: hypertension knowledge survey also revealed that, hypertension
knowledge levels are alarmingly low in rural areas of China, particularly concerning
hypertension complications and medication. The authors also averred that myriad
factors contribute to this low hypertension knowledge level, such as the poor health
education programs, economic conditions, and cultural factors (Li et al., 2013).
Almas et al., (2012) in their cross sectional study in Karachi in Pakistan entitled, good
knowledge about hypertension is linked to better control of hypertension also opined
that, Knowledge about hypertension in hypertensive patients is not adequate and is
alarmingly poor in patients with uncontrolled hypertension. More emphasis needs to
be made on target blood pressure and need for taking antihypertensive for life to
patients by physicians (Almas et al., 2012).
A study in Ghana by Lamptey et al. (2017) to evaluate community-based
hypertension improvement programme also affirmed that respondents were highly
aware of hypertension, but with very low level of hypertension treatment and control
and this requires in-depth investigation of the bottlenecks to treatment and control.
A cross sectional survey which employed 529 participants by Sanne et al., (2012) on
the topic hypertension knowledge among patients from an urban clinic also concluded
that, there is hypertension knowledge deficits in specific content areas among the
urban population. Educational programmes focusing on newly diagnosed
26
hypertensive patients and aimed at filling targeted knowledge deficits may be a cost-
effective approach to increase hypertension knowledge in similar populations.
A descriptive, quantitative and transversal study, performed by Lima et al (2015)
entitled the patient's knowledge about hypertension: an analysis based on
cardiovascular risk attested that people with the highest cardiovascular risk are the
ones showing the poorest knowledge about the complications related to hypertension.
Abdullahi & Amzat (2011) also conducted a research on knowledge and perceptions
related to hypertension, lifestyle, behaviour modifications and challenges that are
facing hypertensive patients, of which the authors enunciated that, there is high poor
level of knowledge about hypertension and perceptions toward lifestyle-modification.
Patients lacked understanding some points of risk factors, manifestation and lifestyle
modifications of hypertension. So educational programmes that can enhance patients'
awareness regarding hypertension disease are urgently needed among these patients.
A cross - sectional study on the levels of knowledge, attitude and preventive practices
of hypertension among residents aged 18 years and above in Kampung Baru Ixora,
Sarikei in Malaysia also showed that 52.5% of the respondents had adequate
knowledge, 57.4% had positive attitude and 61.4% of them had good preventive
practices of hypertension (Shaikh et al., 2012).
A study conducted in Nigeria among staff of the University of Ibadan by Abdullahi &
Amzat (2011) also demonstrated that the majority of the respondents had a fair
knowledge about the complications of hypertension. However, knowledge about the
risk factors and attitude toward hypertension was very poor (Abdullahi & Amzat,
2011). A study on hypertension knowledge, attitude and practice also concluded that
27
a significant proportion of hypertensive patients have poor knowledge about
hypertension (Shaikh et al., 2012).
As expected, knowledge of hypertension was appropriate for trained pharmacists.
However, it found a small percentage of pharmacists who did not know the guidelines
for the treatment of high blood pressure. Knowledge of hypertension was not partial
by age, work experience or scope of practice, but by gender. More worrisome was the
fact that adequate knowledge of hypertension did not lead to a better attitude towards
blood pressure monitoring and awareness, since only a quarter of respondents said
they had good blood pressure. Particularly of concern was that pharmacists did not
regularly monitor their blood pressure and that about 10% of them never checked
their blood pressure. Suboptimal attitude/awareness of hypertension by health
professionals has been reported in other studies (Mitwalli et al., 2013).
This discovery underscores the need for behavioral intervention and motivation to
improve blood pressure monitoring in pharmacists, given the importance of early
detection and treatment of high blood pressure. Measurement of BP identifies adults
at high risk of cardiovascular disease due to hypertension (U.S. Preventive Services
Task Force, 2014).
2.3 Awareness on Hypertension
Globally, from 2000 to 2010, high-income countries saw substantial improvements in
hypertension awareness, treatment, and control. While these rates still demonstrate
substantial room for improvement, they are far superior to the rates seen in
low/middle–income countries where there has been little improvement and perhaps
some worsening in the rates of awareness, treatment, and control from 2000 to 2010
(Mills et al., 2016).
28
Awareness of participants on hypertension issues was 44% as against the 50% in the
study by Ike et al. (2010). There was a misconception that stroke and hypertension
can be caused by gods or enemy, respectively. Attitude to hypertension was negative
especially among participants, as majority strongly disagreed with having
hypertension in their lifetime and does not affect young people. Apparently these
participants will not go for a routine blood pressure check based on their belief. It was
also noted that majority of the participants could not differentiate between daily
activities and regular exercise as it was strongly agreed that daily activities was same
as regular exercises unlike in the study by Ohata et al. (2005) where all participants
appreciated a 12-week regular exercise as an intervention. Identified risk factors were
in line with Wang et al. (2006) and Omorogiwa et al. (2009) in their studies. Smoking
was not identified as a risk factor as in the report by Ricks (2004) and Aghaji (2008)
but snuff was enlisted. The unhealthy lifestyles in relation to nutrition include the
chewing of kolanut, use of table salt, and alcohol as in the studies by the
aforementioned researchers.
The high prevalence of hypertension in the rural Ga district since the study in 1973
could be attributed to transformation of rural areas, which could have resulted in a
decrease in physical activity from use of automobile transportation and increased
mechanization in agriculture. Parallel, Ghanaians are adopting lifestyles that they
perceive to be desirable or modern, changing the types of food, consumed both in
rural and urban areas (Mills et al., 2016).
Wilber & Barrow (2013) indicate that only 26% of hypertensives in the study were
aware they had high BP. The low levels of awareness may be partly due to poorly
developed health services and the relatively low functional literacy rate in rural
Ghana. Only 50% of those with previously known hypertension were receiving
29
antihypertensive treatment, and only 16.7% of them had their BP under control.
Community hypertension surveys in various parts of the United States have shown
that most people with hypertension are undetected, untreated, or inadequately treated.
In many populations, half of the hypertensives are known to have hypertension, half
of the known hypertensives are treated, and half of the treated hypertensives are
controlled (Hart, 2013). Low levels of awareness have been described in most studies
in Africa. In a recent study from greater Accra, 34% were aware they had high BP,
18% were receiving treatment, and only 4% had their BP controlled (Amoah, 2013).
Ghanaian patients often present late with complications of hypertension such as heart
failure, stroke, and chronic renal failure (Amoah, 2013). Effective treatment of
hypertension could prevent 250,000 deaths each year in sub-Saharan Africa (Hart,
2013).
The prevalence of hypertension increased with age, as has been observed in most
studies (Amaoh, 2013). Hypertension prevalence was 60% among respondents 65
years of age, while it was 6% in those 18–24 years. Most of the respondents were in
jobs that involved physical activity to varying degrees (73%) and also carried out
other activities several times a week. The mean BMI of 21.5 6 2.8 kg/m2 and 23.9 6
5.4 kg/m2 for men and females, respectively, compare to those obtained for men (21.2
and 24.5 kg/m2, respectively) in rural residents of Accra (Amoah, 2013). Overweight
and obesity are no longer rare in rural residents (Amoah, 2013) and may be partly
responsible for the high prevalence of hypertension in the Ga District. Hypertension
prevalence was significantly higher in those who were overweight and obese as well
as those involved in less physical activity. The prevalence of hypertension increased
as body mass increased from 18% in those with normal body mass to100% in
respondents with grade 3 overweight. This finding was consistent with available
30
literature since increased fat mass is associated with increased risk of hypertension
even in lean populations. No significant association was observed between
hypertension prevalence and alcohol consumption.
Epidemiologic data have shown a lower risk of coronary death and ischemic stroke in
those who drink the equivalent of one to four standard drinks a day in Western
societies. Moderate alcohol intake is believed to have some cardiovascular benefits.
Evidence from African studies have been inconclusive; some show an association of
regular and moderate alcohol intake with hypertension, and others show no
association (Olatunbosun et al., 2013). The absence of an association in the present
study could possibly be due to lack of accurate ascertainment of alcohol in intake.
Smoking rates are relatively low in the rural communities studied, which offers a
window of opportunity for smoking prevention. Health promotion efforts should be
intensified so that rural persons do not take up smoking with its attendant health
problems.
No significant association was observed between family history of hypertension in a
first-degree relative and the subsequent development of hypertension. This conclusion
may not be valid, considering the high level of hypertension unawareness detected in
this study; subjects are unlikely to be aware of hypertension in other family members.
Those with a history of diabetes had an increased risk of being hypertensive, although
this association was not statistically significant. Having some degree of formal
education carried a lower risk of developing hypertension compared to having no
education at all, but having more than nine years of education carried a higher risk
compared to no education at all (Olatunbosun et al., 2013).
There is a common misconception that people with high blood pressure always
experience symptoms. Most people with high blood pressure actually have no
31
symptoms at all and may not even know they have it. Sometimes high blood pressure
can cause symptoms such as headache, shortness of breath, dizziness, chest pain,
palpitations of the heart or nose bleeds. If people ignore measuring blood pressure
because they think symptoms will alert them to the problem, it can be dangerous
because high blood pressure is often a silent killer. Everyone should know his or her
blood pressure numbers (WHO, 2013).
According to Shaikh et al., (2011) reported that more than 70% of patients knew that
stress, high cholesterol and obesity were the risk factors for hypertension and that
52.7% of them did not know that they were physically active, risk factor for
hypertension. In addition, Ali et al. (2006) reported that study participants were aware
that stress, excessive salt intake and obesity are risk factors for high blood pressure.
But there was little awareness about excessive drinking, smoking and a sedentary
lifestyle. In the same line, Akter, et al. (2014) estimated that in a Hispanic study of the
community of hypertension on risk factors, treatment, diagnosis and prognosis
indicated that only 28% knew the correct definition of hypertension and 3% of
unknown etiology.
In addition, Ali et al., (2006) who reported that the participants in their study were
aware that stress, excessive salt intake and obesity as risk factors of hypertension. But
there was poor awareness with regards to excessive alcohol intake, smoking and a
sedentary lifestyle. In the same line Akter, et al. (2014) held that in a community
study done on Hispanic subjects regarding knowledge about hypertension on risk
factors, treatment, diagnosis and prognosis showed that only 28% knew the correct
definition of hypertension and 3% aware that etiology was unknown.
32
A median (50%) of people with high BP were aware that they were hypertensive and
only a small proportion (10%) of hypertensive individuals had a controlled BP. For
example, in a similar sample and population, these numbers are lower than those of
African Americans from 1991 to 1993 (93% aware, 83% treated and 68% for BP
controlled) or Barbados in 1994 (82% aware, 60% treated and controlled at 52%)
(Freeman, et. al. 1996). However, in the Seychelles, hypertension rates were higher
than in several developing countries, for example in rural Zaire in 1986 (31% aware,
13% treated and 3% controlled) or in the Eastern Mediterranean region in 1990 (only
about 20% of hypertensives are aware of their condition) (Alwan, 1993), where
hypertension was only recently recognized as a major public health problem. Allergic
hypertension and hypertension intermediates in Seychelles are not unexpected results,
as hypertension has become a major public health problem recently, perhaps because
of the rapid epidemiological transition over the past two or three decades. Although a
national program for the prevention and control of cardiovascular disease was
launched in 1991, achieving these goals may take a long time. Low levels of BP
control in the general population are consistent with poor compliance as measured by
electronic surveillance: only 28% of newly diagnosed hypertensives achieved a 360-
day adherence of at least 85% to one drug per day (Bovet et. al., 1997). Overall, it can
be said that the current detection and control rates in Seychelles have been similar to
those in western countries for decades and that in the 1970s, as “the rule of the
halves” (where half of hypertensives are aware of hypertension, half of aware
hypertensives are treated, and half of those treated are controlled). It took 30-40 years
to significantly improve the detection and control of hypertension in western countries
and rates remain optimal. Rapid improvement in the detection and control of
hypertension, which is faster than in western countries, is therefore needed to prevent
33
or reduce the growing burden of disease associated with increased rates of
hypertension in countries in epidemiological transition (Burt et. al., 1995).
2.4 Attitude of Adults towards Hypertension
Oliveria et al., (2015) conducted a descriptive survey to understand the current status
of hypertension (HTN) knowledge, awareness, and attitudes in a group of
hypertensive patients. Our results suggest that patients are knowledgeable about HTN
in general, but are less knowledgeable about specific factors related to their condition,
and specifically their own level of BP control. The median duration of HTN was 14
years, suggesting that even though these patients have had this condition for a long
duration their knowledge is inadequate. Patients were unaware that SBP is important
in BP control and reported that physicians did not emphasize the significance of high
SBP levels. Further, many patients (41%) did not know their BP value nor could they
accurately report whether it was elevated.
Patients were knowledgeable about the meaning of HTN, and the seriousness of the
condition to their health. Ninety-six percent knew that lowering BP would improve
health and 96% thought that people can do things to lower their high BP. Nearly 70%
of patients knew that high BP could lead to congestive heart failure. Almost all
patients were aware of their HTN with 91% reporting that a doctor or health care
provider had told them that they have HTN.
Improved recognition of the importance of SBP has been identified in recent years as
one of the major public health and medical challenges in the prevention and treatment
of HTN because of the potential impact on the morbidity and mortality associated
with cardiovascular disease and stroke. Patients are generally unaware that SBP is
important in HTN and BP control. Sixty-five percent of patients were told their
34
optimal BP reading while only about half reported that they were specifically told that
the top and bottom numbers are important to keep under control. When asked which
measure is more important, 41% reported that diastolic is more important, 13%
reported that systolic is more important, while 30% reported that both systolic and
diastolic are important, and 17% did not know. Thirty-nine percent did not know the
normal level for SBP or reported that normal SBP is 140 mm Hg or greater.
Conversely, more than 69% of patients identified normal DBP as less than 90 mm Hg.
Patients were knowledgeable about the cut point for DBP, with only 8% reporting that
90 mm Hg or greater was normal. These findings suggest the need for education of
patients, physicians, and other health care providers related to the importance of
elevated SBP and cardiovascular risk.
Many patients did not know their BP level nor could they accurately classify their
level as elevated or normal. These findings suggest that patients' perception of their
BP level does not reflect their actual readings except for the majority of those with
controlled BP. Further, 41% of patients reported that their values were in the normal
range, but in fact they were elevated.
The importance of hypertension awareness and knowledge and the potential impact of
BP education programs have been reported previously. Patients who were aware that
elevated BP levels lead to reductions in life expectancy had a higher compliance level
with medication use and follow-up visits than patients without this awareness.
Surveys of hypertensive patients in three clinical sites showed that lack of knowledge
concerning target SBP level was an independent predictor of poor BP control.
Reductions in SBP and DBP and improved medication-use compliance have been
achieved through an education program that stressed, in part, “knowing high BP.”
35
This research all points to the need to improve hypertension knowledge and
awareness in order to increase medication-use compliance and BP control.
An opportunity exists to use patient-reported sources for HTN information in order to
disseminate HTN information. In aprevious study, physicians, other health care
providers, mass media, and print and video materials were important sources of
information as reported by the patients. The mass media have also been identified as a
major source of patient information in a study by Kjellgren et al., (2014) and
represents an important opportunity to influence patient knowledge, awareness, and
attitudes toward HTN control.
2.5 Consequence of Hypertension
Globally, hypertension is a major risk factor for coronary heart disease and ischemic
as well as hemorrhagic stroke. Hypertension has been shown to be positively and
continuously related to the risk for stroke and coronary heart disease. In some age
groups, the risk of cardiovascular disease doubles for each increment of 20/10 mmHg
of blood pressure, starting as low as 115/75 mmHg. In addition to coronary heart
diseases and stroke, complications of hypertension include heart failure, peripheral
vascular disease, renal impairment, retinal hemorrhage and visual impairment.
Treating systolic blood pressure and diastolic blood pressure until they are less than
140/90 mmHg is associated with a reduction in cardiovascular complications (WHO,
2016).
Long-standing hypertension causes accelerated atherosclerosis, which in turns leads to
all of the biological fallout of this disease. Some consequences include: stroke,
coronary artery disease, myocardial infarction, aneurysmal and occlusive aortic
disease. Long-standing hypertension also causes the heart to remodel and undergo a
36
process of hypertrophy (left ventricular hypertrophy or LVH). Hypertrophy can lead
to diastolic dysfunction, which can lead to congestive heart failure (CHF) since the
heart is too stiff to relax properly. The stiffened heart requires elevated filling
pressures, and this can worsen the dysfunction. Long-standing hypertension can also
cause the heart to dilate and lose its ability to pump during systole (systolic congestive
heart failure). Lastly, the kidneys are injured by long-standing hypertension and this is
a significant cause of renal failure (Baker, 2015).
Long term high pressure against arterial walls eventually damages and strains them.
This may lead to several complications, the most well-known complication being
atherosclerosis which describes a buildup of fatty deposits or plaques in the walls
lining the arteries. As the walls thicken with the deposits, they calcify and become
brittle with a narrow lumen which restricts the flow of blood. Atherosclerosis is
responsible for a host of other disease conditions such as stroke and heart attacks. The
formation of a blood clot at the site of the plaque may block the artery completely and
this leads to ischemia or a lack of blood supply to the heart, a common cause of heart
attack (Mandal, 2017).
Once hypertension causes complications, treating these complications entails costly
interventions such as cardiac bypass surgery, carotid artery surgery and dialysis, all of
which drain individual and government budgets. An estimated 10% of health care
spending is directly related to increased blood pressure and its complications,
increasing to as much as 25% of health care spending in Eastern Europe and Central
Asia (Peberdy, 2016). The African region has the highest prevalence of hypertension
among adults aged over 25, implying a massive economic burden for the continent,
including the cost of caring for all the complications arising from hypertension such
as cerebrovascular disease, ischemic heart disease and congestive heart failure as well
37
as indirect costs such as the lost productivity of workers struck by stroke, heart
failure, and ischemic heart disease. Other costs include the lost savings and assets that
are foregone when families must meet catastrophic healthcare expenditures, such as
those associated with rehabilitation following stroke, or dialysis following renal
failure (Van-de-Vijver, 2013).
The economic burden of hypertension on individuals, families and the nation has a
major consequence (Arredondo & Aviles, 2014). In developing countries, 1 in 3
adults have hypertension, and at least half are unaware they have the disease (Arno &
Viol, 2013). In the case of Mexico, according to the latest findings from the National
Health Survey (Campos et al., 2013), in 2012 there are 22.4 million hypertensive
patients, of which only 11.2 million (50%) have a health diagnosis; 8.2 million are
under medical treatment, and only 5.7 million have their hypertension under control.
The implications of this panorama of hypertension are enormous, not only because of
the direct costs (diagnosis and treatment) but also because of the indirect costs
(temporary disability, permanent disability, and premature mortality) and the impact
of the disease in terms of the productivity and economy of any country (Arredondo et
al., 2013).
It is estimated that it will cost nearly US$ 1 trillion if current global blood pressure
levels persist over a 10-year period, and that if hypertension goes untreated, indirect
costs could be as high as US$ 3.6 trillion annually (Peberdy, 2016). Increasing
economic growth and development, accompanied by rapid unplanned urbanization in
the developing world, can only serve to increase the prevalence of raised blood
pressure, and in turn, lead to populations developing major cardiovascular problems.
This is because, as is the case with all non-communicable diseases, behavioural
factors play a major role in increasing blood pressure and hypertension therefore
38
serves as a serious warning sign that major lifestyle changes are required (Peberdy,
2016).
In the case of Mexico, (Arredondo et al., 2013), there was a 24% increase in terms of
the economic burden of hypertension, comparing 2010 vs. 2012. Taking 2011 as the
cutoff, the overall cost for hypertension was US $5,733,350,291. This includes
$2,718,280,941 in direct costs and $3,015,069,350 in indirect costs. Healthcare costs
for hypertension hit the pockets of patients and their families, so that of every $100
spent on hypertension care in Mexico, $52 comes from patients’ pockets and $48
comes from the health institutions. Nearly 80% of deaths due to cardiovascular
disease occur in low- and middle-income countries. They are the countries that can
least afford the social and economic consequences of ill health. current age
standardized mortality rates of low-income countries are higher than those of
developed countries (WHO, 2013).
There is a strong relationship between hypertension and Chronic Kidney Disease
(CKD).
Hypertension is an important cause of End-Stage Renal Disease (ESRD), contributing
to the
disease itself or, most commonly, contributing to its progression. On the other hand,
hypertension is highly prevalent in CKD patients, playing a role in the high
cardiovascular
morbidity and mortality of this particular population (Morgado & Pedro, 2014).
Hypertension as a cause of CKD, the relationship between abnormal blood pressure
and kidney dysfunction was first established in the 19th century. The prevalence of
both, and of the associated burden of cardiovascular morbidity and mortality, has been
39
dramatically increasing worldwide. Data from several renal databases identifies
systemic hypertension as the second most common cause of ESRD, with diabetes
mellitus being the first. In the United States (US), hypertension is the leading cause of
ESRD in African-American patients. Additionally, for any given cause of CKD, the
elevation in systemic blood pressure accelerates the rate at which the glomerular
filtration rate (GFR) declines. This is particularly true for patients with proteinuric
nephropathies (Morgado & Pedro, 2014).
A Cardio Vascular disease (CVDs) is number one killer disease in Ghana today.
Doctors at the Korle Bu Teaching Hospital say almost 70 % of all deaths at the
hospital are caused by hypertensive conditions. The disease affects nearly one out of
every five Ghanaian adults. A recent report by the Ghana Health Service says more
people are becoming hypertensive due to unhealthy lifestyles. Doctors explain that
hypertension is a silent killer because many have it for years without realizing it. It
silently damages the brain, the heart, the kidneys and the eyes. Commonly referred to
as high blood pressure or BP, hypertension is the major cause of strokes, heart attacks,
heart failure and chronic renal failure. These and other blood pressure related diseases
constitute more than half of all admission cases at Korle Bu (www.Myjoyonline.com,
2017).
The Ghana Health Service (2017) states that hypertension is the second most reported
medical condition in the Greater Accra and Brong Ahafo Regions. In 2015, it was the
5th in Greater Accra and 4th Brong Ahafo Regions. The Regional Director of the
Ghana Health Service, Madam Irene Agyapong Amarteifio told Joy News' Adisa
Lansa that the upsurge in cases is traceable to the poor lifestyles of urban dwellers.
From the records from all our OPDs in the public sector in the regions, when
40
compiled in 2016 it showed that hypertension which used to be the fourth most
common, now it is the second.
Hypertension tends to affect the working age group who are supporting often several
other people and if people get hypertension and it's not controlled they get stroke and
is a huge burden on the health system and the family. Hypertension is a leading cause
of deaths in adults. It is one of the major causes of admissions and the main
complications are strokes, heart attack, and kidney failure; at Korle-Bu data shows
that hypertension was the major cause of admissions and it contributed to about 67%
of deaths, most of them through strokes. Hypertension is still a major health care
problem. In the urban centres hypertension prevalence is about 30 %. In Kumasi and
Accra again it is the leading cause of deaths in adults. But that is not the only cause
for concern. Cardiologists say if lifestyles do not improve, hypertensive patients may
soon not get the care they require. The number of patients may soon outstrip the
doctors. For now, the Cardio Centre at Korle Bu is restricting itself to four surgeries a
week instead of two or four a day due to lack of medical personnel. The centre has
had its fair share of the brain drain (www.Myjoyonline.com, 2017).
2.6 Epidemiological Trend and Distribution of Hypertension
In United States, estimates of hypertension (generally defined as systolic blood
pressure ≥140 mm Hg and/or diastolic blood pressure ≥90 mm Hg, or taking
antihypertensive medications) prevalence in the United States varies somehow. A
study conducted with a total population of 15,739, aged between 45–64 years,
revealed a prevalence rate of 35% in the years 2007–2009. A similar study by the
Woman's Health Initiative in U.S in the years between 1993 and 1997 of a total
population of 90,755 women aged 50–79 years also revealed a prevalence rate of
41
hypertension of 37.8%. In the Behavioural Risk Factor Surveillance System (BRFSS)
in U.S, self-reported hypertension prevalence increased from 21.2% in 2011 to 25.7%
in 2012 (Ahluwalia et al., 1997).
In developing countries, the trend is for a rapid increase in hypertension prevalence,
and in developed countries, the previous trend of a decrease in hypertension
prevalence is actually reversing. Generally, the worldwide burden of hypertension in
2000 was estimated to be 972 million persons or 26.4% of the adult world population,
with 333 million in developed and 639 million in developing countries. It has been
estimated that by 2025, 1.56 billion individuals will have hypertension, an increase of
60% from 2010 (Morgado & Pedro, 2014).
Chronic diseases have a longer history in Ghana than is usually thought especially
hypertension. Data gathered from Korle-Bu hospital showed a steady increase of
hypertension and cardiovascular diseases. Hospital-based and community-based
studies conducted since the 1950s provide important information on prevalence and
morbidity trends for hypertension.
In the 1970s, the World Health Organisation (WHO) sponsored research in Mamprobi
on Cardiovascular Disease (CVD) recorded hypertension prevalence of 13% in the
community. A non-communicable disease survey conducted in 2008 recorded a
national prevalence of 27.8% for hypertension. Studies conducted after the national
survey show higher prevalence rates across different groups in different regions:
28.7% in Kumasi in the Ashanti Region; 32% prevalence in Bawku/Zebilla in the
Upper East Region; 36.9% in Keta-Dzelukope in the Volta Region; and 47.8% among
a cohort of women in Accra (Amoah, 2013). Reported facility cases of hypertension
increased by 67 per cent, from 58,677 in 2005 to 97,980 in 2006 (Amoah, 2013). In
42
2007, national out-patient hypertension cases totaled 250,000. During the same
period, major causes of death have shifted from solely communicable diseases to a
combination of communicable and chronic non-communicable diseases.
2.6.1 Worldwide Distribution of Hypertension
Overall, approximately 20% of the world’s adults are estimated to have hypertension,
when hypertension is defined as BP in excess of 140/90 mm Hg. The prevalence
dramatically increases in patients older than 60 years: In many countries, 50% of
individuals in this age group have hypertension. Worldwide, approximately 1 billion
people have hypertension, contributing to more than 7.1 million deaths per year.
National health surveys in various countries have shown a high prevalence of poor
control of hypertension. These studies have reported that prevalence of hypertension
is 22% in Canada, of which 16% is controlled; it is 26.3% in Egypt, of which 8% is
controlled; and it is 13.6% in China, of which 3% is controlled (Dreisbach, 2014).
2.6.2 Age Distribution of Hypertension
A progressive rise in BP with increasing age is observed. Age-related hypertension
appears to be predominantly systolic rather than diastolic. The SBP rises into the
eighth or ninth decade, whereas the DBP remains constant or declines after age 40
years. Previous study reported that the prevalence of hypertension grows significantly
with increasing age in all sex and race groups. The age-specific prevalence was 3.3%
in white men (aged 18-29 y); this rate increased to 13.2% in the group aged 30-39
years. The prevalence further increased to 22% in the group aged 40-49 years, to
37.5% in the group aged 50-59 years, and to 51% in the group aged 60-74 years. In
another study, the incidence of hypertension appeared to increase approximately 5%
for each 10-year interval of age (WHO, 2016).
43
2.6.3 Sex Distribution of Hypertension
The age-adjusted prevalence of hypertension was 34%, 25.4%, and 23.2% for men
and 31%, 21%, and 21.6% for women among blacks, whites, and Mexican
Americans, respectively. Previous study reported that prevalence of hypertension was
12% for white men and 5% for white women aged 18-49 years. However, the age-
related BP rise for women exceeds that of men. The prevalence of hypertension was
reported at 50% for white men and 55% for white women aged 70 years or older
(Dreisbach, 2014).
The prevalence of hypertension (screening BP ≥160/95 mm Hg or taking medication)
was 43.9% and 32.8% for men and women, aged 35 to 64, after adjusting for age to
the world population. Based on the same methods of age standardization and BP
detection, these values are higher than those of several industrialized countries
participating in the WHO MONICA project (eg. Switzerland: 18.1% and 14.0%;
Scotland, 32.0% and 25.4% but not Finland, 45.3% and 37.6%). 45.3% and 37.6%) or
in the US NHANES II study (white population, 28.0% and 24.6%, but in the black
population 39.0% and 47.3%) (Drizd et al., 1986). The prevalence of hypertension is
also higher in Seychelles than in many developing countries (eg. Tanzania, 13.7% and
14.5 or China, 24.6% and 21.5%). High blood pressure levels have been reported in
some urban areas (eg, 23% and 27% in a Zulu urban setting of South Africa or 35%
and 23% in Sao Paulo). The high prevalence of hypertension in Seychelles is
consistent with a particularly high incidence of stroke in the country (WHO, 1996).
A study previously reviewed that high BP was independently associated with men,
older adults, blacks and a high body mass index. High blood pressure tended to be
associated with high alcohol consumption and low physical activity. These results are
44
not unexpected because these factors have been shown to be related to hypertension in
other populations. Seychelles has not been clearly linked to socio-economic status. In
some developed and developing countries, an inverse correlation between
socioeconomic status and hypertension has been observed, while in developing
countries a direct relationship has been established at an earlier stage of the
epidemiological transition (WHO, 1996).
2.6.4 Race or Ethnicity Distribution
Black individuals have a higher prevalence and incidence of hypertension than white
persons. The prevalence of hypertension has been reported to be increased by 50% in
blacks. Most studies in the United Kingdom and the United States report not only a
higher prevalence but also a lower awareness of hypertension in black people than in
white people. Mortality from hypertension in African-Caribbean–born people is 3.5
times the national rate; similar data have been published for African American
citizens (Lind & Chiu, 2013). The prevalence and incidence of hypertension in
Mexican Americans are similar to or lower than those in non-Hispanic whites.
NHANES III reported an age-adjusted prevalence of hypertension at 20.6% in
Mexican Americans and 23.3% in non-Hispanic whites. In general, Mexican
Americans and Native Americans have lower BP control rates than non-Hispanic
white persons and black individuals (Lind & Chiu, 2013).
To understand ethnic influence, an understanding of the renin-angiotensin system
(RAS) is essential. Renin secretion is suppressed when the kidney detects that the
amount of sodium excretion is increased; thus, this is a clue to the excess sodium in
the circulation. Black people tend to develop hypertension at an earlier age and have
lower renin activity; target organ damage also differs in black people from that in
45
white people. In addition, black people have a poorer response to treatment with
angiotensin converting enzyme (ACE) inhibitors compared with white people; the
evidence for beta-blockers being less effective in black people is also clear. However,
diuretics are more effective at a young age in black people. In comparative
assessments of black people and Asians, strokes are more common in black people,
but coronary heart disease is more common in Asians. Both groups have a higher
incidence of chronic renal failure than white people, but this is more due to
hypertension in black people and diabetes in Asians (Lind & Chiu, 2013).
46
CHAPTER THREE
METHODOLOGY
3.0 Introduction
The methodology deliberates on how the research objectives are achieved. It
introduces the study design and type. The chapter further stated clearly how data was
collected to meet research objectives, the instruments that were used to collect the
data, the sampling techniques that were employed, data analysis method, ethical
considerations associated with the study as well as the limitations.
3.1 Study Setting
Sunyani Municipality is one of the twenty-seven (27) administrative districts in the
Brong Ahafo Region of Ghana. It lies between Latitudes 70 20’N and 70 05’N and
Longitudes 20 30’W and 20 10’W and shares boundaries with Wenchi District to the
North, Dormaa District to the West, Asutifi District to the South and Tano North
District to the East. There are effective economic and social interactions with the
neighbouring districts which promote resource flow among these districts. The
municipality has a total land area of 829.3 square kilometres (320.1square miles).
Sunyani also serves as the regional capital for Brong Ahafo. One-third of the total
land area is not inhabited or cultivated. The municipality is divided into twenty (20)
large communities namely; Sunyani, Abesim, New Dormaa, Atronie, Kotokrom,
Yawhimakrom, Asuakwa, Kuffour Camp, Atuahenekrom, Benu Nkwanta,
Nwawansua, Liberation Barracks, Nkrankese, Kontorkrom (Adomako), Yeboahkrom
(Shed), Kurosua, Nsagobesa No.2, Nwowasu, Abesim-Nkran No.1, and Kurasua
No.1. Sunyani experiences double rainfall pattern. The main rainy season is between
47
March and September with the minor from October to December. This offers two
farming seasons in a year which supports higher agricultural production in the
municipality. Sunyani municipality enjoys food security throughout the year as a
result of the zone in which it is located. The supply of starchy stables and cereals in
the market is satisfactory.
In the year 2010, the population of the Sunyani municipality was 123,224 people with
a growth rate of 3.8 percent (GSS, 2010). The population in the municipality is
generally concentrated in the four largest localities (Sunyani, Abesim, Fiapre and
New Dormaa) which hold about 74.3 percent of the population, with only 25.7
percent distributed among the other settlements. Sunyani, the municipal capital
accommodates about 60 percent of the total population.
The, GSS (2010) criterion indicated that persons aged 15 years and above and have
completed basic school (Primary, JHS or Middle school level) are literates, about 76
percent of the population of the municipality are illiterates. The municipality can
therefore, be said to be highly illiterate when compared to the national average of 53.3
percent. Agricultural activities (including crop farming, animal husbandry and others)
constitute the highest intake of workers in the municipality forming 45.9 percent,
followed by Industry (carpentry, bricks and block laying, timber related industries,
construction workers etc),14.7 percent. Service and Administration (Government
workers, financial institutions, communication workers, hairdressers, seamstresses
etc), constitute 9.6 percent, professional and technical (Engineers, consultants etc.), 9
percent, commerce 8.6 percent and whereas others such as head potters, truck pushers,
mining form 1.4 percent (GSS, 2010).
48
3.2 Study Design
A cross-sectional survey design was adopted for the study. Quantitative data method
of data collection was employed through the use of structured questionnaire. The
study also made use of secondary data from the municipal health directorate to
determine the trend and distribution of hypertension in the municipality. The cross-
sectional survey design was employed because it helps the researcher to solicit the
needed information to arrive at a tangible conclusion. This research was conducted in
four urban communities (Sunyani area1, Bakoniaba, Penkwase, and Estate) in the
Sunyani Municipality with a sample of three hundred and forty-three (343) adults
(19+), selected through a household survey.
3.3 Sample Size
A total of 343 respondents (19+ years) comprised with 86 each from three different
communities and 85 from the fourth community were selected for the study, as a
result of small population within that community.
The sample size was determined using the Cochran’s (1977) formula for calculating
sample size when population size is finite.
Thus;
Where; n = sample size, n0 = sample size derived from equation, N = Population, and
1= Constant.
49
Thus, using the Brong Ahafo Region’s hypertension prevalence (3,230) as the
population, at 95% confidence level and 5% precision (e), the sample size derived
from equation (n0) is 384.
Cochran (1977) developed a formula to calculate a representative sample for
proportions as
n0= z 2 q p / e 2
where, n0 is the sample size, z is the selected critical value of desired confidence level
, p is the estimated proportion of an attribute that is present in the population, q= 1-p
and e is the desired level of precision. For example, suppose we want to calculate a
sample size of a large population whose degree of variability is not known. Assuming
the maximum variability, which is equal to 50% (p =0.5) and taking 95% confidence
level with ±5% precision,
then p = 0.5 and hence q =1-0.5 = 0.5; e = 0.05; z =1.96.
So, n0= (1.96)2(0.5) (0.5)/ (0.05)2 = 384.16 =384

୬଴
Therefore, n = (౤బషభ)
ଵା
ಿ
ଷ଼ସ
n= (యఴరషభ) = 343.3 ≈ 343
ଵା
యమయబ
3.4 Population
The study accessible population comprised adults with or without indications of risk
for hypertension in urban communities within the Sunyani Municipality. The target
population was persons above 19 years in both sexes as at the time of the study and
who had been residing in the community for a period of more than three months. The
total population of persons above 19 years per the 2010 Population and Housing
50
Census is 29,490. It is assumed that people above 19 years stood at risk of
hypertension. The hypertension prevalence in Brong Ahafo is 3,230. Exclusion
criteria include persons below 20 years, physical disability, mental disability and the
presence of communication barriers, those who agreed to participate only in Step 1
and those who refused to participate in the study.
3.5 Sample and Sampling Techniques
A multi-stage sampling comprising stratified sampling, systematic sampling, and
purposive techniques were used in selecting the household respondents for the study.
Proceeding to the selection of respondents for the study, the municipality is divided
into four zones called clusters. In each cluster, systematic sampling technique was
used to select the various houses where persons within the target age group were
contacted to respond to the questionnaire. In using the systematic sampling technique,
every 5th house, starting from the entering point of each community was selected and
one respondent was purposively selected in each household for the study based on
inclusive criteria. The interval (5th) was used because there are 1715 households in all
the four selected communities. Therefore, using an interval of 5, gives a sample size
of 343. This was done until the required number of respondents from each cluster was
attained. In all, 86 houses were contacted and 85 from the fourth community were
selected for the study, as a result of the small population within that community.
51
3.6 Data Collection Method
The data for the study was collected using a variety of methods. First, quantitative
data was collected using structured questionnaire in order to achieve specific
objective1, 2 and 3 which deal with knowledge, awareness, attitude and perception
related to hypertension respectively. Primary data was collected with reference to
WHO STEPS approach for non-communicable diseases assessment with particular
emphasis on steps 1 and 2. These steps were used to determine the hypertension status
of the respondents.
STEP 1: was used to capture information related to nutritional habit, sedentary
lifestyle, socio-demographic characteristics and many others with the use of
questionnaire.
STEP 2: was also used to capture information on weight, height, blood pressure level
and BMI. These were carried out with the use of instruments such as digital weighing
scale, tape measurement and digital blood pressure monitor.
The information gathered from using these steps enabled the researcher to determine
the BMI of the respondents and also their hypertension status.
Data collection was assisted by trained enumerators and health professionals who
helped to carry out the study.
52
3.7 Measurement procedures
Pulse Rate and Blood Pressure Measurements
The pulse rate and resting blood pressure was recorded using a calibrated, digital
blood pressure monitor.
Procedure:
a. The respondent was made to sit for at least five minutes prior to testing.
b. His/her right arm was bare and resting at an angle of 45 degrees on a table
with palm up.
c. A cuff of appropriate size was wrapped firmly around the wrist.
d. The start button was then pressed and the cuff inflated.
e. Once maximum inflation was reached, the cuff automatically deflated and
both the resting blood pressure and the resting pulse rate were recorded.
f. Both pulse readings and resting blood pressure were taken three times within
about 5 minutes for the validity and authenticity of the information obtained.
Weight
Weight was measured using a scale (Electronic weighing scale).
Procedure:
a. The respondents were asked to remove all excess clothing and made to stand
upright on the scale on bare footed
b. The weight of the respondent was recorded in kilograms to the nearest whole
number.
53
Height
A tape measure was used to measure the overall height of the respondents.
Procedure:
a. Tape measure was taped against a wall with tape measure 20 cm above ground
level.
b. The respondent was made to remove his/her shoes, stand feet together and
arms at the sides and made to stand with heels, buttocks and upper back
against the wall in a complete upright position.
c. The measurement from the 20th cm level to the highest point on the head was
measured.
d. The overall height was recorded/obtained by adding 20cm to the remaining
height obtained above the bench mark level, all in centimetres.
e. The height was then expressed in metres.
f. The height in metres was then squared. BMI was calculated from this
expression using the following formula: Body weight (kg)/height (m) 2.
Waist-to-Hip Ratio (WHR)
With abdomen relaxed, a horizontal measurement was taken at the level of the
narrowest part of the torso just below the twelfth rib using a tape measure. The
respondent was made to stand upright while taking the measurement of the waist.
While the respondent stood erect and in upright position, a horizontal measurement
was taken at the level of maximum circumference of the hips/buttocks.
54
Procedure:
a. The respondent was made to stand with feet together and the arms were at the
sides.
b. The waist and hip circumference were measured, all in centimetres
c. The tape was wrapped horizontally around the entire circumference of the
waist and on the hip at different times
d. Measurement was repeated for three times in each case for consistency.
e. Scores were recorded to the nearest centimetres
f. The waist-hip ratio was determined.
3.8 Data Analysis and Processing
Data collected was edited to exclude errors, re-organised, coded and processed for
efficient analysis. Access to the data was limited to the researcher and the supervisor
at the initial stage of the research till completion. Data was analysed with Statistical
package for Social Sciences (SPSS) Version 22.0 and Microsoft Excel 2016. Data was
analysed for frequency distribution, proportion and percentages for quantitative
variables, mean ± SD, correlations and rates. Results were calculated based on 95%
Confidence level and 5% significance level (alpha (a) = 0.05). Results were presented
in tables, charts and interpretations of findings were made as possible.
3.9 Quality Control
To ensure the reliability of the instrument, pre-testing of the questionnaire was done
by administering to 10 residents at Sunyani Area 2, so as to allow the researcher to
identify errors in the instrument. The pre-tested respondents possess similar
55
characteristics as the sampled subjects. The questionnaire was also given to the
supervisor for improvement in order to ensure its validity. A day training session was
organised for all the research assistants who assisted the researcher with the data
collected. All the research assistants were taken through the data collection
instruments for them to familiarize themselves with the instruments.
3.10 Ethical Consideration
Ethical approval for the study was first obtained from the University for Development
Studies. Ethical approval for conduct of the study was also obtained from the Sunyani
Municipal Health Directorate. Informed consent was obtained from community heads
and chiefs, household heads, community opinion leaders and the participants of the
study. The aim and the processes of the research were fully explained to the
participants and their informed consent was obtained for participation.
Participants were informed about the instruments to enable them understand the
procedures and give their full approval. The importance of the study was made known
to the participants as well as any possible risk that may be involved. Participation was
made voluntarily rather than imposition, thus, individuals were given the right to or
not to take part in the study. Only consenting individuals were chosen to respond to
the questionnaire and other measurements taken. Although the data were handled by
the researcher and supervisor, confidentiality was guaranteed as respondents were
dealt with individually. All information provided to the interviewers by participants
was strictly confidential.
56
CHAPTER FOUR
RESULTS
4.0 Introduction
This chapter covers the results presentation and analysis.
4.1: Sociodemographic characteristics of the study population
Table 4.1 describes the distribution of sociodemographic characteristics of the study
population stratified by gender. As shown from the table, there were more
respondents (36.7%) in the age category 20-29 compared to other age categories,
whiles the age category 50-59 has the least number of respondents (4.7%). Majority
of the respondents were Christians (67.1%), of Akan ethnicity (62.4%) and resided in
the urban areas (60.3%). Most of the respondents were unmarried, comprising 37.6%
singles, 14.6% divorcees and 6.7% each of widows and cohabitants. Majority had
some form of formal education (84.8%), and had some form of employment (self-
employed, 28.6% and employed, 25.3%) with most (83.4%) earning a monthly
income of GH¢1000 or less.
When the respondents were stratified based on gender, there were significantly more
females (42.5%) with the 20-29years age bracket than males (26.2%) whiles there
were more males within the 40-49years (27%) and 50-59 years (10.7%) than females.
The proportions of respondents who are Christians, Fantes, married, had attained
secondary education, employed and earned incomes > GH¢ 2000 were higher among
male respondents whiles that for respondents who are Ewes, single, had no education,
were unemployed and earned incomes < GH¢ 500 were higher among females.
57
Table 4. 1: Sociodemographic characteristics of the study population stratified by

gender
Total Male Female

Variables
(n=343) (n=122) (n=221)
Age Distribution of Respondents
20 -29 126(36.7%) 32(26.2%) 94(42.5%)
30-39 98(28.6%) 32(26.2%) 66(29.9%)
40-49 67(19.5%) 33(27.0%) 34(15.4%)
50-59 16(4.7%) 13(10.7%) 3(1.4%)
≥ 60 36(10.5%) 12(9.9%) 24(10.8%)
Distribution of Religious Background
Christian 230(67.1%) 91(74.5%) 139(62.9%)
Islam 62(18.1%) 18(14.8%) 44(19.9%)
Traditional 48(14%) 13(10.7%) 35(15.8%)
Others 3(0.8%) 0(0%) 3(1.4%)
Ethnic Distribution
Akan 214(62.4%) 70(57.4%) 144(65.2%)
Akuapim 18(5.2%) 7(5.7%) 9(4.2%)
Ewe 41(12%) 4(3.3%) 37(16.7%)
Fante 48(14%) 32(26.2%) 16(7.4%)
Ga 10(2.9%) 3(2.5%) 7(3.6%)
Gonja 12(3.5%) 6(4.9%) 6(2.9%)
Place Residence of Respondents
Rural 136(39.7%) 49(40.2%) 87(39.4%)
Urban 207(60.3%) 73(59.8%) 134(60.6%)
Marital Status of Respondents
Married 118(34.4%) 51(41.8%) 67(30.3%)
Single 129(37.6%) 38(31.1%) 91(41.2%)
Divorced 50(14.6%) 16(13.1%) 34(15.4%)
Cohabitating 23(6.7%) 3(2.5%) 20(9%)
Widowed 23(6.7%) 14(11.5%) 9(4.1%)
58
Educational Level
Primary 43(12.5%) 17(13.8%) 26(11.8%)
JHS 30(8.7%) 14(11.5%) 16(7.2%)
Secondary/Technical/Vocational 97(28.3%) 44(36.1%) 53(24%)
Tertiary 121(35.3%) 44(36.1%) 77(34.8%)
None 52(15.2%) 3(2.5%) 49(22.2%)
Employment Status
Unemployed 158(46.1%) 46(37.7%) 112(50.7%)
Self Employed 98(28.6%) 32(26.2%) 66(29.9%)
Employed 87(25.3%) 44(36.1%) 43(19.4%)
Income Level
< GH¢500 145(42.3%) 40(32.8%) 105(47.5%)
GH¢500-<Ghc1000 85(24.8%) 30(24.6%) 55(24.9%)
GH¢1000-<Ghc1500 56(16.3%) 24(19.7%) 32(14.5%)
GH¢1500->Ghc2000 22(6.4%) 10(8.1%) 12(5.4%)
> GH¢2000 35(10.2%) 18(14.8%) 17(7.7%)
Data presented as number (percentage).
4.2: Prevalence of Hypertension among study participants
The prevalence of hypertension among study participants stratified by gender and age
are shown in figure 4.1 and figure 4.2 respectively. As shown in figure 4.1, the
prevalence of hypertension was found to be 22.7% of which majority (24.0%) were
females and 20.5% were males.
In addition, the prevalence increased with increasing age (20-29 years) through to 60
years and above. This was represented by 2.4% for age category 20-29 years, 8.2%
for 30-39 years, 38.8% for 40-49 years, 81.3% for 50-59 years and 77.8% for 60 and
above years respectively (Figure 4.1)
59
Figure 4. 1: Prevalence of hypertension among study participants stratified by
gender
60
Figure 4. 2: Prevalence of hypertension among study participants stratified by
age
4.3 Hypertension Knowledge
Table 4.2 shows respondent’s knowledge on hypertension. Out of the 343
respondents, 62.1% had heard of hypertension with majority (70.5%) being males.
Although a total of 32.1% responded correctly to hypertension “meaning high blood
pressure when stratified by gender. However, 22.4% and 8.5% responded that
hypertension means high level of stress/tension and high blood sugar levels
respectively.
61
When asked how dangerous hypertension to health was 38.5% responded was
extremely dangerous, 17.2% said it’s not dangerous at all while 22.2% answered
somewhat dangerous of which females (26.2%) were the majority .
Majority (37.3%) of the respondents acknowledged that lowering high blood pressure
improve a person's health of which the females (42.1%) were more. However, 23.9%
did not know that lowering high blood pressure improve a person’s health of which
the males (31.1%) were the majority.
Only 5.0% of the study participants know that in blood pressures measurement, both
the top and bottom numbers correspond with systolic blood pressure (SBP) and
diastolic blood pressure (DBP) respectively. On knowledge of the average SBP and
DBP values, more than 50% responded to ≤140/90 mmHg with majority being males.
23.9% of the respondents responded that both SBP and DBP were more important
while 22.7% having no knowledge on which among SBP, DBP or both were more
important.
Majority (47.8%) of the respondents acknowledged that people can do things to lower
their blood pressure with males (58.2%) being the majority. A total (53.6%) of the
respondents responded that, lowering blood pressure even a little bit improves health
with 21.6% and 24.8 acknowledging having no idea (Table 4.2).
62
Table 4. 2: Respondents Knowledge of Hypertension stratified by gender
Variables Total, n(%) Male, n(%) Female, n(%)

Heard of Hypertension
Yes 213 (62.1%) 86 (70.5%) 127 (57.5%)
No 130 (37.9%) 36 (29.5%) 94 (42.5%)
Hypertension Means
High blood pressure 110 (32.1%) 49 (40.2%) 61 (27.6%)
High level stress/tension 77 (22.4%) 20 (16.4%) 57 (25.8%)
Nervous Condition 21 (6.1%) 9 (7.4%) 12 (5.4%)
High blood sugar 29 (8.5%) 18 (14.8%) 11 (5.0%)
Don’t know 106(30.9%) 26 (21.3%) 80 (36.2%)
Knowledge on how dangerous hypertension is to your health
Extremely 132(38.5%) 52 (42.6%) 80 (36.2%)
Somewhat 76 (22.2%) 18 (14.8%) 58 (26.2%)
Not At all 59 (17.2%) 26 (21.3%) 33 (14.9%)
Don’t know 76 (22.2%) 26 (21.3%) 50 (22.6%)
Lowering High Blood Pressure
Yes 128 (37.3%) 35 (28.7%) 93 (42.1%)
No 79 (23.0%) 24 (19.7%) 55 (24.9%)
Somewhat 54 (15.7%) 25 (20.5%) 29 (13.1%)
Don’t know 82 (23.9%) 38 (31.1%) 44 (19.9%)
Knowledge on the Top Number of BP measurement
Don’t know 326(95.0%) 115(94.3%) 211 (95.5%)
SBP 17 (5.0%) 7 (5.7%) 10 (4.5%)
Knowledge on the Bottom Number of BP measurement
Don’t know 326(95.0%) 115(94.3%) 211 (95.5%)
DBP 17 (5.0%) 7 (5.7%) 10 (4.5%)
Knowledge on Top Number of Normal Blood Pressure
<140 105 (30.6%) 39 (32.0%) 66 (29.9%)
140 85 (24.8%) 30 (24.6%) 55 (24.9%)
>140 61 (17.8%) 27 (22.1%) 34 (15.4%)
Don’t know 92 (26.8%) 26 (21.3%) 66 (29.9%)
63
Knowledge Bottom Number of Normal Blood Pressure

<90 174(50.7%) 79 (64.8%) 95 (43.0%)
90 64 (18.7%) 15 (12.3%) 49 (22.2%)
>90 25 (7.3%) 10 (8.2%) 15 (6.8%)
Don't know 80 (23.3%) 18 (14.8%) 62 (28.1%)
Measure(s) is/are more Important
Top 111(32.4%) 39 (32.0%) 72 (32.6%)
Bottom 72 (21.0%) 27 (22.1%) 45 (20.4%)
Both 82 (23.9%) 39 (32.0%) 43 (19.5%)
Don’t know 78 (22.7%) 17 (13.9%) 61 (27.6%)
Knowledge on How to Lower Blood Pressure
Yes 164(47.8%) 71 (58.2%) 93 (42.1%)
No 75 (21.9%) 12 (9.8%) 63 (28.5%)
Don’t know 104(30.3%) 39 (32.0%) 65 (29.4%)

Knowledge on whether Lowering Blood Pressure Improve Health
Yes 184(53.6%) 61 (50.0%) 123 (55.7%)
No 74 (21.6%) 39 (32.0%) 35 (15.8%)
Don’t know 85 (24.8%) 22 (18.0%) 63 (28.5%)
Data presented as number (percentage)
4.4: Knowledge on Risk Factors of Hypertension
Figure 4.3 illustrates the knowledge of respondents on the risk factors associated with
hypertension. The findings indicate majority 177(51.6%) of the respondents identified
other diseases as the risk factor of hypertension. However, less than 50% of the
respondents identified factors such as; excessive alcohol consumption, excessive
smoking, poor eating style, physical inactivity, high blood pressure, and age of a
person as the risk factors of hypertension.
64
Risk Factors of Hypertension
Don’t know 22.7
Age of a person 45.2
High blood pressure 45.5
Physical inactivity 46.6
Other Diseases 51.6
Poor eating style 49.6
Excessive smoking 46.1
Excessive alcohol consumption 40.5
0 10 20 30 40 50 60
Percentage of Respondents
Figure 4. 3: Knowledge on Risk Factors of Hypertension
4.5: Knowledge on Symptoms of Hypertension
Figure 4.4 depicts the knowledge of respondents on the symptoms of hypertension.
The results show that the majority of the respondents representing 53.1% and 53.6%
identified dizziness and shortness of breath respectively, as the symptoms of
hypertension. However, less than 50% of the respondents identified headache, blurred
vision, chest pain, high blood pressure and heart attack as the symptoms of
hypertension among hypertensives.
65
Symptoms of Hypertension
Don’t know 23
Heart attack 27.4
High Blood Pressure 43.1
Chest pain 42.3
Shortness of breath 53.6
Dizziness 53.1
Blurred Vision 45.8
Headache 39.9
0 10 20 30 40 50 60
Percenatge of Respondents
Figure 4. 4: Knowledge on Symptoms of Hypertension
4.6: Association between knowledge on the danger of hypertension and Socio-
demographics
As shown in Table 4.4, out of the total 343 participants studied, majority of the
females (66.3%) had knowledge on the dangers of hypertension with the male
(33.7%) being the least, however, this was not statistically significant (p = 0.3579).
There were significant (p = 0.05) association between dangers of hypertension and
religion with Christians (73.4%) being the majority and Islam (14.4%) being the least.
A total of 34.6% of respondents who resides in the rural area had knowledge on
dangers of hypertension and 47.4% did not and this was statistically significant
66
(0.0180). Again, 65.4% of the urban dwellers had knowledge on dangers of
hypertension and 52.6% did not.
There was an association (p = 0.0203) between knowledge on dangers of hypertension
and no formal education with 11.5% having knowledge on dangers of hypertension
and 20.7% did not.
There were significant association (p = 0.0132; p = 0.0002) between knowledge on
dangers of hypertension and cigarette and shisha smoking with 20.7% and 8.7% of
cigarette and shisha smokers having knowledge on dangers of hypertension and
32.6% and 23.0% did not respectively.
67
Table 4. 3: Association between knowledge on the danger of hypertension and

Socio-demographics Characteristics
Variable Knowledge on the danger of hypertension Chi-square P-value

Total, n(%) Knowledge No Knowledge
Gender
Male 122 (35.6%) 70 (33.7%) 52 (38.5%) 0.845 0.3579
Female 221 (64.4%) 138 (66.3%) 83 (61.5%)
Religion
Christian 230 (67.1%) 153 (73.6%) 77 (57.0%) 10.110 0.0015
Islam 62 (18.1%) 30 (14.4%) 32 (23.7%) 4.762 0.0291
Traditional 48 (14.0%) 25 (12.0%) 23 (17.0%) 1.713 0.1906
Others 3 (0.9%) 0 (0.0%) 3 (2.2%)
Ethnicity
Akan 214 (62.4%) 132 (63.5%) 82 (60.7%) 0.258 0.6113
Akuapim 18 (5.2%) 3 (1.4%) 15 (11.1%)
Ewe 41 (12.0%) 30 (14.4%) 11 (8.1%) 3.063 0.0801
Fante 48 (14.0%) 24 (11.5%) 24 (17.8%) 2.648 0.1037
Ga 10 (2.9%) 10 (4.8%) 0 (0.0%)
Gonja 12 (3.5%) 9 (4.3%) 3 (2.2%)
Residence
Rural 136 (39.7%) 72 (34.6%) 64 (47.4%) 5.598 0.0180
Urban 207 (60.3%) 136 (65.4%) 71 (52.6%)
Educational Level
Primary 43 (12.5%) 29 (13.9%) 14 (10.4%) 0.953 0.3291
JHS 30 (8.7%) 15 (7.2%) 15 (11.1%) 1.560 0.2117
Secondary/technical/voc 97 (28.3%) 60 (28.8%) 37 (27.4%) 0.084 0.7725
Tertiary 121 (35.3%) 80 (38.5%) 41 (30.4%) 2.807 0.0938
None 52 (15.2%) 24 (11.5%) 28 (20.7%) 5.390 0.0203
Employment Status
Unemployed 158 (46.1%) 90 (43.3%) 68 (50.4%) 1.662 0.1974
Self employed 98 (28.6%) 58 (27.9%) 40 (29.6%) 0.122 0.7267
Employed 87 (25.4%) 60 (28.8%) 27 (20.0%) 3.384 0.0658
68
Income Level
<Ghc500 145 (42.3%) 82 (39.4%) 63 (46.7%) 1.760 0.1846
Ghc500-<Ghc1000 85 (24.8%) 59 (28.4%) 26 (19.3%) 3.642 0.0563
Ghc1000-<Ghc1500 56 (16.3%) 30 (14.4%) 26 (19.3%) 1.402 0.2365
Ghc1500->Ghc2000 22 (6.4%) 16 (7.7%) 6 (4.4%) 1.439 0.2304
>Ghc2000 35 (10.2%) 21 (10.1%) 14 (10.4%) 0.007 0.9347
Smoke Cigarette
Yes 87 (25.4%) 43 (20.7%) 44 (32.6%) 6.144 0.0132
No 256 (74.6%) 165 (79.3%) 91 (67.4%)
Smoke Shisha
Yes 49 (14.3%) 18 (8.7%) 31 (23.0%) 13.690 0.0002
No 273 (79.6%) 169 (81.3%) 104 (77.0%)
Alcohol
Yes 106 (30.9%) 64 (30.8%) 42 (31.1%) 0.004 0.9466
No 237 (69.1%) 144 (69.2%) 93 (68.9%)
Exercise
Yes 202 (58.9%) 126 (60.6%) 76 (56.3%) 0.620 0.4312
No 141 (41.1%) 82 (39.4%) 59 (43.7%)
Data presented as number (percentage). Categorical variable compared using chi-
square test and p-value < 0.05 considered statistically significant
4.7: The knowledge of respondents on normal blood pressure range and the
socio-demographic characteristics
Table 4.6 illustrates the association between the knowledge of respondents on normal
blood pressure range and the socio-demographic characteristics. As shown from the
table, the proportions of males and females who had knowledge on the isolated
systolic (male, 32.0% vs. female, 32.6%) and diastolic (male, 22.1% vs. female,
20.4%) blood pressure ranges were similar. The proportion of males who however
69
had knowledge on the combined blood pressure reading was higher (32.0%) than the
proportion of females (19.5%) whiles that of females who did not know about any of
the three, was higher (27.6%) than males (13.9%). Similar proportions of the various
religions had knowledge on normal blood pressure, however, the proportion of
traditionalists who had no knowledge at all was higher than the proportions of other
religions. Similarly, all ethnicities studied had similar knowledge on the normal blood
pressures with the Ewe group showing higher proportions of respondents who did not
know about normal blood pressure.
Knowledge on normal blood pressure was higher among respondents who resided in
the urban area (25.6%), who had had tertiary education (30.6%) and were single
(32.6%). The proportions of unemployed and employed respondents who had
knowledge on normal blood pressure were similar, with both being higher than the
proportion of self-employed individuals, whiles the proportion of GH¢ 1000- 1500
income earners was higher than other categories with respect to the knowledge on
normal blood pressure readings,
70
Table 4. 4: Knowledge on Normal BP and Socio- Demographics characteristics
VARIABLE Top (111) Bottom (72) Both (82) Don’t know (78)
Gender
Male 39(32.0) 27(22.1) 39(32.0) 17(13.9)
Female 72(32.6) 45(20.4) 43(19.5) 61(27.6)
Religion
Christian 69(30.0) 63(27.4) 54(23.5) 44(19.1)
Islam 24(38.7) 6(9.7) 15(24.2) 17(27.4)
Traditional 15(31.2) 3(6.2) 13(27.1) 17(35.4)
Others 3(100.0) 0(0.0) 0(0.0) 0(0.0)
Ethnicity
Akan 54(25.2) 66(30.8) 48(22.4) 46(21.5)
Akuapim 10(55.6) 0(0.0) 4(22.2) 4(22.2)
Ewe 20(48.8) 0(0.0) 9(22.0) 12(29.3)
Fante 24(50.0) 3(6.2) 11(22.9) 10(20.8)
Ga 0(0.0) 3(30.0) 7(70.0) 0(0.0)
Gonja 3(25.0) 0(0.0) 3(25.0) 6(50.0)
Residence
Rural 57(41.9) 24(17.6) 29(21.3) 26(19.1)
Urban 54(26.1) 48(23.2) 53(25.6) 52(25.1)
Educational level
Primary 17(39.5) 8(18.6) 7(16.3) 11(25.6)
JHS 4(13.3) 9(30.0) 6(20.0) 11(36.7)
Secondary/technical/vocational 33(34.0) 25(25.8) 22(22.7) 17(17.5)
Tertiary 37(30.6) 26(21.5) 37(30.6) 21(17.4)
None 20(38.5) 4(7.7) 10(19.2) 18(34.6)
Marital status
Married 55(46.6) 19(16.1) 18(15.3) 26(22.0)
Single 14(10.9) 41(31.8) 42(32.6) 32(24.8)
Divorced 17(34.0) 9(18.0) 13(26.0) 11(22.0)
Cohabitating 13(56.5) 0(0.0) 3(13.0) 7(30.4)
Widowed 12(52.2) 3(13.0) 6(26.1) 2(8.7)
71
Employment Status
Unemployed 47(29.7) 39(24.7) 41(25.9) 31(19.6)
Self employed 34(34.7) 14(14.3) 19(19.4) 31(31.6)
Employed 30(34.5) 19(21.8) 22(25.3) 16(18.4)
Income Level
< GH¢ 500 44(30.3) 22(15.2) 37(25.5) 42(29.0)
GH¢500-< GH¢1000 20(23.5) 29(34.1) 13(15.3) 23(27.1)
GH¢1000-< GH¢1500 18(32.1) 13(23.2) 19(33.9) 6(10.7)
GH¢1500-> GH¢2000 16(72.7) 0 (0.0) 3(13.6) 3(13.6)
> GH¢2000 13(37.1) 8(22.9) 10(28.6) 4(11.4)
Smoke Cigarette
Yes 44(50.6) 18(20.7) 16(18.4) 9(10.3)
No 67(26.2) 54(21.1) 66(25.8) 69(27.0)
Smoke Shisha
Yes 27(55.1) 6(12.2) 6(12.2) 10(20.4)
No 84(28.6) 66(22.4) 76(25.9) 68(23.1)
Alcohol
Yes 44(41.5) 29(27.4) 17(16.0) 16(15.1)
No 67(28.3) 43(18.1) 65(27.4) 62(26.2)
Exercise
Yes 65(32.2) 37(18.3) 52(25.7) 48(23.8)
No 46(32.6) 35(24.8) 30(21.3) 30(21.3)
4.8: Association between Knowledge on Risk Factors of hypertension and Socio-
Demographics
Table 4.7 shows the association between the sociodemographic variables and
knowledge of respondents on the risk factors hypertension. Majority (65.3%) of the
72
females in this study had high score of knowledge on risk factors whiles the least
(34.7%) were males.
There was significant relationship (p = 0.0035) between Akuapim tribe and
knowledge of respondents on the risk factors hypertension with 2.9% having high
score on the risk factors and 10.6% having low score.
Again, 20.9% of participants who had secondary/technical/vocation education had
high score and 45.2% of this same category had low score of knowledge of
respondents on the risk factors hypertension and this was statistically significant (p <
0.0001). Furthermore, majority (40.6%) of participants with tertiary education had
high score of knowledge of respondents on the risk factors hypertension with 23.1%
scoring the least (p = 0.0018).
There were significant (p < 0.05) associations between divorced and widowed
participants and knowledge of respondents on the risk factors hypertension with
17.2% and 4.2% of divorced and widowed having high score and 8.7% and 12.5%
having low score respectively.
Furthermore, 13.4% of participants who received monthly income between GH¢
1000-1500 had high score and 23.1% of the same category had low score and this was
significantly (p = 0.0257) with knowledge of respondents on the risk factors
hypertension (Table 4.5).
73
Table 4. 5: Association between Knowledge on Risk Factors of Hypertension and

Socio- Demographics Characteristics
Variable Knowledge on Risk Factors Chi-square P-value

High, n (%) Low, n (%)
Gender
Male 83 (34.7%) 39 (37.5%) 0.243 0.6221
Female 156 (65.3%) 65 (62.5%)
Religion
Christian 160 (66.9%) 70 (67.3%) 2.174 0.1404
Islam 44 (18.4%) 18 (17.3%) 0.059 0.8073
Traditional 35 (14.6%) 13 (12.5%) 0.277 0.5988
Others 0 (0.0%) 3 (2.9%)
Ethnicity
Akan 153 (64.0%) 61 (58.7%) 0.888 0.3460
Akuapim 7 (2.9%) 11 (10.6%) 8.525 0.0035
Ewe 26 (10.9%) 15 (14.4%) 0.865 0.3523
Fante 37 (15.5%) 11 (10.6%) 1.448 0.2288
Ga 7 (2.9%) 3 (2.9%)
Gonja 9 (3.8%) 3 (2.9%)
Residence
Rural 88 (36.8%) 48 (46.2%) 2.638 0.1043
Urban 151 (63.2%) 56 (53.8%)
Educational Level
Primary 31 (13.0%) 12 (11.5%) 0.136 0.7127
JHS 30 (12.6%) 0 (0.0%)
Secondary/technical/voc 50 (20.9%) 47 (45.2%) 21.050 < 0.0001
Tertiary 97 (40.6%) 24 (23.1%) 9.730 0.0018
None 31 (13.0%) 21 (20.2%) 2.938 0.0865
Marital status
Married 79 (33.1%) 39 (37.5%) 0.635 0.4257
Single 96 (40.2%) 33 (31.7%) 2.198 0.1382
Divorced 41 (17.2%) 9 (8.7%) 4.206 0.0403
74
Cohabitating 13 (5.4%) 10 (9.6%) 2.020 0.1552

Widowed 10 (4.2%) 13 (12.5%) 8.011 0.0047
Employment Status
Unemployed 112 (46.9%) 46 (44.2%) 0.202 0.6532
Self employed 61 (25.5%) 37 (35.6%) 3.589 0.0582
Employed 66 (27.6%) 21 (20.2%) 2.186 0.1392
Income Level
< GH¢500 104 (43.5%) 41 (39.4%) 0.497 0.4808
GH¢500-< GH¢1000 65 (27.2%) 20 (19.2%) 2.467 0.1163
GH¢1000-< GH¢1500 32 (13.4%) 24 (23.1%) 4.979 0.0257
GH¢1500-> GH¢2000 12 (5.0%) 10 (9.6%) 2.548 0.1104
> GH¢2000 26 (10.9%) 9 (8.7%) 0.392 0.5315
4.9: Association between Knowledge on Symptoms of Hypertension and Socio-
Demographics Characteristics
Table 4.6 shows the association between knowledge on symptoms of hypertension
and Socio-demographic respondents. There were significant association between
Akan and Fante tribes and knowledge on symptoms of hypertension with 67.4% of
Akan and 8.2% of Fantes responding “yes” to knowledge of symptoms while 56.6%
of Akan and 20.8% responding “otherwise”. Participants who were divorced or
widowed were significantly (p <0.05) linked to knowledge on symptoms of
hypertension. Among divorced participants, 10.3% responded “yes” to having
knowledge on symptoms of hypertension and 19.5% responded having “no” to having
knowledge on symptoms of hypertension. Again, among the widowed, 9.8%
responded to having knowledge on symptoms of hypertension whiles 3.1% responded
75
no respectively. Majority (50.3%) of the unemployed participants responded of
having no knowledge on symptoms of hypertension and 42.4% had knowledge on
symptoms of hypertension and this was statistically significant (p = 0.0463).
Furthermore, there were significant association (p < 0.05) between income level
(those receiving average monthly income of GH¢ 500 and above) and knowledge on
symptoms of hypertension with the majority responding to having knowledge on
symptoms of hypertension (Table 4.6).
Table 4. 6: Association between Knowledge on Symptoms of Hypertension and

Socio- Demographics Characteristics
VARIABLE Knowledge on Symptoms Chi-square P-value

Yes, n(%) No, n(%)
Gender
Male 61 (33.2%) 61 (38.4%) 1.011 0.3146
Female 123 (66.8%) 98 (61.6%)
Religion
Christian 121 (65.8%) 109 (68.6%) 0.301 0.5832
Islam 37 (20.1%) 25 (15.7%) 1.108 0.2926
Traditional 23 (12.5%) 25 (15.7%) 0.736 0.3909
Others 3 (1.6%) 0 (0.0%) - -
Ethnicity
Akan 124 (67.4%) 90 (56.6%) 4.230 0.0397
Akuapim 4 (2.2%) 14 (8.8%) - -
Ewe 26 (14.1%) 15 (9.4%) 1.788 0.1812
Fante 15 (8.2%) 33 (20.8%) 11.260 0.0008
Ga 3 (1.6%) 7 (4.4%) - -
Gonja 12 (6.5%) 0 (0.0%) - -
Residence
76
Rural 70 (38.0%) 66 (41.5%) 0.428 0.5129

Urban 114 (62.0%) 93 (58.5%)
Educational Level
Primary 22 (12.0%) 21 (13.2%) 0.122 0.7271
JHS 12 (6.5%) 18 (11.3%) 2.461 0.1167
Secondary/technical/voc 49 (26.6%) 48 (30.2%) 0.532 0.4656
Tertiary 71 (38.6%) 50 (31.4%) 1.905 0.1676
None 30 (16.3%) 22 (13.8%) 0.404 0.5251
Marital Status
Married 56 (30.4%) 62 (39.0%) 2.769 0.0961
Single 72 (39.1%) 57 (35.8%) 0.391 0.5316
Divorced 19 (10.3%) 31 (19.5%) 5.761 0.0164
Cohabitating 19 (10.3%) 4 (2.5%) - -
Widowed 18 (9.8%) 5 (3.1%) 6.008 0.0142
Employment Status
Unemployed 78 (42.4%) 80 (50.3%) 3.969 0.0463
Self employed 58 (31.5%) 40 (25.2%) 1.693 0.1932
Employed 48 (26.1%) 39 (24.5%) 0.110 0.7408
Income Level
<Ghc500 75 (40.8%) 70 (44.0%) 0.372 0.5417
Ghc500-<Ghc1000 37 (20.1%) 48 (30.2%) 4.649 0.0311
Ghc1000-<Ghc1500 35 (19.0%) 21 (13.2%) 2.111 0.1463
Ghc1500->Ghc2000 12 (6.5%) 10 (6.3%) 0.008 0.9302
>Ghc2000 25 (13.6%) 10 (6.3%) 4.957 0.0260
77
4.10: Hypertension Awareness
The findings in Table 4.7 show respondents hypertension awareness. A total of 22.7%
had been confirmed hypertensive by a doctor or healthcare provider of which 20.5%
were males and 24.0% were females from the 343 participants.
On doctor advise on how to control blood pressure 30.6% of the participants affirmed
“no” to receiving doctor’s advice of which 32.8% were males and 29.4% were
females.
Again, on awareness of top number in blood pressure measurement, 28.7% males and
29.9% females were aware that, the value should be <140mmHg with the majority
either did not know or responded that it should be >140mmHg. Also, on awareness of
the bottom number in blood pressure measurement, 35.0% were aware the value
should be <90mmHg with the rest responding to either >90mmHg or did not know.
When asked, which of the number on blood pressure measurement was important to
keep under control, approximately 60% of the participants did not know whether the
top or the bottom number. However, this was not statistically significant (p > 0.05)
stratified by gender (Table 4.7).
78
Table 4. 7: Hypertension Awareness among Respondents stratified by gender
Variables Total, n(%) Male, n(%) Female, n(%)

Person with HP
Yes 78 (22.7%) 25 (20.5%) 53 (24.0%)
No 265 (77.3%) 97 (79.5%) 168 (76.0%)
Doctor Advise on how to control Blood Pressure
Yes 189 (55.1%) 63 (51.6%) 126 (57.0%)
No 105 (30.6%) 40 (32.8%) 65 (29.4%)
Don’t know 49 (14.3%) 19 (15.6%) 30 (13.6%)
Awareness of Top Blood Number
<140 101 (29.4%) 35 (28.7%) 66 (29.9%)
140 81 (23.6%) 32 (26.2%) 49 (22.2%)
>140 73 (21.3%) 32 (26.2%) 41 (18.6%)
Don’t know 88 (25.7%) 23 (18.9%) 65 (29.4%)
Awareness of Bottom Blood Number
<90 120 (35.0%) 40 (32.8%) 80 (36.2%)
90 70 (20.4%) 31 (25.4%) 39 (17.6%)
>90 67 (19.5%) 19 (15.6%) 48 (21.7%)
Don't know 86 (25.1%) 32 (26.2%) 54 (24.4%)
Top Number is Important to Keep Under Control
Yes 123 (35.9%) 38 (31.1%) 85 (38.5%)
No 106 (30.9%) 36 (29.5%) 70 (31.7%)
Don't Know 114 (33.1%) 48 (39.3%) 66 (29.9%)
Bottom Number is Important to Keep Under Control
Yes 131 (38.2%) 43 (35.2%) 88 (39.8%)
No 111 (32.4%) 38 (31.1%) 73 (33.0%)
Don't Know 101 (29.4%) 41 (33.6%) 60 (27.1%)
79
4.11: Association between Awareness of Hypertension and Socio- Demographic
Characteristics
Table 4.8 shows the association between the socio-demographic variables and
awareness of hypertension. Gender was significantly associated (p<0.0173; x2 =
5.667) with awareness of hypertension with majority (59.6%) being females.
Those with no formal education (p < 0.0001; x2 = 22.52) and those with tertiary
education (p < 0.0001; x2 = 19.3) were significantly associated with awareness of
hypertension. A higher percentage (44.1%) of respondents with tertiary education
responded yes to awareness while smaller percentage (8.0%) of respondents with no
formal education responding yes to awareness.
There were significant association between participants who were single, married,
cohabitating and awareness of hypertension with 47.4% single, 30.0% married and
2.8%, cohabitating participants being aware of hypertension.
Again, 29.1% of those who were gainful employed were aware of hypertension and
19.2% were not and this was statistically significant.
In addition, respondents who smoke cigarette (p = 0.0414; x2 = 4.16), shisha (p
<=0.0009; x2 = 11), and exercising (p < 0.0001; x2 = 36.09) have significant
association with the awareness of hypertension (Table 4.8).
80
Table 4. 8: Association between Awareness of Hypertension and Socio-

Demographic Characteristics
Variable Awareness of Hypertension Chi-square P-value

Total, n (%) Yes n (%) No (%)
Gender
Male 122 (35.6%) 86 (40.4%) 36 (27.7%) 5.667 0.0173
127
Female 221 (64.4%) (59.6%) 94 (72.3%)
Religion
145
Christian 230 (67.1%) (68.1%) 85 (65.4%) 0.265 0.6070
Islam 62 (18.1%) 43 (20.2%) 19 (14.6%) 1.693 0.1932
Traditional 48 (14.0%) 25 (11.7%) 23 (17.7%) 2.379 0.1230
Others 3 (0.9%) 0 (0.0%) 3 (2.3%) - -
Ethnicity
140
Akan 214 (62.4%) (65.7%) 74 (56.9%) 2.667 0.1024
Akuapim 18 (5.2%) 74 (3.3%) 11 (8.5%) 4.348 0.0370
Ewe 41 (12.0%) 25 (11.7%) 16 (12.3%) 0.025 0.8744
Fante 48 (14.0%) 26 (12.2%) 22 (16.9%) 1.492 0.2219
Ga 10 (2.9%) 6 (2.8%) 4 (3.1%) - -
Gonja 12 (3.5%) 9 (4.2%) 3 (2.3%) - -
Residence
Rural 136 (39.7%) 82 (38.5%) 54 (41.5%) 0.312 0.5765
131
Urban 207 (60.3%) (61.5%) 76 (58.5%) - -
Educational Level
Primary 43 (12.5%) 24 (11.3%) 19 (14.6%) 0.825 0.3637
JHS 30 (8.7%) 20 (9.4%) 10 (7.7%) 0.291 0.5893
Tertiary 121 (35.3%) 94 (44.1%) 27 (20.8%) 19.300 < 0.0001
None 52 (15.2%) 17 (8.0%) 35 (26.9%) 22.520 < 0.0001
Marital Status
Married 118 (34.4%) 64 (30.0%) 54 (41.5%) 4.724 0.0297
101
Single 129 (37.6%) (47.4%) 28 (21.5%) 23.040 < 0.0001
Divorced 54 (15.7%) 28 (13.1%) 26 (20.0%) 2.859 0.0908
Cohabitating 23 (6.7%) 6 (2.8%) 17 (13.1%) 13.580 0.0002
81
Widowed 23 (6.7%) 18 (8.5%) 5 (3.8%) 2.736 0.0981

Employment Status
Unemployed 158 (46.1%) 93 (43.7%) 65 (50.0%) 1.305 0.2533
Self employed 98 (28.6%) 58 (27.2%) 40 (30.8%) 0.496 0.4815
Employed 87 (25.4%) 62 (29.1%) 25 (19.2%) 4.160 0.0414
Income Level
<Ghc500 145 (42.3%) 85 (39.9%) 60 (46.2%) 1.291 0.2558
Ghc500-<Ghc1000 85 (24.8%) 60 (28.2%) 25 (19.2%) 3.460 0.0629
Ghc1000-<Ghc1500 56 (16.3%) 32 (15.0%) 24 (18.5%) 0.699 0.4033
Ghc1500->Ghc2000 22 (6.4%) 15 (7.0%) 7 (5.4%) 0.370 0.5433
>Ghc2000 35 (10.2%) 21 (9.9%) 14 (10.8%) 0.073 0.7871
Smoke Cigarette
Yes 87 (25.4%) 62 (29.1%) 25 (19.2%) 4.160 0.0414
151 105
No 256 (74.6%) (70.9%) (80.8%)
Smoke Shisha
Yes 49 (14.3%) 20 (9.4%) 29 (22.3%) 11.000 0.0009
193 101
No 294 (85.7%) (90.6%) (77.7%)
Alcohol
Yes 106 (30.9%) 66 (31.0%) 40 (30.8%) 0.002 0.9664
147
No 237 (69.1%) (69.0%) 90 (69.2%)
Exercise
152
Yes 202 (58.9%) (71.4%) 50 (38.5%) 36.090 < 0.0001
No 141 (41.1%) 61 (28.6%) 80 (61.5%)
4.12: Association between Hypertension Status and Demographic Characteristics
The finding of Table 4.9 shows the associations between hypertension status and
socio-demographic characteristics of study participants. Christians (p = 0.0007; x2 =
11.370) and Muslims (p = 0.0082; x2 = 6.995) were significantly associated with
82
hypertension status of which 51.3% Christians and 28.2% Muslims were
hypertensives.
Majority (55.1%) of the respondents who reside in the rural areas were hypertensive
and this was statistically significant (p = 0.0015; x2 = 10.110).
About 10.3% of participants with primary education were hypertensive and 13.2%
were not hypertensive.
There were significant association between participants who were single (25.6%), (p
= 0.0130; x2 = 6.163); cohabitating (16.7%), (p < 0.0001; x2 = 16.010) and widowed
(12.8%), (p = 0.0140; x2 = 6.035) with hypertension and those without hypertension
of the same category (41.1%, 3.8% and 4.9).
In addition, income level < GH¢500 (p < 0.0089; x2 = 6.836) were significantly
associated with hypertension status (Table 4.11)
83
Table 4. 9: Association between Hypertension Status and Demographic

Characteristics
Variable Hypertensive Non-Hypertension Chi-square P-value

Gender
Male 25 (32.1%) 97 (36.6%) 0.545 0.4604
Female 53 (67.9%) 168 (63.4%) 0.545
Religion
Christian 40 (51.3%) 190 (71.7%) 11.370 0.0007
Islam 22 (28.2%) 40 (15.1%) 6.995 0.0082
Traditional 13 (16.7%) 35 (13.2%) 0.599 0.4389
Others 3 (3.8%) 0 (0.0%) 10.280 0.9456
Ethnicity
Akan 46 (59.0%) 168 (63.4%) 0.502 0.4786
Akuapim 6 (7.7%) 12 (4.5%) 1.213 0.2707
Ewe 10 (12.8%) 31 (11.7%) 0.072 0.7883
Fante 4 (5.1%) 44 (16.6%) 6.594 0.9961
Ga 3 (3.8%) 7 (2.6%) 0.309 0.9994
Gonja 9 (11.5%) 3 (1.1%) 19.330 0.4359
Residence
Rural 43 (55.1%) 93 (35.1%) 10.110 0.0015
Urban 35 (44.9%) 172 (64.9%) 10.110
Educational Level
Primary 8 (10.3%) 35 (13.2%) 4.493 0.0340
JHS 6 (7.7%) 24 (9.1%) 0.141 0.7077
Secondary/technical/voc 20 (25.6%) 77 (29.1%) 0.347 0.5560
Tertiary 28 (35.9%) 93 (35.1%) 0.017 0.8962
None 16 (20.5%) 36 (13.6%) 2.249 0.1337
Marital Status
Married 26 (33.3%) 92 (34.7%) 0.051 0.8211
Single 20 (25.6%) 109 (41.1%) 6.163 0.0130
Divorced 9 (11.5%) 41 (15.5%) 0.684 0.4082
Cohabitating 13 (16.7%) 10 (3.8%) 16.010 < 0.0001
84
Widowed 10 (12.8%) 13 (4.9%) 6.035 0.0140

Employment Status
Unemployed 39 (50.0%) 119 (44.9%) 0.630 0.4275
Self employed 19 (24.4%) 79 (29.8%) 0.878 0.3488
Employed 20 (25.6%) 67 (25.3%) 0.004 0.9491
Income Level
<Gh¢500 43 (55.1%) 102 (38.5%) 6.836 0.0089
Gh¢500- Gh¢999 20 (25.6%) 65 (24.5%) 0.040 0.9994
Gh¢1000-< Gh¢1499 6 (7.7%) 50 (18.9%) 5.509 0.0189
Gh¢1500- Gh¢1999 9 (11.5%) 13 (4.9%) 4.560 0.0327
> Gh¢2000 0 (0 .0%) 35 (13.2%) 11.470 0.9069
Smoke cigarette
Yes 21 (26.9%) 66 (24.9%) 0.130 0.9994
No 57 (73.1%) 199 (75.1%) 0.130
Smoke Shisha
Yes 18 (23.1%) 31 (11.7%) 6.372 0.9969
No 60 (76.9%) 234 (88.3%) 6.372
Alcohol
Yes 19 (24.4%) 87 (32.8%) 2.025 0.9994
No 59 (75.6%) 178 (67.2%) 2.025
Exercise
Yes 41 (52.6%) 161 (60.8%) 1.670 0.9969
No 37 (47.4%) 104 (39.2%) 1.670
85
4.13: Awareness of Personal Blood Pressure Level and Socio-demographic
Characterisstics
Table 4.10 illustrates the proportions between awareness of personal blood pressure
level and Socio- demographic characteristics of respondents. As shown from the
table, males and females had similar proportions (male, 51.6% vs. female, 57.0%) of
awareness of their personal blood pressures. The proportions of Christians (60.4%)
and Ewes (73.2%) who knew their personal pressures was higher than other groups in
their respective categories. Whiles rural and urban respondents had similar responses
(rural, 59.6% vs. urban 52.2%), the proportion of respondents with no education
(59.6%) who were aware of their personal blood pressures was higher than the
proportions of all other groups within the same category. Similarly, employed
respondents (59.8%) and Ghc500-1500 (63.5%) income earners had higher
proportions of respondents who knew their personal blood pressures as shown in table
4.10.
86
Table 4. 10: Awareness of Personal Blood Pressure Level and Socio-demographic

Characteristics
VARIABLE Yes No
Gender
Male 63(51.6) 59(48.4)
Female 126(57.0) 95(43)
Religion
Christian 139(60.4) 91(39.6)
Islam 30(48.4) 32(51.6)
Traditional 20(41.7) 28(58.3)
Others 0(0.0) 3(100)
Ethnicity
Akan 114(53.3) 100(46.7)
Akuapim 8(44.4) 10(95.6)
Ewe 30(73.2) 11(26.8)
Fante 27(56.2) 21(43.8)
Ga 7(70.0) 3(100)
Gonja 3(25.0) 9(95)
Residence
Rural 81(59.6) 55(40.4)
Urban 108(52.2) 99(47.8)
Educational Level
Primary 24(55.8) 19(44.2)
JHS 10(33.3) 20(66.7)
Secondary/technical/voc 54(55.7) 42(44.3)
Tertiary 70(57.9) 50(42.1)
None 31(59.6) 21(40.4)
Marital Status
Married 75(63.6) 34(36.4)
Single 62(48.1) 56(51.9)
Divorced 31(62.0) 19(38)
Cohabitating 11(47.8) 12(52.2)
Widowed 10(43.5) 13(56.5)
87
Employment Status
Unemployed 85(53.8) 60(46.2)
Self employed 52(53.1) 46(46.9)
Employed 52(59.8) 35(40.2)
Income Level
<Ghc500 69(47.6) 76(52.4)
Ghc500-<Ghc1000 54(63.5) 31(36.5)
Ghc1000-<Ghc1500 33(58.9) 23(41.1)
Ghc1500->Ghc2000 13(59.1) 9(40.9)
>Ghc2000 20(57.1) 15(42.9)
Smoke Cigarette
Yes 52(59.8) 35(40.2)
No 137(53.5) 119(46.5)
Smoke Shisha
Yes 25(51.0) 24(49)
No 164(55.8) 130(44.2)
Alcohol
Yes 70(66.0) 36(34)
No 119(50.2) 118(49.8)
Exercise
Yes 120(59.4) 82(40.6)
No 69(48.9) 72(51.1)
88
4.14: Attitudes and Perceptions Related to Hypertension
As shown in Table 4.11, majority (42.6%) of the respondents most especially the
hypertensives (73.1%) considered blood pressure as a personal health concern very
seriously which was significant (p < 0.0001; x2 = 39.96). However, 7.7% hypertensive
did not show any seriousness with blood pressure as a personal health concern and
this was statistically significant (p = 0.0027; x2 = 9.006) too.
In addition, majority (52.6%) hypertensives showed some-what important to taking
medicine to keep blood pressure under control (p = 0.0001; x2 = 15.30) but 15.4%
hypertensives did not attached importance to taking medicine to keep blood pressure
under control (p = 0.0068; x2 = 7.333).
Again, 57.7% hypertensive responded that hypertensive has a cure (p = 0.0352; x2 =
4.434) but 23.1% hypertensives significantly (p = 0.0261; x2 = 4.948) disagree to
hypertension having a cure. However, about 19.2% of the hypertensive did not know
whether hypertension has a cure or not.
Majority (53.8%) of hypertensive were of the view that changing lifestyle (such as;
low cholesterol intake, low salt intake, less stress, quit smoking, exercising, etc) helps
lower high blood pressure and this was statistically significant (p = 0.0405; x2 =
4.197). However, 17.9% hypertensive thought otherwise (p = 0.0132; x2 = 6.138).
Furthermore, majority (62.8%) hypertensives affirmed that, high blood pressure was
an avoidable part of aging whiles 11.5% hypertensives did not know whether or not
high blood pressure was an avoidable part of aging.
When asked a single most important factor in preventing or controlling high blood
pressure; majority (48.7%) of the hypertensives chose hypertensive drugs
89
(medication) (p < 0.0001; x2 = 49.81) and 9.0% hypertensives responded exercising (p
= 0.0074; x2 = 7.162) (Table 4.11).
Table 4. 11: Association between Respondents Attitude and Perceptions Related

to Hypertension
Non- Chi-
Variables Total, n(%) Hypertensive hypertensives square P-value
Considers blood pressure as a personal health concern

39.960
Very serious 146 (42.6%) 57 (73.1%) 89 (33.6%) < 0.0001
14.950
Somewhat serious 130 (37.9%) 15 (19.2%) 115 (43.4%) 0.0001
9.006
Not at all serious 67 (19.5%) 6 (7.7%) 61 (23.0%) 0.0027
Taking medicine to keep blood pressure under control
1.575
Very important 132 (38.5%) 25 (32.1%) 107 (40.4%) 0.2095
15.300
Somewhat important 117 (34.1%) 41 (52.6%) 76 (28.7%) < 0.0001
7.333
Not at all important 94 (27.4%) 12 (15.4%) 82 (30.9%) 0.0068
Hypertension is a Lifelong Diseases
14.800
Yes 142 (41.1%) 47 (60.3%) 95 (35.8%) 0.0001
5.040
No 91 (26.5%) 13 (16.7%) 78 (29.4%) 0.0248
3.748
Don’t know 110 (32.1%) 18 (23.1%) 92 (34.7%) 0.0529
Hypertension Has a Cure
4.434
Yes 162 (47.2%) 45 (57.7%) 117 (44.2%) 0.0352
4.948
No 115 (33.5%) 18 (23.1%) 97 (36.6%) 0.0261
8.176
Don’t know 66 (19.2%) 15 (19.2%) 51 (19.2%) 0.9977
Changing Lifestyle Helps Lowering High Blood Pressure
4.197
Yes 150 (43.7%) 42 (53.8%) 108 (40.8%) 0.0405
6.138
No 100 (29.2%) 14 (17.9%) 86 (32.5%) 0.0132
0.061
Don’t know 93 (27.1%) 22 (28.2%) 71 (26.8%) 0.8051
High blood pressure is an avoidable part of aging
7.099
Yes 170 (49.6%) 49 (62.8%) 121 (45.7%) 0.0077
0.811
No 102 (29.7%) 20 (25.6%) 82 (30.9%) 0.3679
90
5.162
Don’t know 71 (20.7%) 9 (11.5%) 62 (23.4%) 0.0231
Single most important factor in preventing or controlling high blood pressure
49.810
Medications 70 (20.4%) 38 (48.7%) 32 (12.1%) < 0.0001
7.162
Exercising 67 (19.5%) 7 (9.0%) 60 (22.6%) 0.0074
1.738
Less Stress 71 (20.7%) 12 (15.4%) 59 (22.3%) 0.1875
3.584
Quit Smoking 49 (14.3%) 6 (7.7%) 43 (16.2%) 0.0583
0.017
Change Diet (Salt intake) 41 (12%) 9 (11.5%) 32 (12.1%) 0.8978
4.617
Reducing Alcohol 15 (4.4%) 0 (0.0%) 15 (5.7%) 0.0317
1.646
Losing Weight 7 (2%) 3 (3.8%) 4 (1.5%) 0.1995
1.319
Other 23 (6.7%) 3 (3.8%) 20 (7.5%) 0.2507
4.15: Perceive severity of hypertension as a personal health concern and socio-
demographic characteristics of respondents
Table 4.12 illustrates the perceive severity of hypertension as a personal health
concern and socio-demographic characteristics of respondents. Males and females
showed similar responses with respect to the perception of hypertension, with both
genders showing about 80% of responses of very serious and somewhat serious. A
higher proportion of traditionalists (60.4%) said hypertension as a personal health
concern is very serious whiles a higher proportion of Christians (43.9%) said it was
somewhat serious. Generally, the proportions of Ewes and Akuapem ethnicities
(56.1% and 55.6% respectively) who responded “very serious” was higher than the
proportions of all other ethnicities, whiles more rural dwellers (48.5%) responded
“very serious” compared to urban dwellers. The proportions of married respondents,
employed respondents as well as GH¢ 1500- 2000 income earners who responded
91
“very serious” was higher (48.3%, 49.4% and 68.2% respectively) than the
proportions of other groups in their respective categories.
Table 4. 12: Perceive Severity of Hypertension as a Personal Health Concern and

Socio- Demographic Characteristics of Respondents
Variable Very serious Somewhat serious Not at all serious
Gender
Male 51(41.8) 51(41.8) 20(16.4)
Female 95(43.0) 79(35.7) 47(21.3)
Religion
Christian 85(37.0) 101(43.9) 44(19.1)
Islam 32(51.6) 13(21.0) 17(27.4)
Traditional 29(60.4) 16(33.3) 3(6.2)
Others 0(0.0) 0(0.0) 3(100.0)
Ethnicity
Akan 90(42.1) 81(37.9) 43(20.1)
Akuapim 10(55.6) 4(22.2) 4(22.2)
Ewe 23(56.1) 10(24.4) 8(19.5)
Fante 17(35.4) 22(45.8) 9(18.8)
Ga 3(30.0) 7(70.0) 0(0)
Gonja 3(25.0) 6(50.0) 3(25.0)
Residence
Rural 66(48.5) 49(36.0) 21(15.4)
Urban 80(38.6) 81(39.1) 46(22.2)
Educational Level
Primary 7(16.3) 25(58.1) 11(25.6)
JHS 9(30.0) 17(56.7) 4(13.3)
Secondary/technical/voc 38(39.2) 30(30.9) 29(29.9)
Tertiary 69(57.0) 43(35.5) 9(7.4)
None 23(44.2) 15(28.8) 14(26.9)
Marital Status
92
Married 57(48.3) 42(35.6) 19(16.1)

Single 52(40.3) 53(41.1) 24(18.6)
Divorced 17(34.0) 20(40.0) 13(26.0)
Cohabitating 10(43.5) 7(30.4) 6(26.1)
Widowed 10(43.5) 8(34.8) 5(21.7)
Employment Status
Unemployed 68(43.0) 50(31.6) 40(25.3)
Self employed 35(35.7) 44(44.9) 19(19.4)
Employed 43(49.4) 36(41.4) 8(9.2)
Income Level
< GH¢500 69(47.6) 36(24.8) 40(27.6)
GH¢500-< GH¢1000 38(44.7) 41(48.2) 6(7.1)
GH¢1000-< GH¢1500 14(25.0) 30(53.6) 12(24.1)
GH¢1500-> GH¢2000 15(68.2) 7(31.8) 0
> GH¢2000 10(28.6) 16(45.7) 9(25.7)
Smoke cigarette
Yes 42(48.3) 33(37.9) 12(13.8)
No 104(40.6) 97(37.9) 55(21.5)
Smoke Shisha
Yes 13(26.5) 16(32.7) 20(40.8)
No 133(45.2) 114(38.8) 47(16.0)
Alcohol
Yes 46(43.4) 38(35.8) 22(20.8)
No 100(42.2) 92(38.8) 45(19.0)
Exercise
Yes 94(46.5) 79(39.1) 29(14.4)
No 52(36.9) 51(36.2) 38(27.0)
93
4.16: Association between perceptions of hypertension as a lifelong Disease and
Socio- demographic Variables
Table 4.13 shows the findings on the association between perceptions of hypertension
as a lifelong disease and socio-demographic characteristics. Approximately 20%
Traditionalist affirmed that hypertension is a lifelong disease whiles 10.0% disagreed
(p = 0.0102). The Ewe tribe, couples who were married, single and participants
cohabitating were significantly associated (p < 0.05) with the perception that
hypertension is a lifelong disease.
There were significant association with participants who received average monthly
income of GH¢ 500 – GH¢ <1000 and between GH¢1500 – GH¢ <2000 and
perception of hypertension being a lifelong disease.
In addition, smoking shisha and alcohol consumption have significant (p<0.05)
association with perceptions of hypertension as a lifelong disease (Table 4.15).
Table 4. 13: Association between Perceptions of Hypertension as a Lifelong

Disease and Socio- Demographic Characteristics
Hypertension as a Lifelong Disease Chi-square P-value

VARIABLE Total, n (%) Yes n (%) No, n (%)
Gender
Male 122 (35.6%) 46 (32.4%) 76 (37.8%) 1.065 0.3020
Female 221 (64.4%) 96 (67.6%) 125 (62.2%)
Religion
Christian 230 (67.1%) 92 (64.8%) 138 (68.7%) 0.564 0.4528
Islam 59 (17.2%) 19 (13.4%) 40 (19.9%) 2.484 0.1150
Traditional 48 (14.0%) 28 (19.7%) 20 (10.0%) 6.597 0.0102
Others 6 (1.7%) 3 (2.1%) 3 (1.5%)
Ethnicity
94
Akan 214 (62.4%) 83 (58.5%) 131 (65.2%) 1.603 0.2055

Akuapim 18 (5.2%) 3 (2.1%) 15 (7.5%) - -
Ewe 41 (12.0%) 23 (16.2%) 18 (9.0%) 4.147 0.0417
Fante 49 (14.3%) 24 (16.9%) 25 (12.4%) 1.354 0.2446
Ga 10 (2.9%) 4 (2.8%) 6 (3.0%) - -
Gonja 12 (3.5%) 6 (4.2%) 6 (3.0%) 0.379 0.5381
Residence
Rural 136 (39.7%) 57 (40.1%) 79 (39.3%) 0.024 0.8759
Urban 207 (60.3%) 85 (59.9%) 122 (60.7%)
Educational Level
Primary 43 (12.5%) 12 (8.5%) 31 (15.4%) 3.689 0.0548
JHS 30 (8.7%) 9 (6.3%) 21 (10.4%) 1.761 0.1845
Tertiary 121 (35.3%) 55 (38.7%) 66 (32.8%) 1.267 0.2603
None 52 (15.2%) 22 (15.5%) 30 (14.9%) 0.021 0.8852
Marital Status
Married 118 (34.4%) 65 (45.8%) 53 (26.4%) 13.890 0.0002
Single 129 (37.6%) 39 (27.5%) 90 (44.8%) 10.630 0.0011
Divorced 50 (14.6%) 15 (10.6%) 35 (17.4%) 3.135 0.0766
Cohabitating 23 (6.7%) 16 (11.3%) 7 (3.5%) 8.062 0.0045
Widowed 23 (6.7%) 7 (4.9%) 16 (8.0%) 1.222 0.2690
Employment Status
Unemployed 158 (46.1%) 50 (35.2%) 108 (53.7%) 11.490 0.0007
Self employed 98 (28.6%) 52 (36.6%) 46 (22.9%) 7.691 0.0055
Employed 87 (25.4%) 40 (28.2%) 47 (23.4%) 1.007 0.3157
Income Level
<Ghc500 145 (42.3%) 53 (37.3%) 92 (45.8%) 2.433 0.1188
Ghc500-<Ghc1000 85 (24.8%) 43 (30.3%) 42 (20.9%) 3.933 0.0473
Ghc1000-<Ghc1500 56 (16.3%) 20 (14.1%) 36 (17.9%) 0.892 0.3450
Ghc1500-<Ghc2000 22 (6.4%) 16 (11.3%) 6 (3.0%) 9.510 0.0020
>Ghc2000 35 (10.2%) 10 (7.0%) 25 (12.4%) 2.644 0.1040
Smoke Cigarette
Yes 87 (25.4%) 37 (26.1%) 50 (24.9%) 0.061 0.8045
95
No 256 (74.6%) 105 (73.9%) 151 (75.1%)

Smoke Shisha
Yes 49 (14.3%) 27 (19.0%) 22 (10.9%) 4.424 0.0354
No 294 (85.7%) 115 (81.0%) 179 (89.1%)
Alcohol
Yes 106 (30.9%) 54 (38.0%) 52 (25.9%) 5.760 0.0164
No 237 (69.1%) 88 (62.0%) 149 (74.1%)
Exercise
Yes 202 (58.9%) 91 (64.1%) 111 (55.2%) 2.699 0.1004
No 141 (41.1%) 51 (35.9%) 90 (44.8%)
4.17: Perception that Hypertension has a Cure and Socio- Demographic
Characteristics
Table 4.14 shows the perception of hypertension having a cure and socio-
demographic characteristics. From the table, a higher proportion of females (49.8%)
than males (42.6%) perceived that hypertension has a cure with a higher proportion of
Muslims (66.1%) and Ewes (78.0%) as well as rural dwellers (51.5%) reporting a
similar perception than other groups in their respective categories. Similarly, higher
proportions of respondents who had no form of education (73.1%) and respondents
who widowed (65.2%) were perceived hypertension has a cure. Though the responses
of perception of hypertension having a cure was similar among all categories of
employment, it was higher among respondents who earned > GH¢ 2000 (71.4%).
96
Table 4. 14: The Perception that Hypertension has a Cure and Socio-
Demographic Characteristics
Variable Yes No
Gender
Male 52(42.6) 70(57.4)
Female 110(49.8) 111(50.2)
Religion
Christian 95(41.3) 135(58.7)
Islam 41(66.1) 21(33.9)
Traditional 26(54.2) 22(45.8)
Others 0 (0.0) 3(100)
Ethnicity
Akan 96(44.9) 118(55.1)
Akuapim 3(16.7) 15(93.3)
Ewe 32(78.0) 9(22)
Fante 28(58.3) 20(41.7)
Ga 3(30.0) 7(100)
Gonja 0 (0.0) 12(100)
Residence
Rural 70(51.5) 66(48.5)
Urban 92(44.4) 115(55.6)
Educational Level
Primary 12(27.9) 31(72.1)
JHS 16(53.3) 14(46.7)
Tertiary 50(41.3) 62(58.7)
None 38(73.1) 14(26.9)
Marital Status
Married 44(37.3) 74(62.7)
Single 65(50.4) 64(49.6)
Divorced 27(54.0) 23(46)
Widowed 15(65.2) 8(34.8)
97
Employment Status
Unemployed 78(49.4) 80(50.6)
Self employed 44(44.9) 54(55.1)
Employed 40(46.0) 47(54)
Income level
<Ghc500 73(50.3) 72(49.7)
Ghc500-<Ghc1000 34(40.0) 51(60)
Ghc1000-<Ghc1500 24(42.9) 32(57.1)
Ghc1500->Ghc2000 6(27.3) 16(92.7)
>Ghc2000 25(71.4) 10(28.6)
Smoke Cigarette
Yes 42(48.3) 45(51.7)
No 120(46.9) 136(53.1)
Smoke Shisha
Yes 28(57.1) 21(42.9)
No 134(45.6) 160(54.4)
Alcohol
Yes 38(35.8) 68(64.2)
No 124(52.3) 113(47.7)
Exercise
Yes 97(48.0) 105(52)
No 65(46.1) 76(53.9)
4.18: Association between the attitude and perception that changing lifestyle
lowers blood pressure (BP) and Socio- Demographic Characteristics
The 4.15 indicate the association between attitudes and perception that changing
lifestyle lowers and socio-demographic characteristics. The findings show that, there
were significant (p<0.05) association between the perception that changing lifestyle
lowers blood pressure levels and residence, educational level (no formal education,
98
junior high school and tertiary), and self-employed. About 69.3% of urban dwellers,
8.0% no formal education, 4.0% JHS levers, 47.3% with tertiary education and 21.3%
of self-employed participants responded yes to attitudes and perception that changing
lifestyle lowers blood pressure whereas, 53.4%, 12.4%,25.9%, 20.7% and 34.2%
respectively responded no attitudes and perception that changing lifestyle lowers
blood pressure (BP).
99
Table 4. 15: Association between the Attitude and Perception that Changing
Lifestyle Lowers BP and Socio- Demographic Characteristics
VARIABLE Changing Lifestyle Lowers BP Chi-square P-value

Total, n(%) Yes n (%) No, n (%)
Gender
Male 122 (35.6%) 59 (39.3%) 63 (32.6%) 1.649 0.1991
Female 221 (64.4%) 91 (60.7%) 130 (67.4%)
Religion
Christian 230 (67.1%) 105 (70.0%) 125 (64.8%) 1.046 0.3064
Islam 62 (18.1%) 24 (16.0%) 38 (19.7%) 0.776 0.3785
Traditional 48 (14.0%) 21 (14.0%) 27 (14.0%) 0.008 0.9978
Others 3 (0.9%) 0 (0.0%) 3 (1.6%) - -
Ethnicity
Akan 214 (62.4%) 95 (63.3%) 119 (61.7%) 0.101 0.7507
Akuapim 18 (5.2%) 3 (2.0%) 15 (7.8%) - -
Ewe 41 (12.0%) 18 (12.0%) 23 (11.9%) 0.001 0.9813
Fante 48 (14.0%) 18 (12.0%) 30 (15.5%) 0.881 0.3480
Ga 10 (2.9%) 7 (4.7%) 3 (1.6%) - -
Gonja 12 (3.5%) 9 (6.0%) 3 (1.6%) - -
Residence
Rural 136 (39.7%) 46 (30.7%) 90 (46.6%) 8.991 0.0027
Urban 207 (60.3%) 104 (69.3%) 103 (53.4%)
Educational Level
Primary 43 (12.5%) 17 (11.3%) 26 (13.5%) 0.352 0.5530
JHS 30 (8.7%) 6 (4.0%) 24 (12.4%) 7.524 0.0061
Tertiary 121 (35.3%) 71 (47.3%) 50 (25.9%) 16.160 < 0.0001
None 52 (15.2%) 12 (8.0%) 40 (20.7%) 10.630 0.0011
Marital Status
Married 118 (34.4%) 57 (38.0%) 61 (31.6%) 1.529 0.2163
Single 129 (37.6%) 57 (38.0%) 72 (37.3%) 0.017 0.8952
Divorced 50 (14.6%) 18 (12.0%) 32 (16.6%) 1.422 0.2331
100
Cohabitating 23 (6.7%) 9 (6.0%) 14 (7.3%) 0.212 0.6451

Widowed 23 (6.7%) 9 (6.0%) 14 (7.3%) 0.212 0.6451
Employment Status
Unemployed 158 (46.1%) 73 (48.7%) 85 (44.0%) 0.727 0.3939
Self employed 98 (28.6%) 32 (21.3%) 66 (34.2%) 6.843 0.0089
Employed 87 (25.4%) 45 (30.0%) 42 (21.8%) 3.026 0.0819
Income Level
<Ghc500 145 (42.3%) 69 (46.0%) 76 (39.4%) 1.517 0.2181
Ghc500-<Ghc1000 85 (24.8%) 36 (24.0%) 49 (25.4%) 0.087 0.7676
Ghc1000-<Ghc1500 56 (16.3%) 18 (12.0%) 38 (19.7%) 8.782 0.0530
Ghc1500->Ghc2000 22 (6.4%) 12 (8.0%) 10 (5.2%) 1.117 0.2905
>Ghc2000 35 (10.2%) 15 %) 20 (10.4%) 0.012 0.9123
Smoke Cigarette
Yes 87 (25.4%) 37 (24.7%) 50 (25.9%) 0.069 0.7934
No 256 (74.6%) 113 (75.3%) 143 (74.1%)
Smoke Shisha
Yes 49 (14.3%) 25 (16.7%) 24 (12.4%) 1.234 0.2666
No 294 (85.7%) 125 (83.3%) 169 (87.6%)
Alcohol
Yes 106 (30.9%) 41 (27.3%) 65 (33.7%) 1.592 0.2071
No 237 (69.1%) 109 (72.7%) 128 (66.3%)
Exercise
Yes 202 (58.9%) 95 (63.3%) 107 (55.4%) 2.172 0.1405
No 141 (41.1%) 55 (36.7%) 86 (44.6%)
101
4.19: Perceptions that hypertension is an avoidable part of aging and socio-
demographic Characteristics of Respondents
Table 4.16 depicts the association between perceptions that hypertension is an
avoidable part of aging and socio- demographic variables. As indicated on the table,
both genders had similar perceptions as to hypertension being an avoidable part of
aging. A higher proportion of Traditionalists (64.6%) than other religious groups
perceived hypertension to be an avoidable part of aging whiles a higher proportion of
Ewe (73.2%) and rural dwellers (52.2%) made similar observations than other groups
in their respective categories. Similarly, a higher proportion of respondents with
tertiary education (58.7%) and cohabitating (73.9%) individuals had the same
perception of hypertension being an avoidable part of aging. Also, a higher proportion
of employed (58.6%) respondents as well as income earners of GH¢500-1000
(63.5%) perceived that hypertension was an avoidable part of aging.
102
Table 4. 16: Perceptions That Hypertension is an Avoidable Part of Aging and

Socio- Demographic Characteristics
Variable Yes No
Gender
Male 60(49.2) 62(50.8)
Female 110(49.8) 111(50.2)
Religion
Christian 97(42.2) 133(57.8)
Islam 39(62.9) 23(37.1)
Traditional 31(64.6) 17(35.4)
Others 3(100.0) 0(0)
Ethnicity
Akan 105(49.1) 109(50.9)
Akuapim 3(16.7) 15(83.3)
Ewe 30(73.2) 11(26.8)
Fante 19(39.6) 29(60.4)
Ga 4(40.0) 6(60)
Gonja 9(75.0) 3(25)
Residence
Rural 71(52.2) 65(47.8)
Urban 99(47.8) 108(52.2)
Educational Level
Primary 24(55.8) 19(44.2)
JHS 12(40) 18(60)
Tertiary 71(58.7) 50(41.3)
None 20(38.5) 32(61.5)
Marital Status
Married 68(57.6) 50(42.4)
Single 59(45.7) 70(54.3)
Divorced 19(38.0) 31(62)
Widowed 7(30.4) 16(69.6)
103
Employment Status
Unemployed 78(49.4) 80(50.6)
Self employed 41(41.8) 57(58.2)
Employed 51(58.6) 36(41.4)
Income Level
< GH¢500 68(46.9) 77(53.1)
GH¢500-< GH¢1000 54(63.5) 31(36.5)
GH¢1000-< GH¢1500 18(32.1) 38(67.9)
GH¢1500-> GH¢2000 12(54.5) 10(45.5)
> GH¢2000 18(51.4) 17(48.6)
Smoke Cigarette
Yes 41(47.1) 46(52.9)
No 129(50.4) 127(49.6)
Smoke Shisha
Yes 24(49.0) 25(51)
No 146(49.7) 148(50.3)
Alcohol
Yes 57(53.8) 49(46.2)
No 113(47.7) 124(52.3)
Exercise
Yes 94(46.5) 108(53.5)
No 76(53.9) 65(46.1)
104
CHAPTER FIVE
DISCUSSIONS
5.0 Introduction
This section report on the major findings of the study in relation to the literature
review. The discussion of the findings was based on the specific objectives of the
study.
5.1 Socio demographic characteristics of the study population stratified by
gender
The prevalence of hypertension was 22.7% with females being the majority. The
findings of this study showed that hypertension is highly prevalent among adults (19-
60 years) and that majority of affected individuals were females. These results are
consistent with findings by Yemi et al., (2017) who studied awareness of
hypertension and its impact on blood pressure control among adult Nigerians: report
from the Ibadan study of aging, and found that, hypertension was prevalent among
adult of which majority were females. WHO, (1996) also reported that high BP was
independently associated with men, older adults, blacks and a high body mass index,
high alcohol consumption and low physical activity which is similar to this study
Again, prevalence of hypertension increased from 20-29 years category through to 60
above years. Hajjar et al., (2013) study conducted in the United States concluded that
hypertension prevalence was 35.6% with females being the majority and this
prevalence increased from 6.7% in persons 20 to 39 years to 65.2% in persons 60
105
years or older. The greatest increase in hypertension prevalence between 1988–1991
(57.9%) and 1999–2000 (65.4%) occurred in individuals who are 60 years or older.
Also, WHO, (2016) revealed that the age-specific prevalence was 3.3% in white men
(aged 18-29 years); this rate increased to 13.2% in the group aged 30-39 years. The
prevalence further increased to 22% in the group aged 40-49 years, to 37.5% in the
group aged 50-59 years, and to 51% in the group aged 60-74 years.
The World Health Organization, (2016) supports this finding that the prevalence of
hypertension increases significantly with increasing age in all sex and race groups and
the incidence of hypertension appeared to increase approximately 5% for each 10-
year interval of age. The higher prevalence of hypertension among adults’ women
when compared with men could be explained by the loss of the estrogen
cardiovascular protecting effects after menopause.
Majority of the respondents were Christians of which Akans dominated and resided in
the urban areas. Most of the respondents were unmarried, comprising 37.6% singles,
14.6% divorcees and 6.7% each of widows and cohabitants. This implies that
Christians from Akan residing in the urban areas were the most involved in the study.
When the respondents were stratified based on gender, there were significantly more
females (42.5%) with the 20-29years age bracket than males (26.2%) whiles there
were more males within the 40-49years (27%) and 50-59 years (10.7%) than females.
This implies that the age-related (20-29years) BP increased for females exceeded that
of males whiles within 40-59 years BP increased for males exceeded that of females.
This study finding asserts with Dreisbach, (2014) that the age-related BP rise for
women exceeds that of men.
106
5.2 Hypertension Knowledge
The results suggested that respondents in the present study had heard of hypertension
before with most being males and was significant as stratified by gender but their
level of knowledge about the risk factors and symptoms was low. The findings was
similar to the study conducted in Saudi Arabia by Siddiqua et al. (2017) who
concluded that a significant proportion of hypertensive patients had good knowledge
and good attitude towards hypertension but their behaviour could lead to worsening
their health condition in time being and resulting in severe complications and
damaging of other vital organs.
Out of the 343 respondents, 62.1% acknowledged that they had heard of hypertension
however, majority (30.9%) had no idea of the meaning of hypertension. The findings
imply that majority of the respondents did not have adequate knowledge about
hypertension though they had heard of it before. The results is in line with Liljevik &
Lohre, (2012) which assessed the knowledge level and management practices of
hypertension in pregnancy among health care workers in Moshi urban in Tanzania
and concluded that the level of knowledge of hypertension during pregnancy is too
low. The study found that participant were aware of the dangers of hypertension to
their health of which majority were females. This implies that hypertension as one of
the dangers associated with health were made known to the respondents.
With respect of the knowledge of respondents on risk factors associated hypertension,
the study found that majority (51.6%) of the respondents were only able to identify
other diseases as the risk factor of hypertension. However, less than 50% of the
respondents identified factors such as; excessive alcohol consumption, excessive
smoking, poor eating style, physical inactivity, high blood pressure, and age of a
107
person as the risk factors of hypertension. The findings imply that majority of
respondents did not know the risk factors associated with hypertension. This means
that lack of knowledge on the risk factors of hypertension could contribute to the
prevalence of hypertension. Lack of knowledge on the risk factors of hypertension
increase the incidence of the conditions since individuals may involve in those factors
unknowingly. Also, the study supports Li et al., (2013) which concluded that
hypertension knowledge levels are alarmingly low in rural areas of China, particularly
concerning hypertension complications and medication.
With regards to respondents’ knowledge on the symptoms of hypertension, the study
found that majority of the respondents identified dizziness and shortness of breath as
the symptoms of hypertension with less than 50% of the respondents identified
headache, blurred vision, chest pain, high blood pressure and heart attack as the
symptoms of hypertension among hypertensives. The findings imply that respondents
did not have appreciable knowledge on the risk factors of hypertension. Shaikh et al.,
(2012) affirmed to this study that was conducted on attitude and practice concluded
that a significant proportion of hypertensive patients have poor knowledge about
symptoms on hypertension.
The study further found that there was significant association between knowledge on
the danger of hypertension). On the other hand, there was significant association
between danger of hypertension and religion thus Christian and Islam, residence (p <
0.0180; x2 = 5.598), no formal education (p <0.0203; x2 = 5.390) and cigarette (p
<0.0132; x2 = 6.144) and shisha smoking (p <0.0002; x2 = 13.690).
With regard to proportion of knowledge of respondents on normal blood pressure
range and the socio-demographic characteristics, it revealed that males and females
108
who had knowledge on the isolated systolic and diastolic blood pressure ranges,
various religions, all ethnicities, and unemployed and employed were similar. This
finding implies that respondents had higher knowledge on normal blood pressure
range.
Again, association between the sociodemographic characteristics and knowledge of
respondents on the risk factors of hypertension was found that females had high score
of knowledge. Also, there was significant association between Akuapim tribe (p
<0.0035; x2 = 8.525), secondary/technical/vocation education (p <0.0001; x2 =
21.050), tertiary education (p < 0.0018; x2 = 9.730), divorced and widowed (p <
0.0047; x2 = 8.011), monthly income between GH¢ 1000-1500 (p < 0.0257; x2 =
4.0257) and knowledge level respondents on the risk factors hypertension.
Furthermore, the association between knowledge on symptoms of hypertension and
socio-demographic characteristics respondents was identified. It shown that there was
significant association between knowledge on symptoms of hypertension and
demographic profile (Akan and Fante tribes (p<0.0397; x2 = 4.230 and p<0.0008; x2 =
11.260) respectively, divorced or widowed, unemployed (p = 0.0463; x2 = 3.969) and
income level of GH¢ 500 and above (p < 0.05)) whiles the rest of the demographic
profiles were not significant.
5.3 Awareness of Hypertension
The study found that 22.7% of the respondents in the study were aware of their
hypertension status and most were females as confirmed by a doctor or healthcare
provider. The study found that there was a significant association between not
knowing that doctor’s advice can control blood pressure (p < 0.0048) and most were
males. The finding showed that despite high awareness, patients had poor and
109
inappropriate practice for hypertension management. These findings are consistent
with findings by Wilber and Barrow (2013) who concluded that only 26% of
hypertensives in his study knew that they have hypertension and most cases were on
antihypertensive medications. In addition, the respondents’ low levels of awareness
may be partly due to poorly developed health services and the relatively low
functional literacy rate in urban (63%) Ghana.
The rate of awareness of hypertension in this population is similar to studies by Yemi
et al., (2017) and Ulasi et al., (2011) of awareness of hypertension among similar sub-
Saharan African population but lower when compared with studies from high income
countries (Egan et al., 2010; Gee et al., 2012). The low awareness in this study may
be due to the low level of education among the studied populations. It was shown that
there was significant association between awareness of hypertension and demographic
profile (no formal education (p<0.0001; x2 = 22.52), tertiary education (p<0.0001; x2
= 19.3), cigarette smoking (p = 0.0414; x2 = 4.16), shisha smoking (p <=0.0009; x2 =
11) and exercise (p < 0.0001; x2 = 36.09).
This study was similar to Olatunbosun et al., (2013) that having some degree of
formal education carried a lower risk of developing hypertension compared to having
no education at all but having more than nine years of education carried a higher risk
compared to no education at all.
The findings imply that individuals who had no form of formal education are more
likely to become hypertensive more than those who are educated. This may be
attributed to the fact that persons who are educated stand the chance of being
enlightened on the risk factors as linked with hypertension and therefore adopt healthy
lifestyles to avoid the condition. Also this study is similar to Amaoh, (2013) which
110
asserts that prevalence of hypertension increased with age, as has been observed in
most studies and may be partly responsible for the high prevalence of hypertension
Sunyani municipality, Ghana. In addition, most of the participants resided in rural and
semi-urban settings where access to health information and facilities are commonly
limited.
Participants in the low socioeconomic class (less than GH¢ 1000 monthly) were less
likely to be aware of their hypertension in this study and the relationship between
hypertension awareness and socioeconomic status. This finding is similar to studies
conducted from other studies (Hendriks et al., 2012; Mills et al., 2016).
5.4 Attitudes and Perceptions Related to Hypertension
To understand respondents’ attitudes and perceptions with respect to hypertension, the
study found that respondents were knowledgeable about the seriousness of
hypertension as a personal health concern which was statistically significant (p <
0.0001; x2 = 39.960 ). Respondents were aware of hypertension and also 52.6% of
them knew that it is important in taking medicine to keep blood pressure under
control.
Moreover, respondents mentioned that hypertension has a cure. The study found that
majority (53.8%) of hypertensives were of the view that changing lifestyle (such as;
low cholesterol intake, low salt intake, less stress, quit smoking, exercising, etc.) helps
lower high blood pressure and this was statistically significant (p = 0.0405; x2 =
4.197). This implies that knowledge on lifestyle changing, behaviour modification
and perception can have effect on BP regulations. These findings was similar to the
study conducted by Lima et al. (2015) on knowledge and perceptions related to
111
hypertension, lifestyle, behavior modifications and challenges that are facing
hypertensive patients who concluded that there was poor knowledge about
hypertension and perceptions toward lifestyle-modification. Patients lacked
understanding some points of risk factors, manifestation and lifestyle modifications of
hypertension.
When asked a single most important factor in preventing or controlling high blood
pressure; most of the hypertensives responded hypertensive drugs (medication)
(p<0.0001; x2 = 49.810) and exercising (p = 0.0074; x2 = 7.162).
The study found that there was a proportion between perceive severity of
hypertension as a personal health concern and certain socio-demographic
characteristics of respondents. The study revealed that gender has about 80% of high
proportion of seriousness between perceived severities of hypertension as a personal
health concern. According to Kjellgren et al. (2014) reductions in SBP and DBP and
improved medication-use compliance have been achieved through an education
program that stressed, in part, “knowing high BP.” This recent research all points to
the need to improve hypertension knowledge and awareness in order to increase
medication-use compliance and BP control.
Furthermore, perceive severity of hypertension as a personal health concern was
revealed to be higher proportion of traditionalists (60.4%) and Christians (43.9%)
with seriousness. Generally, the proportions of Ewes and Akuapem ethnicities (80.5%
and 77.8% respectively) with seriousness was higher than the proportions of all other
ethnicities as well as residence. The proportions of marital status (>70%) employed
respondents (>70%) as well as GH¢1500- 2000 income (>60%) were revealed to be
higher proportions of seriousness and respectively) than the proportions of other
112
groups in their respective categories to perceive severity of hypertension as a personal
health concern. This implies that demographic characteristics have influence on
attitudes, perceptions of hypertension. In a study conducted, Abed & Abu-Haddaf
(2013) inferred that hypertension was strongly linked with physical inactivity,
education, obesity, low income and family history of high blood pressure.
The study found significant association between perceptions of hypertension as a
lifelong disease and certain socio-demographic variables. Traditionalist, Ewe tribe,
couples who were married, single and participants cohabitating, unemployed, self-
employed, average monthly income of GH¢500–GH¢<1000 and between GH¢1500–
GH¢<2000, smoking shisha and alcohol consumption were all significantly associated
(p < 0.05) with the perception that hypertension is a lifelong disease. The findings
imply respondents’ attitude and perception related to hypertension is dependent on
religion, ethnicity, marital status, employment, income level, smoking shisha and
alcohol.
Findings indicate that there was a higher proportion between the perception that
hypertension has a cure and socio-demographic characteristics of the respondents
such as; females, Muslims, Ewe, rural dwellers, none formal education, widowed,
employment and average income level of > GH¢ 2000. The gender, smoking cigarette
and shisha, and exercise had low proportion with attitudes and perception that
hypertension has a cure. The findings imply that respondents’ attitude and perception
regarding the ability of hypertension to be cured is dependent on gender, religion, and
ethnicity, place of residents, educational level, marital status, and income level.
The study found that there was significant association between attitude and perception
that changing lifestyle lowers hypertension and certain socio- demographic variables.
The study found a significant (p<0.05) association between the perception that
113
changing lifestyle lowers hypertension and socio-demographic variables such as place
of residence, educational level (no formal education, junior high school and tertiary),
and self-employed. However, gender, religion, ethnicity, marital status, income level,
smoke shisha, alcohol and exercise have no significant association between the
perceptions that changing lifestyle lowers BP.
The study revealed proportions between the perception that hypertension is an
avoidable part of aging and socio- demographic variables. The findings show that
there was a higher proportion between the perception that hypertension is an
avoidable part of aging and certain socio- demographic variables such as
traditionalist, Ewe, rural dwellers, tertiary education, cohabiting, employed and
income earners of GH¢500-1000 with p-values less than 0.05. However, gender, and
other socio-demographic variables has lower proportions between perceptions that
hypertension is an avoidable part of aging. This study showed that hypertensive with
more awareness had better attitude than patients with less awareness.
114
CHAPTER SIX
CONCLUSION AND RECOMMENDATIONS
6.1 Conclusion
This research investigates the knowledge, awareness and attitude of adults with
regards to hypertension in the Sunyani Municipality, Ghana. The prevalence of
hypertension was found to be 22.7% with females (67.9%) being the majority. The
findings of this study showed that hypertension is highly prevalent among elderly.
The study also found that majority (62.1%) of the respondents in the present study
had heard of hypertension with most (70.5%) being males but their level of
knowledge about the risk factors and symptoms was low. Most of the respondents did
not know their currents blood pressures status. It was shown that there was significant
association between awareness of hypertension and demographic profile (no formal
education (p<0.0001; x2 = 22.52), tertiary education (p<0.0001; x2 = 19.3), cigarette
smoking (p = 0.0414; x2 = 4.16), shisha smoking (p <=0.0009; x2 = 11) and exercise
(p < 0.0001; x2 = 36.09).
Furthermore, the finding suggests that individuals who had no form of formal
education are more likely to become hypertensive than those who are educated. This
may be attributed to the fact that persons who are educated stand the chance of being
enlightened on the risk factors as linked with hypertension and therefore adopt healthy
lifestyles to avoid the condition.
The study found a significant association between the perception that changing
lifestyle (such as low salt intake, quit smoking and engaging in exercise) lowers
hypertension and socio-demographic variables.
115
In addition, it was shown that there was a higher proportion between the perception
that hypertension is an avoidable part of aging and certain socio-demographic
variables such as participants who had tertiary education, employed and income
earners of GH¢500-1000 with p-values less than 0.05. However, gender (51%), and
other socio-demographic variables has lower proportions between perceptions that
hypertension is an avoidable part of aging.
6.2 Recommendations
Based on the finding of the study, the researcher recommended the following actions:
1. The Regional Health Directorate of Ghana Health Service should design
educational package that will enlighten the general public especially people
living in municipal on the risk factors of hypertension. This will increase the
knowledge of the people on how to adopt healthy lifestyles.
2. The Sunyani MHD in collaboration with opinion leaders should organize mass
screening programme for the people of district to enable them detect those
who are hypertensive. This will enable them organize hypertension
management and control programme for those who are affected.
3. The Sunyani MHD should also organize media education programmes on
healthy living styles that will help avoid the prevalence of the condition
among person’s adults.
116
6.3: Limitations
This study had some limitations. First, in terms of scope because it was delimited to
only the Sunyani Municipality, the findings are likely to be constrained and could not
be generalized even within the Brong Ahafo region.
Secondly, since data were collected through survey questionnaires some respondents
refused to answer some questions.
Financial constraints as well as little time are some of the limitations.
117
REFERENCES
Abed, Y, & Abu-Haddaf, S. (2013). Risk factors of hypertension at UNRWA primary

health care centres in Gaza, Palestine. Int Scholarly Res Not Epidemiol, pp1-9.
Abdullahi, A. A. & Amzat, J., (2011). Knowledge of Hypertension among the Staff of
University of Ibadan, Nigeria, Journal of Public Health and Epidemiology,
3(5)204-209
Addo, J., Smeeth, L., & Leon, D. A., (2013). Hypertension in Sub-Saharan Africa. A
Systematic Review, 50, 1012-1018.
Aghaji, M.N., (2008). Hypertension and risk factors among traders in Enugu. Nigeria.
J. Coll. Med. 13(2)114-115.
Aguirre, R.C., Aguilera, M.R., Aguirre, R.F., & Rowe, P.D., (1999). Cardiovascular
risk factors in health workers. Revista Cubana de Medicina General Integral
2(1), 115-122
Agyemang, C., & Owusu-Dabo, E., (2012). Prehypertension in the Ashanti Region of
Ghana, West Africa. An Opportunity for Early Prevention of Clinical
Hypertension. University Press.
Ahluwalia JS, McNagny SE, Rask KJ (1997). Correlates of controlled hypertension in
indigent, inner-city hypertensive patients. J Gen Intern Med.12:7–14
Akinkugbe, O. O., (1987). World epidemiology of hypertension in blacks. J Clin

Hypertens., 3(1)15–85
Akter, R., Assadi, R., Singh, H., Abaszadhezouri, M.G., Lamichhane, S., Ahadi, H., et
al., (2014). Sources of Information and Level of Knowledge on Hypertension
among Entry Level University Students in Ajman, UAE, American Journal of
Research Communication; 2(5): p 17.
Ali, S., Sathiakumar, N. & Delzell, E., (2006). Prevalence and socio-demographic
dactors associated with tobacco smoking among adult males in rural Sindh,
Pakistan, Southeast Asian J. Trop. Med. Public Health, (37), 1054-60.
Almas, A, Godil, SS, Lalani, S, Samani, ZA, & Khan, AH, (2012). Good knowledge
about hypertension is linked to better control of hypertension; A multicentre
cross-sectional study in Karachi. Pakistan BMC Research Notes. 20(12)5-579.
118
Available:http: //www.biomedcentral.com/1756-0500/5/579 (Accessed 12

April 2018)
Alwan, A. A. S., (1993). Cardiovascular diseases in the Eastern Mediterranean

Region. World Health Stat Q.4(6)97–99
American Heart Association (2006). Heart and Stroke Statistical update. In: Stanhope
M, Danbauchi SS (2007). What is Hypertension: Chike Okoli Foundation.
Available at http://www.chikeokolifoundation.org/articles.php?id=44. Acessed
January 2018
Amoah, A. G. (2013). Hypertension in Ghana: a cross-sectional community

prevalence study ingreater Accra. Ethnic Discussion, 13, 310–315.
Arno, P., & Viola, D., (2013). Hypertension treatment at the crossroads: a role for
economics? Am J Hypertension, 26, 1257-1259
Annual Report of Sunyani Municipal Health Directorate, 2013.
Annual Report of Sunyani Municipal Health Directorate, 2014
Arredondo, A., Aviles, R., & De Icaza, E. (2013). National Institute of Public Health.
Costos de enfermedades crónicas en México. Informe Técnico de Memoria
Metodológica. Technical Report. National Institute of Public Health,
Cuernavaca, México, pp. 23–27
Arredondo, A. & Aviles, R., (2014). Hypertension and Its effects on the economy of
the health system for patients and society: Suggestions for developing
countries. American Journal of Hypertension, 27, (4), 635–636,
https://doi.org/10.1093/ajh/hpu010
Baker, LE, Kirtland, KA, Gregg, EW, Geiss, LS, Thompson, TJ, (2015). Geographic
distribution of diagnosed diabetes in the U.S.: a diabetes belt. Am J Prev
Med 40: 434–9
119
Becker, MH., (1974). The health belief model and personal health behavior.
Thorofare, NJ: Slack
Bourne PA, McGrowder DA, Holder-Nevins D (2014). Public health behaviour-

change intervention model for jamaicans: charting the way forward in public
health. Asian Journal of Medical Sciences 2: 56-6
Bovet, P, Madeleine, G, Perret, F, Gervasoni, JP, Paccaud, F, & Waeber, B. (1997).
One-year compliance to medication in newly diagnosed hypertensive patients
in a developing country. Can J Cardiol. 13(suppl B):206B. Abstract
Brundtland, G. H. (2013). From the World Health Organization. Reducing risks to

health, promoting healthy life. JAMA, 288.
Burt, VL, Cutler, JA, Higgins, M, Horan, MJ, Whelton, P, Brown, C, & Roccella, EJ.
(1995). Trends in the prevalence, awareness, treatment, and control of
hypertension in the adult US population: data from the health examination
surveys, 1960 to 1991. Hypertension. 2(6)60–69
Campos, I., Rojas, R., Pedroza, A., Medina, C. & Barquera, S., (2013). Hipertensión
arterial: prevalencia, diagnóstico oportuno, control y tendencias en adultos
mexicanos. Sal Pub México, 55, 144 -150
Cappuccio, F. P, Micah, F.B. & Emmett, L. (2013). Prevalence, detection,

management, and control of hypertension in Ashanti, West Africa.
Hypertension; 43(5)1017–1022.
Centers for Disease Control and Prevention, CDC (2014). Youth Risk Behavior
Surveillance –United States, 2009. MMWR 2010, 59; (No. SS-5): 1-142.
Retrieved from http://www.cdc.gov/mmwr/pdf/ss/ss5905 accessed on: 15
February, 2018
Chobanian, A.V., Bakris, L.G., & Black, R.H., (2003). The seventh report of the Joint
National Committee on Prevention, Detection, Evaluation, and Treatment of
High Blood Pressure: the JNC 7 report. JAMA 289: 2560-2572.
Cochran, W. G. (1977). Sampling Techniques, Third Edition, New York: John Wiley
& Sons
120
Collins, R., Peto, R., MacMahon, S., Hebert, B., Fiebach, N.H., Eberlein, K.A.,
Godwin, J., Qizilbash, N., Taylor, J.O., & Henneckens, C.H., (1990). Blood
pressure,
stroke, and coronary heart disease, II: short-term reductions in blood
pressure: overview of randomised drug trials in their epidemiological
context. Lancet, 33(5),827–838
Connor, M., Rheeder, P., & Meredith, M., (2005). The South African stroke risk in
general practice study. S. Afr. Med. J., (95), 334-339
Cutler, JA., (1993). Combinations of lifestyle modification and drug treatment in

management of mild-moderate hypertension: a review of randomised
clinical trials. Clin Exp Hypertens, 15, (1), 1193–1204.
Danbauchi, S.S., (2007). What is Hypertension: Chike Okoli Foundation. Available at

http://www.chikeokolifoundation.org/articles.php?id=44.Acessed June, 2018.
Davidsson, P., Hulthe, J., Fagerberg, B. & Camejo, G. (2014). Proteomics of

apolipoproteins and associated proteins from plasma high-density lipoproteins.
Arterioscler Thromb Vasc Biol, 30, 156-63.
Demaio, A.R., Otgontuya, D., De Courten, M., Bygbjerg, I.C., Enkhtuya, P. &
Meyrowitssch D.W., (2013). Hypertension and hypertension related disease in
Mongolia; Findings of a national knowledge, attitudes and practices study.
B.M.C. Public Health, (13):194
Dreisbach, A. W. (2014). Epidemiology of hypertension. Division of Nephrology,

University of Mississippi Medical Center.
https://emedicine.medscape.com/article/1928048 overview#showall
Drizd, T., Dannenberg, A. L., & Engel, A. (1986). Blood pressure levels in pgrsons
18-74 years of age in 1976-80. Trends in blood pressure from 1960 to 1980 in
the United States (NCHS Series 11, No. 234). (DHHS Publication No. (PHS)
86-1684). Washington. DC: U.S. Government Printing Office.
Elliott P, Walker LL, Little MP, Blair-West JR, Shade RE, Lee DR, et al. (2016).
Change in salt intake affects blood pressure of chimpanzees implications for
human populations. Circulation 116:1563–1568,
121
PMID: 1778565, https://doi.org/ 10.1161/CIRCULATIONAHA.106.675579
Egan, BM, Zhao, Y, & Axon, RN. (2010). US trends in prevalence, awareness,
treatment, and control of hypertension, 1988-2008. JAMA. 303 (20), 2043–50
Ezzati M., Lopez A., Rodgers A., Vander H.S. and Murray C. (2013) Comparative
risk assessment collaborative group: selected major risk factors and global and
regional burden of disease. Lancet 360, 1347–1360
Fava, C, Montagnana, M, Almgren, P, Rosberg, L, Lippi, G, Hedblad, B, et al. (2004).
The V433M variant of the CYP4F2 is associated with ischemic stroke in male
Swedes beyond its effect on blood pressure. Hypertension; 52:373-380
Freeman, V, Fraser, H, Forrester, T, Wilks, R, Cruickshank, et. al., (1996). A

comparative study of hypertension prevalence, awareness, treatment and
control rates in St Lucia, Jamaica and Barbados. J Hypertens; 1(4)495–501.
Gao, B., Zhang, L., & Wang, H., (2013). Clustering of major cardiovascular risk
factors and the association with unhealthy lifestyles in the Chinese adult
population. PloS One; 8(1).66-780
Gee, ME, Bienek, A, McAlister, FA, Robitaille, C, Joffres, M, Tremblay, MS, et al.
(2012). Factors associated with lack of awareness and uncontrolled high blood
pressure among Canadian adults with hypertension. Can J Cardiol, 28(3)375–
382.
Ghana Demographic Health Survey (2013). Key Findings. Calverton, Maryland,

USA: GSS, GHS, and ICF Macro; 2008.
Ghana Statistical Service (2010). 2010 population and housing census- population by
districts and sex.
Available: www.ghanadistricts.com/pdfs/2010_pop_census_districts.pdf
(Accessed 23 February 2018)
Glenn, D.S., (2013). Determining Sample Size, I FAS, University of Florida. PEOD-6.
Available fromhttp://edis.ifas.ufl.edu/pdffiles/PD/PD00600.pdf Accessed June
26, 2018.
GHS. (2017). Annual Report. Accra, Ghana: GHS.
122
GNA. (2015). Hypertension on the Increase in Sunyani Municipality. Available at:

http://www.ghanaweb.com/GhanaHomePage/health/Hypertension-on-the-
increase-in-Sunyani-municipality-118216.
Guo, F., He, D., Zhang, W., & Walton, R.G., (2012). Trends in prevalence,
awareness, management, and control of hypertension among United States
adults, 1999 to 2010. J Am Coll Cardiol, 60(2), 599–606.
Hajjar, I., Kotchen, J.M., Kotchen, T.A. (2013). Hypertension: Trends in prevalence,
incidence and control. Annu. Rev. Public Health., 27: 465-90, Available from:
https://www.researchgate.net/publication/275097886_Prevalence_and_Determ
inants_of_Hypertension_among_University_Employees [accessed Aug 02
2018].
Han, T. S., Kelly, I. E., Walsh, K., Greene, R. M. E., & Lean, M. E. J. (1997).
Relationship between volumes and areas from single transverse scans of intra-
abdominal fat measured by magnetic resonance imaging. International
Journal of Obesity & Related Metabolic Disorders, 21(12)49-124.
Hart, JE, Laden F, Puett RC, Costenbader KH, Karlson EW, (2013). Exposure to
traffic pollution and increased risk of rheumatoid arthritis. Environ Health
Perspect 117:1065–1069, doi: 10.1289/ehp.0800503.
Haslett, C., Chilvers, E., Boon, A., & College, R. (2013). Davidson’s Principles and
Practice of Medicine,.19th Edition. Edinburgh, London, New York,
Philadelphia, St. Louis, Sydney, Toronto: Oxford Publishing Press, 388-395.
Hendriks, ME, Wit, FWNM, Roos, MTL, Brewster, LM, Akande, TM, de Beer, IH, et
al. (2012). Hypertension in Sub-Saharan Africa: Cross-sectional surveys in
four rural and urban communities. PLoS One.7(3)
Ike, S.O., Aniebue, P.N., Aniebue, U.U., (2010). Knowledge, perception and practices
of lifestyle-modification measures among adult hypertensive in Nigeria. Royal
Society of Tropical Medicine and Hygiene 104; 1:55-60.
123
Joint, N. C. (2013). The fifth report of the Joint National Committee on Detection,
Evaluationand Treatment of High Blood Pressure (JNCV). Arch Intern
Medicine, 153, 154–183.
Jones, D. W., & Hall, J. E. (2014). Seventh report of the Joint National Committee on
Prevention, Detection,Evaluation, and Treatment of High Blood Pressure and
evidence from new hypertension trials. Hypertension, 43(1): 1-3.
Kastarinen,, M., Antikainen, R., Peltonen, M., Laatikainen, T., Barengo, N. C., Jula,
A, et al. (2009). Prevalence, awareness and treatment of hypertension in
Finland during 1982 -2007: J Hypertens, 27(1), 1552–1559.
Kearney, P.M., Whelton, M., Reynolds, K., Whelton, P.K. & He J., (2004).
Worldwide prevalence of hypertension: a systematic review. J. Hypertens.;
22, 11 -9
Keith, B., (2015). Hypertension and its pharmacological management. Harvard-MIT

Division of Health Sciences and Technology. Department of Anesthesia and
Critical Care, MGH
Kissebah, T. B., Han, T. S., Van Leer, E. M., Seidell, J. C., & Lean, M. E. J. (2014).
Waist circumference action levels in the identification of cardiovascular risk
factors: prevalence study in a random sample. BMJ, 311(7017): 1401-1405
Khatib, O.M., & El-Guindy, M.S., (2004). Clinical guidelines for management of
hypertension, World Health Organization regional office for the Eastern
Mediterranean, Metropole, Cairo, pp 48, 49.
Khosravi AR, Shirani SH, Shahrokhi SH, Mohammadifard N, & Ansari R, (2006).
Antihypertensive Drugs used by Hypertensive Patients: In the Provincial
Cities of Isfahan, Najafabad and Arak. ARYA Journal, 1(4):275–80.
Kjeldsen et al (2014). Drugs, “Updated National and International Hypertension

Guidelines: A Review of Current Recommendations
124
Lamptey, P., Laar, A., Adler, A.J., Dirks, R., Caldwell, A., Prieto-Merino, D., Aerts,
A., Pearce, N., & Perel, P., (2017). Evaluation of a community-based
hypertension improvement program (ComHIP) in Ghana: data from a baseline
survey. BMC Public Health. 17(1)36-48. doi: 10.1186/s12889-017-4260-5.
Lewington, S., Clarke, R., Qizilbash, N., Peto, R., & Collins, R., (2002). Age-specific
relevance of usual blood pressure to vascular mortality: a meta-analysis
of individual data for one million adults in 61 prospective studies.
Lancet; 36(1), 1903–1913
Li, Y., Zheng, X., Tang, L., Xu, W. & Gong, M. (2013). GLP-1 analogs containing
disulfide bond exhibited prolonged half-life in vivo than GLP-1. Peptides, 32,
1303-12.
Liljevik, S, & Lohre, ESVB (2012). Evaluation of knowledge and management

practices of hypertension in pregnancy among health care workers in Moshi
urban, Tanzania. [updated 2012. Thesis work. University of Oslo, Norway;
cited 24 Aug 2016];
Availablefrom:https://www.duo.uio.no/bitstream/handle/10852/29011/Prosjek
tLiljevik.pdf?sequence=3
Lima Santos, P. C. J., de Oliveira Alvim, R., Ferreira, N. E., de Sá Cunha, R., Krieger,
J. E., Mill, J. G., & Pereira, A. C. (2015). Ethnicity and arterial stiffness in
Brazil. American journal of hypertension, 24(3), 278-284.
Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/21183929
Lind, J.M, & Chiu, C.L. (2013). Genetic discoveries in hypertension: steps on the
road to therapeutic translation. Heart
Macedo, M. E., Lima, M. J, Silva, A. O, Alcantara, P, Ramalhinho, V., & Carmona,

J., (2005). Prevalence, awareness, treatment and control of hypertension in
Portugal: the PAP study. J Hypertens, 23(2), 1661–1666
Mahan, V., Deepa, M., Farooq, S., Datta, M., Deepa, R. (2013). Prevalence,
awareness and control of hypertension in Chennai – the Chennai urban rural
epidemiology study (CURES – 52). J. Assoc. Physicians India. 55(5): 326-32.
Available from:
125
https://www.researchgate.net/publication/275097886_Prevalence_and_Determ
inants_of_Hypertension_among_University_Employees [accessed Aug 02
2018].
Mancia, G, Fagard, R, Narkiewicz, K, Redon, J, Zanchetti, A, Bohm, M, et al.,
(2013). ESH/ESC guidelines for the management of arterial hypertension: the
task force for the management of arterial hypertension of the European
Society of Hypertension (ESH) and of the European Society of Cardiology
(ESC). J Hypertens; 3(1), 1281–1357
Mandal, A., (2017). Study of prevalence of type 2 diabetes mellitus and hypertension
in overweight and obese people. Journal of Family Medicine and Primary
Care, 3(1)25-28
Mills, K.T., Bundy, J.D., Kelly, T.N., Reed, J.E., Kearney, P.M., Reynolds, K., et al.,
(2016). Global disparities of hypertension prevalence and control: a
systematic analysis of population based studies from 90 countries. Circulation,
13, (4), 441–50.
Mitwalli, H.A, Harthi, A.A, & Mitwalli, H., (2013). Awareness, attitude, and
distribution of high blood pressure among health professionals. J Saudi Heart
Assoc 25:19-24
Modern Ghana, (2017). Hypertension is Ghana’s number one killer diseases

https://www.modernghana.com/news/140773/1/hypertension-is-ghanas-
number-one-killer-diseases.html
Morgado. E., & Pedro L. N., (2014). Hypertension and chronic kidney disease: Cause
and Consequence-Therapeutic Considerations. Nephrology Department,
Hospital of Faro, Portugal
Murray, C. J. L., Lopez, A. D., (2014). The Global Burden of Disease. A

comprehensive assessment of mortality and disability from diseases, injuries,
and risk factors in 1990 and projected to 2020. WHO 1996
Myjoyonline, 2017
126
Ogah, S.O., Okpechi, I., & Chukwuonye, II., (2012). Blood pressure, prevalence of
hypertension and hypertension-related complications in Nigerian Africans: A
review. World J Cardiol 4:327-340
Okertchiri J.A. (2016). Ghana needs more Diabetic Educators. Daily Guide, 2013.
Nov 16, [Last accessed on 20138 Jan 20].
Available from: http://www.dailyguideghana.com/?p=67402
Ohata M, Nanri H, Matsunshima Y, Sato Y, Ikeda M (2005). Blood pressure-
lowering; effects of lifestyle modificatiion: Possible involvement of nitric
oxide bioavailability. Hypertension Research. 28:779-786
Olatunbosun, S. T., Kaufman, J. S., Cooper, R. S., & Bella, A. F. (2012).
Hypertension in a Black population: prevalence and biosocial determinants of
high blood pressure in a group ofurban Nigerians. Journal Hum Hypertension,
14, 249–257.
Oliviera, A. S., Chen, R. S., McCarthy, B. D., Davis, C.C., & Hill, M.N. (2005).
Hypertension Knowledge, Awareness, and Attitudes in a Hypertensive
Population. Available: http://www.ncbi.nlm.nih.gov/pmc/articles. Accessed 15
January 2018.
Omorogiwa, A., Ezenwa, E.B., Osifo, C., Ozor, M.O.E., Khator, C.N., (2009).
Comparative study on risk factors for hypertension in University setting in
Southern Nigeria. Int. J. Biomed. Health Sci. 5(2):103-107.
Omran, A.R., (1971). The epidemiological transition: a theory of the epidemiology of
population change. Milbank Mem Fund Q,4(2),509–538.
Peberdy, V. (2016). Hypertension: Putting the pressure on the silent killer. IFPMA.
Pour Moghaddas, M, Khosravi, AR, Kelishadi, R, Sarrafzadegan, N, Shirani, S,

Ansari, R, et al. (2004). Trends in Blood pressure level, prevalence and
control of Hypertension in Isfahan, Iran. Iranian Heart Journal. 5(1-2):33–8.
Prochaska, J., & DiClemente, C., (1986). Towards a comprehensive model of change.
In: Miller W, Heather N, eds. Treating Addictive Behaviors: Processes of
Change. New York, NY: Plenum Press; pp.3–27.
Ricks, D., (2004). Nursing Fundamentals; caring and clinical decision making.
Thompson Delmar Learning. United States of America, pp 588-589.
127
Saleem, F, Hassali, MA, Shafie, AA, Ul Haq, N, Farooqui, M, Aljadhay, H et al.

(2013). Pharmacist intervention in improving hypertension-related knowledge,
treatment medication adherence and health-related quality of life: a non-
clinical randomized controlled trial. Health Expect; 18(5)1270-81.
DOI:10.1111/hex.12101
Sanne, S.; Muntner, P.; Kawasaki, L.; Hyre, A.; & DeSalvo, K.B. (2012).
Hypertension knowledge among patients from an urban clinic. Ethn. Dis. 18,
42-47
Shaikh, R.B., Mathew, E., Sreedharan, J., Muttappallymyalil, J., Sharbatti, S. &
Basha, S., (2012). Knowledge regarding risk factors of hypertension among
entry year students of a Medical University, J. of Family Community Med.,
18(3),124–129.
Siddiqua, GK, Hussein, R, & Dornan, JC. (2017). Dying to give birth: the Pakistan
liaison committee’s strategies to improve maternal health in Pakistan. BJOG.
118(2):96–9.
Simon, H, & Zieve, D., (2008). Dietary approaches to prevent and treat hypertension.
Hypertension, 47(2): 296
Stamler, R., Stamler, J., Gosch, F. C. Civinelli, J., Fishman, J., McKeever,
P.,McDonald, A.. & Dyer, A. R. (2013). Primary prevention of hypertension
bynutritional hygienic means: Final report of a randomized, controlled trial.
Journal of the American Medical Association, 22(13), 1801-1807
Stevens, VJ., Corrigan, SA., Obarzanek, E., Bernauer, E., Cook, NR., Hebert, P.,
Mattfeld-Beman, M., Oberman, A., Sugars, C., & Dalcin, AT., (1993). Weight
loss
intervention in phase 1 of the trials of hypertension prevention. TOHP,
Collaborative Research Group. Arch Intern Med.;15,(3),849–858.
Steyn K., Gaziano T.A., Bradshaw D., Laubscher R., Fourie J., South African D. &
Health Coordinating T. (2001) Hypertension in South African adults: results
from the Demographic and Health Survey, 1998. J Hypertens 19, 1717-1725
128
Strasser, T., (1992). Equal blood pressure levels carry different risks in different
risk factor combinations. J Hum Hypertens,6,(1),261–264.
Ulasi, II, Ijoma, CK, Onwubere, BJC, Arodiwe, E, Onodugo, O, & Okafor, C.,
(2011). High prevalence and low awareness of hypertension in a market
population in enugu, Nigeria. Int J Hypertens. 86(9):675–9
U.S. Preventive Services Task Force (2014). Screening for high blood pressure:
Clinical
summary of U.S. Preventive Services Task Force Recommendation. Available
from:
http://www.uspreventiveservicestaskforce.org/uspstf07/hbp/hbpsum.htm
Accessed January 15, 2018
Van-de-Vijver, U. (2013). Status report on hypertension in Africa - Consultative

review for the 6th Session of the African Union Conference of Ministers of
Health on NCDs. PanAfrican Medical Journal, 1472-1477.
Wang, W.L., Fabsitz, R.R., Denvereux, R., Best, L., Welty, T.K., Howard, B.V.,
(2006). A longitudinal study of hypertension risk factors and their relation to
cardiovascular disease, J Hypertens 4(7)403-409.
Whitworth, J. A., (2003). World Health Organization / International Society of

Hypertension statement on management of hypertension. J Hypertens
2(1),1983-1992.
Wilber, JA, & Barrow, JG (1972) Hypertension: a community problem. The

American journal of medicine 52: 653–663.
WHO (1993). Cardiovascular diseases in developing countries. World Health Stat Q.

4, (6)90–150
WHO. (2012). Health expectancy is more important than life expectancy. Message
from the WHO Director General on the World Health Report, 5-6. Geneva,
Switzerland: World Health Organization.
WHO. (2013). A global brief on Hypertension: Silent killer, global public health
crisis. Geneva: WHO.
129
WHO. (2017). Hypertension control. Report of a WHO Expert Committee. World

Health Organ Tech Rep Ser., 8(62), 4–52.
Word Health Organisation. (2016). Global Health Observatory (GHO) data: Raised
blood pressure.
http://www.who.int/gho/ncd/risk_factors/blood_pressure_prevalence_text/en/.
Accessed 24 Feb 2018.
WHO Expert Committee (1996). Hypertension control. WHO Technical Report

Series No 862. Geneva, Switzerland: World Health Organization.
Yemi Raheem Raji, Taiwo Abiona & Oye Gureje (2017). Awareness of hypertension
and its impact on blood pressure control among elderly Nigerians: report from
the Ibadan study of aging. The Pan African Medical Journal; 27:190. Doi:
10.11604/pamj.2017.27.190.11682
130
APPENDIX
This project is being conducted by the Department of Public Health, to assess the
knowledge, awareness and attitudes of adults with regards to hypertension. The
information that you provide will contribute to our knowledge on the subject area.
A. SOCIODEMOGRAPHIC
1. Age (years): __________
2. Gender: [ ] Male [ ] Female
3. Religion: [ ] Christian [ ] Islam [ ]Traditional [ ] Others;
specify___________________
4. Ethnicity: __________________
5. Place of residence: [ ] Rural [ ] Urban
6. Marital Status: [ ] Married [ ] Single [ ] Divorced [ ] Cohabitating [
]Widowed
7. Educational Level: [ ] Primary [ ] JHS [ ] Secondary/Technical/Vocational [
] Tertiary [ ]None
8. Employment Status: [ ] Unemployed [ ] Self Employed [ ] Employed
9. Occupation: _________________________
10. Income: [ ]<Ghc500 [ ]Ghc500-<Ghc1000 [ ]Ghc1000-<Ghc1500 [
]Ghc1500->Ghc2000 [ ]>Ghc2000
11. Do you smoke cigarette? [ ] Yes [ ]No. If Yes, how many sticks per
day?_______________
12. Do you smoke shisha? [ ] Yes [ ]No
13. Do you take alcohol? [ ] Yes [ ]No. If Yes, specify which type of
alcohol__________________
14. Do you exercise? [ ]Yes [ ] No. If yes, how often? ____________________
131
B. HYPERTENSION KNOWLEDGE
1. Have you heard of hypertension before? [ ]Yes [ ]No
2. What does the term hypertension mean?
[ ]High Blood Pressure [ ]High Level Stress/Tension [ ] Nervous Condition [
] High Blood Sugar [ ]Overactivity [ ]Don’t Know
3. How dangerous is hypertension to your health?
[ ]Extremely [ ]Somewhat [ ]Not At All [ ]Don’t Know
4. Would lowering high blood pressure improve a person’s health?
[ ]Yes [ ]No [ ]Somewhat [ ]Don’t Know
5. What do the two numbers reported for blood pressure mean?
i. Top number? ___________________
ii. Bottom number? ________________
6. What should normal blood pressure levels be?
i. Top number? [ ]<140 [ ]140 [ ]>140 [ ]don’t know
ii. Bottom number? [ ]<90 [ ]90 [ ] >90 [ ]don’t know
7. Which measure(s) is (are) more important?
[ ]Top [ ]Bottom [ ]Both [ ]Don’t know
8. Can people do things to lower their blood pressure?
[ ]Yes [ ]No [ ]Don’t Know
9. Can lowering blood pressure even a little bit improve health?
[ ]Yes [ ]No [ ]Don’t Know
132
10. Which of the following do you think may lead to hypertension? (Tick (√) in the
Table below).
Risk Factor Tick (√)
a. Excessive alcohol consumption 
b. Excessive smoking 
c. Poor eating style 
d. Other diseases 
e. Physical Inactivity 
f. High Blood Pressure 
g. Age of a Person 
h. Don’t know 
11. Which of the following do you think are the symptoms of hypertension? (Tick (√)
in the Table below)
Symptom Tick (√)
a. Headache 
b. Blurred Vision 
c. Dizziness 
d. Shortness of Breath 
e. Chest Pain 
f. High Blood Pressure 
g. Heart Attack 
h. Don’t know 
133
C. HYPERTENSION AWARENESS
1. Have you ever been told by your doctor or health care provider that you have
hypertension? [ ] Yes [ ] No
2. Did your doctor or health care provider tell you what your personal blood pressure
should be? [ ] Yes [ ] No [ ]Don’t Know
3. If told, what should your top number be?
[ ]<140 [ ]140 [ ]>140 [ ]don’t know
4. If told, what should your bottom number be?
[ ]<90 [ ]90 [ ] >90 [ ]don’t know
5. Has a doctor or healthcare provider ever told your that the top number is important
to keep under control?
[ ] Yes [ ] No [ ]Don’t Know
6. Has a doctor or healthcare provider ever told your that the bottom number is
important to keep under control?
D. ATTITUDES AND PERCEPTIONS RELATED TO HYPERTENSION
1. How serious do you consider your blood pressure as a personal health concern?
[ ]Very Serious [ ]Somewhat Serious [ ]Not At All Serious
2. How important do you think taking medicine is to keeping blood pressure under
control?
[ ]Very Important [ ]Somewhat Important [ ]Not At All Important
134
3. Do you think that high blood pressure (hypertension) is a lifelong disease?
4. Do you think that high blood pressure (hypertension) has a cure?
5. Can changing lifestyle help to lower your blood pressure?
6. Do you think high blood pressure is an avoidable part of aging?
7. What is the single most important factor in preventing/controlling high blood
pressure?
[ ]Medications [ ]Exercising [ ]Less Stress [ ]Quitting Smoking [
]Change Diet (Salt Intake) [ ]Reducing Alcohol [ ]Losing Weight [ ]Other
E. ANTHROPOMETRY
1. Pulse rate: ____________
2. Height: ________________
3. Weight: ______________
4. Waist circumference: _____________
5. Hip Circumference: ______________
6. SBP: _____________
7. DBP: _____________
135

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UNIVERSITY FOR DEVELOPMENT STUDIES

ASSESSING THE KNOWLEDGE, AWARENES, ATTITUDES AND

PERCEPTIONS OF HYPERTENSION AMONG ADULTS (19 - 60 YEARS) IN

THE SUNYANI MUNICIPALITY, BRONG AHAFO REGION, GHANA

UNIVERSITY FOR DEVELOPMENT STUDIES

ASSESSING THE KNOWLEDGE, AWARENES, ATTITUDES AND

PERCEPTIONS OF HYPERTENSION AMONG ADULTS (19-60YEARS) IN

THE SUNYANI MUNICIPALITY, BRONG AHAFO REGION, GHANA

JOSHUA NYARKO (BSc. PUBLIC HEALTH)

THESIS SUBMITTED TO THE DEPARTMENT OF PUBLIC HEALTH

SCHOOL OF MEDICINE AND HEALTH SCIENCES, UNIVERSITY FOR

DEVELOPMENT STUDIES, IN PARTIAL FULFILLMENT OF THE

REQUIREMENTS FOR THE AWARD OF MASTER OF PHILOSOPHY

DEGREE IN COMMUNITY HEALTH AND DEVELOPMENT

Candidate’s Signature:……………...…………… Date:………………….………

supervised in accordance with the guidelines on supervision of dissertation laid down

by the University for Development Studies.

Supervisor’s Signature:………………………… Date:…………………………

Head of Department’s Signature..………………….……… Date:……..…………

stage comprising cluster sampling, systematic sampling, and purposive sampling

hypertension and demographic profile (no formal education (p<0.0001; x2 = 22.52),

tertiary education (p<0.0001; x2 = 19.3), cigarette smoking (p = 0.0414; x2 = 4.16), shisha

hypertension is an avoidable part of aging and socio-demographic characteristics.

for their invaluable contributions in my academic development.

would not have been such a masterpiece.

support towards the achievement of this study.

To my family and friends

ACKNOWLEDGEMENT ....................................................................................................... iii

LIST OF FIGURES ...................................................................................................................x

CHAPTER ONE ........................................................................................................................1

1.1 Background to the Study......................................................................................................1

1.2 Statement of the Problem.....................................................................................................3

1.3 Significance of the Study .....................................................................................................5

1.4 Conceptual Framework........................................................................................................6

1.5 Justification of the Study ...................................................................................................10

1.6 Research Question .............................................................................................................11

1.7.1 Main Objective................................................................................................................11

1.7.2 Specific objectives ..........................................................................................................12

1.8 Organisation of the Study ..................................................................................................12

CHAPTER TWO .....................................................................................................................13

LITERATURE REVIEW ........................................................................................................13

2.1 Overview of Hypertension.................................................................................................13

2.1.1 Determinants of Hypertension ........................................................................................18

2.2 Knowledge on Hypertension..............................................................................................25

2.3 Awareness on Hypertension ..............................................................................................28

2.5 Consequence of Hypertension ...........................................................................................36

2.6 Epidemiological Trend and Distribution of Hypertension.................................................41

2.6.1 Worldwide Distribution of Hypertension .......................................................................43

2.6.2 Age Distribution of Hypertension...................................................................................43

2.6.3 Sex Distribution of Hypertension ...................................................................................44

2.6.4 Race or Ethnicity Distribution ........................................................................................45

CHAPTER THREE .................................................................................................................47

3.1 Study Setting......................................................................................................................47

3.2 Study Design......................................................................................................................49

3.3 Sample Size........................................................................................................................49

3.4 Population ..........................................................................................................................50

3.5 Sample and Sampling Techniques .....................................................................................51

3.6 Data Collection Method.....................................................................................................52