CHAPTER ONE

INTRODUCTION

1.1              Background of the study     

Considering the high prevalence of hypertension, severe complications and lack of adequate control, it is believed that hypertension is a major health problem throughout the world. It is estimated that hypertension affects about 1 billion people all over the world and it is the main risk factor for many other cardiovascular diseases (Brady & Lusk, 2015). The prevalence of hypertension in Nigeria may form a substantial proportion of the total burden in Africa because of the large population of the country currently estimated to be over 170 million (Akinlua  & Davis 2015). Although the recent advances in the diagnosis and treatment of hypertension have been shown to prevent cardiovascular diseases and to extend life, hypertension still remains an inadequately managed worldwide disease. There are a range of factors that increase the risk of developing hypertension. Tobacco use increases the incidence of cardiovascular diseases including hypertension. Alcohol consumptions is related to 5% to 30% of hypertension cases in general population. Similarly, about 30% of cases attributed to increased salt consumption and 20% to physical inactivity (Beck & Polit 2014). Recent reports have provided evidence that increasing rates of non-communicable diseases, including hypertension are associated with other determinants like increases in rapid unplanned urbanization, globalization, and socio demographic and nutritional transition. (Beck & Polit 2014).) The cause of uncontrolled hypertension is multifactorial. In order to actively improve their lifestyle, patients must have knowledge and understanding of hypertension and the potential health risks associated with the condition, as well as the potential positive effects of lifestyle modification. Inadequate patient knowledge and awareness about blood pressure (BP) are also potential causes for non-adherence to taking antihypertensive drugs, and consequently, high rates of uncontrolled blood pressure Patients with hypertension should have the knowledge they need to take care of themselves, to be able to define their condition, to evaluate risk factors, and to appreciate the significance of lifelong medical control (DeMartinis, 2011). Furthermore, patients with a good knowledge of their disease are more motivated to practice home blood pressure monitoring, which significantly improves medication adherence and blood pressure control. The estimated total number of adults with hypertension in 2000 was 972 million; 333 million in economically developed countries and 639million in economically developing countries.

It has been suggested that the prevalence of cardiovascular disease and hypertension is increasing rapidly in sub-Saharan Africa. According to WHO data HTN deaths in Ethiopia reached 9,743 or 1.190/0 of total deaths. It holds 13th rank among top 20 cause of death in Ethiopia. In the case of Bishoftu General Hospital, total number of hypertensive patients is 684 according to data obtained from the hospital record office. The current prevalence in many developing countries, particularly in urban societies, is said to be already as high as those seen in developed countries. The higher prevalence of hypertension in urban areas compared to rural areas strongly implicates differences in lifestyle as an explanatory factor. Higher levels of obesity and increased salt and fat intake from consuming more processed foods and engaging in jobs with minimal physical activity are likely explanations for higher hypertension in urban populations (Frisoli, Weng, Smith, & Zeng 2011).

Appropriate lifestyle changes often called non-pharmacological approaches are the cornerstone for the prevention of hypertension. Hypertension is a modifiable risk factor for cardiovascular diseases and stroke. Proper treatment of hypertension can reduce the risk of stroke up to 42% and of coronary heart disease by about 14.3%. However, lifestyle is a vital issue in managing hypertension. (Muyung, Kerr, Lusk, and Ronis, 2017).

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