Corresponding Author: Joaquim
Pinto
E-mail: [email protected]
INTRODUCTION
According to the World Health Organization
(WHO, 2016), hypertension is a cardiovascular disease
that cannot be diagnosed when systolic/diastolic blood pressure reaches 140/90
mmHg or more (Fitri,
2015). This disease is a disease that causes
cardiovascular disease (Nguyen et
al., 2016). An estimated 1 in 4 American adults has
hypertension. Currently, 600 million people with hypertension worldwide, and 3 million
die annually. Worldwide, hypertension is up to around 7.5 million deaths or
12.8% of the world's total. Data from WHO shows the incidence of hypertension
is found in Africa. As many as 46% of all cases in the world are women and men (WHO,
2016), also according (Organization,
2013) (Yonata
& Pratama, 2016), showed ed 972
patients with hypertension worldwide or 26.4% of the world's population suffer
from hypertension. This case can increase by around 29.2% in 2025. Of the 972
million people who suffer from hypertension, there are 333 million people in developed
countries, namely America, Australia, Germany, Canada and in an additional 639
from newly developing countries, such as Indonesia
Hypertension is one of the most common
adult chronic diseases for which treatment is available (Ward &
Schiller, 2013). The disease is available across all
races, sexes, ages and groups but has a much higher
prevalence among blacks and concomitantly higher mortality from sequelae. The
risks associated with hypertension include fatal and non-fatal outcomes involving
the brain, heart, and kidneys (Williams
et al., 2014). Although the development of
cerebrovascular and cardiovascular complications from hypertension has been
frequently described, in recent years, less attention has been paid to
coexisting renal disease (Manuntung
& Kep, 2019). Hypertension is systolic blood pressure
above 140 mmHg and diastolic blood pressure equal to or above 90 mmHg (Fatani et
al., 2021). Many factors, such as age, genetics,
gender, smoking, alcohol consumption, nutritional status, and sleep patterns
cause hypertension (Oikonomou
et al., 2022).
Also, according to the National Strategy
of the Ministry of Health of Timor Leste (Depkes-TL, 2011-2030), states that in
2005 the number of residents of Timor Leste over 60 years increased to 52,950
and in 2030 increased to 119,150, from 5.38% the population increased by 6.05%.
On the other hand, many rural areas have major problems getting primary health
care due to lack of transport, geographical distance, poor road conditions and
physical disabilities. Chronic disease is a very increased and permanent need
for individuals, families and communities because there is no ability (SAFITRI,
2020). Poor health care due to lack of
transportation, geographical distance, poor condition of roads, and poor
conditions and physical disabilities. Chronic illness is a greatly increased
and permanent need for individuals, families, and communities because there is
no ability. Poor health increases the ability of the elderly population, and a
report from the Guido Valadares National Hospital in 2015 shows that the number
of hypertensive patients hospitalized from 15 to 45 years of age is 229 (136
males and 93 females). In 2016, the number of inpatients was 603 (362 men and
241 women).
Table 1. Classification of Blood Pressure (BP) by the American Society of Hypertension and the International Society of Hypertension
|
Classification
|
Systolic (mmHg)
|
Diastolic (mmHg)
|
|
Optimal
|
<120
|
<80
|
|
Normal
|
120-129
|
80-84
|
|
Normal High
|
130-139
|
85-89
|
|
Class 1 hypertension
|
140-159
|
90-99
|
|
Class 2 hypertension
|
160-179
|
100-109
|
|
Class 3 hypertension
|
>180
|
>110
|
|
Systolic isolated hypertension
|
>140
|
<90
|
Source: ASH and
ISH, 2013
Table 2. BP classification by WHO and ISH 2016
|
Classification
|
Systolic (mmHg)
|
Diastolic (mmHg)
|
|
Severe hypertension
|
>180
|
>110
|
|
Moderate
hypertension
|
160-179
|
100-109
|
|
Hypertension
Friend
|
140-159
|
90-99
|
|
Restrictive
hypertension
|
120-149
|
90-94
|
|
Systolic
borderline hypertension
|
120-149
|
< 90
|
|
Systolic isolated
hypertension
|
>140
|
< 90
|
|
Normal
|
< 1 35
|
< 8 5
|
Source: WHO
and ISH, 2016
Factors contributing to the
incidence of hypertension caused by the interaction of risk of stress, obesity,
nutritional status, lifestyle (preventable) and uncontrolled factors are
genetics, age, gender and ethnicity (Triyanto, 2014).
METHOD
This
descriptive, correlative and descriptive study uses quantitative and
qualitative methods together to produce a deeper understanding of the
quantitative results with a cross-sectional study approach due to analyzing correlations
affecting risk factors and effects utilizing cumulative data accumulation. and
the same time (HR, 2018). The number of hypertensive male and female
inpatients hospitalized from 23 January to 23 February 2020 was selected using
random sampling. The patient inclusion criteria were all inpatients with a
diagnosis of hypertension at the time of data collection, with as many as 32
patients.
Before data
collection, ethical clearance was obtained from the Technical and Ethical
Committee of the National Institute of Health for Ethical Review.
Confidentiality is maintained during the research. Data was collected using a
questionnaire focused on stress, attitudes toward smoking and alcohol
consumption. Questioners were coded and scored based on never (score N=0),
sometimes (score S=1), often (with F=2), and routine (score R=3) and entered into the statistical package for social sciences
(SPSS) and analyzed using frequency distribution, percentage distribution,
cumulative distribution, correlation and regression.
RESULTS AND DISCUSSION
1.
Frequency
Distribution
The research results are presented according to
stress, smoking attitudes and alcohol consumption, as
below:
Table 3. Frequency Distribution According to Respondent
Characteristics
|
Characteristics
|
F
|
%
|
|
Age
|
|
|
|
<20
|
3
|
9.0
|
|
21-40
|
8
|
25,0
|
|
41-60
|
15
|
47,0
|
|
>60
|
6
|
19.0
|
|
Gender
|
|
|
|
Man
|
26
|
81.0
|
|
Woman
|
6
|
19.0
|
|
Education
|
|
|
|
Primary school
|
11
|
34,4
|
|
Re-high school
|
3
|
9,4
|
|
Secondary school
|
15
|
46,9
|
|
University
|
3
|
9,4
|
|
Profession
|
|
|
|
agricultural culture
|
8
|
25.0
|
|
Housewife
|
6
|
18,8
|
|
Student
|
1
|
3,1
|
|
Public employer
|
11
|
34,4
|
|
Journalism
|
1
|
3,1
|
|
Driver
|
1
|
3,1
|
|
Driver's assistant
|
1
|
3,1
|
|
fisherman
|
2
|
6,3
|
|
A businessman
|
1
|
3,1
|
|
History
Not
Yes
|
21
11
|
65,6
34,4
|
|
Classification
|
|
|
|
level
1
|
4
|
12.5
|
|
grade
2
|
17
|
53,1
|
|
grade
3
|
11
|
34,4
|
Source: Results of data analysis,20 20
Table 4. Frequency
Distribution of Average Consumption of Cigarettes, Alcohol and Stress Factors
|
|
variable ∑ _ cigarette consumption (X1)
|
∑ varies _ alcohol
consumption (X2)
|
∑ Stress factor variable
(X3)
|
|
N
|
Legitimate
|
32
|
32
|
32
|
|
Is lost
|
0
|
0
|
0
|
|
Means
|
14.81
|
16,47
|
27.59
|
Source: Results of data analysis 2020
2.
Multiple
Linear Regression Analysis
It uses multiple linear analysis to determine the relationship and
influence of each independent variable (X 1) smoking behavior, (X 2) alcohol
consumption, (X 3) stress and the dependent variable (y) hypertension. Then
this is the result and establishes a relationship between the independent and
dependent variables based on the analysis and using SPSS software version 2
3.00 for windows.
Table
5. Results of Multiple Linear Regression Analysis
|
Independent variable
|
Beta Coefficient
|
S
Grade Significance of t-test
|
Conclusion
|
|
Constant
|
0.244
|
|
|
|
Smoking attitude (x1)
|
0.197
|
0.0 41 < 0.05
|
There is influence
|
|
Alcohol
Consumption (x2)
|
0.293
|
0.0 22 < 0.05
|
There is influence
|
|
stress
|
0.397
|
0.0 06 < 0.05
|
There is influence
|
|
F test significance value = 0.00 0 R value = 0.724
R-Square value = 0.525
|
|
Source: 2019 Data Analysis Results
The
significance value of the t-test for the smoking behavior variable is 0.041,
which is less than the value of 0.05; it can be said that the smoking behavior
variable (X1) has a significant effect on the hypertension variable (Y). The
significance value of the t-test for the alcohol consumption variable is 0.022,
which is less than the value of 0.05. It can be said that the alcohol
consumption variable (X2) has a significant effect on the hypertension variable
(Y). The significance value of the t-test for the stress variable is 0.006,
which is less than 0.05. It can be said that the stress variable (X3) has a
significant effect on the hypertension variable (Y).
3.
Correlation
Test Results I
Table 6. Results of correlation
test results between smoking behavior and hypertension i
|
Correlation of opinion behavior
|
|
|
behavior _ smoking _X1
|
Hypersensitivity I _Y
|
|
behavior _ smoking _X1
|
Pearson correlation
|
1
|
0.508 **
|
|
Sig. (2-tails)
|
|
0.003
|
|
N
|
132
|
132
|
|
Hypersensitivity I _Y
|
Pearson correlation
|
0.508 **
|
1
|
|
Sig. (2-tails)
|
0.003
|
|
|
N
|
312
|
132
|
|
**. Significant correlation at
the level of 0.01 (2-tailed).
|
Source: Results of
2019 data analysis
Table 7. Correlation Test Results of Alcohol Consumption with Hypertension
|
Correlation of alcohol
consumption
|
|
|
Consume the _Alcohol_X2
|
Hypersensitivity I _Y
|
|
Consume _Alcohol_X2
|
Pearson correlation
|
1
|
,540 **
|
|
Sig. (2-tails)
|
|
,001
|
|
N
|
132
|
132
|
|
Hypersensitivity I _Y
|
Pearson correlation
|
0.540 **
|
1
|
|
Sig. (2-tails)
|
0.001
|
|
|
N
|
132
|
132
|
|
**. Significant correlation at
the level of 0.01 (2-tailed).
|
Source: Results of analysis data 2019
Table 8.
Results of
Correlation Test I Stress with Hypertension I
|
Stress Correlation
|
|
|
Stress_X3
|
Hypersensitivity I _Y
|
|
Stress_X3
|
Pearson correlation
|
1
|
,441 *
|
|
Sig. (2-tails)
|
|
,011
|
|
N
|
132
|
132
|
|
Hypersensitivity I _Y
|
Pearson correlation
|
,441 *
|
1
|
|
Sig. (2-tails)
|
,011
|
|
|
N
|
132
|
132
|
|
*. Significant correlation at
the level of 0.05 (2-tailed).
|
Source: 2019 data analysis results
a.
Effect of
Smoking Behavior Factors on Hypertension
The results of research in the interior room of HNGV men and women
to 32 respondents showed that the mean value of smoking behavior was 14.81%.
And the results of the analysis verify the hypothesis that smoking behavior has
a significant effect on hypertension with a correlation coefficient of 0.943
because Cronbach's Alpha value is greater than 0.6. Thus, there is a relationship
between smoking behavior and the risk of cardiovascular disease. Excessive
smoking behavior, there is a high risk of smoking consequences which depends on
the number of cigarettes per day.
According to a statement (Mustolih et al., 2017), smoking is one of the factors associated with hypertension
because cigarettes contain nicotine. Cigarette consumption can cause nicotine
which is absorbed into the small blood vessels in the lungs and brain. Nicotine
in the brain can signal the adrenal glands to release or release epinephrine or
adrenaline, causing vasodilation and forcing the heart to work hard, thereby
increasing arterial pressure.
Based on the study's results, table 6 shows that smoking behavior
correlates with hypertension with a moderate Pearson Correlation coefficient
with a value of r = 0.508 and a Sig. P value of <0.05 with a value of 0.03
indicates a significant relationship between the independent and dependent
variables.
b.
Effect of
Alcohol Consumption Factors on Hypertension
As reported (Tritama, 2015), people who always consume alcohol above the limit can rapidly
change their blood pressure because alcohol has a carbon monoxide effect that
can increase the blood's acid. Excessive alcohol consumption, or 3x/day, as
much as 7%, is a cause of hypertension.
The research results in the interior room of HNGV men and women to
32 respondents showed that the mean value of the alcohol consumption factor was
16.47%. And the results of the analysis of the verification factor for the
hypothesis that alcohol consumption has a significant effect on hypertension
with a correlation coefficient of 0.855 because the Cronbach's Alpha value is
greater than 0.6.
There is a relationship between alcohol consumption and a high
risk of developing the cardiovascular disease with many witnesses. The factor
of greater alcohol consumption is that there is a high risk due to high alcohol
consumption depending on the amount of daily consumption.
Based on the study's results, table 7 shows that there is the
truth that the alcohol consumption factor correlates with hypertension with the
results of the Pearson Correlation coefficient, which is moderate with a value
of r = 0.540 and a Sig. P value of <0.05 with a value of 0.001 indicates a
significant relationship between the independent variables and the dependent.
c.
Effect of
Stress Factors on Hypertension
The results of research in the interior room of HNGV men and women
to 32 respondents showed that the mean value of the stress factor was 27.59%.
And the analysis results of the verification of the stress hypothesis factor
have a significant effect on hypertension with a correlation coefficient of
0.768 because the Cronbach Alpha value is greater than 0.6.
There is a relationship between stress factors and a high risk of
cardiovascular disease with many witnesses. Excessive stress factors have a
high risk of high-stress consequences depending on the stress conditions of the
day.
Based on the results of the study,
table 8 shows that there is the truth that the stress factor correlates with
hypertension with a moderate Pearson Correlation coefficient with a value of r
= 0.441 and a Sig. P value of <0.05 with a value of 0.011 indicates a
significant relationship between the independent and dependent variables. As statement
(Azizah & Dwi Hartanti, 2016), stress is a condition that is not as specific as suffered by
someone due to emotional, physical and environmental effects. If an
individual's behavior disorder occurs, it can temporarily cause stress, and if
it occurs continuously, it can affect an increase in blood pressure
CONCLUSION
The incidence of hypertension is
significantly influenced by smoking behavior, alcohol consumption and stress
factors. In addition, these three factors are also influenced by other factors
such as excessive salt consumption, not doing sports activities and other
unhealthy lifestyle behaviors.
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