ABSTRACT

Introduction: According to the Center for Disease Control (CDC), hypertension contributes to the prevalence of other CV risk factors, such as insulin resistance, lipid abnormalities, changes in renal function. Aim: This study was aimed at assessing the knowledge on the non-pharmacological management of hypertension among the elderly (60+) years in the Ndongo community. Methodology: This was a cross sectional study conducted among 50 participants. The study made use of a convenient sampling technique using a structured questionnaire as the main instrument of data collection. Results: Regarding the knowledge of participants on the non-pharmacological management of hypertension, findings from the study revealed that, overall proportion of participants with adequate knowledge on the non-pharmacological management of hypertension was 72.0%. Regarding the challenges faced by the elderly, results from the study revealed that, the most cited challenge faced by the participants in the non-pharmacological management of hypertension is lack of finance 45 (90.0%). Conclusion: A large proportion of the participants had adequate knowledge on the non-pharmacological management of hypertension but faced financial challenges.

Key word: Knowledge, Non-pharmacological Management, Hypertension

CHAPTER ONE

INTRODUCTION

1.1 Background of the study

Recently, the pattern of diseases has changed from communicable to non-communicable diseases; this alteration in disease pattern happened as a result of industrialization or modernization (McKeown, 2012). According to the ranking globally, hypertension was place among the first ten cause of mortality (WHO, 2014). Clinically, hypertension is defined as a systolic blood pressure> 140mmHg and / or a diastolic blood pressure> 90mmHg (Kofi, 2012). However, according to the World Health Organization, hypertension is defined as a rise in blood pressure of two measurements >140/90mmHg systolic pressure, or >110mmHg diastolic pressure at any time (WHO, 2015). Adoption of healthy lifestyles is an important component in the prevention and management of hypertension. Lifestyle modification alone can be adequate to normalize blood pressure (BP) in individuals in their pre-hypertensive stage while for those with higher BP, it acts as an adjunct to pharmacotherapy, increasing the effectiveness of drugs and reducing the required dosage (WHO, 2015).

Historically, hypertension was difficult to be detected due to the lack of instrument for the reliable measurement of the blood pressure, it was not until the invention of the first practical sphygmomanometer by Riva-Rocci in 1896, and the subsequent exploration of the auscultatory findings by Korotkoff (1905) that the true clinical significance of high blood pressure could be examined (Smith et al., 2014). Due to this the Center for Disease control (CDC) stated that, adults above the age of 18 years should undergo opportunistic screening by healthcare providers at all points of care in India, either during the course of their visits to the health facilities, or separately as a screening examination if requested by the person. Targeted screening at the community level of high-risk groups like the elderly (>60 years), obese, current smokers, those with diabetes, those with existing cardiovascular disease, and those with a strong family history of heart disease or stroke can be undertaken by trained non-physician staff.

Globally, the high prevalence of hypertension worldwide has played a major contribution to the global burden of disease associated to CVD. Almost ten years ago, Kearney analysis indicated that more than a quarter of the world’s adult population had hypertension in 2000, and that this proportion would increase to 29% by 2025 – less than ten years from now. Overall, the prevalence of hypertension appears to be around 30-45% of the European population, increasing with age (Kearney, 2000). A study conducted by Landsberg et al. (2012) in USA aimed at assessing the knowledge on the non-pharmacological management of hypertension in the elderly revealed that, majority (96.0%) of the participants had knowledge on the non-pharmacological management of hypertension. The majority of the participants’ (90.8%) opinions were in agreement with the importance of diet in hypertension (HTN), and 97.6% agreed that salt reduction aids HTN control. The majority (86.8%) agreed that maintenance of regular exercise helps in control of high BP.

In Africa, an estimated number of adults with raised BP in Sub-Saharan Africa rose from 30 million in 1975 to over 100 million in 2016 due to population growth, ageing and westernization of lifestyle. It is therefore paradoxical that despite the availability of effective AHT drugs and the progress that has been made in the treatment of hypertension, the number of people whose BP is controlled is disappointingly low (Chapman et al., 2012). Adherence to medication is one of the most important factors for successfully managing a chronic disease. Non-adherence is a common problem among patients with chronic diseases, especially diabetes, hypertension, and hyperlipidemia.15-17 Management of these chronic diseases requires taking several medications, making it difficult for patients to adhere to their medications (Fezeu et al., 2011). A Study conducted in a resource poor setting in Nigeria, only 32.1% of the hypertensive patients showed good compliance to antihypertensive therapy (Busari et al., 2010)

In Cameroon, in a study conducted by Ferlle et al. (2011) reported that of a population of 10011, the prevalence was reported as 24.6%. The increasing prevalence of hypertension has been attributed to increased urbanization and westernization of life style, with high prevalence found in urban areas. Moreover, a study performed in 2012 in Cameroon revealed that 59.9% of known hypertensive patients were taking antihypertensive drugs, despite being aware of their condition (Dzudie et al., 2010). Also, a study carried out in Buea (Cameroon) in 2014 revealed that only 33.3% of hypertensive patients were complying with their antihypertensive drug therapy (Adidja, 2014).

Life style modification is an adjunct for hypertensive management and prevention (CDC, 2015). Continued life style healthy practices can reduce the number and dosage of antihypertensive drugs (Black et al., 2016). This include; daily physical exercise, dietary control such as reduction and avoidance of sodium intake, alcohol, stress reduction and regular blood pressure monitoring (CDC, 2017). This non-pharmacological measures are necessary to increase the effectiveness of drugs. There is therefore need for the elderly to have knowledge on the non-pharmacological management of hypertension so that any pre-hypertensive stage is aborted and the management become easy.

1.2 Problem statement

According to the Center for Disease Control (CDC), hypertension contributes to the prevalence of other CV risk factors, such as insulin resistance, lipid abnormalities, changes in renal function, endocrine abnormalities, obesity, left ventricular hypertrophy, diastolic dysfunction, and abnormalities in vascular structure in the elderly (CDC, 2012). In 2008, 57% of older adults Worldwide aged 60 and above had been diagnosed of with hypertension, and the number of people living with hypertension stood at 1 billion (WHO, 2008).

Non-pharmacological compliance not only reduces overall medical expenditures, but also improves clinical outcomes. Poor compliance to hypertensive therapies can lead to increased complications for untreated diseases, additional medical therapies, disease progression, premature disability and death (Yuh et al., 2015).

Even though the non-pharmacological management of hypertension in the elderly has been reported as an important public health issue, finding a strategy to implement it among the elderly is very challenging (Simeone et al., 2014).

Also, several findings on the knowledge of the elderly on the non-pharmacological management of hypertension has proven to be low in most countries (Chen et al., 2013). However, no data has been recorded in the Ndongo community about the knowledge of the elderly (45 – 60 years) on the non-pharmacological management of hypertension. This persuaded the researcher to carry out this study among the elderly aged (60+) in the Ndongo community. This study will be beneficial to the participants in that, it is going to broaden their knowledge on the non-pharmacological management of hypertension.

1.3 Research Questions        

1. What knowledge do the elderly (60₊ years) have on the non-pharmacological management of hypertension?
2. What are the challenges faced in the non-pharmacological management of hypertension amongst the elderly aged 60+ years?

1.4 Research Objectives

1.4.1 General Objectives

1. To assess the knowledge on the non-pharmacological management of hypertension among the elderly (60+) years in the Ndongo community.

1.4.2 Specific Objectives

1. To assess the knowledge of the elderly (60+ years) on the non-pharmacological management of hypertension in the Ndongo community.
2. To identify the challenges faced in the non-pharmacological management of hypertension amongst the elderly aged 60+ years in the Ndongo community.