Document Type : Original Article

Authors

1 Department of Pharmacology and Toxicology, College of Pharmacy, Rafha, Northern Border University, Arar, Saudi Arabia

2 Department of Pharmacy Practice, College of Pharmacy, Rafha, Northern Border University, Arar, Saudi Arabia

3 Department of Basic science, College of Pharmacy, Rafha, Northern Border University, Arar, Saudi Arabia

4 Department of Pharmacognosy, College of Pharmacy, Rafha, Northern Border University, Arar, Saudi Arabia

5 Alofoug College of Science & Technology, Khartoum, Sudan

6 Sudan International University, Khartoum, Sudan

Abstract

BACKGROUND: Sudan has a high prevalence of hypertension or high blood pressure, a key risk factor for cardiovascular illnesses. Therefore, this study aimed to investigate the socio-demographic characteristics, antihypertensive medication adherence, lifestyle changes, and the relationships between these factors and blood pressure control.
METHODS: A cross-sectional study was conducted from March to August 2023 in tertiary care hospitals in Sudan. A structured questionnaire was used to gather information from 385 hypertensive individuals who participated in the study. 
RESULTS: The results estimated a positive correlation between the independent variables measuring medication adherence. Diet, stress management, and exercise also moderately correlated with each other and the independent variables. Systolic and diastolic blood pressure levels had a high correlation at 0.93, and most variables correlated moderately with the dependent variable of blood pressure control. The regression model (R = 0.698) using the dependent variable (blood pressure control) as the outcome strongly correlated with the independent variables, explaining almost 49% of the variance in hypertension control. It was observed that blood pressure control was significantly predicted by adherence to antihypertensive medication, proper diet, exercise, and stress reduction among the participants. 
CONCLUSION: The study emphasizes the significance of lifestyle changes for effective hypertension control, specifically adherence to antihypertensive medication, diet, exercise, and stress management. Hypertensive patients in Sudan experienced much better blood pressure control and a decreased risk of cardiovascular problems after changing their lifestyle. 

Keywords

1. Ambaw Kassie G, Alemu A, Yosef Gebrekidan A, Asmare Adella G, Eshetu K, Wolie Asres A, et al. Undiagnosed hypertension and associated factors among adults in ethiopia: a systematic review and meta-analysis. BMC Cardiovasc Disord. 2023 May 27;23(1):278. https://doi.org/10.1186/s12872-023-03300-0
2. WHF. World heart report 2023, confronting the world’s number one killer 2023.
3. Rodriguez-Iturbe B, Pons H, Johnson RJ. Role of the Immune System in Hypertension. Physiol Rev. 2017 Jul 1;97(3):1127-64. https://doi.org/10.1152/physrev.00031.2016
4. Schmidt BM, Durao S, Toews I, Bavuma CM, Hohlfeld A, Nury E, Meerpohl JJ, Kredo T. Screening strategies for hypertension. Cochrane Database Syst Rev. 2020 May 7;5(5):CD013212. https://doi.org/10.1002/14651858.CD013212.pub2
5. Alzain MA. Prevalence, awareness, and social determinants of hypertension: a cross-sectional study in Northern State, Sudan. Jordan J Appl Sci Nat Sci Ser. 2020;14(2):13-8. https://doi.org/10.35192/jjoas-n.v14i2.280
6. Sowmyashree K, Vinutha S, Venkatesh K, YK PK, Bharathi D, Chandan K. An Updated Review On Hypertension. Int J Curr Innov Adv Res. 2023:17-23. https://doi.org/10.47957/ijciar.v6i1.145
7. Murray CJ, Aravkin AY, Zheng P, Abbafati C, Abbas KM, Abbasi-Kangevari M, et al. Global burden of 87 risk factors in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2020 Oct 17;396(10258):1223-49. https://doi.org/10.1016/s0140-6736(20)30752-2
8. Timsina YP, Pandey P, Mondal IH, Dar AH. Non-pharmacological management of hypertension: a systematic review. Food Chem Adv. 2023;3:100406. https://doi.org/10.1016/j.focha.2023.100406
9. Ilyas M. Hypertension in adults: part 1. Prevalence, types, causes and effects. South Sudan Med J. 2009;2(3):9-10.
10. Tesfa E, Demeke D. Prevalence of and risk factors for hypertension in Ethiopia: A systematic review and meta-analysis. Health Sci Rep. 2021 Sep 22;4(3):e372. https://doi.org/10.1002/hsr2.372
11. Izawa H, Yamada Y, Okada T, Tanaka M, Hirayama H, Yokota M. Prediction of genetic risk for hypertension. Hypertension. 2003 May;41(5):1035-40. https://doi.org/10.1161/01.hyp.0000065618.56368.24
12. Santana NMT, Mill JG, Velasquez-Melendez G, Moreira AD, Barreto SM, Viana MC, et al. Consumption of alcohol and blood pressure: Results of the ELSA-Brasil study. PLoS One. 2018 Jan 8;13(1):e0190239. https://doi.org/10.1371/journal.pone.0190239
13. Choi HM, Kim HC, Kang DR. Sex differences in hypertension prevalence and control: Analysis of the 2010-2014 Korea National Health and Nutrition Examination Survey. PLoS One. 2017 May 25;12(5):e0178334. https://doi.org/10.1371/journal.pone.0178334
14. Bushara SO, Noor SK, Ibraheem AA, Elmadhoun WM, Ahmed MH. Prevalence of and risk factors for hypertension among urban communities of North Sudan: Detecting a silent killer. J Family Med Prim Care. 2016 Jul-Sep;5(3):605-10. https://doi.org/10.4103/2249-4863.197317
15. Elfaki BA, Mustafa HE. Hypertension and Determinants Factors among Sudanese Population. 2020;1(1):39-48.
16. Omer SA, Alhamed M, Elmubarak MA, Elmubarak MA, Ibrahim RM, Ahmed FS, et al. Prevalence of undiagnosed hypertension and related risk factors in Wad-Medani Alkobra locality in Gezira State, Sudan, 2022. GSC Adv Res Rev. 2023;14(3):38-44. https://doi.org/10.30574/gscarr.2023.14.3.0068
17. Abusalih H, Sabeib ZA. Update of the nutritional situation in the Republic of the Sudan. The North African Journal of Food and Nutrition Research. 2020;4(9):S17-S24. https://doi.org/10.51745/najfnr.4.9.S17-S24
18. Valenzuela Ruiz PL, Carrera Bastos P, González Gálvez B, Ruiz Hurtado G, Ordovás Muñoz JM, Ruilope Urioste LM, et al. Lifestyle interventions for the prevention and treatment of hypertension. Nat Rev Cardiol. 2021 Apr;18(4):251-75. https://doi.org/10.1038/s41569-020-00437-9
19. Organia E, Pangandaman H, Adap D, Lambayong J, Mukattil N, Macarambon R, et al. A systematic review on the effectiveness of lifestyle modifications in the management of hypertension. Int J Health Med Curr Res. 2019;4(4):1550-64. http://dx.doi.org/10.22301/IJHMCR.2528-3189.1550
20. Blumenthal JA, Babyak MA, Hinderliter A, Watkins LL, Craighead L, Lin P-H, et al. Effects of the DASH diet alone and in combination with exercise and weight loss on blood pressure and cardiovascular biomarkers in men and women with high blood pressure: the ENCORE study. Arch Intern Med. 2010 Jan 25;170(2):126-35. https://doi.org/10.1001/archinternmed.2009.470
21. Treciokiene I, Postma M, Nguyen T, Fens T, Petkevicius J, Kubilius R, et al. Healthcare professional-led interventions on lifestyle modifications for hypertensive patients - a systematic review and meta-analysis. BMC Fam Pract. 2021 Apr 5;22(1):63. https://doi.org/10.1186/s12875-021-01421-z
22. Schutte AE, Jafar TH, Poulter NR, Damasceno A, Khan NA, Nilsson PM, et al. Addressing global disparities in blood pressure control: perspectives of the International Society of Hypertension. Cardiovasc Res. 2023 Mar 31;119(2):381-409. https://doi.org/10.1093/cvr/cvac130
23. Abdelbagi O, Musa IR, Musa SM, ALtigani SA, Adam I. Prevalence and associated factors of hypertension among adults with diabetes mellitus in northern Sudan: a cross-sectional study. BMC Cardiovasc Disord. 2021 Apr 10;21(1):168. https://doi.org/10.1186/s12872-021-01983-x
24. Ghazi L, Bello NA. Hypertension in Women Across the Lifespan. Curr Atheroscler Rep. 2021 Jun 19;23(8):43. https://doi.org/10.1007/s11883-021-00941-4
25. Wright AK, Welsh P, Gill JM, Kontopantelis E, Emsley R, Buchan I, et al. Age-, sex- and ethnicity-related differences in body weight, blood pressure, HbA1c and lipid levels at the diagnosis of type ٢ diabetes relative to people without diabetes. Diabetologia. ٢٠٢٠ Aug;٦٣(٨):١٥٤٢-53. https://doi.org/10.1007/s00125-020-05169-6
26. Man W, Wang Y. Age-associated arterial remodelling. EC Cardiology. 2017;4(4):137-64.
27. Steinman L, Heang H, van Pelt M, Ide N, Cui H, Rao M, et al. Facilitators and Barriers to Chronic Disease Self-Management and Mobile Health Interventions for People Living With Diabetes and Hypertension in Cambodia: Qualitative Study. JMIR Mhealth Uhealth. 2020 Apr 24;8(4):e13536. https://doi.org/10.2196/13536
28. Kim S, Tong B, Lee J, Borodge D, Kooner K. Lifestyle Counseling for Medication Adherence in Glaucoma. Clin Ophthalmol. 2021 Aug 17;15:3521-9. https://doi.org/10.2147/OPTH.S321351
29. Tam HL, Wong EML, Cheung K. Effectiveness of Educational Interventions on Adherence to Lifestyle Modifications Among Hypertensive Patients: An Integrative Review. Int J Environ Res Public Health. 2020 Apr 7;17(7):2513. https://doi.org/10.3390/ijerph17072513
30. Tibebu A, Mengistu D, Negesa L. Adherence to recommended lifestyle modifications and factors associated for hypertensive patients attending chronic follow-up units of selected public hospitals in Addis Ababa, Ethiopia. Patient Prefer Adherence. 2017 Feb 24;11:323-30. https://doi.org/10.2147/ppa.s126382
31. Warren-Findlow J, Seymour RB, Brunner Huber LR. The association between self-efficacy and hypertension self-care activities among African American adults. J Community Health. 2012 Feb;37(1):15-24. https://doi.org/10.1007/s10900-011-9410-6
32. Gregorich M, Strohmaier S, Dunkler D, Heinze G. Regression with Highly Correlated Predictors: Variable Omission Is Not the Solution. Int J Environ Res Public Health. 2021 Apr 17;18(8):4259. https://doi.org/10.3390/ijerph18084259
33. Pretto CR, Winkelmann ER, Hildebrandt LM, Barbosa DA, Colet CF, Stumm EMF. Quality of life of chronic kidney patients on hemodialysis and related factors. Rev Lat Am Enfermagem. 2020;28:e3327. https://doi.org/10.1590/1518-8345.3641.3327
34. Kim JK, Crimmins EM. Blood Pressure and Mortality: Joint Effect of Blood Pressure Measures. J Clin Cardiol Cardiovasc Ther. 2020;2(1):1009. https://doi.org/10.31546/2633-7916.1009
35. Ribeiro F, Teixeira M, Alves AJ, Sherwood A, Blumenthal JA. Lifestyle Medicine as a Treatment for Resistant Hypertension. Curr Hypertens Rep. 2023 Oct;25(10):313-28. https://doi.org/10.1007/s11906-023-01253-5
36. Ott C, Schmieder RE. Diagnosis and treatment of arterial hypertension 2021. Kidney Int. 2022 Jan;101(1):36-46. https://doi.org/10.1016/j.kint.2021.09.026
37. Cilli E, Ranieri J, Guerra F, Ferri C, Di Giacomo D. Cardiovascular disease, self-care and emotional regulation processes in adult patients: balancing unmet needs and quality of life. Biopsychosoc Med. 2022 Sep 30;16(1):20. https://doi.org/10.1186/s13030-022-00249-y