International Journal of Public Health Science (IJPHS)

Vol. 9, No. 2, June 2020, pp. 121~128

ISSN: 2252-8806, DOI: 10.11591/ijphs.v9i2.20427  121

Determinants of hypertension among adults living

in Bole Sub-city, Addis Ababa

Selam Ayele Kassie1, Kidanemariam G/Michael Beyene2, Mesafint Abeje Tiruneh3

1
Tirunesh Beijing General Hospital, Addis Ababa, Ethiopia
2
Ethiopian Food, Medicine and Healthcare Administration and Control Authority, Addis Ababa, Ethiopia
3
Bethzatha General Hospital, Addis Ababa, Ethiopia

Article Info ABSTRACT

Article history: Complications of hypertension account for 9.4 million deaths world wide every
year. Evidences indicated that hypertension and elevated blood pressure are
Received Mar 5, 2020 increasing partly due to increase in determinants. In Addis Ababa,
Revised Apr 17, 2020 there is limited information on determinants of hypertension among adults.
Accepted May 1, 2020 Hence, this study aimed to assess determinants of hypertension among adults
living in Bole Sub-city, Addis Ababa. Community based unmatched
case-control study was conducted. Simple random sampling technique was
Keywords: used to select 122 cases and 244 controls. Data were collected using
interviewer administered structured questionnaire and measurement of blood
Addis Ababa pressure, weight and height. Binary logistic regression model was used for data
Adult analysis. A total of 348 adults were included in the study with 95% response
Case-Control rate. The study showed that age (AOR=7.68, 95% CI: 2.31–25.48),
Determinants average family monthly in come (AOR=6.39, CI: 1.60-25.55), family history
Ethiopia of hypertension (AOR=4.50, CI: 1.14-17.62), body mass index (AOR=3.76,
Hypertension CI: 1.49-9.48), physical activity (AOR=3.66, CI: 1.21–11.07), tobacco use
(AOR=8.99,CI:2.02-39.86), salt consumption (AOR=5.22, CI: 1.47-18.48),
stress (AOR=5.18, CI:2.42–11.09), knowledge (AOR=8.82, CI: 3.14-24.72)
and diabetic mellitus (AOR=8.42, CI: 1.44-48.97) were significantly associated
with hypertension. Cases had higher exposure to risk factors
of hypertension than controls. Age, average family monthly income,
physical activity, saltcon sumption, diabetic mellitus, stress, tobacco use,
body mass index, family history of hypertension and knowledge were
associated with hypertension. There is a need to health education to prevent
tobacco use, regular exercise, reduce salt consumption and other life style
modifications to reduce hypertension.
This is an open access article under the CC BY-SA license.

Corresponding Author:
Selam Ayele Kassie,
Tirunesh Beijing General Hospital,
Addis Ababa, Ethiopia.
Email: [email protected]

1. INTRODUCTION
Non-communicable diseases were attributable to around three-quarters of the total global mortalities
in 2017. Cardiovascular disease was the dominant cause of non-communicable disease related morbidities
and mortalities [1]. Uncontrolled hypertension is the leading risk factor for cardiovascular disease [2].
The burden of hypertension in developing countries is increasing [3].
Hypertension, known as high or raised blood pressure, is a global public health concerns.
It contributes to the burden of heart disease, stroke and kidney failure, and premature mortality and
disability [4]. Globally, the magnitude of hypertension was 1.39 billion population [5]. Most people with

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122  ISSN: 2252-8806

hypertension experiences two-fold higher risk of developing coronary artery disease, four times higher risk
of congestive heart failure and seven times higher risk of cerebrovascular disease [6]. Cardiovascular disease
is the leading global cause of death, accounting for more than 17.3 million deaths per year, a number that
is expected to grow to greater than 23.6 million by 2030. Of these, complications of hypertension accounts
for 9.4 million deaths worldwide per year. In 2013, cardiovascular deaths were 31% of all global deaths.
The greatest burden of cardiovascular disease was in low and middle-income countries (LMICs),
with approximately 80% of cardiovascular deaths [7].
There is a disparity in prevalence of hypertension between high-income and, low and
middle-income countries. From 2000 to 2010, hypertension prevalence decreased by 2.6% in high-income
countries, but in low and middle-income countries it increased by 7.7%. Almost three times more people with
hypertension live in developing countries (1.04 billion people) than developed countries
(694 million people) [5]. The World Health Organization (WHO) estimated that hypertension prevalence
is highest in African region with about 46% of adults aged 25 years and older was hypertensive. In Africa,
people with hypertension increased from 54.6 million in 1990 to 92.3 million in 2000, 130.2 million in 2010
and could increase to 216.8 million by 2030 [8]. A study conducted in Nigeria indicated hypertension
prevalence among Nigerian population was predicted to be 44.9% [9].
Evidences indicated that hypertension and elevated blood pressure are increasing partly due to increase
in smoking, obesity, harmful use of alcohol, lack of exercise and other risk factors [10]. Hypertension mainly
associated with lifestyle and environmental factors rather than genetics. It has stronger causal link with tobacco
use, excessive use of alcohol, physical inactivity, unhealthy diet and obesity. The risk factors that lead
to hypertension can be reversible or irreversible [11]. Different determinants have been known as hypertension
risk factors. Socio-demographic characteristics, including sex, age, diabetes mellitus, parental hypertension
history, sleep duration, body mass index, smoking and alcohol consumption were statistically associated
with hypertension [12].
A study done in Ethiopia revealed that hypertension prevalence among Ethiopian population was about
19.6 %. The prevalence of hypertension was higher in the urban population [13]. A study conducted in Addis
Ababa indicated that hypertension prevalence was 25% which is significantly higher in men than women [14].
A similar studies showed that prevalence of hypertension was 28.3% in Amhara region (Gondar),
16.9% in Oromia region (Bedele), 22.4% in Southern region (Durame), 18.1% in Tigray region (Humera)
and 30.2 % in Addis Ababa [13]. Another survey conducted in Addis Ababa also showed that 25% were found
to have hypertensive and 35.4% of hypertensive found in Bole sub city [14].
Awareness about prevention, treatment and control of hypertension is very low and there is limited
information on determinants of hypertension. The previous studies conducted in Addis Ababa mainly focused
on prevalence of hypertension showed various risk factors that have been linked with hypertension but there are
studies that contradict about determinant factors which may be because of the study design weakness.
The findings of this study will provide information for policymakers and concerned stakeholders to devise
effective strategies and appropriate interventions to reduce the determinants of hypertension. Hence, this study
aimed to assess determinants of hypertension among adults living in Bole Sub-city in Addis Ababa, Ethiopia.

2. RESEARCH METHOD
2.1. Study design and setting
Community-based unmatched case-control study was employed to identify determinants
of hypertension among adults living in Bole sub-city, Addis Ababa, Ethiopia. Data were collected from
August 18 to September 28, 2018. Addis Ababa is the diplomatic capital of the African Union and capital
city of Ethiopia. It has ten sub-cities and 116 districts. The city has an estimated population of 3,384,569.
Bole Sub-city is one of the Sub-cities of Addis Ababa. Bole Sub-city has 14 districts with estimated
population of 308,995 (145,225 males and 163,770 females). In addition, there are 79,020 households in Bole
Sub-city [15].

2.2. Study population

The study population was adults living in Bole sub-city in Addis Ababa. Cases were in age
of >25 years old with systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg
or those who were taking antihypertensive drugs; and controls were in the age of >25 years old with systolic
blood pressure <140 mmHg and/or diastolic blood pressure <90 mmHg and who did not report a history
of hypertension were included in the study. Those who were critically sick during the data collection period
were excluded from the study.

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2.3. Sample size determination

The sample size was calculated using double population proportion formula for predictor variables
by using EPI-info version 7.2.1.0 and considering; 95% confidence level, 80% power, case to controls ratio
of 1:2 and proportions of hypertension taken from a study conducted in Bahir Dar [16]. Hence, the required
sample size for the study was 366 of which 122 cases and 244 controls.

2.4. Sampling procedure

To select the study participants, simple random sampling technique was used. Lists of districts were
obtained from Sub-city. The districts were listed, and lottery method was employed to randomly draw
the required number of districts. Hence, four districts (30% of the total districts) were selected from
the 14 districts of Bole Sub-city. To select the number of study participants, equal allocation of study
participants was done. Ninety-two participants were selected from each selected districts. The study
participants were selected from each household until the required sample size obtained.

2.5. Data collection procedures and quality assurance

Interviewer administered structured questionnaire adapted from WHO [17] and weight, height and
blood pressure measurements were used to collect the data. The questionnaire was first developed in English
and then translated into local language (Amharic) for appropriateness and easiness in approaching the study
participants and back translated to English language to check its consistency of meaning.
Before the commencement of the actual data collection, the questionnaire was pretested on 5% randomly
selected residents who were later excluded from the study. The pre-testing did not lead to major changes
in the questionnaire, except correction of few typographical mistakes. The questionnaire was consisted
of questions related to socio-demographic characteristics, life style, stress, knowledge, and renal disease and
diabetic mellitus status.
The data collection methods were face-to-face interviews and physical measurements of height,
weight and blood pressure. Height and weight were measured with a standard and calibrated instrument.
Blood pressure was measured using a standard measuring device with the participant sitting after resting for
at least five minutes and two blood pressure readings were taken on all participants and an average
of the readings was used to declare the presence or absence of hypertension. Eight nurses with substantial
experience in data collection were recruited and trained for one day on study objective, data collection
procedures and instruments, participants approach, confidentiality and right of the study participants before
the data collection period. Consistency and completeness of the collected data were checked before any effort
to enter code and analyze it. Each day, 10% of the completed questionnaires were reviewed and checked for
completeness and relevance.

2.6. Data management and analysis

Epi-Info version 7.2.1.0 statistical software was used for data coding, entry and cleaning.
The cleaned data were imported to SPSS version 23.0 for analysis. Descriptive analysis was performed
as appropriate and results were presented in tables.At 25% level of significance, bivariate analyses were done
to identify potentially significant independent predictors with the outcome variable. The independent
variables that were associated with dependent variable in bivariate analysis were included in multiple logistic
regression analysis. The association between dependent variable and independent variables were analysed
using Binary Logistic Regression Model. Hosmer and Lemeshow Goodness-of-fit test was used to check
adequacy of the final model and fitted to the data well (p-value=0.375). For Binary Logistic Regression
Model; AOR at 95%CI were computed and variables with p-value less than 0.05 were considered
as statistically significant to dependent variable.

3. RESULTS AND DISCUSSIONS

3.1. Results
3.1.1. Socio-demographic factors of the study participants
From the 366 participants, 348 adults were participated in the study which makes the response rate
of 95.0%. Fifty-nine cases and 131 controls (54.6%) were males and 32 cases and 112 controls (41.4%) were
25-35 years old. About 47 cases and 118 controls (47.4%) were single. Forty-two cases and 67 controls
(31.3%) were self-employed, and 25 cases and 79 controls (29.9%) had degree and above education level.
About 50 cases and 126 controls (50.6%) had less than 5,000.00 Ethiopian Birr average family monthly
income. Furthermore, 99 cases and 219 controls (91.4%) had no family history of hypertension and 64 cases
and 155 controls (62.9%) had normal body mass index that can be seen in Table 1.

Determinants of hypertension among adults living in Bole Sub-city, Addis Ababa …(Selam Ayele Kassie)
124  ISSN: 2252-8806

Table 1. Socio-demographic factors of adult population in Bole Sub-city, Addis Ababa

Variables Category Cases, n (%) Controls, n (%) Total, n (%)
Male 59 (31.1) 131 (68.9) 190 (54.6)
Sex
Female 57 (36.1) 101 (63.9) 158 ( 45.4)
25-35 32 (22.2) 112 (77.8) 144 (41.4)
Age in years 36-45 38 (34.2) 73 (65.8) 111 (31.9)
>45 46 (49.5) 47 (50.5) 93 (26.7)
Single 47 (28.5) 118 (71.5) 165 (47.4)
Married 56 (36.1) 99 (63.9) 155 (44.5)
Marital status
Divorced 9 (45.0) 11 (55.0) 20 (5.7)
Widowed 4 (50.0) 4 (50.0) 8 (2.3)
House wife 11 (61.1) 7 (38.9) 18 (5.2)
Government employee 4 (10.0) 36 (90.0) 40 (11.5)
Private employee 28 (40.6) 41 (59.4) 69 (19.8)
Daily laborer 1 (9.1) 10 (90.9) 11 (3.2)
Occupation
Self-employed 42 (38.5) 67 (61.5) 109 (31.3)
NGO 2 (7.4) 25 (92.6) 27 (7.8)
Merchant 18 (35.3) 33 (64.7)) 51 (14.7)
Others (retire, student, unemployed) 10 (43.5) 13 (56.5) 23 (6.6)
Illiterate 12 (80.0) 3 (20.0) 15 (4.3)
Read and write 9 (50.0) 9 (50.0) 18 (5.2)
Primary school 24 (41.4) 34 (58.6)) 58 (16.7)
Educational status
Secondary school 30 (36.6) 52 (63.4) 82 (23.5)
Diploma or TVET 16 (22.5) 55 (77.5) 71 (20.4)
Degree and above 25 (24.0) 79 (76.0) 104 (29.9)
<5000.00 50 (28.4) 126 (71.6) 176 (50.6)
Family average monthly income
5000.00-10,000.00 39 (33.1) 79 (66.9) 118 (33.9)
in Ethiopian Birr
>10,000.00 27 (50.0) 27 (50.0) 54 (15.5)
Yes 17 (56.7) 13 (43.3) 30 (8.6)
Family history of hypertension
No 99 (31.1) 219 (68.9) 318 (91.4)
Under weight 3 (10.0) 27 (90.0) 30 (8.6)
Body mass index (BMI) Normal weight 64 (29.2) 155 (70.8) 219 (62.9)
Over weight 49 (49.5) 50 (50.5) 99 (28.4)

3.1.2. Life style characteristics

The study showed that 99 cases and 222 controls (92.2%) were non tobacco users and 74 cases and
193 controls (76.7%) were non-alcohol consumers. About 48 cases and 111 controls (45.7%) were physically
active. In addition, 89 cases and 208 controls (85.3%) had optimal salt consumption that can be seen in Table 2.

Table 2. Life style characteristics of adult population in Bole Sub-city, Addis Ababa
Variables Category Cases, n (%) Controls, n (%) Total, n (%)
Non user 99 (30.8) 222 (69.2) 321 (92.2)
Tobacco use Current user 11 (64.7) 6 (35.3) 17 (4.9)
Past user 6 (60.0) 4 (40.0) 10 (2.9)
Non consumer 74 (27.7) 193 (72.3) 267 (76.7)
Alcohol consumption Current consumer 30 (51.7) 28 (48.3) 58 (16.7)
Past consumer 12 (52.2) 11 (47.8) 23 (6.6)
Active 37 (26.8) 101 (73.2) 138 (39.7)
Physical activity Optimal 48 (30.2) 111 (69.8) 159 (45.7)
Inactive 31 (60.8) 20 (39.2) 51 (14.7)
Low 3 (15.0) 17 (85.0) 20 (5.7)
Salt consumption Optimal 89 (30.0) 208 (70.0) 297 (85.3)
High 24 (77.4) 7 (22.6) 31 (8.9)

3.1.3. Stress and morbidity characteristics

Among the total study participants, 52 cases and 45 controls (28.9%) had stress, nine cases and three
controls (3.4%) had diabetes mellitus and 10 cases and eight controls (5.2%) had renal disease that can
be seen in Table 3.

Table 3. Stress and morbidity characteristics among adult population in Bole Sub-city, Addis Ababa
Variables Category Cases, n (%) Controls, n (%) Total, n (%)
Yes 52 (53.6) 45 (46.4) 97 (28.9)
Stress
No 64 (25.5) 187 (74.5) 251 (72.1)
Yes 9 (75.0) 3 (25.0) 12 (3.4)
Diabetes mellitus
No 107 (31.8) 229 (68.2) 336 (96.6)
Yes 10 (55.6) 8 (44.4) 18 (5.2)
Renal disease
No 106 (32.1) 224 (67.9) 330 (94.8)

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3.1.4. Knowledge level

Out of the total study participants, 74 cases and 122 controls (56.3%) had poor knowledge and
39 cases and 94 controls (38.2%) had medium knowledge about hypertension that can be seen in Table 4.

Table 4. Knowledge level of study participants, Addis Ababa

Knowledge level Cases, n (%) Controls, n (%) Total, n (%)
Good knowledge 3 (15.8) 16 (84.2) 19 (5.5)
Medium Knowledge 39 (29.3) 94 (70.4) 133 (38.2)
Poor knowledge 74 (37.8) 122 (62.2) 196 (56.3)

3.1.5. Determinants of hypertension

At 25% level of significance bivariate binary logistic regression analysis marital status, occupation, family
average monthly income, age, education level, family history of hypertension, tobacco use, alcohol consumption,
stress, knowledge, diabetic mellitus status, renal disease, physical activity, salt consumption and body mass index
were significantly associated with hypertension. However, in multivariable binary logistic regression analysis;
age, average family monthly income, family history of hypertension, tobacco use, physical activity, salt consumption,
stress, knowledge, diabetic mellitus and body mass index were significantly associated with hypertension.
The odds of developing hypertension among respondents of age 36-45 years and >45 years were 6.07
and 7.68 times the odds of those aged 25-35 years respectively (AOR=6.07, 95% CI: 2.34-15.79 and
AOR=7.68, 95% CI: 2.31-25.48). The odds of developing hypertension among respondents with average family
monthly income of >10,000.00 Ethiopian Birr were 6.39 times the odds of those with average family monthly
income of less than 5000.00 Ethiopian Birr (AOR=6.39, 95% CI: 1.60-25.55). The odds of developing
hypertension among respondents who had family history of hypertension were 4.50 times
the odds of those who had no family history of hypertension (AOR=4.50, 95% CI: 1.14-17.62).
The odds of developing hypertension among respondents who had over weight were 3.76 times the odds
of those who had normal weight (AOR=3.76, 95% CI: 1.49-9.48). The odds of developing hypertension among
respondents who use tobacco currently were 8.99 times the odds of those who never use tobacco
(AOR=8.99, 95% CI: 2.02-39.86). The odds of developing hypertension among respondents who are physically
inactive were 3.66 times the odds of those who are physically active (AOR=3.66, 95% CI: 1.21-11.07).
The odds of developing hypertension among respondents who had high salt consumption were 5.22 times
the odds of those who had optimal salt consumption (AOR=5.22, 95% CI: 1.47-18.48). The odds of developing
hypertension among respondents who had stress were 5.18 times the odds of those who had no stress
(AOR=5.18, 95% CI: 2.42-11.09). The odds of developing hypertension among respondents who had poor
knowledge were 8.82 times the odds of those who had medium knowledge about hypertension
(AOR=8.82, 95% CI: 3.14-24.72). In addition, the odds of developing hypertension among respondents who had
diabetes mellitus were 8.42 times the odds of those who had no diabetes mellitus (AOR=8.42, 95% CI: 1.44-48.97)
that can be seen in Table 5.

Table 5. Bivariate and multivariable binary logistic regression analysis for factors associated with
hypertension among adults living in Bole Sub-city, Addis Ababa
Hypertension
Variable Category COR(95% CI) AOR(95% CI) P-value
Yes No
25-35 32 112 1 1
Age in years 36-45 38 73 1.82 (1.05-3.17) 6.08 (2.34-15.79) 0.000*
>45 46 47 3.43 (1.95-6.03) 7.68 (2.32-25.48) 0.001*
Illiterate 12 3 0.08 (0.02-0.30) 4.91(0.57-42.30) 0.147
Read and write 9 9 0.32 (0.11-0.88) 1.60 (0.37-6.93) 0.530
Primary school 24 34 0.45 (0.23-0.89) 2.12 (0.62-7.29) 0.232
Educational level
Secondary school 30 52 0.55 (0.29-1.04) 0.99 (0.35-2.82) 0.988
Diploma or TVET 16 55 1.09 (0.53-2.23) 0.48 (0.17-1.37) 0.169
Degree and above 25 79 1 1
Single 47 118 1 1
Married 56 99 1.42 (0.89-2.27) 0.67 (0.30-1.47) 0.314
Marital status
Divorced 9 11 2.05 (0.80-5.28) 0.40 (0.09-1.87) 0.245
Widowed 4 4 2.51 (0.60-10.46) 0.40 (0.03-5.18) 0.480
House wife 11 7 2.51 (0.90-6.97) 2.82 (0.56-14.15) 0.207
Government employee 4 36 0.18 (0.06-0.53) 0.44 (0.10-1.98) 0.283
Private employee 28 41 1.09 (0.59-2.02) 3.28 (1.19-9.01) 0.021
Daily laborer 1 10 0.16 (0.02-1.29) 0.71 (0.05-9.43) 0.793
Occupation
Self-employee 42 67 1 1
NGO employee 2 25 0.13 (0.03-0.57) 0.05 (0.01-0.33) 0.002
Merchant 18 33 0.87 (0.44-1.74) 0.94 (0.31-2.82) 0.909
Other 10 13 1.23 (0.49-3.05) 1.46 (0.36-6.00) 0.598

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126  ISSN: 2252-8806

Hypertension
Variable Category COR(95% CI) AOR(95% CI) P-value
Yes No
<5000 birr 50 126 1 1
Average family
5000-10,000 birr 39 79 1.24 (0.75-2.06) 1.75 (0.79-3.87) 0.170
monthly income
>10,000 birr 27 27 2.52 (1.35-4.71) 6.40 (1.60-25.55) 0.009*
Family history of Yes 17 13 2.89 (1.35-6.19) 4.50 (1.15-17.63) 0.031*
hypertension No 99 219 1 1
Under weight 3 27 0.27 (0.08-0.92) 0.45 (0.09-2.32) 0.341
Body mass index Normal weight 64 155 1 1
Over weight 49 50 2.37 (1.45-3.87) 3.77 (1.50-9.49) 0.005*
Non user 99 222 1 1
Tobacco use Current user 11 6 4.11 (1.48-11.43) 8.99 (2.03-39.87) 0.004*
Past user 6 4 3.36 (0.93-12.18) 3.83 (0.63-23.33) 0.145
Non consumer 74 193 1 1
Alcohol consumption Current consumer 30 28 2.79 (1.56-4.99) 1.76 (0.75-4.12) 0.194
Past consumer 12 11 2.85 (1.20-6.73) 2.05 (0.52-8.09) 0.304
Active 37 101 1 1
Physical activity Optimal 48 111 1.18 (0.71-1.96) 1.17 (0.52-2.63) 0.703
Inactive 31 20 4.23 (2.15-8.32) 3.66 (1.21-11.07) 0.022*
Low 3 17 0.41 (0.12-1.44) 0.88 (0.19-4.13) 0.874
Salt consumption Optimal 89 208 1 1
High 24 7 8.01 (3.33-19.28) 5.23 (1.48-18.49) 0.010*
Yes 52 45 3.38 (2.07-5.51) 5.18 (2.42-11.09) 0.000*
Stress
No 64 187 1 1
Good knowledge 3 16 0.45 (0.13-1.64) 0.64 (0.09-4.54) 0.651
Knowledge Medium knowledge 39 94 1 1
Poor knowledge 74 122 1.46 (0.91-2.34) 8.82 (3.15-24.72) 0.000*
Diabetes mellitus Yes 9 3 6.42(1.70-24.20) 8.42 (1.45-48.98) 0.018*
No 10 229 1 1
Yes 10 8 2.64 (1.01-6.89) 1.98 (0.42-9.23) 0.386
Renal disease
No 106 224 1 1 1
Note:* Statistically significant at 5% level of significance

3.2. Discussions
The present study assessed determinants of hypertension among adults in Bole Sub-city in Addis
Ababa, Ethiopia. The study found that age, average family monthly income, family history of hypertension,
tobacco use, physical activities, salt consumption, stress, knowledge, diabetic mellitus status and body mass
index were significantly associated with hypertension. The odds of developing hypertension among respondents
of age 36-45 years and greater than 45 years old were more than six and seven-times the odds
of those participants aged 25-35 years old respectively. This might be due to the fact that as age increases
the risk of hypertension might increase and hormonal changes as a result of ageing might cause high blood
pressure. This is consistent with studies conducted in Addis Ababa, Durame and Nigeria [9, 14, 18].
The odds of developing hypertension among respondents with average family monthly income
of >10,000.00 Ethiopian Birr were more than six-times the odds of those respondents with average monthly
income of <5000.00 Ethiopian Birr. This might be due to difference in economic status. As income increase life
style (such as eating style and physical activities) might be changed this might increase the risk
of hypertension. This is similar with a study conducted in Jigjiga [19]. The odds of developing hypertension
among respondents who had family history of hypertension were more than four-times the odds of those who
had no family history of hypertension. This might be due to family members share genes, behaviors, lifestyles,
and environments which might increase the risk of hypertension and was consistent with the studies conducted
in Western Rajasthan, Malaysia and Jigjiga [19-21].
The odds of developing hypertension among respondents who had over weight were more than
three-times the odds of those who had normal weight. This might be due to as BMI increases the number
of tissues becomes more and the cell size becomes bigger with increase in the weight that might increase
the risk of hypertension. This finding is congruent with the studies conducted in India, Gondar and
Bahr Dar [16, 22, 23]. The odds of developing hypertension among respondents who were physically inactive
were more than three-times the odds of those who are physically active. This might be due to the fact that
exercise (during recreation, traveling, working and regular exercise) has effects in protecting heart disease
and diseases of the blood vessels, including high BP. This is similar with studies conducted in Nepal,
Malaysia and Kenya [21, 24, 25]. The odds of developing hypertension among respondents who use tobacco
currently were more than eight-times the odds of those who had never use tobacco. This might be due
to the fact that tobacco use increases the risk of atherosclerosis which leads to increases pressure of the flow
of the blood in arteries thus leading to hypertension. This is consistent with the studies conducted
in Vietnamese and Gilgel, Ethiopia [26, 27].

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The odds of developing hypertension among respondents who had high salt consumption were more
than five-times the odds of those who had optimal salt consumption. This might be due to the facts that
sodium retains fluid inside the body. This increases intravascular volume of fluid in the body leading to high
BP. This is similar with reports in Durame and evidence observed and reported in Africa [11, 18]. The odds
of developing hypertension among respondents who had stress were more than five-times the odds of those
who had no stress. This might be due to the fact that a situation of stress resulted in pronounced increase
in the level of BP. This is consistent with studies conducted in Arba Minch and Tigray [28, 29]. The odds
of developing hypertension among respondents who had poor knowledge were more than eight-times
the odds of those who had medium knowledge. This might be as knowledge increases on hypertension and
the risk factors of hypertension the exposure to the risk of hypertension might decreases. This is consistent
with studies conducted in Karkala and Tanzania [30, 31].
The odds of developing hypertension among respondents who had diabetes mellitus were more than
eight-times the odds of those who had no diabetes mellitus. This might be due to the fact that the presence
of diabetic mellitus might increase the risk of hypertension. This is consistent with studies conducted in Bahir
Dar and Addis Ababa [16, 32]. It is interesting to note that contrary to a study conducted in Jigjiga [19],
the present study showed that about 50.8% cases and 56.4% controls were male. However, being male did
not significantly associated with hypertension. This is the difference in study population. In addition,
marital status, education status, alcohol use and renal disease status were not significantly associated
in the current study as compared to studies conducted in Jigjiga, Nigeria, Arba Minch and
Addis Ababa [9, 28, 33, 34], This might be due the difference in exposure, study population, study setting
and study design.

4. CONCLUSION
The current study found that cases had higher exposure to risk factors of hypertension than the controls
among adults of the community in Bole Sub-city, Addis Ababa. Age, average family monthly income, family history
of hypertension, tobacco use, physical activity, salt consumption, stress, diabetic mellitus status, body mass index and
knowledge about hypertension were significantly associated with hypertension. Appropriate preventive and control
interventions at all levels might facilitate to minimize exposure to hypertension risk factors which could cause
the social, health and economic consequences among the community of the Bole sub-city.
Therefore, health educations to promote the life style modifications including cessation of smoking, regular exercise,
relieving stress, reducing salt consumption and regular check up for hypertension are important.

ACKNOWLEDGEMENTS
The authors would like to thank the data collectors for their collaboration during the data collection.
We would also like to thank the study participants.

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