Afr. J. Food Agric. Nutr. Dev. 2022; 22(8): 21432-21443 https://doi.org/10.18697/ajfand.113.

21215

DIET AND HYPERTENSION: FOOD TO EAT AND TO AVOID

Raza Ullah1, Saima Sarir2, Younas Khan3*, Shakeel Ahmad4,

Rula Odeh Alsawalqa5, Shafqat Ullah6, Mohammad Sahhad7

Younas Khan

*Corresponding email author: [email protected]

1MPhil
Scholar, Department of Rural Sociology, The university of Agriculture
Peshawar Pakistan
2Lecturer, Department of Rural Sociology, The university of Agriculture Peshawar
Pakistan
3PhD Scholar, Department of Rural Sociology, The university of Agriculture
Peshawar Pakistan
4Teaching/Research associate, Department of Sociology, Kohat University of
Science & Technology, Kohat-Pakistan
5Associate Professor, Department of Sociology, The University of Jordan
6Lecturer,
Department of education and psychology, Kohat University of Science &
Technology, Kohat-Pakistan
7Epidemiologist, Gajju Khan Medical College Swabi Khyber Pukhtunkhwa,
Pakistan

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ABSTRACT

The current study, which was conducted in the district Dir (Upper) in Khyber
Pukhtunkhwa Pakistan, investigated the relationship between dietary patterns and
the prevalence of hypertension. A total of three hundred and thirty one sample size
was determined from 2500 respondents as per the Sekarn criteria. The sampled
respondents were recruited from Rural Health Centers (RHC) and other clinics and
dispensaries in Tehsil (Sub-division) Sheringal of district Dir Upper, Khyber
Pukhtunkhwah Pakistan using a convenient sampling method. Further, the data
were collected through a structured questionnaire covering the study variables,
which were dietary habits (independent variable) and hypertension (dependent
variable). Moreover, the selected data were analyzed by the application of SPSS
(25 version) by applying descriptive statistics and chi-square test statistics
analysis. Furthermore, all the attributes of hypertension were indexed and cross-
tabulated to expose the association with dietary habits at bivariate level analysis.
With descriptive statistics, the results indicated that majority of the respondents,
with regards to gender identity, who suffered from hypertension were male,
between the age group of 40-59 years, with a high illiteracy level. At bivariate level
a significant association was found between hypertension and lack of proper food;
less vegetable consumption; and excessive usage of salty food was the major
cause of hypertension. Based on the aforementioned findings, it is possible to
conclude that the respondents' poor daily food habits were the root cause of their
hypertension. Furthermore, the consumption of fatty and salty foods rather than
vegetables was discovered to be additional contributing factors to hypertension in
the research location. As a result, the study recommends that changes in dietary
habits, living alteration, regular blood pressure checks and consultations with
doctors, a diet plan, exercise, avoiding stress and anxiety, and raising awareness
about the prevalence of hypertension are all essential for hypertension issue to be
controlled.

Key words: Sociology of Food, Dietary habits, Hypertension, Chi-square, Dir

Lower

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INTRODUCTION

Hypertension or high blood pressure is the force of blood against the artery walls
during circulation in the body. Around the world, approximately one billion people
have high blood pressure that causes premature deaths and the number is
expected to rise to 1.56 billion by 2025. Worldwide, eight million people die every
year due to hypertension. It is also known as silent killer and it mostly results from
increasing age and poor life style. Moreover, there is a close linkage between
hypertension and diabetes; sixty percent of people with hypertension also have
diabetes [1]. Hypertension had been a disease of people living in urban and
developed countries; however, recent studies show its increase in other developing
countries especially in rural areas. Several social factors affect hypertension
including income, education, employment, and insecurity of life [2].

Likewise, research validated that anxiety, depression, self-esteem, and hostility are
associated with hypertension [3,4]. Destructive social environment is also
responsible for hypertension due to the prevalence of social interaction among
society. This interaction of social factors with the diseases have compelled
sociologists to study the social factors in line with medical investigation to
overcome the chronic condition of the diseases affecting social life adversely. The
fourth version of healthy people, a countrywide health program held by United
States Department of Health and Human Services has described population
health, especially using social determinants approach. Moreover, a work full
panacea was designed by the concerned department to eradicate poverty and
provide education to all and other social aspects, which deteriorate the health of
inhabitants. This plan makes a new topic area of social determinants of health
approach to reframe a new approach towards the achieving of sustainable health
[4].

Biological, psychological, and social factors are associated risk factors of

hypertension. Psychological condition of a person significantly influences the
physical appearance of human body. Experimental evidence showed high
prevalence of stress, anxiety, and depression among hypertensive patients.
Depression is dominant in hypertensive people and association of hypertension
with depression has been recognized before, as investigators showed patients
reporting high stages of fertility were indicated three times likely to become
hypertensive in the near future [5]. The study further recommends that anxiety is
also one of other major reasons of increasing blood pressure, considered as a
significant factor in the etiology of hypertension. Stress is also identified to be an
associated factor with hypertension, which causes numerous cardiac

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complications. Stress level also perpetuates the rise of heart rate in young age.
Hypertension is the greatest significant determinant of kidney and cardiovascular
diseases, and an important risk factor for mortality. Every year at least 7.1 million
of people die worldwide because of hypertension. In 2008, nearly a billion older
people and adults aged 25 years had hypertension, in which three quarters of the
figure were living in developing countries [6]. Despite such high frequency,
awareness and blood pressure control are unfortunately poor in developing
countries as disclosed by World Health Organization [6]. As an ignored global
health issue, farmers and agricultural workers are thought to be healthier and have
lower mortality and morbidity rates than non-farming people of urban and rural
residents. This argument had been conveyed as probably attributable to a healthier
lifestyle, particularly with reference to smoking habits and drinking. In addition,
consumption of healthier foods and physical activities followed by farmers versus
non-farmers in rural and urban territory. Keeping in view the above stock of
literature, the present study is designed to explore the socio-economic factors
leading to hypertension and the association between unhealthy food and
hypertension through x2 test statistics.

MATERIALS AND METHODS

A cross-sectional research design through quantitative measure was conducted in
Tehsil Sheringal (district Dir upper Khyber Pukhtunkhwa Pakistan). As per pilot
survey (Dec, 2019), the study faced difficulties regarding access to health services
due to the persistent nature of institutional impediments in the developmental
sectors. Patients visited just one Rural Health Center [RHC] and four
clinics/dispensaries, namely Hashmi Medical Center, Riaz Pharmacy, Rehman
Hospital and University Health Center. As per the record of the RHC and the fore-
mentioned clinics, a total of 2500 patients visit these health centers each month.
Based on 2500 patient record, a sample size of 331was obtained as per Sekarn [7]
criteria of sample size selection. Further, convenient sampling technique was used
for data collection through structured questionnaire [Likert scale]. Pre-tested and
necessary changes were made in the questionnaire in light of feedback in the pilot
survey. The sample size was further proportionally allocated to each clinic as per
the formula given by Bowley as mentioned below (see table 1).
n! =#" ∗ N!
Where n = Required sample size
N = Population size
N! = Size of ith strata
n! = sample Size to be taken from ith strata

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After the collection of primary data, Statistical Package for the Social Sciences (25
versions) was used to edit the data and draw the results. Descriptive statistics,
frequency and percentage distribution at univariate level was analyzed. Whereas,
at bivariate level, inferential statistics (chi square test) was used through cross
tabulation method (indexation of dependent variable) to ascertain the association
between dependent (hypertension) and independent variables (dietary habits). The
procedure to calculate the Chi Square test results then followed.

RESULTS AND DISCUSSION

Demographic profile determines the potentials and abilities of an individual’s

performance at either level. The sub-section explains the gender, age, educational
qualification, occupation, family size, monthly income, working hours, blood
pressure (diastolic & systolic), disease duration and use of medicine to control
hypertension as well as whether the respondents take readings of their blood
pressure on a regular basis or not. Based on descriptive statistics table (2), the
majority 53.5% of the respondents belonged to the same age group, 40-59 years.
It could be deduced from these findings that, respondents between the age group
40 to 59 years suffered more, and were more affected by hypertension as
compared to the older or those below the categorization. Furthermore, with regards
to gender identity, majority of the respondents were male, 66.8%. Based on these
results, it could be concluded that male members of the study area suffered more
due to psychological and physical burdens of familial dynamics in terms of being a
household head, and their children responsibilities. However, women who suffered
from hypertension, suffered as a result of domestic violence. In addition, 49% of
the sampled respondents were illiterate. Based on these findings it could be
concluded that, non-availability of schooling and other sources of awareness are
factors that led to the deterioration of the health of the local inhabitants. In addition,
occupational distribution of the sampled respondents showed that many, 35.6%,
were unemployed. Similarly, many, 48% of the respondents had high blood
pressure levels. In addition, with regards to the use of medicines for blood
pressure, a majority, 69.5%, of the sampled respondents used medicines for
controlling blood pressure level while the remaining 30.5% managed their condition
by being involved in other activities like walking and other exercises.

Table 4 shows the perceptions of sampled respondents regarding hypertension;

61.3% of them disclosed that hypertension is a serious problem. Further, 58.3%
opined that hypertension has increased in rural areas, and 58% of the sampled
respondents stated that hypertension is a serious killer. Moreover, 48.9% of

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respondents are more conscious regarding hypertension. In addition, 55.9% of the
respondents stated that hypertension is a major threat to the life of rural
population, 60.1% responded that death ratio increased due to hypertension day
by day, and 56.5% of the respondents agreed that in rural areas, people were not
conscious of hypertension.

Table 5 highlights the association between hypertension and dietary habits through
application of chi square test statistics. A significant association (P=0.035) was
found between hypertension and lack of food concern. Likewise, a significant
association (P=0.026) was detected between hypertension and lack of proper food
access and utilization. Moreover, a significant association (P=0.004) was found
between hypertension and lack of diet plan on daily basis. However, a non-
significant association (P=0.065) was detected between hypertension and eating of
beef and fatty food. Lastly, a significant association (P=0.035; P=0.000) was found
between hypertension and less usage of vegetables and salty food utilization,
respectively.

It could be deduced from the above inferences that, hypertension is a disease

referred to sometimes as a silent killer that disrupts the overall societal patterns.
Rural inhabitants are more unconscious of hypertension. The pushing factors
towards hypertension cases included lack of resources and awareness regarding
dietary intake, less vegetable usage, salty and fatty food access. Risk factors, like
socio economic status, gender, family type, education, dietary habits, race, salt
intake, alcohol consumption, tobacco smoking, physical inactivity and sedentary
lifestyle, as social determinants cause non-communicable diseases like
hypertension as witnessed by Mushtaq and Najum [8], Peter and Khan [9] and
Khan [10].

CONCLUSION

A cross-sectional based study was conducted in district upper Dir to explore the
dietary habits as an association with hypertension. The study revealed at
descriptive statistics that out of 331 sample respondents, a majority who suffered
from hypertension were male, in the age group of 40-59 years. Fatty and excessive
salty food consumption on a regular basis were the major pushing factors of
surging hypertension in the study area. This study recommends that hypertension
can only be controlled if changes are made in dietary habits, life modification,
regular checkup of blood pressure and consulting doctors, diet plan, exercise,
avoidance of stress and anxiety and awareness about prevalence of hypertension.
Moreover, salty and sugary foods, and foods high in saturated fats can increase

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blood pressure. At the same time, avoiding red meat and drinks that contain added
sugars, and consumption of indigenous food is strongly recommended to
overcome hypertension.

ACKNOWLEDGEMENTS
The author(s) appreciates all the sampled participants for giving the primary data.
Also, the principal author acknowledged all the contribution of The Agriculture
University Peshawar for awarding of M. Phil degree in the field of sociology. In
addition, the authors fully acknowledged the work of anonymous reviewers and the
editorial team of this esteemed journal for making this article possible.

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Table 1: Distribution of sample size in various Hospitals of UC Sheringal
S.No Hospitals Average no. of Monthly Sample Size
Patients
1 Rural Health Centers 2000 265
2 Clinics/ Dispensaries 500 66
Total 2500 331

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Table 2: Descriptive Statistics
Characteristics No. of
Respondents(%)
Age Group

20-39 32 (9.7)
40-59 177(53.5)
60-79 119(36.0)
80 & Above 3(0.9)
Gender
Male 221(66.8)
Female 110(33.2)
Educational qualification
Illiterate 162(48.9)
Primary 65(19.6)
Middle 46(13.9)
Matriculate 35(10.6)
Intermediate 10(3.0)
Bachelor 9(2.7)
Master & above 4(1.2)
Occupational Status
Unemployed 118(35.6)
Labor 24(7.3)
Self-Employ 58(17.5)
Govt. employ 63(19.0)
Housewife 68(20.5)
Total 331(100.0)

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Table 3: Blood Pressure and Medicines used by the sampled Respondents

Characteristics No. of
respondents (%)
Blood Pressure
Systolic 140-150 and Diastolic 90- 159(48.0)
95
Systolic 151-160 and Diastolic 95- 85(25.7)
100
Systolic 161-170 and Diastolic 2(0.6)
101-100
Systolic 171-180 and Diastolic 85(25.7)
106-110
Use of medicine
Yes 230(69.5)
No 101(30.5)
Total 331(100.0)
Source: Survey 2019

Table 4: Frequency and Percentage distribution Regarding Hypertension

Statements/ Attributes Yes(%) No(%) Uncertain(%)

Hypertension is a serious problem 203(61.3) 50(15.1) 78(23.6)
Hypertension has increased in 193(58.3) 59(17.8) 79(23.9)
rural areas
You consider hypertension as a 192 (58.0) 63(19.0) 76(23.0)
silent killer
You are more concerned about 162(48.9) 115(34.7) 54(16.3)
hypertension now
You considered hypertension as a 185(55.9) 55(16.6) 91(27.5)
major threat to the life of rural
population
There is an increase in death rate 199(60.1) 48(14.5) 84(25.4)
due to hypertension now a day’s
People in rural areas don’t care 187(56.5) 62(18.7) 82(24.8)
about hypertension

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 Table 5: Association of Hypertension with Dietary habits
Statement Attribute Yes(%) No(%) Uncertain Total Statistics
(%)
You are not concerned Yes 84(25.4) 23(6.9) 23(6.9) 130(39.3) x2=10.376
about the food you eat No 96(29.0) 53(16.0) 40(12.1) 189(57.1) P=0.035

Uncertain 04(1.2) 03(0.9) 05(1.5) 12(3.6)

Lack of proper food is a Yes 121(36.6) 38(11.5) 33(10.0) 192(58.0) x2=11.053
major cause of your No 25(7.6) 15(4.5) 16(4.8) 56(16.9) P=0.026
hypertension
Uncertain 38(11.5) 26(7.9) 19(5.7) 83(25.1)
You do not have a diet plan Yes 61(18.4) 12(3.6) 10(3.0) 83(25.1) x2=15.637
for eating on daily basis No 96(29.0) 51(15.4) 41(12.4) 188(56.8) P=0.004

Uncertain 27(8.2) 16(4.8) 17(5.1) 60(18.1)

Beef is an integral part of Yes 42(12.7) 28(8.5) 23(6.9) 93(28.1) x2=8.831
your diet No 119(36.0) 37(11.2) 35(10.6) 191(57.7) P=0.065

Uncertain 23(6.9) 14(4.2) 10(3.0) 47(14.2)

You eat fatty food on daily Yes 42(12.7) 28(8.5) 23(6.9) 93(28.1) x2=8.831
basis No 119(36.0) 37(11.2) 35(10.6) 191(57.7) P=0.065

Uncertain 23(6.9) 14(4.2) 10(3.0) 47(14.2)

You eat fat free food Yes 61(18.4) 12(3.6) 10(3.0) 83(25.1) x2=15.637
regularly No 96(29.0) 51(15.4) 41(12.4) 188(56.8) P=0.004

Uncertain 27(8.2) 16(4.8) 17(5.1) 60(18.1)

Less use of vegetable Yes 84(64.6) 23(6.9) 23(6.9) 130(39.3) x2=10. 376
leads to hypertension No 96(29.0) 53(16.0) 40(12.1) 189(57.1) P=0.035

Uncertain 4(1.2) 3(0.9) 5(1.5) 12(3.6)

Salt free food is useful in Yes 96(29.0) 53(16.0) 29(8.8) 178(53.8) x2=31. 254
hypertension No 51(15.4) 4(1.2) 9(2.7) 64(19.3) P=0.000

Uncertain 37(11.2) 22(6.6) 30(9.1) 89(26.9)

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