Investigation of the quality of life of patients with hypertension in health centers
Farbod Ebadi Fard Azar1, Mahnaz Solhi1, Fakhreddin Chabaksvar2
1 Department of Health Services and Health Education, Iran University of Medical Sciences, Tehran, Iran
2 School of Health, Iran University of Medical Sciences, Tehran, Iran
|Date of Submission||11-Dec-2019|
|Date of Acceptance||05-Mar-2020|
|Date of Web Publication||28-Jul-2020|
Dr. Fakhreddin Chabaksvar
School of Health, Iran University of Medical Sciences, Tehran
Source of Support: None, Conflict of Interest: None
INTRODUCTION: Hypertension is one of the most critical factors for chronic diseases such as cardiovascular disease, stroke, arrhythmias, heart failure, and renal disease. The aim of this study was to evaluate the quality of life and its related factors in hypertensive patients.
MATERIALS AND METHODS: This study was descriptive research. The sampling method was simple random, i.e., 137 were selected among the ten health centers of the list of the existing patients by simple random sampling. Data were collected using a questionnaire World Health Organization Quality of Life-BREF (Short Form-26). After collecting the questionnaires, the data analysis was carried out using SPSS software and using statistical methods (e.g., number, percentage, mean, standard deviation, and MANOVA tests).
RESULTS: The results showed that the mean score for the physical domain (52.82), the psychological domain (50.26), the social domain (48.33), the environmental domain (46.1), and the total quality of life (49.60). Among the demographic variables, the education level variable (P =0.000), job (P = 0.013), and the duration of hypertension (P = 0.039) were significantly correlated with the quality of life of patients. The “levels of education” variables are significantly correlated with the physical domain (P = 0.000), psychological domain (P = 0.000), social domain (P = 0.000), and environmental domain (P = 0.000) of the quality of life. The “job status” variable is only significantly correlated with the social domain of the quality of life (P = 0.005). The “duration of hypertension” variable is only significantly associated with the physical domain of the quality of life (P = 0.011).
CONCLUSION: The findings of the present study show that demographic variables such as educational level, occupation, and duration of hypertension have a significant relationship with the quality of life domains of hypertensive patients. It is recommended that the principled education of patients is a step toward the improvement of the quality of life of patients.
Keywords: Blood pressure, hypertension, quality of life
|How to cite this article:|
Azar FE, Solhi M, Chabaksvar F. Investigation of the quality of life of patients with hypertension in health centers. J Edu Health Promot 2020;9:185
|How to cite this URL:|
Azar FE, Solhi M, Chabaksvar F. Investigation of the quality of life of patients with hypertension in health centers. J Edu Health Promot [serial online] 2020 [cited 2020 Oct 22];9:185. Available from: https://www.jehp.net/text.asp?2020/9/1/185/290952
| Introduction|| |
Hypertension is one of the most critical factors for chronic diseases such as cardiovascular disease, stroke, arrhythmias, heart failure, and renal disease which is defined as a systolic blood pressure of 140 mmHg or more and a diastolic blood pressure of 90 mmHg or more, and is the first factor of premature death and failure among all causes of death in the world. It is a common disease without any symptoms, and a person may have hypertension for years without knowing that he/she has a blood pressure. Recent studies have estimated the general prevalence of hypertension in Iran by 22%, and evidence suggests a growing trend in Iran., Hypertension has hit about 50 million Americans and more than 600 million people around the world. It is also the most common cause of adult visits to doctors. Hypertension is the cause of 45% of myocardial infarction, 51% of stroke deaths, and 9.5 million deaths annually, and it is predicted that hypertension will account for one-fourth of all deaths by 2030., The annual cost of hypertension in the US is $ 46 billion, including health-care costs, drugs for treatment, and working days lost.,, Like most chronic diseases, hypertension is closely associated with lifestyle, mental health, and quality of life of patients, and if it is not controlled on-time and appropriately, it will cause various diseases, significant disabilities, reduction of productivity, and ultimately reduction of the quality of people's lives.,,,, The study of Ebadi et al. and Shamsi et al. showed that the total score of quality of life in healthy individuals was higher than hypertensive patients. Recently, one of the main essential goals of the country's health system has been to improve the quality of life.,, In recent years, interest in the assessment and improvement of the quality of life of patients with chronic diseases has increased significantly so that the improvement of the daily performance and quality of life of patients with chronic illness has become a goal. According to the World Health Organization (WHO), the quality of life is people's understanding of living in the form of culture and values prevailing in the society and is in line with individual goals, standards, expectations, and interests. In other words, the quality of life is a logical process and a concept based on culture, which demonstrates a summary of values, beliefs, symbols, and experiences formed by that culture and provides a way of knowing and understanding human conditions and experiences in life. Given that high blood pressure in people causes severe dietary restrictions, changes in daily activities and recreational activities, and high stress on the sick, this can negatively affect the quality of life of the patient. Therefore, the present study was conducted to evaluate the quality of life in hypertensive patients in Mahdasht health centers in Karaj to determine the factors affecting the quality of life in hypertensive patients.
| Materials and Methods|| |
This study was descriptive research carried out to study the quality of life of patients with hypertension in hypertensive patients in Mahdasht health centers in Karaj, Iran. According to contextual studies and previous investigations as well as using the corresponding statistical formula, the sample size was determined to be 118 people. Given 10% of the additional sample size related to the sample loss, the total sample size was estimated to be 130 people. The sampling method was simple random, i.e., 137 were selected among the ten health centers of the list of existing patients by simple random sampling. Inclusion criteria included willingness to participate in the study, having at least 1 year of history of hypertension, and no diabetes and exclusion criteria included incomplete completion of questionnaires, in the acute and severe stages of the disease (hypertensive emergency), data were collected using a questionnaire in which two questionnaires were used for research purposes. The first questionnaire was a demographic profile questionnaire which used one item to determine demographic variables such as gender, age, job, education, marital status, family history of the disease, and year of the disease. The second questionnaire was WHO Quality of Life-BREF (Short Form-26), which was a 26-item questionnaire that measured four aspects, for example, physical health, psychological health, social relationships, and environmental health with 24 items. Each of the areas of quality of life had 7, 6, 3, and 8 items, and two questions did not belong to either of the areas and evaluated the state of health and quality of life in general. The questionnaire was in the form of a 5-point Likert scale. The reliability and validity of the quality of life questionnaire were confirmed with correlation and Cronbach's alpha values >0.7. The project was implemented as follows: first, the researcher gets a letter of introduction from the Iran University of Medical Sciences (IUMS). Then, after going to Alborz University of Medical Sciences and obtaining a license, he shows up in the health centers of the city. Afterward, he explains the research purpose to the patients. Then, after obtaining their informed consent, patients were asked to complete the questionnaires.
After collecting the questionnaires, the data analysis was carried out using SPSS software version 21 (IBM Corporation, Armonk, NY, USA) and using statistical methods (e.g., number, percentage, mean, standard deviation, and MANOVA tests).
The following ethical issues were considered in the present research. First, the ethics code of IR.IUMS.REC 1395.9321108003 was approved by the Faculty of Health of IUMS. The required permissions were gained from the health network organization. The research patients were assured about the confidentiality of the study data. They were informed about the study objectives and were allowed to enter or exit the research at will. Proper conditions were provided for comprehending the content and patients' responses.
| Results|| |
In the present study, a total of 137 individuals were sampled whose demographic characteristics are observed in [Table 1]. The results of [Table 1] showed that the number of males (62.04) is higher than females (37.95). In the study, 100% of the people were married and only 6.59% had higher education. In terms of job status, nearly 60% of people were self-employed and housekeeper and 56.93% of individuals had a family history of hypertension. Furthermore, the average age of patients was 52.62 years, and the mean duration of hypertension in the subjects was 3.78 years.
|Table 1: Demographic characteristics of hypertensive patients based on gender, marital status, education level, occupation, and family history of hypertension|
Click here to view
The results of [Table 2] showed the mean percentage of the maximum score for physical domain (52.82), psychological domain (50.26), social domain (48.33), environmental domain (46.1), and total quality of life (49.60).
In [Table 3], multivariate tests showed that among the demographic variables, the education level variable (P = 0.000), job (P = 0.013), and the duration of hypertension (P = 0.039) were significantly correlated with the quality of life of patients.
|Table 3: The results of multivariate regression test (MANOVA) for variables of gender, levels of education, job, history of hypertension, and the duration of hypertension to communicate with life quality in patients with hypertension|
Click here to view
In [Table 4], unilabiate post hoc analysis using multiple regression showed that the “levels of education” variable were significantly correlated with the physical domain (P = 0.000), psychological domain (P = 0.000), social domain (P = 0.000), and environmental domain (P = 0.000) of the quality of life. The “job status” variable was only significantly correlated with the social domain of the quality of life (P = 0.005). The “duration of hypertension” variable was only significantly associated with the physical domain of the quality of life (P = 0.011).
|Table 4: The results of the univariate potshot test by using multiple regression for variables of gender, levels of education, job, History of hypertension, and the duration of hypertension to communicate with life quality in patients with hypertension|
Click here to view
| Discussion|| |
The aim of this study was to evaluate the quality of life and its related factors in hypertensive patients in Mahdasht health centers in Karaj, Iran. Findings associated with demographic variables in this study show that the number of male patients was more than female, which was consistent with the study of Mesror Rodsary et al. However, in Khezri et al.'s research and Heidari and Shahbazi's study, female participants were more than male participants. There was no significant relationship between gender and quality of life in the present study, which was in line with the study of Mesror Rodsary et al.; however, it was inconsistent with the study of Carrasco Garrido et al. Carrasco Garrido et al. found that gender is one of the factors affecting the quality of life, and females have lower levels of quality of life than males in both physical and psychological dimensions. In the present study, there was a significant relationship between the levels of education and the quality of life. The higher the level of education, the higher the quality of life scores of individuals. The results were consistent with the studies of Mesror Rodsary et al. and Shams et al.; however, they were inconsistent with the study of Nabavi et al. Moreover, the study of Shabany et al. was not in accordance with the present results, i.e., there was no significant relationship between the levels of education and the quality of life. This lack of connection was due to the illiteracy, different cultures, and ethnicities of most of his research units. In the present study, all individuals were married. A majority of the participants in the studies of Khezri et al. and Heidari and Shahbazi were married. In this study, there was a significant relationship between the quality of life in patients with hypertension and job, which was consistent with the studies of Mesror Rodsary et al. and Bairami et al.
However, in the study of Shabany et al., there was no relationship between employment status and quality of life. This lack of connection may be due to the inactivity of most of his research units. In the present study, 56.93% of patients had a family history of hypertension, which was in line with the study of Bairami et al. In the study of Eftekhar Ardebili et al., 60% of the individuals in the intervention group and 47.4% of the individuals in the control group had a history of hypertension in the first-degree relatives. Based on the findings of the present study regarding the quality of life of patients with hypertension, the mean overall score of the quality of life was moderate and weak (49.60), which was in agreement with the studies of Eftekhar Ardebili et al., Mesror Rodsary et al., and Mohalli et al. The results of these studies showed that the overall score of the quality of life in these patients was moderate. Moreover, the results of the study of Trevisol et al. showed that the status of all aspects of the quality of life in patients with hypertension was below average and undesirable.
On the contrary, in their study, Gusmão et al. found that the scores of the quality of life of patients were high, suggesting that antihypertensive therapy had little or no adverse effects on the quality of life of patients. According to the researchers of the study, it was probably because of a low number of side effects of modern antihypertensive drugs. The results of this study showed that among the four domains of the quality of life, physical health and environmental health domains had the highest and the lowest score, respectively. In a study by Rimaz et al. on the quality of life of the head of household women, the environmental health had the lowest quality of life score; however, the highest quality of life score was associated with the “social relation” domain. In a study by Ebadi et al. entitled “the comparison of the quality of life of hypertensive male patients with healthy individuals,” they used the Short Form-36 questionnaire, and the quality of life score associated with the physical health dimension was higher in both the groups of healthy individuals and hypertensive patients than the psychological health score. Furthermore, Hadi and Malek and Ziapour and Kianipour reported similar results., Limitations of this study included self-reporting and low sample size. Given that in this study, the quality of life status of patients with hypertension was not acceptable, it is suggested that researchers promote the quality of life of patients with hypertension using educational models.
| Conclusion|| |
The results of this study showed that the quality of life of patients with hypertension is moderate and undesirable. Among demographic variables, educational level, occupation, and duration of hypertension were the most correlated with patients' quality of life. Among these demographic variables, the level of education had a significant relationship with all domains of quality of life. It is recommended that the principled education of patients is a step toward the improvement of the quality of life of patients.
Our grateful thanks go to all participants in the present study. This article was derived from a PhD dissertation on Health Education and Health Promotion under the ethics code of IR. IUMS. REC 1395.9321108003 approved by the Faculty of Health of IUMS. The researchers of this research thereby appreciated hypertension patients referred to Karaj health centers.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Blacher J, Levy BI, Mourad JJ, Safar ME, Bakris G. From epidemiological transition to modern cardiovascular epidemiology: Hypertension in the 21st
century. Lancet 2016;388:530-2.
Ramezankhani A, Pooresmaeili A, Rakhshandehrou S. The effect of group discussion method educational on knowledge, attitude and preventive behaviors of high blood pressure in women 20-49 years old Islamshahr Cit. Razi J Med Sci 2017;24:11-9.
World Health Organization. Salt Reduction and Iodine Fortification Strategies in Public Health: Report of a Joint Technical Meeting Convened by the World Health Organization and The George Institute for Global Health in Collaboration with the International Council for the Control of Iodine Deficiency Disorders Global Network. Sydney, Australia: World Health Organization; 2014.
Castetbon K, Grange D, Guibert G, Vernay M, Escalon H, Vincelet C. Recent changes in sociodemographic characteristics, dietary behaviors and clinical parameters of adults receiving food assistance in France. BMC Public Health 2016;16:779.
Vanhoof JM, Delcroix M, Vandevelde E, Denhaerynck K, Wuyts W, Belge C, et al
. Emotional symptoms and quality of life in patients with pulmonary arterial hypertension. J Heart Lung Transplant 2014;33:800-8.
Mirzaei M, Moayedallaie S, Jabbari L, Mohammadi M. Prevalence of hypertension in Iran 1980-2012: A systematic review. J Tehran Heart Cent 2016;11:159-67.
Dadipoor S, Shahsavari S, Ghaffari M, Farshidi H, Alavi A, Safari-Moradabadi A. A case-control study on lifestyle-related factors of hypertension in Iran. J Public Health 2019;6:1-6.
Perez V, Chang ET. Sodium-to-potassium ratio and blood pressure, hypertension, and related factors. Adv Nutr 2014;5:712-41.
Kjeldsen S, Feldman RD, Lisheng L, Mourad JJ, Chiang CE, Zhang W, et al
. Updated national and international hypertension guidelines: A review of current recommendations. Drugs 2014;74:2033-51.
Tselha N, Shimrah C, Kulshreshtha M, Devi NK. Association between hypertension and adiposity indicators: A study among the Muslim population of Uttar Pradesh. Diabetes Metab Syndr 2019;13:2335-8.
Myers T. Hypertension patient compliance; Doctoral dissertation. 2016.
Puri P, Singh S, Srivastava S. Reporting heterogeneity in the measurement of hypertension and diabetes in India. Journal of Public Health 2019;13:1-8.
Cepeda Marte JL, Javier A, Ruiz-Matuk C, Paulino-Ramirez R. Quality of Life and Nutritional Status in diabetic patients on hemodialysis. Diabetes Metab Syndr 2019;13:576-80.
Sotodeh-Asl N, Neshat-Dust H, Kalantari M, Talebi H, Khosravi A. Comparison of effectiveness of two methods of hope therapy and drug therapy on the quality of life in the patients with essential hypertension. J Clin Psychol 2010;2:1-5.
Thatthong N, Sranacharoenpong K, Praditsorn P, Churak P, Ponprachanuvut P, Srisangwan N, et al
. Innovative tool for health promotion for at-risk Thai people with hypertension. J Public Health 2019;5:1-7.
Ghasemi SR, Zangeneh A, Rajabi-Gilan N, Reshadat S, Saeidi S, Ziapour A. Health-related quality of life in informal settlements in Kermanshah, Islamic Republic of Iran: Role of poverty and perception of family socioeconomic status. East Mediterr Health J 2019;25:775-83.
Abbasi P, Kianipour N, Demir Özdenk G, Ziapour A. Dataset of leisure time among students at Kermanshah University of Medical Sciences and its relationship with health-related quality of life (HRQOL). Data Brief 2018;21:122-7.
Nazari B, Bakhshi S, Kaboudi M, Dehghan F, Ziapour A, Montazeri N. A comparison of quality of life, anxiety and depression in children with cancer and healthy children, Kermanshah-Iran. Int J Pediatr 2017;5:5305-14.
Ebadi A, Shamsi A, Refahi Y. Comparison of the quality of life in men with and without hypertension. Avicenna J Nurs Mid Care 2012;20:5-15.
Shamsi A, Refahi A, Malmir M, Mollahadi M, Ebadi A. Comparison of quality of life in military personnel with and without hypertension. Annals of military and health sciences research 2012;10:213-8.
Bairami S, Fathi Y, Mohammadinasab S, Barati M, Mohammadi Y. Relationship between self-care behaviors and quality of life among hypertensive patients visiting comprehensive health centers in Hamadan, Iran. J Educ Community Health 2017;4:20-7.
Kaboudi M, Dehghan F, Ziapour A. The effect of acceptance and commitment therapy on the mental health of women patients with type II diabetes. Ann Trop Med Public Health 2017;10:1709-13. [Full text]
Montazeri N, Kianipour N, Nazari B, Ziapour A, Bakhshi S. Health promoting behaviors among university students: A case-sectional study of Kermanshah University of Medical Sciences. Int J Pediatr 2017;5:5091-9.
Khalili M, Golpayegani M, Shahrjerdi S. The effect of eight weeks Pilates training on pain and quality of life in men with Rheumatoid arthritis. Journal of research sport rehabilitation 2014;2:41-52.
Heidarzadeh M, Ghanavati A, Pashaie A, Kolahdoozipour J, Mohamad Karam A, Rahimzadeh A, et al
. Quality of life in congestive heart failur patients: Comparing with other groups. Iran J Nurs Res 2015;10:54-62.
Nejat S, Montazeri A, Naieni HK, Mohammad K, Majdzadeh S. The World Health Organization quality of Life (WHOQOL-BREF) questionnaire: Translation and validation study of the Iranian version. J School Public Health Instit Public Health Res 2006;4:1-12.
Mesror Rodsary D, Dabiri Golchin M, Parsa Yekta Z, Haghani H. Evaluation of health-related quality of life in hypertensive patients in selected hospitals affiliated to Tehran University of Medical Sciences. Adv Nurs Mid 2013;23:11-8.
Khezri R, Ravanipour M, Motamed N, Vahedparast H. Effect of self-management empowering model on the quality of life in the elderly patients with hypertension. Iran J Age 2016;10:68-79.
Heidari M, Shahbazi S. Effect of self-care training program on quality of life of elders. Iran J Nurs 2012;25:1-8.
Carrasco Garrido P, de Miguel Díez J, Rejas Gutiérrez J, Centeno AM, Gobartt Vázquez E, Gil de Miguel A, et al
. Negative impact of chronic obstructive pulmonary disease on the health-related quality of life of patients. Results of the EPIDEPOC study. Health Qual Life Outcomes 2006;4:31.
Shams AN, Mohsenpour B, Ghaderi E, Rezaei F, Delavari AR. Qualityof lifein 15-64 yearsold people in Kurdistanprovince, westernpart of Iran. Journal of fundamentals of mental health 2010;12:448-56.
Nabavi S, Shoja M, Mohammadi S, Rashedi V. Health-related quality of life in community-dwelling older adults of Bojnurd in 2014. J North Khorasan Univ Med Sci 2014;6:433-9.
Shabany HM, Mohmmad AJ, Shekarabi R, Hosseini A. The relationship between medication adherence and quality of life in renal transplant patients. Iran Journal of Nursing 2010;23:29-34.
Eftekhar Ardebili H, Moradi H, Mahmoudi M. Effect of educational intervention based on the health belief model in blood pressure control in hypertensive women. J Mazandaran Univ Med Sci 2014;24:62-71.
Mohalli F, Mahmoudirad GH, Alhani F, Ebadinejad Z, Foroozanfar H. The Effect of Family-centered Empowerment Model on the Indicators of the Ability of Patients with Hypertension. IJNR 2019;13:8-14.
Trevisol DJ, Moreira LB, Kerkhoff A, Fuchs SC, Fuchs FD. Health-related quality of life and hypertension: A systematic review and meta-analysis of observational studies. J Hypertens 2011;29:179-88.
Gusmão JL, Mion D Jr., Pierin AM. Health-related quality of life and blood pressure control in hypertensive patients with and without complications. Clinics (Sao Paulo) 2009;64:619-28.
Rimaz S, Dastoorpoor M, Vesali Azar Shorbeyani S, Saiepour N, Beigi Z, Nedjat S. The survey of quality of life and its related factors in female-headed households supported by Tehran municipality district 9. Iran J Epidem 2014;10:48-55.
Ebadi A, Shamsi A, Refahi AA, Saied Y. Comparison of the quality of life in men with and without hypertension. Avicenna J Nurs Mid Care 2012;20:5-15.
Ziapour A, Kianipour N. Health-related quality of life among university students: The role of demographic variables. J Clin Diagn Res 2018;12:JC01-4.
Hadi N, Malek ML. Evaluation of health state and quality of life in primary school teachers of Shiraz, 2003. Med J Hormozgan Univ 2007;10:387-92.
[Table 1], [Table 2], [Table 3], [Table 4]