A Cross-Sectional Study to Assess Health Related Quality of Life (HRQOL) and Lifestyle Practices among Hypertensive patients in Outpatient Department of a Hospital in Jamshedpur

 

Upama De1*, Grace Das2, Aditi Raj Nivedita Ghosh3, Piyasi Ghosh Pratyusa Basu3,

Priti Kumari Purnima Gorai3, Shreya Roy Sneha3

1Professor, College of Nursing, Tata Main Hospital, Jamshedpur, Jharkhand, India.

2Tutor, College of Nursing, Tata Main Hospital, Jamshedpur, Jharkhand, India.

34th Year Basic B.Sc. Nursing student, College of Nursing, Tata Main Hospital, Jamshedpur, Jharkhand, India.

*Corresponding Author Email: upama.de@tatasteel.com

 

ABSTRACT:

Introduction: Health is the consequence of a complex interplay of individual elements (genetic background, lifestyle, individual characteristics) and societal factors (education level, occupation, level of socialization), as well as the quality of medical care and the management of therapeutic interventions. Personal health assessment is how people define their own health and quality of life. WHO (World Health Organization) defines quality of life as “individuals” impressions of their place in life within the framework of the culture and value systems in which they live, as well as their objectives, expectations, standards, and worries. Aim: To determine the health-related quality of life (HRQOL) and lifestyle practices of hypertensive patients, and to find out the association between health-related quality of life with lifestyle practices and socio-demographic variables of the hypertensive patients. Method: Analytical cross-sectional research design was used. Study was conducted in Tata Main Hospital, Jamshedpur from March to December 2024 among 403 hypertensive patients. Total 403 samples were selected using a Consecutive non-random sampling technique. The data was collected using a Self- Structured Questionnaire and Structured questionnaires on health-related quality of life (SF-36). Results: Acquired data were analysed using descriptive and inferential statistics. The findings of the study show a considerable impact on health-related quality of life (HRQOL). The study emphasizes the importance of taking a comprehensive approach to hypertension management with a focus on enhancing overall quality of life. This study of 403 participants with hypertension found that 54.59% don't engage in vigorous activity, 55.83% exercise less than once a week, and 56.07% have had hypertension for over 20 years. Significant associations were found between lifestyle practices (p=3.8-9.49) and health outcomes, highlighting the importance of lifestyle in managing hypertension.

 

KEYWORDS: Hypertension, health related quality of life (HRQOL), lifestyle practices, socio-demographic variables, determine, hypertensive patients.

 

 

INTRODUCTION:

Health results from a complex interaction of individual factors (genetics, lifestyle) and social factors (education, occupation), along with medical care quality. Personal health assessment reflects how individuals perceive their well-being. WHO defines quality of life as one’s perception of their position in life within their cultural and value context.1 Hypertension, defined as systolic BP >140mmHg and diastolic BP >90mmHg, is a major global health issue.2 Effective nurse-led interventions, lifestyle modifications, and awareness programs are crucial to controlling hypertension.4 The WHO's first report on high blood pressure highlights its global impact, noting that four out of five cases are untreated. Expanding treatment coverage could prevent 76 million deaths by 2050.11 Hypertension is a major global health issue:

·       India: 24-30% (urban), 12-14% (rural)

·       Global impact: 13.5% premature deaths, 54% strokes, 47% ischemic heart disease

·       Projected 2025: 1.56 billion adults with hypertension.3

 

A 2019 study in Kurdish, Iran, by FatemehRajati et al. found that 15.7% of the population was hypertensive, with the highest prevalence (35.2%) in those aged 56–65. The mean systolic and diastolic BP were 108.5±17.6 mmHg and 69.8±10.2 mmHg, respectively, with BP increasing with age (p<0.001). Hypertension was more prevalent in women, significantly after 45years (p<0.05). Among 575 hypertensive participants, 80.7% were aware, 73.2% received treatment, and 53.3% had controlled BP. Lifestyle factors such as diet, obesity, smoking, alcohol use, and stress significantly contribute to hypertension. Health education and lifestyle changes can reduce systolic BP and lower cardiovascular disease risk.5 The term "lifestyle" has varied definitions across disciplines, with differing hypotheses and research variables.6 Georges Louis de Buffon coined "lifestyle" with "The style is the man himself." It is studied in sociology as social class and in psychology as individual behaviour.7 To control blood pressure without medication, identifying lifestyle factors like dietary alteration is key, as poor eating habits have contributed to rising hypertension rates in developing nations like Ghana.8 Hypertension affects three in ten South Asian adults, driven by poor diet, obesity, smoking, alcohol, stress, and inactivity, along with metabolic conditions.9 Maintaining a healthy lifestyle, including body mass index, nutrition, smoking, alcohol intake, sodium excretion, and sedentary behaviour, can lower systolic blood pressure (BP) by 3.5mm Hg and reduce the risk of cardiovascular disease (CVD) by 30%. Health education, when combined with lifestyle intervention techniques, can improve lifestyle factors such as reducing fat, salt, and sodium intake, switching to a more fruit and vegetable- based diet, quitting smoking, drinking less alcohol, engaging in regular exercise, maintaining a healthy body weight, and reducing stress.10

 

Meng Xiao et al. (2019) studied 567 hypertensive patients in Chongqing, China, finding that lower economic burden and regular exercise improved HRQOL. Women benefited from younger age, larger households, and emotional self-regulation, while men showed higher health scores with alcohol use and emotional self-regulation.12 U. Venkatesh, Ashoo Grover et al. (2015–2016) found hypertension prevalence was 17.2%, higher in urban (18.3%) than rural areas (15.5%) and in males (18.2%) than females (16.1%), despite greater lifestyle risks in rural settings.13 Identifying and modifying lifestyle factors can improve health-related quality of life in hypertension. Early intervention is crucial to prevent related complications, highlighting the need for further study in our population.

 

PROBLEM STATEMENT:

A cross-sectional study to assess heath related quality of life (HRQOL) and lifestyle practices among hypertensive patients in outpatient department of a hospital in Jamshedpur.

 

OBJECTIVES OF THE STUDY:

1.     To determine the health-related quality of life (HRQOL) among hypertensive patients.

2.     To determine the lifestyle practices of hypertensive patients.

3.     To find out the association between quality of life and lifestyle practices among hypertensive patients.

4.     To determine the association between health-related quality of life (HRQOL) with socio- demographic variables among hypertensive patients.

 

MATERIALS AND METHODS:

This study employed a descriptive survey approach with an analytical cross-sectional design to assess the health-related quality of life (HRQOL) and lifestyle practices among hypertensive patients visiting the General Medicine outpatient department at Tata Main Hospital, Jamshedpur. The hospital, a 983-bedded multi-speciality secondary care facility, serves a significant patient population, with 100-120 patients visiting the general medicine OPD daily.

 

The target population comprised adult hypertensive patients, while the accessible population included those with or without co-morbidities visiting the General Medicine OPD. A sample of 405 patients was selected using consecutive sampling technique, with a calculated sample size of 368 (using the formula n=Z²p(1-p)/d²) and a 10% inflation to account for potential non-response or incomplete data.

 

Inclusion criteria comprised adult hypertensive patients visiting the OPD, while exclusion criteria included patients with pain/discomfort and those unable to read/write in English or Hindi. Data collection utilized a self-structured questionnaire and the Short Form-36 (SF-36) tool to assess HRQOL among hypertensive patients.

 

Ethical permission was obtained from Principal, College of Nursing, Tata Main Hospital and Head of Department, General Medicine, Tata Main Hospital.

Data Collection Process:

After obtaining ethical committee approval, the study was conducted in the general medicine outpatient department from 12.09.2024 to 21.09.2024. Using consecutive sampling, participants meeting the inclusion criteria were selected. The researcher explained the study's purpose and benefits, emphasizing the relationship between hypertension, socio-demographic variables, and lifestyle practices, and assured respondents of confidentiality. Participants were screened for eligibility through verbal communication and blood pressure monitoring. Their language preference was noted, and both verbal and written consent were obtained from those meeting the inclusion criteria. The consenting participants then completed two tools: a lifestyle practices questionnaire (Tool 1) and the SF-36 quality of life survey (Tool 2), which took approximately 15 minutes to complete under the researcher's supervision.

 

RESULT :

Bio-Physiologic Characteristics:

Bio-physiologic measurement reveals that the majority of adults (59.31%) were overweight, with 38.71% having normal weight and 1.98% being underweight. Additionally, most participants had mild hypertension (52.11%), with 33.75% having normal blood pressure, 12.66% having severe hypertension, and 1.48% having moderate hypertension. A significant proportion (55.83%) also reported a family history of hypertension, compared to 40.70% with no family history and 3.47% with unknown family history.

 

Sociodemographic Characteristics:

Socio demographic characteristics reveals the demographic characteristics of the sample. The majority (77.67%) were from urban areas, married (85.36%), and lived with family (94.79%). Most participants had a joint family structure (75.93%), were employed (59.06%), and belonged to the upper class (43.42%). Additionally, nearly half (49.87%) reported no comorbidities, while 43.18% had one comorbidity, and 6.95% had multiple comorbidities.

 

SECTION A:

Table 1: Frequency and percentage distribution according to Bio-physiologic measurements and demographic variables

Sl.

Characteristics of participants

Frequency

Percentage

1.

BMI

 

 

 

Under weight (<18kg/m2)

8

1.98%

 

Normal (18 to 24 kg/m2)

156

38.71%

 

Over weight (>24 kg/m2)

239

59.31%

2.

Blood Pressure

 

 

 

Normal (130/85 mmHg)

136

33.75%

 

Mild hypertension (160/100 mmHg)

210

52.11%

 

Moderate hypertension (180/110 mmHg)

6

1.48%

 

Severe hypertension (180/120 mmHg)

51

12.66%

3.

Family history of Hypertension

 

 

 

Yes

225

55.83%

 

No

164

40.70%

 

Unknown

14

3.47%

 

DEMOGRAPHIC VARIABLES

 

 

4.

Area of residence

 

 

 

Rural

90

22.33%

 

Urban

313

77.67%

5.

Marital status

 

 

 

Single

16

3.97%

 

Married

344

85.36%

 

Divorced

5

1.24%

 

Widowed

38

9.43%

6.

Living status

 

 

 

Living alone

15

3.72%

 

Living with family

382

94.79%

 

Living with caregivers

5

1.24%

 

Living in any organization

1

0.25%

7.

Family structure

 

 

 

Nuclear

84

20.84%

 

Joint

306

75.93%

 

Extended

4

1.00%

 

Broken

9

2.23%

8.

Occupational status

 

 

 

Student

7

1.74%

 

Employed

238

59.06%

 

Self-Employed

20

4.96%

 

Unemployed

69

17.12%

 

Retired

69

17.12%

9.

Socio-economic status

 

 

 

Upper class (Rs 9098 per month and above)

175

43.42%

 

Upper middle class (Rs 4549-Rs 9097 per month)

83

20.60%

 

Middle class (Rs 2729-Rs 4550 per month)

72

17.87%

 

Lower middle class (Rs 1365 – Rs 2728 per month)

48

11.91%

 

Lower class (Below Rs 1365 per month)

25

6.20%

10.

Any other long-term illness

 

 

 

No comorbidity

201

49.87%

 

One comorbidity

174

43.18%

 

More than one comorbidity

28

6.95%

 

SECTION B:

Table 2: This section represents the quality of life among the participants in each domain.

Sl. No.

Domains

Good quaity of life (gqol)

Poor quality of life (pqol)

1

Physical functioning (PF)

51.87%

48.13%

2

Role limitation due to physical health (RP)

43.90%

56.10%

3

Role limitation due to emotional problem (RE)

63.77%

36.23%

4

Energy\Fatigue (VT)

61.70%

38.30%

5

Emotional wellbeing (MH)

55.83%

44.17%

6

Social functioning (SF)

51.90%

48.10%

7

Pain (BP)

57.07%

42.93%

8

General health (GH)

50.30%

49.70%

 

SECTION C:

Association of life style practices with the domain of HRQOL:

This section reveals significant associations between various lifestyle practices and health-related quality of life domains. Physical functioning was linked to vigorous intense activity, exercise intensity, hypertension duration, fasting habits, salt intake, and sleep patterns. Role limitations due to physical health were associated with exercise intensity, hypertension duration, diet, substance use, and sleep patterns. Energy/fatigue was linked to exercise intensity, hypertension duration, diet, and sleep patterns. Social functioning, pain, and general health also showed significant associations with various lifestyle practices, while emotional well-being showed no significant associations.

 

Table 3: This section represents the association of lifestyle practices with the domains of health-related quality of life.

DOMAINS

PF

RP

RE

VT

MH

SF

BP

GH

 

 

 

Vigorous intense activity

 

 

χ2

22.20*

2.72

0.06

2.94

0.77

5.00*

11.40*

6.90*

df

1

1

1

1

1

1

1

1

p table value

3.8

3.8

3.8

3.8

3.8

3.8

3.8

3.8

 

 

 

 

Exercise

 

 

 

χ2

13.80*

17.69*

1.35

17.13*

3.72

3.69

11.37*

16.32*

df

3

3

3

3

3

3

3

3

p table value

7.82

7.82

7.82

7.82

7.82

7.82

7.82

7.82

 

 

 

Hypertension diagnosis time

 

 

χ2

28.42*

8.93*

0.82

9.57*

1.64

2.90

0.84

6.60*

df

2

2

2

2

2

2

2

2

p table value

5.9

5.9

5.9

5.9

5.9

5.9

5.9

5.9

 

 

 

 

Dietary habits

 

 

 

χ2

5.10

9.03*

4.45

79.80*

5.92

3.13

0.95

4.28

df

3

3

3

3

3

3

3

3

p table value

7.82

7.82

7.82

7.82

7.82

7.82

7.82

7.82

 

 

 

 

Fasting habits

 

 

 

χ2

25.90*

3.02

5.19

4.44

0.26

2.49

2.95

3.06

df

2

2

2

2

2

2

2

2

p table value

5.9

5.9

5.9

5.9

5.9

5.9

5.9

5.9

 

 

 

 

Additional salt intake

 

 

χ2

6.70*

3.14

3.90

0.48

0.80

10.17*

7.99*

6.25*

df

2

2

2

2

2

2

2

2

p table value

5.9

5.9

5.9

5.9

5.9

5.9

5.9

5.9

 

 

 

 

Substance use

 

 

 

χ2

7.68

9.70*

9.40*

4.05

2.45

4.72

10.48*

3.94

df

3

3

3

3

3

3

3

3

p table value

7.82

7.82

7.82

7.82

7.82

7.82

7.82

7.82

 

 

 

 

Sleeping pattern at day time

 

 

χ2

19.80*

18.49*

0.01

1.38

2.26

5.04*

7.54*

2.92

df

1

1

1

1

1

1

1

1

p table value

3.8

3.8

3.8

3.8

3.8

3.8

3.8

3.8

 

 

 

 

Sleeping pattern at night time

 

 

χ2

11.50*

62.81*

2.48

7.82*

6.37

11.19*

8.59*

4.42

df

3

3

3

3

3

3

3

3

p table value

7.82

7.82

7.82

7.82

7.82

7.82

7.82

7.82

*=Significant

 

Table 4: This section represents the association of socio-demographic variables with the domains of health-related quality of life.

DOMAINS

PF

RP

RE

VT

MH

SF

BP

GH

 

 

 

Area of residence

 

 

 

χ2

1.65

0.25

0.38

0.02

0.003

0.23

1.27

8.68*

df

1

1

1

1

1

1

1

1

p table value

3.8

3.8

3.8

3.8

3.8

3.8

3.8

3.8

 

 

 

Marital status

 

 

 

χ2

6.30

5.20

0.42

3.90

2.27

1.22

66.73*

6.81

df

3

3

3

3

3

3

3

3

p table value

7.82

7.82

7.82

7.82

7.82

7.82

7.82

7.82

 

 

 

Living status

 

 

 

χ2

2.01

1.91

1.56

2.64

1.84

1.09

2.57

3.40

df

3

3

3

3

3

3

3

3

p table value

7.82

7.82

7.82

7.82

7.82

7.82

7.82

7.82

 

 

 

Family structure

 

 

 

χ2

9.97*

14.36*

2.19

6.44

6.59

14.61*

4.19

6.69

df

3

3

3

3

3

3

3

3

p table value

7.82

7.82

7.82

7.82

7.82

7.82

7.82

7.82

 

 

 

Occupational status

 

 

 

χ2

34.42*

20.77*

1.93

11.50*

8.83

20.57*

16.29*

8.90

df

4

4

4

4

4

4

4

4

p table value

9.49

9.49

9.49

9.49

9.49

9.49

9.49

9.49

 

 

 

Socio-economic status

 

 

 

2 chi

3.83

8.56

31.30*

9.12

15.02*

7.60

5.50

16.85*

df

4

4

4

4

4

4

4

4

p table value

9.49

9.49

9.49

9.49

9.49

9.49

9.49

9.49

 

 

 

Any other long-term illness

 

 

 

χ2

10.30*

1.36

2.27

78.81*

4.60

2.98

7.70*

7.40*

df

2

2

2

2

2

2

2

2

p table value

5.9

5.9

5.9

5.9

5.9

5.9

5.9

5.9

*=Significant

 

SECTION D:

Association of socio – demographic variables with the domain of HRQOL:

This section reveals significant associations between various socio-demographic variables and health-related quality of life domains. Physical functioning, role limitations due to physical health, and social functioning were linked to family structure and occupational status. Energy/fatigue and emotional well-being were associated with socio-economic status. Role limitations due to emotional problems were also linked to socio-economic status. Pain was associated with marital status and occupational status, while general health was linked to area of residence, socio-economic status, and presence of other long-term illnesses.

 

DISCUSSION :

The present study reveals that the mean and standard deviation of the physical functioning as 57.70±27.88, Role limitation due to physical health 54.30±38.50, Role limitation due to emotional problem 61.80±37.30, Energy and fatigue 54.90±15.90, emotional well-being 63.70±14.30, Social functioning 69.90±20.20, Pain66.60±19.60 and general health as 53.60±13.20. similar study was conducted in Manmohan cardiothoracic vascular and transplant center, Kathmandu where that mean value and standard deviation of physical functioning was 68.30±24.50, Role limitation due to physical functioning was 47.38±47.99, Role limitation due to emotional Problem was 48.58±40.28, Energy and fatigue was 63.16±20.61, emotional well-being was 78.66±18.12, Social functioning was 90.60±18.60, Pain was 73.69±27.13 and General health was 55.88±22.08.

 

In this study has total of 403 hypertensive participants were included among them according to BMI majority belongs to overweight group (59.5%), majority of the sample were mild hypertensive patients (52.11%),majority of the participant had family history of hypertension (55.83%).Among 403 participants, majority of the participants were residing in the urban area (77.67%), a higher percentage were married (85.36%), most of the participants were living with there family (94.79%), majority of the sample belongs to nuclear family 20.84%. A higher percentage of them were employed (59.06%), majority of them belongs to upper class with income of Rs 9098 per month and above (43.42%). The majority of the samples have no comorbidity (49.87%).

 

 Nursing professionals play a vital role in caring for hypertensive patients through practice, research, education, and administration, focusing on assessment, personalized interventions, health education, and collaboration. To enhance care, comprehensive health assessments using standardized tools like SF-36 are essential to evaluate physical, psychological, and social health, and identify factors impacting quality of life.

 

This study has limitations, including its focus on outpatient department visitors, which may not represent all hypertensive patients. Additionally, the reliance on self-reported data introduces potential biases and inaccuracies, as patients may provide socially desirable responses rather than accurate reports of their behaviours.

 

Future research directions include conducting observational cross-sectional studies among hypertensive patients and non-hypertensive individuals to explore treatment outcomes and awareness.

 

Additional studies can investigate awareness, treatment, and control of hypertension in the Indian adult population, inter-domain associations, and associations between specific questions and variables, providing further insights into hypertension management.

 

CONCLUSION:

This research investigated the health-related quality of life (HRQOL) of individuals with hypertension, uncovering significant declines in physical and emotional well-being. Key factors such as age, gender, and co- existing health conditions were found to influence HRQOL. The study underscores the importance of adopting a comprehensive approach to hypertension management, prioritizing enhancements to overall quality of life.

 

CONFLICT OF INTEREST:

The authors have no conflicts of interest regarding this investigation.

 

ACKNOWLEDGEMENTS:

We express our heartfelt gratitude to Almighty God for his blessings. Special thanks to Air Vice Marshal (Rtd.) Dr. Sudhir Rai, Ms. Upama De (Principal, College of Nursing, Tata Main Hospital), Dr. Ashok Sunder (Head of the Department, General Medicine, Tata Main Hospital), consultants and medical professionals, Ms. Shalini S. (Vice Principal, College of Nursing, Tata Main Hospital) for their invaluable guidance. We extend our gratitude to our mentors Ms. Upama De (Guide) and Ms. Grace Das (Co-Guide). We truly appreciate support from faculty members, librarian, staff and friends for their constant support.

 

ETHICS AND CONSENT:

This study adhered to ethical principles, ensuring participant confidentiality and anonymity. Informed consent was obtained from all participants through a comprehensive consent form, which explained the study's purpose and benefits. Participants were assured of confidentiality, anonymity, and voluntary participation, and signed and dated the form. The study was approved by the Principal, College of Nursing, Tata Main Hospital, Head of the Department, General Medicine, Tata Main Hospital.

 

REFERENCE:

1.      Suciu Liana, Cristescu Carmen et al. The Impact of Hypertension and associated comorbidities on quality-of-Life assessment questionnaire SF-36 V2. Farmacia. 2013; 61(3): 504.

2.      Iqbal Muhammad Arshad, Jamal F. Syed. Essential Hypertension. National Library of Medicine. 2023; 1-9.

3.      First WHO Report details devastating impact of hypertension and ways to stop it, New York, 2023. available on https://surl.gd/rrdcsf

4.      Eenu, Sheoran Poonam, SarinJyoti. Effectiveness of nurse led Intervention regarding management of hypertension on awareness, treatment compliance, life style and quality of life among hypertensive adults: A systematic review. Indian Journal of Forensic Medicine & Toxicology .2021; 15(2): 127.

5.      RajatiFatemeh et al. Prevalence, awareness, treatment, and control of hypertension and their determinants: Results from the first cohort of non-communicable diseases in a Kurdish settlement. Scientific Reports. 2019;2.

6.      Gremigni Paola and Casu Giulia. Narrative Review and Analysis of the Use of “Lifestyle” in Health Psychology. National Library of Medicine. 2023; 1.

7.      Brivio Francesca, Vigano Anna et al. Narrative Review and Analysis of the Use of “Lifestyle” in Health Psychology. Academic Open Access Publishing. 2023; 20(5): 1-10.

8.      Dickey A Richard, Janick J John. Lifestyle Modifications in the prevention and treatment of hypertension. Science Direct. 2001; 7(5): 392-399.

9.      Beilin LJ. Lifestyle and hypertension-an overview. Taylor and Francis Online. 1999; 21(5-6): 749-762.

10.   Buda SiyumEyasu, HanforeKelbisoLolemo et al. Lifestyle modification practice and associated factors among diagnosed hypertensive patients in selected hospitals, South Ethiopia. Clinical Hypertension. 2017; 23(26): 1-9.

11.   Hypertension.WHO.https://www.who.int/news-room/factsheets/detail/hypertension

12.   Xiao Meng, Zhang Fan et al. Health-Related Quality of Life of Hypertension Patients: A Population-based Cross-Sectional Study in Chongqing, China. International Journal of Environmental Research and Public Health.2019;16(13):1-2.

13.   Venkatesh U, Grover Ashoo et al. Urban-Rural disparities in blood pressure and lifestyle risk factors of hypertension among Indian individuals. Journal of Family Medicine and Primary Care. 2022; 11(9): 5476- 5480

14.   https://dictionary.cambridge.org/dictionary/english/assess

15.   https://www.britannica.com/topic/quality-of-life

16.   Brivio Francesca, Vigano Anna et al. Narrative review and analysis of the use of “lifestyle” in health psychology. Academic Open Access Publishing.2023;20(5):1-10

17.   https://www.who.int/newsroom/factsheets/detail/hypertension#:~:Text=Hypertension%20(high%20bloo%20pressure)%20is,get%20your%20blood%20pre3ssure%20checked

18.   https://en.m.wikipedia.org/wiki/Outpatient_department#:~:text=An%20outpatient%20department%20or%20outpatient,be%20admitted%20for%20overnight%20care

19.   https://sphweb.bumc.bu.edu/otlt/mphmodules/sb/behavioralchangetheories/beha vioralchangetheories2.html

20.   Bhagat Kumar Sanjeev, Mahajan Harsh, Srivastava Shalini, JunejaKhushboo. Quality of life and its determinants among hypertensive patients in a rural area of district Gautam Buddha Nagar, Uttar Pradesh – A community-based cross-sectional study. Journal of Family Medicine and Primary Care. 2024 ;13(2): 607- 612

21.   Patil Mansi, Hedaoo Prashant Radhika. Assessment of Health-Related Quality of Life Among Male Patients With uncontrolled and Uncontrolled Hypertension in Semi Urban India. Sage Journals. 2023; 60: 1-8.

22.   Chhetri R., Bista B. Health related quality of life of hypertensive patients attending a tertiary level hospital in Kathmandu. Journal of Manmohan Memorial Institute of Health Sciences. 2023; 8(1): 11-23.

23.   Cong, Tran Duy. Health related quality of life and associated factors among hypertensive patients. Journal Of Hypertension. 2022; 40(Suppl 1): e228-e229.

24.   AdamuIKidist, FelekeAmsalu. Health related quality of life among adult hypertensive patients on treatment in Dessie City, Northeast Ethiopia. PLOS ONE. 2022; 17(9): 1-11.

25.   Mannan Adnan, AkterMahmudaKazi, Association between comorbidity and health-related quality of life in a hypertensive population: a hospital-based study in Bangladesh. BMC Public Health. 2022; 22(181): 1- 10

26.   Sang Shengxiang, Kang Ning. The influencing factors of health-related quality of life among rural hypertensive individuals: a cross-sectional study. Health and Quality of Life Outcomes. 2021; 19(244): 1-8

27.   Alshammari A Sulaiman, Alajmi N Anajmi. Quality of Life and Awareness of Hypertension Among Hypertensive Patients in Saudi Arabia. National Library of Medicine. 2021; 13(5): 1-8.

28.   Shah B Rima, Patel M Juhi. Determinants of health-related quality of life in patients with hypertension. National Journal of Physiology, Pharmacy and Pharmacology. 2020; 10(3): 262-268.

29.   Alsaqabi S Yasir, Rabbani Unaib. Medication Adherence and Its Association with Quality of Life Among Hypertensive Patients Attending Primary Health Care Centers in Saudi Arabia. National Library of Medicine. 2020; 12(12):1- 11

30.   G Geremew, F Ambaw. Adherence to Lifestyle Modification Practices and Its Associated Factors Among Hypertensive Patients in Bahir Dar City Hospitals, North West Ethiopia. Dovepress. 2023; 2023(16): 111- 120.

31.   Rahimi Amir, NkombuaLushiku. Hypertensive patients’ knowledge and practices on lifestyle modification in Extension 6, Middelburg. National Library of Medicine. 2022; 64(1): 1-6.

32.   Dhakal Amrita, KC Takma. Adherence to lifestyle modifications and its associated factors in hypertensive patients. Journal Of Clinical Nursing. 2021; 31(15-16) : 2181-2188.

33.   SmachewMoges, MelakFentieMelkitu. Lifestyle Modification Practice and Associated Factors Among Diagnosed Hypertensive Patients in Selected Hospitals in Central Gondar Zone. Nutrition and Metabolic Insights. 2022; 15 :1-8.

34.   Tozivepi N Samantha, Takawira Simon. The Nexus Between Adherence to Recommended Lifestyle Behaviors and Blood Pressure Control in Hypertensive Patients at Mutare Provincial Hospital, Zimbabwe: A Cross-Sectional Study. Patient Preference and Adherence. 2021; 15: 1027-1036.

35.   Jumbo Dan Alali, Dienye O. Paul. Lifestyle practices among Hypertensive patients attending the family medicine clinic in a tertiary hospital in Nigeria. GSC Advanced Research and Reviews. 2021;6(2):170.

36.   Sefah Bernard, Onyame Addison. Knowledge, attitude and lifestyle practices pertaining to hypertension among the people of Ahoe-Ho. Journal of Hypertension and Management. 2021; 7(1): 1-6.

37.   Angelo Tadesse Abiy, Geltore Ermias Teketel. Lifestyle modification practice and associated factors among hypertensive patients in Mizan Tepi University Teaching Hospital South West Ethiopia, 2019: cross-sectional study. PAMJClinical Medicine. 2020; 2:56-61.

38.   Joardar Islam Ariful, Khaled Islam Fakhrul Md. Factors Associated with Hypertension among Urban Dwellers with Sedentary Lifestyle: A crosssectional study. Journal of National Institute of Neurosciences Bangladesh .2020; 6(2):129-132.

39.   Idris M. Idris, WoldayJ.Samuel. Factors Influencing Lifestyle Modification Practice among Hypertensive Patients: A cross-sectional study in two selected Eritrean Hospitals. Global Journal of Medical Research: I Surgeries and Cardiovascular System. 2020; 20(4): p.2-6.

40.   Sharma K. Suresh. Research approach and Design.In: Nursing Research and Statistics.3rd edition, New Delhi: Elsevier. 2018. p.236-240

41.   https://www.sciencedirect.com/topics/nursing-and-health-professions/shortform-36

42.   Ahmed Mahmud Sindew, BerhaneAynie. Health related quality of life and associated factors among hypertensive patients attending public hospitals in Addis Ababa, Ethiopia, 2024. Science Direct. 2024;50(1)

 

 

Received on 02.06.2025         Revised on 24.06.2025

Accepted on 12.07.2025         Published on 13.08.2025

Available online from August 20, 2025

Asian J. Nursing Education and Research. 2025;15(3):126-132.

DOI: 10.52711/2349-2996.2025.00027

©A and V Publications All right reserved

 

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. Creative Commons License.