INTRODUCTION:

WHO has chosen hypertension as the public health threat, and celebrated the world hypertension day every year. Hypertension also called as India’s silent killer. High blood pressure is both preventable and treatable. According to the report of WHO 2010, there was as estimated 972 million people with hypertension in the year 2000, 65% lived in developing world with the number predicted to grow to 1.5 billing by 2025.

This is especially in developing with high illiteracy rates (Maher, et, al.2010).

Celina (2013) studied the effectiveness of comprehensive nursing care package on health related quality of life among hypertensive clients seeking health careservices from OmayalAchi Community Health Center. The study concluded the Information Education Communiation package, counseling and warm foot bath both independently and cumulatively as nursing care package had a significant impact in improving the health related quality of life among hypertensive clients in the interventional group.

REVIEW OF LITERATURE:

Occupational health and safety is essential in preventing illness and promoting health and welfare of workers. Occupational nurses render health care services to the individuals, for their places of employment. Research in adult population neglected in many circumstances. If the blood pressure is normal or falls into pre hypertensive range, the health professionals take action for prevention of hypertension. Occupational health should aim at the promotion and maintenance of highest degree of physical, mental, social wellbeing of workers in all occupations. Experts says, in India large number of people’s blood pressure levels are in the range of 120 – 139\80 - 89 millimeter of mercury is called as pre-hypertensive category. WHO has selected hypertension as its theme for the year 2013(Kamala.G, 2013).

Merrill RM, etal, (2011) who has evaluated the best-practice worksite wellness programme in small employee setting found that yoga, Tai Chi, and Qigong therapy are the most useful exercises. The study also identified that worksites are the feasible channels for reaching the employed population

NEED FOR THE STUDY:

Rocckville (2011) a report from the Framingham Heart Study examined the incidence of hypertension (BP greater than 140/90 mmHg) over a four year period among patients who initially had optimal (less than 120/80 mmHg), normal (120-129/80-84 mmHg) or high normal (130-139/85-89 mmHg) BP. A four year (2008- 2011) progression to hypertension shows increase in the frequency of development of hypertension was observed in these three groups 5%, 18%, and 37%, respectively under 65 years 16%, 26%, and 50 %, respectively in 65+ years subjects

Prabakaran (2001) studied ten Indian industrial work sites regarding prevention of cardiovascular diseases. Risk factor surveillance was carried out. Health promotion education, counseling sessions and exercises like dancing were implemented. The intervention group showed a significant decline in mean body weight, blood pressure, and work stress perception.

STATEMENT OF THE PROBLEM:

Quasi experimental study to assess the relationship between lifestyle and Blood Pressure among pre hypertensive employees in a workplace hypertension prevention program

OBJECTIVES OF THE STUDY:

To find out the correlation between lifestyle and the level of Blood Pressure regarding prevention of hypertension among pre hypertensive employees.

HYPOTHESIS:

There will be a significant relationship between lifestyle and the level of Blood Pressure regarding prevention of hypertension among pre hypertensive employees.

METHODOLOGY:

Research Approach: Quantitative research approach

Research design: Quasi experimental design.

Research setting:

Eight cashew nut processing industries in Kalkulam Thaluk and Vilavancode Taluks gave permission to conduct the study.

Population:

The population of the study was the employees and the subjects with pre hypertension.

Sample:

Sphygmomanometer used to estimate pre hypertension among the 560 employees. 120 samples selected from selected cashew nut processing industries.

Criteria for sample selection:

Inclusion Criteria:

The pre hypertensive employees who were

· In the range of Systolic Blood Pressure 120-139 mm of Hg and/ or Diastolic Blood Pressure 80-89 mm of Hg.

· Who knows Tamil and/or English.

· Who present at the time of data collection

Sampling Technique:

Non random sampling Technique

Research Tool:

Sphygmomanometer used to estimate pre hypertension among the employees from the Selected industries. Two readings of blood pressure taken with the help of the sphygmomanometer at the interval of 5 minutes and the average if these reading was considered as the final reading. The blood pressure was categorized, and 120-139mm of Hg Systolic, 80-89 mm of Hg Diastolic Blood Pressure is pre hypertensive.

Lifestyle Assessment Scale regarding prevention of hypertension consists of 60 items which was used to assess the lifestyle activities of selected employees regarding prevention of hypertension. The score ranged from ‘0’ to ‘3’. The maximum attainable score was 180.

Content Validity:

Lifestyle Assessment Scale was prepared by the investigator based on the review of literature and were given to the experts in the field Community Health Nursing

Pilot study:

The pilot study was conducted among 12 pre hypertensive employees from an industry from Vilavancodu Taluk.

Ethical consideration:

The proposed study was conducted after the approval by the institutional ethical review committee and dissertation committee. Permission was obtained from the selected industries. The consent of the participants also be obtained.

Method of Data Collection Procedure:

The formal permission was obtained from the authorities of industries. The investigator introduce her to the subjects and establish a good rapport with them. A written consent was obtained from each subject. Appropriate orientation was given to the subjects about the aim of the study. The investigator will select the pre hypertensive workers with use of sphygmomanometer, who suit in the inclusion criteria. Workplace hypertension prevention program is a structured teaching programme includes two parts. Wellness teaching and training includes structured teaching regarding prevention of hypertension and skill training of group of wellness exercises for the pre hypertensive employees. At the end of the 7^thweek outcome measures on lifestyle and blood pressure level was measured with the participants

Plan for data analysis:

Karl Pearson Correlation was used to correlate between life style and level of BP among sample subjects.

RESULTS:

Correlation Between Post-test Lifestyle and Blood Pressure Score of Pre Hypertensive Employees.

Table 1 shows the post-test mean lifestyle score of pre hypertensive employees was 113.56 with a standard deviation of 7.73. The post-test mean Systolic Blood Pressure was 122.50 with a standard deviation of 6.37. Post-test lifestyle and Systolic Blood Pressure correlation score r = − 0.86, p > 0.001. This show life style score was negatively correlated with the Systolic Blood Pressure. This shows when lifestyle increases Systolic Blood Pressure decreases.

Table 2 shows the post-test mean lifestyle score of pre hypertensive employees was 113.56 with a standard deviation of 7.73. The post-test mean diastolic blood pressure was 79.6 with a standard deviation of 6.36. The post-test lifestyle and Diastolic Blood Pressure correlation score r = − 0.81 p > 0.001. This show life style score was negatively correlated with the diastolic blood pressure. This shows when lifestyle increases diastolic blood pressure decreases.

Table 1: Overall correlation between post- test lifestyle and Systolic Blood Pressure score among sample subjects.

S. No	Variables and paticipants range of items score (Max-Min)	Mid point	post test		r value	Inter pretation	Level of significance
			mean	SD
1	Life style(X) 170-131 130-91 90-51	150.5 110.5 70.5	113. 56	7.73	-0.86	Moderately negative co-relation	Table value 0.321 P > 0.001
2	Systolic Blood Pressure. mm of Hg(n=120) (Y) 100-119 120-139	100.5 129.5	122.50	6.37

Table 2: Overall correlation between post- test lifestyle and Diastolic Blood Pressure score among sample subjects.

S. No

Variables and paticipants range of items score (Max-Min)

Mid point

post test

r value

Inter pretation

Level of significance

mean

Life style (X)

170-131

130-91

90-51

150.5

110.5

70.5

113.56

7.73

-0.81

Moderately negative co-relation

Table value 0.321

P > 0.001

Diastolic Blood Pressure mm of Hg(n=120) (Y)

70-79

80-89

74.5

79.5

79.06

6.36

Figure 1: Scatter diagram representing the correlation of post-test lifestyle and SBP in sample subjects

Scatter diagram representing the correlation of post-test lifestyle and Systolic Blood Pressure score r = − 0.86, p > 0.001. This show life style score was negatively correlated with the Systolic Blood Pressure. This shows when lifestyle increases.

Figure 2: Scatter diagram representing the correlation of post-test lifestyle and DBP in sample subjects

Scatter diagram representing the correlation of post-test lifestyle and Diastolic Blood Pressure in sample subjects. The post-test lifestyle and Diastolic Blood Pressure correlation score r = − 0.81, p > 0.001. This show life style score was negatively correlated with the Diastolic Blood Pressure. This shows when lifestyle increases Diastolic Blood Pressure decreases.

DISCUSSION:

Young (2015) assessed the relationship between lifestyle factors and hypertension in a community dwelling Korean adults. 586 males and 1156 females more than 20 years old were selected as samples. Multi variant logistic regression analysis showed the sleep duration, education level, frequency of drinking and smoking status were not associated with hypertension status. Economic status and mental stress were significantly associated with hypertension. The result of this study showed that risk factors such as alcohol consumption, smoking, physical activity and unhealthy diet are modifiable. The results suggested that empowerment is important in motivating towards the behaviour change. Life style modification is the main approach in prevention of hypertension. Health care professionals play an important role in promoting and facilitating behaviour change.

Musini (2012) stated that The United States Department of Health and Human Services suggested to reduce Blood Pressure through lifestyle modifications. United States Department of Health and Human Services also released the Eighth Report of Joint National Committee recommending nine new guidelines on the management of adult hypertension. The greatest change is in patient’s aged ≥60 years to initiate pharmacologic treatment at Systolic Blood Pressure ≥ 150mmHg or Diastolic Blood Pressure ≥90 mmHg to a goal of Systolic Blood Pressure ≤150 mmHg and Diastolic Blood Pressure ≤90 mmHg. The new Eighth Report of Joint National Committee has not changed the parameters for the new Pre hypertension classification and lifestyle modification remains the recommended treatment.

CONCLUSION:

Lifestyle can be modified only by individual’s own decision. This can be achieved through adequate knowledge. Educational lifestyle modification program implemented in a workplace setting is feasible and can have a positive effect on lowering Blood Pressure among adults with pre hypertension. It reduces the rate of progression to hypertension with age and may prevent hypertension altogether. Therefore patients should make lifestyle adjustments and providers need to be more vigilant in monitoring, counselling, and adjusting their management of Blood Pressure, recognizing pre hypertension. Pre hypertension is not designated as a disease category or a diagnosis rather it is designed to identify those individuals at risk of developing hypertension. The published work is a part of the Tamilnadu Dr. MGR Medical University Chennai.

REFERENCES:

1. Celina,D, (2013)effectiveness of comprehensive nursing care package on health related quality of life among hypertensive clients seeking health care services from OmayalAchi Community Health Center, TNNMC, JCHN, Volume 1,issue 1, Jan-June 2013, page 13.

2. Kamala.G, (2013),Community health nursing, Florence publications, Hyderabad, second edition, page no 485.

3. Maher.D, smeethl, sekajugoj,(2010) Health transition Africa- practical policy proposal for primary guide, accessed January 2011.

4. Merrill RM.(2011). Evaluation of a best-practice worksite wellness programme in a small-employer setting using selected well-being indices. J Occup Environ Med. 2011 Apr;53(4):448-54.

5. Musini, V (2012). Evidence for practice – Cochrane hypertension report. Retrived from http:// hypertension. cochrane. org/ evidence – practice.

6. Prabakaran.D, Jeemon.P, et,al(2009)Worksite intervention programme on cardiovascular risk factors as Indian industrial population, World heart foundation, JACC, 2009;53;1718-1728.

7. Rockville, M.D. (2011). Framingham Heart Study. Article No :01-3290. Retrived from http://hp2010.nhibihin.net/atpiii/ calculater.asp

8. Young.W.(2015). Heart disease. Retrived from http:// www. med. yale. ed/ library/ heart. bk/ 21.pdf.

Received on 13.03.2019 Modified on 17.04.2019

Asian J. Nursing Education and Research. 2019; 9(3):323-326.

DOI: 10.5958/2349-2996.2019.00069.7