AGE, OBESITY, SATURATED FAT CONSUMPTION, AND SMOKING HABITS AS RISK

FACTORS ON THE INCIDENCE OF PRIMARY HYPERTENSION IN WEST COAST

REGION, PASAR KRUI ON AUGUST 2023

Regu 3 Perjalanan dan Penelitian Anggota Muda XXVI AMP

Faculty of Medicine, Universitas Padjajaran, Bandung, Indonesia

Author(s)
1st author: Shabrina Adam
Full Name (with Academic degree(s)): Shabrina Aghniya Adam, S.Ked.
Affiliation: Faculty of Medicine, Universitas Padjajaran
Address: Jatinangor, Sumedang
Phone: 081931481058
Email: shabrina20002@mail.unpad.ac.id

2nd author: Alifiansyah Muharram

Full Name (with Academic degree(s)): Alifiansyah Muharram, S.Ked.
Affiliation: Faculty of Medicine, Universitas Padjajaran
Address: Jatinangor, Sumedang
Phone: 081931481058
Email: alifiansyah20001@mail.unpad.ac.id

3rd author: Kevin Arya Prayoga

Full Name (with Academic degree(s)): Kevin Arya Prayoga, S.Ked.
Affiliation: Faculty of Medicine, Universitas Padjajaran
Address: Jatinangor, Sumedang
Phone: 081931481058
Email: kevin20001@mail.unpad.ac.id

4th author: Vanessa Ettenia Setiawan

Full Name (with Academic degree(s)): Vanessa Ettenia Setiawan, S.Ked.
Affiliation: Faculty of Medicine, Universitas Padjajaran
Address: Jatinangor, Sumedang
Phone: 081931481058
Email: vanessa20001@mail.unpad.ac.id

5th author: Rafalya Masyitha

Full Name (with Academic degree(s)): Rafalya Masyitha, S.Ked.
Affiliation: Faculty of Medicine, Universitas Padjajaran
Address: Jatinangor, Sumedang
Phone: 081931481058
Email: rafalya20001@mail.unpad.ac.id

6th author: Dessy Fernanda Mirip

Full Name (with Academic degree(s)): Dessy Fernanda Mirip, S.Ked.
Affiliation: Faculty of Medicine, Universitas Padjajaran
Address: Jatinangor, Sumedang
Phone: 081931481058
Email: dessy20001@mail.unpad.ac.id

7th author: Navita Azzahra

Full Name (with Academic degree(s)): Navita Azzahra
Affiliation: Faculty of Medicine, Universitas Padjajaran
Address: Jatinangor, Sumedang
 Phone: 081931481058
Email: navita20001@mail.unpad.ac.id

ABSTRACT

Background: This study focuses on primary hypertension, which refers to the elevation of
blood pressure above normal levels without an identifiable underlying cause, and its prevalence
in Kabupaten Pesisir Barat, Lampung Province, Indonesia. With a growing incidence of
hypertension and its association with cardiovascular complications, this research investigates
the current occurrence of the condition and its influencing risk factors within the community.
By analyzing data from Puskesmas Krui in August 2023, the study aims to provide insights that
can contribute to the optimization of non-communicable disease prevention and control
programs in the region, promoting healthier lifestyles and addressing modifiable risk elements.
Method: This was an observational analytic study of people in Kabupaten Pesisir Barat. Subject
of this study consists of 77 respondents. Primary Data was collected on August 16 at Krui
Public Health Center (Pusat Kesehatan Masyarakat, Puskesmas). The statistical analysis was
processed using the Chi-Square test.
Results: The risk factors of primary hypertension incidence that were statistically significant
with a p value < 0.050 were old age (p=0,000), obesity (p=0.026), saturated fat consumption
(p=0.004), and smoking habits (p=0.033).
Conclusions: There is a significant relationship between old age, obesity, fatty food
consumption habits, and smoking with the incidence of hypertension in people of Kabupaten
Pesisir Barat.
Keywords: Fat Food; Old Age; Obesity; Primary hypertension; Risk factors; Smoking

I.INTRODUCTION

Primary hypertension, also known as essential hypertension, is an elevation of blood

pressure above normal levels within the circulatory system. Guidelines from Eighth Joint
National Committee (JNC VII) define hypertension with systolic blood pressure above 140
mmHg and diastolic blood pressure above 90 mmHg. Initially, this condition often remains
asymptomatic leading to be undetected before complications involving the heart and blood
vessels arise. The prevalence of hypertension in Indonesia has increased, reaching 34.1%
according to the 2018 Riskesdas. In Lampung Province, essential hypertension cases
reached 174,891 with a prevalence of 19.58%. Kabupaten Pesisir Barat, one of the
populated district in lampung, has the lowest life expectancy. Hypertension is a leading
cause of death, particularly through complications from the heart and blood vessels.

Various risk factors contribute to hypertension, including family history, age, gender,
ethnicity, nutrition, stress, obesity, exposure to harmful substances like smoking and
excessive alcohol, and insufficient physical activity. The first line management of
hypertension is through lifestyle modification. Thus, hypertension control necessitates a
healthy lifestyle and the management of modifiable risk factors.

This study aims to analyze the incidence of hypertension and its associated risk factors
in Kabupaten Pesisir Barat. This research is crucial in supporting non-communicable
disease prevention programs in the region. The study will take place at Puskesmas Krui,
Kabupaten Pesisir Barat, and will be written under the title "Age, Obesity, Saturated Fat
 Consumption, and Smoking Habits as Risk Factors on The Incidence of Primary
Hypertension in West Coast Region, Pasar Krui on August 2023".

II. METHODS
This research was conducted using an observational analytic method with a cross-
sectional design, analyzing the relationship between the independent variable (risk factor)
and the dependent variable (primary hypertension) by taking measurements at one time.
This research analyzed the relationship between age, gender, family history, salty food
consumption habits, saturated fat consumption habits, obesity, smoking habits, and exercise
habits on the incidence of primary hypertension. Both variables are grouped into categorical
data. Thus, the statistical test used is the “Chi Square test”.
Minimum of age range that were included in this study are 15 years old. Family history
of hypertension are relatives such as father, mother, child, or grandmother or grandfather
who are consuming hypertension medication or diagnosed with hypertension. A person is
said often consuming salty food if someone eats salty food more than 3 times a week with
more than 1 teaspoon per meal. A person is said often consuming fatty foods if someone
likes to eat fried foods, offal, mutton, beef, and eats them 3 times a week or more. The
criteria for having a good exercise habit are if someone is used to exercising regularly 3-5
times every week such as running, cycling, swimming, jumping rope for 30-45 minutes.
The sampling method used in this study was non-probability sampling with a
convenience sampling approach. The samples selected in this study were the respondents
who can be reached by the researcher, namely the people of Kabupaten Pesisir Barat who
came to Puskesmas Krui and are willing to become research subjects by filling out an
informed consent form. Data was collected at Puskesmas Krui on August 16 2023. Primary
data were obtained from questionnaires asked to respondents and from the results of blood
pressure measurements. The study was approved by Puskesmas Krui with a registered
number 440/265/Pkm.Krui/VIII/20023.

III. RESULTS
In total, 77 respondents had participated in this study. There were 40 respondents (52%)
with normal blood pressure and 37 respondents (48%) with hypertension among
respondents (Table 1). Based on the analysis, there is a significant relationship in obesity
(p=0.026), saturated fat consumption (p=0.004), and smoking habits (p=0.033) (Table 2)
with the incidence of primary hypertension.

Table 1. Univariate Analysis Results

No Variable Hypertension Incidence Total

Hypertension Non-Hypertension
n % n % n %
Age
Old Age 18 90 2 10 20 25
Adult 19 40 38 60 57 75
Sex
Male 16 47 18 53 34 44
Female 21 49 22 51 43 56
Obesity
Obesity 30 57 23 43 53 69
Normal 7 30 17 70 24 31
Family History
Exist 19 50 19 50 38 49
None 21 54 18 46 39 51
 Fatty Food Consumption
Often 30 60 20 40 50 65
Rare 7 26 20 74 27 35
Salty Food Consumption
Often 13 40 20 61 33 43
Rare 24 55 20 46 44 57
Smoking Habits
Smoke 28 59 20 41 48 62
None 9 31 20 69 29 38
Exercise Habits
Often 17 49 18 51 35 45
Rare 20 48 22 52 42 55

Table 2. Bivariate Analysis Results

No Variable P Value OR 95% CI

1 Age 0.000* 17.526 3.675 - 83.580

2 Sex 0.877 1.074 0.436 – 2.643

3 Obesity 0.026* 3.168 1.126 – 8.911

4 Family History 0.736 1.167 0.477 – 2.855

5 Saturated Fat Consumption 0.004* 4.286 1.530 – 12.005

6 Salty Food Consumption 0.188 1.846 0.738 – 4.616

7 Smoking Habits 0.033* 3.111 1.175 – 8.238

8 Exercise 1.000 0.963 0.392 – 2.362

OR: Odds Ratio

CI: Confidence Interval

IV. DISCUSSION

Primary hypertension, also known as essential hypertension, is a chronic medical

condition characterized by elevated blood pressure levels persistently higher than normal,
without an identifiable underlying cause. It is a common condition and can lead to serious
health problems if not managed. Blood pressure is influenced by two main factors: cardiac
output and total peripheral resistance. So, anything that altered the total of these factors can
contribute to the elevation of blood pressure, such as age, sex, family history, saturated fat
consumption, salty food consumption, smoking habits, and exercise.
The results of this study show that the average age of research subjects suffering from
hypertension was 57.6 ± 12.3. Based on these results, it was also found that the age range
for hypertension sufferers was 45-70 years. The results of statistical tests also show that
there is a relationship between age and the incidence of hypertension with a p-value of
0.000.
The results of this research are supported by several previous studies. A research
conducted by Black and Hawks (2005) with an age range of 30 to 50 years statistically
proves that age is a risk factor associated with the incidence of hypertension. Sugiharto
(2007) also stated that age is related to the incidence of hypertension and is one of the risk
factors often found in hypertensive patients. Based on his research, it was found that those
aged 36-45 years had a 1.23 times higher risk of suffering from hypertension, those aged
45-55 years had a 2.22 times higher risk, and those aged 56-65 years had 4.76 times higher
risk of suffering from hypertension than younger individuals.
The increase in incidence of hypertension is influenced by old age and can be
influenced by several factors. This is associated with anatomical and physiological changes
in the cardiovascular system. As we age, the walls of the ventricles and heart valves thicken,
and the elasticity of blood vessels decreases. This condition can have an impact on
increasing pressure and heart work, resulting in an increase in blood pressure.
The results of research conducted on 34 female subjects and 43 male subjects showed
that statistical tests did not show any significant relationship between gender and the
incidence of hypertension (p = 0.877). This finding aligns with previous research conducted
in Lampung Regency, which similarly found no association between gender and the
incidence of hypertension. Until now, no theory suggests that gender is more susceptible to
hypertension.
The result of this study showed that more than half of the research subjects were obese
(68%). From the subjects that were obesed, 56.6% suffered from. The results of statistical
tests show that there is a significant relationship between obesity and the incidence of
hypertension with a p value of 0.026. Research subjects subjects who are obese is more
likely to suffer from hypertension than subjects with normal body mass index.
This is in accordance with the research from Survey Keluarga Indonesia V which states
that obese people have a higher risk of hypertension. Of the 30,133 families surveyed, obese
individuals are 4 times more at risk of suffering from hypertension than individuals with
normal body mass index. Obesity can increase blood pressure directly or indirectly.
Directly, obesity can result in increased cardiac output. The greater the body mass, the
greater the amount of circulating blood and this causes cardiac output to increase.
Meanwhile, indirectly, obesity stimulates the activity of the sympathetic nervous system
and the Renin Angiotensin Aldosterone System (RAAS) by mediators such as cytokines,
hormones and adipokines. Thus, obesity is a risk factor for hypertension that influences the
incidence of hypertension.
The results of this study showed that 50% of subjects had a family history of
hypertension. Subjects who had a family history of hypertension had the same percentage
of hypertension events compared to subjects who did not have a family history of
hypertension. The results of this research show that there is no significant relationship
between family history and hypertension. This may be caused because the sample of this
study is not large enough so it does not describe the family history of people who have
hypertension.
This study showed that there was no significant relationship between the habit of
consuming salty foods and the incidence of hypertension (p=0.250). This research does not
align with the research conducted by Patricia N. et al. at the Ranomuut Health Center in
Manado City which found that there was a relationship between consumption of salty foods
and the incidence of hypertension in the elderly. The differences from the group subjects
who are elderly may be the explanation of the different results.
Research conducted by Rusliafa J et al. (2014) showed that coastal communities suffers
more hypertension, this is due to a higher consumption of sodium in processed and salted
seafood. The results of Mahmudah's study (2016) showed that a sodium intake of 4.627
gram could mean that subjects with excessive sodium intake had a 4.627 times greater risk
of experiencing hypertension than subjects with good sodium intake. Thus, sodium intake
and consumption may contribute to primary hypertension incidence.
The results of the analysis of this study indicate that there is no relationship between
consumption of salty foods and hypertension. This may be caused because there are
different salt consumption habits in the coastal communities subject group.
 The results of this study showed that more than half of the research subjects frequently
consumed saturated fat (65%). From the subjects who often consume saturated fat foods,
39% suffer from hypertension. The results of statistical tests show that there is significant
a relationship between the habit of consuming saturated fat and the incidence of
hypertension with a p value of 0.008. The results of this study also show that individuals
who have a habit of consuming saturated fat are 4 times more likely to suffer from
hypertension than subjects who rarely consume saturated fat.
Excessive intake of saturated fat can trigger atherosclerosis, which is a risk factor for
hypertension. Atherosclerosis causes an increased resistance in the walls of blood vessels
which will trigger an increase in heart rate and blood flow volume, causing an increase in
blood pressure. The results of research conducted by Herawati also show that individuals
who consuming fat has has a 9.37 times higher risk of hypertension compared to people
who do not usually consume fat.
In this study, from 58.3% people who smoke had hypertension. Based on previous
studies, smoking is often associated with the incidence of hypertension. These results are
also consistent with research, where a significant relationship was found between smoking
habits and the incidence of hypertension (P value = 0.033). This could be due to increase
of nicotine which mediates the activity of the sympathetic nervous system and the release
of the hormones such as epinephrine, norepinephrine, and vasopressin. The increases in
heart rate, blood pressure, blood glycerol and blood lactate/pyruvate ratio associated with
smoking may be adrenergic mediated; these changes are supposed to be caused by local
norepinephrine release from adrenergic axon terminals in the tissues. rather than an increase
in circulating catecholamines.
The results showed that most of the patients had a regular exercise. Data supporting
exercise habits in this study shows that most research subjects exercised for the ideal
duration which is 30-45 minutes per exercise. Even so, the results of statistical tests showed
no significant relationship (p=1.000) between exercise and the incidence of hypertension.
Among subjects who did not exercise regularly, 47.6% had high blood pressure. The
prevalence of hypertension may be influenced by physical activity (exercise) in research
subjects. According to Syatria (2006), regular exercise can lower blood pressure. Adequate
exercise can reduce the risk of cardiovascular disease and all causes of death, including
hypertension (Davis, 2004).

V. CONCLUSION
Based on the results of the research that has been done, it can be concluded that:
1. There is a relationship between old age and the incidence of hypertension with a p value
= 0.000 and OR = 17.526
2. There is a relationship between obesity and the incidence of hypertension with a p value
= 0.030 and OR = 3.168
3. There is a relationship between the habit of consuming fatty foods and the incidence of
hypertension with a p value = 0.008 and OR = 4.286
4. There is a relationship between smoking and the incidence of hypertension with a p
value = 0.033 and OR = 3.111
5. There is no relationship between the risk factors of gender, family history, salty food
consumption habits, exercise habits, and the incidence of hypertension (p value > 0.05)

Research conducted on the community of Pesisir Barat Regency in Krui Health Center
showed a significant relationship between old age, obesity, habit of consuming fatty foods,
and smoking with incidence of primary hypertension
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