RISK FACTOR AND PREVALENCE OF HYPERTENSION IN THEEMPLOYEE OF CRACKERS FACTORY AT RANCAILAT VILLAGE, KRESEK COUNTY, BANTEN PROVINCE

Dian Mardhiyah*, Eriyasih, Nurjanah A, Pramita N, Rozalina Zakaria

1Public Health Department Faculty of Medicine, YARSI University Indonesia

*Corresponding Author's Email: dian_mardhiyah@yahoo.co.id

ABSTRACT

Introduction: Hypertension is one of the society health problems occurs in developing country as well as in the developed one. Hypertension is a disease which the systolic blood pressure reaches ≥ 140 mmHg and/or ≥ 90 mmHg for the diastolic. According to the reports of Kresek Primary Healthcare Center on health service in 2017, hypertension is the second highest disease occurs in Kresek County. Method: This study has a purpose to find out correlation between hypertension risk factors and hypertension incidence on The Haji Oman Traditional Crackers Factory. The population in this study was 30 labors from Haji Oman Traditional Crackers Factory. The result showed that there was correlation between smoking as the risk factor of hypertension, and hypertension incidence (p<0.035). Although the other risk factors did not show any significant correlation. The population with hypertension were 73.3% (22 people), prehypertension 10.0% (3 people), and normal blood pressure were 26.7% (5 people).

Keywords: Hypertension Risk Factors, Hypertension, Labor.

INTRODUCTION

Health is precious investment to create high quality human source. Health Regulation protects every citizen from high risk noncontagious disease such as hypertension, stroke, diabetes and heart disease which mainly caused by high intake on sodium, calories and fat (Kemenkes, 2013).

Hypertension brings problems to all nations, developing countries nor developed ones. Hypertension is a situation of systolic blood pressure ≥ 140 mmHg and ≥ 90 mmHg for diastolic pressure. Hypertension known as “silent killer” for it shows noneany symptoms. Uncontrolled hypertension causes to cardiovascular disease seven times higher, six times higher prone to Congestive Heart Failure (CHF) and three times susceptible becoming heart attack (Rahajeng & Tuminah, 2009).

Health Primary Research in 2007 and 2013 (Riskesdas) in Indonesia show tendency of inclining prevalence of hypertension, diabetes, stroke and joint disease (rheumatoid). The numbers will not stop there (Kementrian Kesehatan 2017). (Riskesdas 2013) showed hypertension prevalence among 18 years old population is quite high (25.8%) and in Banten province is 23%. The prevalence is escalating due to age growth which can be recognized by medical diagnostic or blood pressure measurement on site. Care giver only detects hypertension 36.8% of total populations, which means 63.2% hypertension prevalence had not been detected (Mansjoer et al. 2015).

Primary Healthcare Center of Kresek in 2017 reported ten major diseases which were acute respiratory disease ranking at top with incidence of 9,208 patients follows with essential hypertension prevalence of 3,221 patients and pharyngitis incidence of 2,626 patients and at the bottom of the list is diarrhea with

794 patients. Which means hypertension is the second disease most reported in Primary Healthcare Center of Kresek in 2017 (Puskesmas Kresek. 2017).

Employee is every person who is working for salary or any other rewards. It has two criteria: person who is working and receiving salary and rewards (DPR RI. 2003). For any employee, Hypertension affects his job and also his productivity and whole company performance and at the end will create economical cost for the company (Hawari, 2001). Public awareness to control blood pressure is far from ideal, especially among productive age. Most of them don’t realize they already have hypertension or prehypertension (high risk to hypertension) due to hypertension shows no symptoms to most patients and lack of knowledge on disease and risk factors of hypertension (Hanum, 2014).

According to previous studies, high prevalence of hypertension is caused by two factors: uncontrolled conditions (such as heredity, sex and age) and controlled conditions (such as obesity, lack of exercise, smoking habits, and alcohol and sodium consumption). Hypertension is influenced by double risk factors which are endogen such as neurotransmitter, hormones and genetics and also exogenous factor such as smoking, nutrition and stressor (Sigarlaki, 2014; Badan Penelitian dan Pengembangan Kementrian Kesehatan RI, 2013).

Based on these facts emerge question on correlation of hypertension risk factors and hypertension prevalence to group of employees Traditional Cracker Factory in Rancailat Village, Kresek County in 2018. Several studies have been performed on prevalence of hypertension but only a few specified to analyze certain group of age such as factory employees. That is the reason why this study is performed.

METHODOLOGY

This is quantitative study with descriptive design. Population in this study is whole employees of Traditional Cracker Factory Haji Oman located in Rancailat Village where the Primary Healthcare Center Kresek County is also located, which the villagers have low knowledge on hypertension. The sampling technique is using nonprobability technique which using total sampling.

This study is using questionnaires list of questions to gather information from respondents. The questions are multiple choices answered on risk factors hypertension. The process begins with collecting all respondents in the early morning to explain the purpose of the study and how to answer the questionnaire.

The main instrument of this study is adult size sphygmomanometer which has been calibrated and stethoscope. The measurement was performed on sitting position or lying down with supported arm as high as heart level and affected palm facing up. Uncover the sleeve, palpate artery brachialis and place arm cuff neatly and less tight. Put the stethoscope membrane on artery brachialis, secure the pump valve. Inflate the cuff until the pressure shows 30 mmHg higher than systolic palpate pressure, unscrew the valve slowly to deflate the cuff and pressure decent average 2-3 mmHg per second. Listen carefully to the first beat (the first Korotkoff sound indicates systolic pressure), continue to deflate the cuff gradually until the abstinence of the beat (the fourth Korotkoff indicates adult diastolic pressure) and finally deflate arm cuff fast. Repeat the measurement twice with 5 minutes interval to collect the average of two measurements (Bickley, 2009). The measurement was performed in the morning before morning shift and minutes after answering the questionnaire.

The sample then compared with standard value of normal adult blood pressure (above 18 years old). Blood pressure then classified according to The Eight Joint National Committee (JNC 8) into four groups. In general hypertension is condition when the blood pressure reaches ≥ 140/90 mmHg. Respondent is classified of having hypertension if systolic or diastolic pressure is above standard or both systolic and diastolic reach above standard (James, Oparil, Carter, et al. 2014)

Table 1: Classification of hypertension in adults (age ≥ 18 years)

Source: The Eighth Joint National Committee (JNC 8)

The sample data has been processed using statistic program: Statistical Package for Social Science 23.0 version for Mac.

RESULT

Total respondents were 30 persons, which are employed at Traditional Cracker Factory Haji Oman in Rancailat Village, Kresek County. Table 2 shows characters of two group respondent.

Table 2: Characteristics of Respondents

Demographic of Respondent

Demographic of respondents are shown on Table 2. The population is dominated by adults – middle age adults (25 – 60/65 years old) as 76.7% of total population or 23 respondents and the smallest group is young adult age as 10% of total population or 3 respondents.

Education level is most at low grade (elementary – junior high school/Islamic elementary school) as 28 respondents or 93.3% and 2 respondents have middle school background (senior high school/ vocational high school) or 6.7%.

Male respondents are cover 60% of total population or consist of 18 respondents and the rest population is female respondents of 40% (12 respondents).

Hypertension Prevalence

Blood pressure represents the strength of blood presses against blood vessels due to cardiac pumps to the entire body tissue. Blood pressure is classified into two: systolic and diastolic pressure. Systolic pressure is strongest pump against artery when blood is pumped into artery during systole ventricle. Diastolic pressure is the lowest pressure against artery when blood is drowning out of artery to all vessels during diastole ventricle (Sherwood, 2012).

The respondents with normal blood pressure (<120 mmHg and <80 mmHg) consist of 8 respondents (26.7%). And the rest of respondents indicate hypertension as 73.3% or 22 respondents.

Figure 1: Prevalence of hypertension in workers at Haji Oman Traditional Crackers Factory

Based on diastolic pressure, there’s 20% respondents indicates hypertension grade I and 33.3% hypertension grade II. Average systolic pressure of total population is 144.33 mmHg which means hypertension grade I dominates withe percentage 33.3%. Based on diastolic pressure, 46.7% respondents indicates hypertension grade I and 20.0% indicates hypertension grade II. Average for diastolic pressure is 87.33 mmHg in the range of 70 – 120 mmHg.

Respondents are classified into hypertension if the systolic and/or diastolic pressure is exceeded normal value. Based on that definition, the data shows 74.4% prevalence hypertension which consist of hypertension grade I (36.7%) and hypertension grade II (36.7%) (Figure 1). Proportion prehypertension is quite high, 10%. It is highlighted since the risk is higher as the risk factors grow.

Figure 2. Prevalence of hypertension based on hypertension classification

The Risk Factors of Hypertension

As show in Table 3, the most relevant factor to hypertension is smoking habits to respondents of 14 person (46.7%) with statistic p=0.035; OR=12.25 and 95% CI=1.26-118.36. The risk factors for hypertension are in following order: lack of exercise as 20 respondents (66.7%) with statistic p=1,000; OR=0 and 95%CI=0. Then cigarette smoke exposure as 63.6% with statistic p=0.466; OR= 2, 11 and 95%CI=0, 28-15, 77. Fat consumption as 63.6% with statistic p=0,589; OR=2, 11 and 95%CI=0, 28-15,

77. Sodium consumption as 60% with statistic p=1,000; OR=0, 64 and 95%CI=0, 06-6.80. Coffee consumption as 53.3% with statistic p=0,104; OR=4, 44 and 95%CI=0, 80-24, 61. Gender for male 46.7% with statistic p= 0,678; OR=0, 57 and 95% CI=0, 11-2, 93. Nutrition status for under is 36.7% with statistic p= 0,689; OR=1, 67 and 95% CI=0, 31-8, 74. Vegetables consumption 26.7% with statistic p= 0,678; OR=0, 57 and 95% CI=0, 11-2, 93. Alcohol consumption 3.3% with statistic p= 1,000; OR=0 and 95%CI=0.

Table 3: Relationship between hypertension risk factors and hypertension incidence

Exercise. This study doesn’t show correlations between exercise and hypertension prevalence (p=1,000). This result is resembled with study of (Primatesta 2001) that explained lack of exercise is not going to create hypertension (Primatesta, Falascheti, Gupta, Marmot & Poulter, 2001).

Smoking habits. This study shows correlations between smoking habits and hypertension (p=0,035), whereas smoking habits makes incidence of hypertension increase 12.25 time higher than nonsmokers. This result is resembled with study of Rahajeng which explained smoking habits increase the risk of hypertension (Sihombing, 2010). Nicotine in cigarette causes periphery vasoconstriction and kidney vessels that will increase the blood pressure. Smoking 1 cigarette per day will increase your blood pressure 10-25 mmHg and increase your heart beat 5-20 times per minute (Price, Wilson, Sitepoe, 2006). Heavy smokers is related to malignancy hypertension and the risk of renal artery stenosis that lead arteriosclerosis. This mentioned by dr. Thomas S Bowman of Brigmans and Women’s hospital in his study (Bowman, et al. 2007).

Expose to cigarettes smoke. Statistic testing in this study shows no correlations (p=0,466). Even the data shows respondents with hypertension whom exposed to cigarette smoke are more than respondents whom not exposed to cigarette smoke. This result is resemble with study of (Vozoris & Laugheed 2008) that explained cigarette smoke exposure will increase the possibility of having hypertension than those who are not (Vozoris & Lougheed 2008). American Heart Association also declares after a few minutes expose to cigarette smoke can elevate blood pressure , because cigarette smoke is one of the causes of arteriosclerosis (Mahmud & Feely, 2001).

Same result came from study of (Mahmud & Feely 2003) which explained cigarette smoke exposure is relevant to blood pressure increases (Klag, Wang, Meoni, Brancati, Cooper, Liang et al. 2002).

Coffee consumption. Although the percentage respondents with hypertension with coffee consumption is higher than no consumption, but it doesn’t show on statistic testing (p=0,104). Even though coffee consumption will increase the chance of hypertension, as 4.44 times more than respondents who don’t

consume coffee. According to several studies over consumption on coffee per day can increase blood pressure. Michael J. Klag et al reported respondents who consume coffee 1-2 cups per day show higher blood pressure than with no consumption of coffee (Klag, Wang, Meoni, Brancati, Cooper, Liang, et al. 2002). Caffeine in coffee has effect on blood pressure acutely especially to patients with hypertension (Mahmud, Feely, 2001). The biological mechanism happens when caffeine binds adenosine receptors which activated sympatric neurons system by elevating catecholamine’s plasma concentration and stimulate adrenaline gland and cortisol secretion (Zhenzhen, Gang, Benjamin, Lawrence, Liwei. 2011) the end result is vasoconstriction and peripheral total retention elevation and increase blood pressure (Klag, Wang, Meoni, Brancati, Cooper, Liang, et al. 2002).

Alcohol consumption. This study doesn’t show the same result with (Puddey, 2006). (Puddey, 2006) explained the potential risk of hypertension is increase with alcohol consumption (Puddey, Beilin. 2006). This difference possibly caused by the level of alcohol consumption is still low among the employees Cracker Factory Haji Oman, so in statistic testing the result is insignificant.

Vegetables consumption. This study shows among respondents who has hypertension with vegetables consumption is higher (46.7%) and statistically irrelevant (p=0,678). It shows vegetables consumption is not enough to prevent hypertension, need adequate amount of consumption. (Rosihan and Anwar 2014) explained inadequate fruits and vegetables consumption has risk five times of having hypertension (OR=5,3) compare with adequate consumption. (Sumaerih 2006) studied in (Indramayu and Lu Wang et al.2008) studied in Boston, proved higher consumption of potassium can lower blood pressure (Anwar, 2014).

Sodium consumption. Statistic testing in this study doesn’t show correlation (p=1.000) even though 60% of respondents with sodium consumption are having hypertension which are higher than who don’t consume sodium. WHO suggests sodium restriction less than 6 grams per day (2400 mg sodium). Excess sodium ingredients especially in form of sodium chloride can cause body fluid imbalance and hypertension. This result is resemble with study on fisherman of Bajo Tribe in Tasipi Island Muna County (2015) which explained hypertension incidence is higher to those who consume more sodium (Elvivin, dkk. 2016).

Fat consumption. This study doesn’t show any correlations between hypertension with fat consumption (p=0,589). Even though the number of hypertension with fat consumption higher (63.3%) than who don’t consume fat (10.0%), this condition will increase the prevalence of hypertension as 2.11 times more. Other studies show correlation between fat consumption with primary hypertension because fats can elevate LDL level from food, then cause plaque in blood vessels. The more LDL aggregates on arterial wall will increase inflammation process stimuli and apoptosis response. This condition will damage the vessel’s surface and elevate blood pressure (Kumbla, 2016).

Nutrition status. This study doesn’t show any correlation between hypertension with poor nutrition status or good nutrition status. This result is not the same with (Rahmani et al. 2015) which explained one of controllable risk factor to hypertension is obesity or over weight. Obesity increases the risk 2 to 6 times higher of having hypertension than ideal weight. And Framingham explained obesity has 10 times higher of having hypertension (Dhianningtyas & Hendrati. 2006).

Gender. This study involved more male respondents than female. This study is also resembled with study of (Rahajeng 2009). (Rahajeng 2009) showed higher case in men perhaps caused by unhealthy habits such as smoking, alcohol consumption, unsatisfied job and unemployment (Rahajeng Tuminah, Sulistyowati. 2009).

CONCLUSIONS

Based on data analysis on statistic testing, found correlation between smoking habits risk factor to hypertension incidence (p=0.035) with OR hypertension incidence to smoker 12.25 (95%CI = 1.26- 118.36), and risk factor of lack of exercise, cigarette smoke exposure, coffee and alcohol consumption, low intake vegetables, sodium and fat consumption, under nourished and male gender have no correlation to hypertension incidence. Even though data show several factors affect incidence of hypertension, such as lack of exercise, cigarette smoke exposure, coffee and vegetables consumption, sodium and fat consumption. Smoking habits among employees Crackers Factory Haji Oman is very prominent, which need special attention since the lack of knowledge on smoking habits which can cause hypertension.

RECOMMENDATIONS

1. For Primary Healthcare on Kresek County is able to use this study as base to run Programs on Prevention Disease, to set the strategies in preventing and handling hypertension.

2. For people to promote prevention on risk factors of hypertension completely and continuously so hypertension can be avoided and to minimize its risk factors.

3. For the next studies on hypertension can use this study as adjuvant information and can enhance the study on other risk factors.

ACKNOWLEDGEMENT

Highest gratitude to Primary Healthcare Kresek County, Haji Oman as the owner of Cracker Factory and its employees as respondents of this study.

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