Qom University of Medical Sciences Journal

Introduction
Hypertension results from increased cardiac output, vascular resistance, or both. Studies show that hypertension is one of the most important causes of cardiovascular diseases, the most common cause of heart failure and stroke in most countries, and the most common cause of kidney failure. The risk of death due to cardiovascular diseases increases with the increase in blood pressure. The concept of self-care was first proposed by Orem in 1959. Orem defines self-care as “the practice of activities that individuals initiate and perform on their own behalf in maintaining life, health, and well-being”.
The health-promoting lifestyle is the most effective strategy for preventing and controlling chronic diseases. Based on the results of previous studies, a health-promoting lifestyle, in addition to gaining independence and economic savings, reduces the effects of illness and disability as well as the length of hospitalization, which ultimately leads to the improvement of community health. The use of new care approaches, such as Orem’s self-care model, can play an essential role in managing chronic diseases such as hypertension. Therefore, this study aims to investigate the health-promoting lifestyle and its related factors in hypertensive patients referred to health centers in Hamadan, Iran.
Methods
This cross-sectional study was conducted in 2020. Using a consecutive sampling method, 310 patients with hypertension referred to the comprehensive urban health service centers of Hamadan City were selected. In addition to demographic information, the risk factors, the presence of hypertension complications, the duration of hypertension, the number of antihypertensive drugs, the presence of comorbidities, systolic and diastolic blood pressure, history of hypertension in first-degree relatives, history of receiving education in the field of hypertension were extracted from the patients’ medical files. The health-promoting lifestyle profile (HPLP) was also used to measure the engage in a health-promoting lifestyle through interviews. Data were described using descriptive statistics (Mean±SD for quantitative variables and frequency and percentage for qualitative variables) and were analyzed using t-test, Mann-Whitney U test, one-way analysis of variance, and Kruskal Wallis test. P<0.05 was considered statistically significant.
Results
The mean age of the patients was 58.0±12.9 years. Of 310 patients, 197(63.5%) were female and 245(79.0%) and married. It was reported that 62 patients (20.0%) had a favorable income level, 180(58.1%) had moderate income, and 68(21.9%) had poor income level. Furthermore, 256 patients (82.6%) had a high school diploma or lower education. Among 309 patients who completed the questionnaire about smoking, 89(28.7%) were smokers. The average number of antihypertensive drugs used by patients was 1.5±0.6. Moreover, 174 patients (56.1%) had comorbid diseases.
The mean overall score of HPLP was 129.8±16.6, ranged 101-174. The scores of HPLP domains were as follows: spiritual growth=27.1±3.7 (ranged 18-37), responsibility=35.7±4.7 (ranged 24-48), interpersonal relations=20.5±0.3 (ranged 12-27), stress management=11.6±2.5 (ranged 7-20), physical activity=15.3±4.6 (ranged 7-28), and nutrition=19.6±2.6 (ranged 12-26). The overall and subscale scores of HPLP had a significant relationship with gender, which were significantly higher in women than in men. All dimensions of HPLP were lower in the group that received hypertension education than in the group that did not receive this education; however, this difference was statistically significant only in the total score and in the domains of responsibility, stress management, and physical activity. The overall score and the score of six dimensions were higher in patients with no comorbidities than in patients with comorbidities.
Spearman’s correlation test results showed a negative and significant relationship between age and HPLP score in all areas (P<0.001) except for nutrition. A negative and significant association was also observed between systolic and diastolic blood pressures and total HPLP score, indicating that with the decrease in health-promoting lifestyle, the diastolic and systolic blood pressures increase. Moreover, the findings showed that with the increase in the number of antihypertensive drugs, health-promoting lifestyle declines.
Conclusion
The health-promoting lifestyle of hypertensive patients in Hamadan is not at a good level. Since the health-promoting lifestyle is important for patients with hypertension, it is necessary to emphasize these behaviors in the educational programs for these patients and make them aware of the consequences of poor health-promoting lifestyle.
Ethical Considerations
Compliance with ethical guidelines
This study was approved by the Hamadan University of Medical Sciences (Code: IR.UMSHA.REC.1398.872)
Funding
This article was extracted from the PhD dissertation of Zohre Sadeghian, approved by Department of Community Medicine, School of Medicine, Hamadan University of Medical Sciences, and was funded by Hamadan University of Medical Sciences.
Authors contributions
Conceptualization and study design: Farzaneh Esna-Ashari and Farnaz Fariba; Data analysis and data interpretation: Azar Pirdehghan; Statistical analysis: Mahta Sangestani; Drafting the manuscript: Zohre Sadeghian.
Conflicts of interest
The authors declared no conflict of interest.
Acknowledgements
The authors would like to thank the Vice-Chancellor for Research of Hamadan University of Medical Sciences for financial support and all patients participated in this study for their cooperation.