The Prevalence of High Blood Pressure in Armenia PDF
Preview The Prevalence of High Blood Pressure in Armenia
UCLA UCLA Electronic Theses and Dissertations Title The Prevalence of High Blood Pressure in Armenia Permalink https://escholarship.org/uc/item/4pd1k4zs Author Akaragian, Salpy Akaragian Publication Date 2017 Peer reviewed|Thesis/dissertation eScholarship.org Powered by the California Digital Library University of California UNIVERSITY OF CALIFORNIA Los Angeles The Prevalence of High Blood Pressure in Armenians A dissertation submitted in partial satisfaction of the requirements for the degree Doctor of Philosophy in Nursing by Salpy Akaragian 2017 © Copyright by Salpy Akaragian 2017 ABSTRACT OF THE DISSERTATION The Prevalence of High Blood Pressure in Armenians by Salpy Akaragian Doctor of Philosophy in Nursing University of California, Los Angeles, 2017 Professor Deborah Koniak-Griffin, Chair Hypertension (HTN) is a significant and growing national and international public health problem that contributes to cardiovascular morbidity and mortality. In Armenia, limited data exist on the prevalence of the high blood pressure (HBP) or HTN and associated risk factors. Past research often employs self-report data on blood pressure (BP) or objective measures of BP that do not follow current Joint National Committee-8 (JNC-8) guidelines. Further, little is known about the relationship between adherence to antihypertensive medication(s), knowledge and awareness of HTN, and current BP. The rapid socio-demographic and infrastructural changes occurring in Armenia create an urgent need for further scientifically rigorous research on HBP. The purpose of this descriptive, cross-sectional dissertation study, guided by the Health Lifestyle Theory, was to examine the prevalence of HBP and selected risk factors associated ii with HBP in a convenience sample of Armenian men and women ages 21 and older, living in Armenia. The risk factors included: demographic, physiologic, health lifestyle behaviors, socioeconomic and inherited. The study also examined knowledge, awareness, and attitudes/perceptions related to HBP by awareness, treatment and control categories. The Morisky Medication Adherence Scale-8 was used to measure adherence. Participants (n = 200) were predominantly middle-aged, married females, with a high school education or higher. Blood pressure was measured following JNC-8 guidelines at a single time point in a community setting. Over half of the adults of the sample were found to be prehypertensive or hypertensive. For those diagnosed with HTN, adherence to prescribed antihypertensive medication(s) was low. The correlation between adherence and awareness scores was not significant. A significant association was found between HBP and waist-hip ratio, age, body mass index, total cholesterol, low high density lipoprotein cholesterol, and high low density lipoprotein cholesterol as reported in past research. Waist circumference was the strongest predictor of HBP, followed by personal history of HBP, high total cholesterol level, being male, and older age. Findings of this study have several implications for clinical practice. A similar larger study with a national representative sample needs to be conducted in Armenia to determine the prevalence and correlates of HBP. iii The dissertation of Salpy Akaragian is approved. Felicia Hodge Donald Morisky Adeline Nyamathi Deborah Koniak-Griffin, Committee Chair University of California, Los Angeles 2017 iv Dedication I wish to express my deepest appreciation and gratitude to the University of California, Los Angeles, for providing me with an exemplary education in Nursing. My grandfather, a survivor of the 1915 Armenian Genocide, placed such a great value on education that, orphaned at the young age of seven, he taught himself to read and write not only in Armenian, but in several other languages. My parents, the children of genocide survivors, did not have the financial means to study past the sixth grade, but had a love of education that they passed on to all four of their children. They made sure we received excellent educations. Today, all three of my siblings and I are university graduates--many with medical and juris doctorate degrees. I am exceedingly grateful to my mentors, teachers, and life coaches in the United States and in Armenia for my education. They have instilled in me the perseverance and resilience to reach my personal and professional goals. My dream was to receive the highest possible level of education in Nursing, and I am exceptionally thrilled to have fulfilled my objectives and attained my vision. In celebration, I dedicate this dissertation to the many generations of people who value education; to the many scholars, teachers, administrators, and donors who provide the opportunity to pursue an education; and to the successes and scholarly pursuits of current and future students, including my precious grandchildren Alina, Alex, Aiden, Anto, and Vivienne. v Table of Contents List of Figures .............................................................................................................................. xiv List of Tables ................................................................................................................................ xv Abbreviations and Acronyms ..................................................................................................... xvii Vita ............................................................................................................................................... xix Chapter 1: The Prevalence of High Blood Pressure in Armenians ................................................. 1 Prevalence of Hypertension in Race, Ethnicity, Gender, and Age ........................................... 2 Hypertension and Cardiovascular Disease in Armenians ......................................................... 2 Prevalence of and Risk Factors for Hypertension in Non-Armenians ...................................... 4 Knowledge, Awareness and Attitudes/Perceptions .................................................................. 5 Prevalence of HBP by Awareness, Treatment, and Control ..................................................... 6 Adherence to Hypertensive Medications .................................................................................. 7 Purpose of the Study and Aims ................................................................................................. 7 Specific Aim 1 .................................................................................................................... 8 Specific Aim 2 .................................................................................................................... 8 Specific Aim 3 .................................................................................................................... 8 Specific Aim 4 .................................................................................................................... 8 Specific Aim 5 .................................................................................................................... 8 Conceptual Framework ............................................................................................................. 9 Research Design........................................................................................................................ 9 Significance to Nursing Science and Practice ........................................................................ 10 Chapter 2: Literature Review ........................................................................................................ 13 Background of the Literature Search ...................................................................................... 14 vi Prevalence of HBP or HTN and Parameters ........................................................................... 15 HBP or HTN in Armenians living in Armenia ....................................................................... 16 HBP or HTN in Armenians Living Outside of Armenia ........................................................ 19 HBP or HTN in Non-Armenians ............................................................................................ 20 Household Health Survey (HHS) in Armenia ........................................................................ 24 Demographic and economic status data ............................................................................ 25 Health status ...................................................................................................................... 26 Health behavior/lifestyle ................................................................................................... 26 Use of Public Health Clinic (PHC)/early diagnostic and prevention services .................. 27 Public awareness of open enrollment (OE), family medicine (FM) and free PHC .......... 27 Knowledge, awareness, and attitudes/perceptions ............................................................ 28 Community involvement .................................................................................................. 28 Summary ................................................................................................................................. 29 Chapter 3: Theoretical Framework ............................................................................................... 31 Health Lifestyle Theory (HLT) ............................................................................................... 32 Class circumstances .......................................................................................................... 33 Age and gender ................................................................................................................. 34 Race/ethnicity ................................................................................................................... 34 Collectivities ..................................................................................................................... 35 Living conditions .............................................................................................................. 36 Socialization and Experience .................................................................................................. 36 Life Choices (Agency) ............................................................................................................ 37 Life Chances (Structure) ......................................................................................................... 37 vii Choice and Chance Interplay .................................................................................................. 37 Disposition to Act (Habitus) ................................................................................................... 38 Practices (Action).................................................................................................................... 38 Alcohol use ....................................................................................................................... 39 Smoking ............................................................................................................................ 39 Diet .................................................................................................................................... 39 Checkups ........................................................................................................................... 40 Health Lifestyle (Reproduction) ............................................................................................. 41 Research Support on HLT Structural Variables and Practices ............................................... 41 Russia ................................................................................................................................ 42 Belarus, Russia, and Ukraine ............................................................................................ 43 Kazakhstan and Kyrgyzstan .............................................................................................. 45 Descriptive studies conducted in eight fSU countries ...................................................... 46 Summary ................................................................................................................................. 46 Chapter 4: Methods ....................................................................................................................... 48 Purpose and Specific Aims ..................................................................................................... 48 Specific Aim 1 .................................................................................................................. 48 Specific Aim 2 .................................................................................................................. 49 Specific Aim 3 .................................................................................................................. 49 Specific Aim 4 .................................................................................................................. 49 Specific Aim 5 .................................................................................................................. 49 Research Design...................................................................................................................... 49 Sample..................................................................................................................................... 50 viii
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