Enoghase Itua Erasmus

KNOWLEDGE AND PERCEPTION OF HYPERTENSION MANAGEMENT AMONG PATIENTS IN UJEOLEN HEALTH CENTER EKPOMA CHAPTER ONE INTRODUCTION 1.1 Background to the Study Hypertension is becoming a major public health burden globally, because of its higher morbidity, mortality, disability and financial burden mainly among adults who have a productive life. It is the main and very important modifiable risk issue for cardiovascular problems, stroke, renal problems, and retinopathy (Mills et al., 2016). Early detection and adequate prevention strategies with proper treatment, and control must pay high attention to reduce the disease burden (Boateng et al., 2017). Hypertension is the most known significant risk factor causing untimely death due to cardiovascular and cerebrovascular problems. According to World Health organization (WHO), more than 80% of deaths from hypertension and related cardiovascular diseases (CVDs) currently arise in low and middle-income countries and is predominantly common among persons of low socio-economic status (World Health Organization, 2017). The presence of hypertension more than doubles the risk for coronary heart disease; including acute myocardial infarction and sudden death and more than triples the risk of congestive heart failure and strokes. Obesity, unhealthy diet, diabetes mellitus, excessive alcohol intake, physical inactivity and smoking are considered as risk factors for hypertension (World Health Organization, 2017). Hypertension, also known as high blood pressure is the persistent blood pressure in the arteries above ninety millimetres of mercury (mmHg) between the heart beats (diastolic) or over 140 millimetres of mercury (mmHg) at the beats (systolic) (Irazola et al., 2016). According to Jones & Hall, (2019), hypertension is the persistent raised levels of blood pressure in which the systolic pressure is above 140 mmHg and diastolic pressure above 90 mmHg. The normal blood pressure is below 120/80 mmHg; blood pressure between 120/80 and 139/89 is called ‘Pre-hypertension, and a pressure of 140/90 or above is considered high (abnormal) blood pressure. According to Expert Committee on Non-Communicable Diseases, blood pressure of 120/80 mmHg is considered normal for a 30 year old person, while blood pressure of 140 mmHg is considered high for such a person (Joint, 2018). Similarly, blood pressure of 150/90 mmHg is considered normal for a 60-year old person, while blood pressure of 160/100 mmHg is high for such a person. Hypertension is sometimes called “the silent killer” because people who have it are often symptom-free. In this study, hypertension is perceived as a systolic blood pressure greater than 140 mmHg and a diastolic blood pressure greater than 90 mmHg among adults. The top number which is the systolic pressure corresponds to the pressure in the arteries as the heart contracts and pumps blood forward into the arteries (Joint, 2018). According to WHO (2018), hypertension is categorized into primary and secondary hypertension. Primary hypertension has an unknown cause and accounts for ninety per cent to ninety five per cent of all hypertension cases (WHO, 2018). This type of hypertension is strongly associated with lifestyle. Usually, the patients do not have many signs and symptoms but may experience frequent headache, tiredness, dizziness or nose bleeds. Although the cause is not known, obesity, smoking, alcohol, diet and heredity play a role in essential or primary hypertension (WHO, 2018). Secondary hypertension has a known cause and accounts for five per cent to ten per cent of all hypertension cases. Olatunbosun et al., (2017) maintained that the most common cause of secondaryhypertension is an abnormality in the arteries supplying blood to the kidneys. Other causes include airway obstruction during sleep, stress, diseases and tumors of the adrenal glands, lifestyle, spinal cord injury, hormone abnormalities (oral contraceptive estrogen replacement), thyroid disease, toxemia of pregnancy, renal problems such as vascular lesion of renal arteries, diabetic neuropathy, pains as well as anxiety and hypoglycemia. There are some factors which predispose adults to hypertension. The trends of hypertension (HTN) are increasing every year because of the changing pattern of lifestyle behaviors in Nepal (Koju et al., 2015), and the prevalence of HTN is reported to be increasing rapidly in the urban areas and the same trend is in rural areas too (Vaidya, Aryal, & Krettek, 2018). Lack of knowledge about the morbidity, complications and the method of control and management of hypertension contributes to a large percentage of undetected and untreated hypertensive peoples in the community (Vaidya, Oli, Eiben, & Krettek, 2017). Several former studies identified that there was a significant lack of awareness about the reasons of hypertension and its complications among the hypertensive patients (Sofia et al. 2018). A hospital based study conducted in Kathmandu found the respondents’ knowledge regarding hypertension was poor (Kongarasan and Shah 2018). Another study had revealed that adequate knowledge of hypertension is related with better control of hypertension (Sharma, Bhuvan, Alrasheedy, Kaundinnyayana, & Khanal, 2019). However, community based studies have shown inadequate knowledge, poor attitude and practice among patients with hypertension in Nepal (Shrestha et al., 2016) and Pakistan (Almas et al., 2017). Such level of knowledge, perception and practice affect the control of high blood pressure despite of appropriate treatment. Therefore, health care professionals must not only diagnose and treat patients with hypertension but also create awareness about prevention and management strategies to decrease the prevalence and complications of hypertension. Hence, the researcher seek to examine the knowledge and perception of hypertension management among patients in Ujoelen Health Center Ekpoma. 1.2 Statement of Problem The problem of hypertension remains an area of public health focus globally (WHO, 2018). It is estimated that globally, 25 million or one half of all deaths and most of the physical disabilities are attributable to non-communicable diseases (NCDs), and this is still on the increase year after year. The highest rated among them is hypertension. WHO (2018) estimated that in 2000, hypertension and mental disorders caused 59% of deaths and 46% of the global burden of disease. Hypertension has been shown to have series of consequences, and adequate knowledge of risk factors can help in the prevention of hypertension. Therefore, patients in health centers need to have the knowledge and good perception of hypertension to reduce the prevalence of hypertension disease, improve health and optimum well-being. Regrettably, most patients due to ignorance of risk factors and preventive measures of hypertension engage in unhealthy lifestyles such as excessive consumption of alcohol, sedentary lifestyle, excess consumption of sodium intake, tobacco and cigarette smoking, obesity, reduced intake of fruits and vegetables, stress and consumption of foods rich in cholesterol. These unhealthy lifestyle practices have increased the prevalence of hypertension in the world including Nigeria, which culminates into high cases of deaths. Hypertension is one of the problems affecting especially a great portion of the adult population and currently causes one in every eight deaths worldwide, making it the third leading killer disease in the world. However, it has been observed that mostly likely that patients’ may not have adequate knowledge of hypertension. Evidence regarding the knowledge of hypertension does not seem to exist in the study area Ekpoma, Edo State. Also, some studies have been conducted on the knowledge of hypertension in many parts of the world including Nigeria. The literature reviewed showed that related studies were conducted among pregnant women, workers in banking industry, urban elderly and in rural communities, and in different countries. Incidentally, there are no studies, to the best knowledge of the researcher that have been carried out on the knowledge and perception of hypertension management among patients in Ujoelen Health Center Ekpoma. This study is therefore will be carried out to determine the knowledge and perception of hypertension management among patients in Ujoelen Health Center Ekpoma. 1.3 Objectives of the Study The purpose of this study is to determine the knowledge and perception of hypertension management among patients in Ujoelen Health Center Ekpoma. Specifically, the study will be guided by the following objectives: 1. To ascertain the knowledge of hypertension management among patients in Ujoelen Health Center Ekpoma 2. To determine the perception of hypertension management among patients in Ujoelen Health Center Ekpoma 3. To ascertain hypertension management among patients in Ujoelen Health Center Ekpoma Research Questions The researcher developed the following questions: 1. What is the knowledge of hypertension management among patients in Ujoelen Health Center Ekpoma? 2. What is the perception of hypertension management among patients in Ujoelen Health Center Ekpoma? 3. What is the level of hypertension management among patients in Ujoelen Health Center Ekpoma? 1.5 Significance of the Study This study will be of great benefits in many ways; firstly, the results of this study will provide information on knowledge and perception of hypertension management among patients in Ujoelen Health Center Ekpoma. The results of this study will be useful to health educators, medical and paramedical officers, public health officers, counsellors, media educators, researchers, curriculum planners, government and adults in many ways. The study may help to develop a positive regard towards hypertension. The ministry of health may benefit from the study by discovering a gap in knowledge of the population, and emphasize strategies to teach the adult population on how to prevent the risk factors. It may also be useful to other researchers to carry out this study in areas where disease prevention measures and health promotion are needed with regards to hypertension. Answering the research questions associated with the research project offers insight into managing hypertension by revealing an understanding of individual’s health related knowledge, perceptions and behaviours. Future researchers may also use this study as a reference and guide for future studies on knowledge and perception of hypertension management among patients in Ujoelen Health Center Ekpoma as there is paucity of local data in this area. 1.6 Scope of Study The study is delimited to knowledge and perception of hypertension management among patients in Ujoelen Health Center Ekpoma. The research will be carried out in a 3months timeframe. The respondents will be patients in Ujoelen Health Center Ekpoma between the age of 18-60 years. 1.7 Operational Definition of Terms Hypertension: abnormally high blood pressure, a state of great psychological stress. Hypertension Management: Hypertension is managed using lifestyle modification and antihypertensive medications. Hypertension is usually treated to achieve a blood pressure of below 140/90 mmHg to 160/100 mmHg. Knowledge: facts, information, and skills acquired through experience or education; the theoretical or practical understanding of a subject. Perception: Perception is the organization, identification, and interpretation of sensory information in order to represent and understand the presented information, or the environment. CHAPTER TWO LITERATURE REVIEW This chapter discusses the literature related to knowledge and perception of hypertension management. It particularly focuses on the conceptual review, empirical review, theoretical review and summary of literature reviewed. 2.1 Conceptual Review Concept of Hypertension Hypertension is a leading cause of cardiovascular morbidity and mortality. In 2016 in the Unites States, hypertension was documented as the primary cause of death in over 56,000 deaths and as a contributing factor in an additional 250,000 deaths out of the 2.4 million deaths reported for that year (Center for Disease Control and Prevention, 2021). Hypertension is a common chronic disease, estimated to affect over 29% of the adult population as reported in The National Health and Nutrition Examination Survey (NHANES- and-, which represents a probability sample of the US civilian population (WHO, 2017). The high prevalence of hypertension together with its deleterious effect on health make it a major public health problem; In a recent report the Institute of Medicine called hypertension "a neglected disease that is often ignored by the general public and underappreciated by the medical community" Determinants of Hypertension High Blood Pressure and Age Blood pressure is considerably lower in children than in adults and increases steadily throughout the first two decades of life. In adults, cross-sectional and longitudinal surveys have shown that systolic and diastolic blood pressure increase progressively with age. For example, in the WHO survey, systolic blood pressure increased about 0.29 to 0.91 mm Hg per year in men and 0.6–1.31 per year in women. This increase remains stable and possibly declines after age 50 for diastolic but not for systolic blood pressure, leading to a steep increase in pulse pressure; a key risk factor for cardiovascular outcome. These trends have been demonstrated in both genders and most ethnic groups. Similarly, many studies document an increase in hypertension prevalence with age (Hajjar et al., 2018). In the United States, hypertension prevalence increased from 6.7% in persons within the ages 20 to 39 years to 65.2% in persons 60 years or older. The greatest increase in hypertension prevalence between- (57.9%) and- (65.4%) occurred in individuals who are 60 years or older (Hajjar et al., 2018). On hypertension in the Ashanti Region, West Africa: an opportunity for early prevention of Clinical Hypertension; documented 40% and 29% as a prevalence of both hypertensive and hypertensive respectively with hypertension being more in non hypertensive males than non-hypertensive females particularly people aged around 35 years (Addo et al., 2018). Anthropometric Indexes Body mass index (BMI) is an important correlate of blood pressure and hypertension prevalence. By the current World Health Organization (WHO, 2016) criteria, a BMI <18.5kg/m2 is considered underweight, 18.5–24.9 kg/m2 ideal weight and 25–29.9kg/m2 overweight or pre-obese. The obese category is sub-divided into obese class I (30–34.9kg/m2), obese class II (35–39.9kg/m2) and obese class III (≥40kg/m2). A BMI greater than 28kg/m2 in adults was associated with a three to four-fold greater risk of morbidity due to CVDs than in the general population. The recent increase in overweight and obesity in the United States both in adults and children may explain, in part, the associated increase in hypertension prevalence over the past decade. In the NHANES-III data, obese men and women had a hypertension prevalence ranging from 49% to 64% with increasing degrees of obesity in men and from 39% to 63% with increasing obesity in women versus 27% in normal-weight men and 23% in normal-weight women. According to Han et al. (2019), weight gain is also associated with an increase in hypertension incidence and the age-related rise in systolic blood pressure. In an analysis of four Chicago epidemiological studies, weight gain was associated with an increase in pulse pressure. In the Framingham Heart Study, a 5% weight gain was associated with a 20% to 30% increase in hypertension incidence (Han et al., 2019). Nutritional/Dietary Behaviour Measures Results of observational studies and clinical trials document an association between sodium chloride (NaCl) intake and blood pressure. The effect of NaCl on blood pressure increases with age, with the height of the blood pressure, and in persons with a family history of hypertension. Among population groups, age-related increments of blood pressure and the prevalence of hypertension are related to NaCl intake (Elliott et al., 2016). In societies with high potassium intakes, both mean blood pressure levels and the prevalence of hypertension tend to be lower than in societies with low potassium intakes. Meta-analyses of clinical trials have concluded that oral potassium supplements significantly lower both systolic and diastolic blood pressures (Cappuccio et al., 2018). Within and among populations, as with potassium, there is an inverse association between dietary calcium intake and blood pressure, and low calcium intake is associated with an increased prevalence of hypertension (Cutler et al., 2018). A study by Maham et al. (2018), in India indicates that majority (93.2%) of the subjects (190) incorporated into a study of risk factor profile of noncommunicable diseases in an industrial productive had low daily intake of vegetables and fruits. Sedentary lifestyle Sedentary life style and low educational attainment have each been linked to the rise in blood pressure with age, low socio-economic status, low occupational class, psycho-social factors such as hostility and time urgency/impatience, job strain, depression (Davidson et al., 2019). Tobacco Smoking Smoking, which is believed to be the number one major single known cause of noncommunicable diseases such as hypertension, is widespread around the world. Estimate of the World Health Organization (WHO) indicates that roughly about 30% of the global adult male populations are smokers (WHO, 2018). It is estimated that tobacco-related deaths exceed 4 million annually. It has been estimated that by 2030, diarrhoeal diseases and lower respiratory infections will have been surpassed by chronic obstructive airways diseases as causes of mortality (Murray & Lopez 2019). While the prevalence of tobacco use in many industrialized nations is reducing, there is a growing epidemic of smoking in the developing world. In many African countries, there is paucity of data on the epidemiology of tobacco and smoking. Based on the available data however, in African countries, it appears smoking among adults is more common among males and the poor. An estimated 4.8 million deaths case worldwide in 2000 was believed to have occurred due tobacco smoking, particularly occurring in developing countries (Ezzati et al., 2018). Physical Inactivity Physical inactivity is known to be a major public health problem of concern in 2010 as physical activity levels of people of all ages tended to decrease. The Centres for Disease Control (CDC, 2019) reported that among the youth in America aged 12 and 13 years, 69% were regularly active. However, the number dropped to 38% for young people between the ages of 18-21 years. A physically inactive child is more likely to become a physically inactive adult, which could lead to chronic diseases including hypertension of lifestyle. Patterns of inactivity, also known as sedentism, begin early in life, making the promotion of physical activity among children imperative. The prevalence of physical inactivity among youth worldwide has increased. In the international level, 67% of young children in Canada did not meet the average physical activity guidelines to achieve optimal growth and development (CDC, 2019). Environmental Factors Urbanization is an important factor in the aetiology of obesity, and a major risk factor for hypertension. It accelerates the changes in diet, physical inactivity and increases access to tobacco products and high fat foods which are all risk factors of hypertension. Diet and physical inactivity are modifiable risk factors associated with changes in lifestyle. Diets of the African population tend to differ between rural and urban dwellers. Studies have shown that rural dwellers diets are low in fat and sugar but high in carbohydrates and fibre (Steyn et al., 2018), while their urban counterparts show high fat and low fibre and carbohydrate intake (Bourne et al., 2019) which is typical of a Western diet. Knowledge of hypertension management Hypertension is one of the most common chronic health problems in the world and a major risk factor for mortality and morbidity (Kearney et al., 2004). Controlling hypertension by changing lifestyle habits could reduce the cost of health care by reducing the use of pharmacological and invasive cardiovascular treatments. Disease prevention and control should be the primary means of ensuring public health and disease treatment (Connor et al., 2020). For knowledge about risk factors for hypertension, the results of the study showed that more than half of hypertensive patients were aware of this; family history, smoking, and excessive salt intake have increased the risk of high blood pressure. While most of them did not know; aging, overweight, inactivity, stress, alcohol consumption, high cholesterol levels and some medications are associated with an increased risk of hypertension. This may be due to the low level of education of patients and the fact that patients have other concerns than the time to monitor their disease in clinics. The most common risk factors for hypertension in volunteers were excessive salt intake (77.4%), followed by family history (73.4%) and the lowest alcohol consumption (47.6%) (Demaio, et al., 2018). Knowledge of hypertension is very essential because it contributes enormously to the prevention and management of the condition and also drug adherence (Saleem et al., 2018). A study conducted in 2017 to assess the knowledge level and management practices of hypertension in pregnancy among health care workers in Moshi urban in Tanzania found out that the level of knowledge of hypertension during pregnancy is too low (Liljevik & Lohre, 2017). A recent study by Siddiqua et al. (2017) in Saudi Arabia in 2017 concluded that a significant proportion of hypertensive patients have good knowledge and attitude towards hypertension but they show moderate levels of practice which can lead to worsening their health condition in time being and resulting in severe complications and damaging of other vital organs also. A descriptive cross - sectional study conducted in China on the topic “health literacy in rural areas of China: hypertension knowledge survey also revealed that, hypertension knowledge levels are alarmingly low in rural areas of China, particularly concerning hypertension complications and medication. The authors also averred that myriad factors contribute to this low hypertension knowledge level, such as the poor health education programs, economic conditions, and cultural factors (Li et al., 2018). Almas et al., (2017) in their cross sectional study in Karachi in Pakistan entitled, good knowledge about hypertension is linked to better control of hypertension also opined that, Knowledge about hypertension in hypertensive patients is not adequate and is alarmingly poor in patients with uncontrolled hypertension. More emphasis needs to be made on target blood pressure and need for taking antihypertensive for life to patients by physicians (Almas et al., 2017). A study in Ghana by Lamptey et al. (2017) to evaluate community-based hypertension improvement programme also affirmed that respondents were highly aware of hypertension, but with very low level of hypertension treatment and control and this requires in-depth investigation of the bottlenecks to treatment and control. A cross sectional survey which employed 529 participants by Sanne et al., (2017) on the topic hypertension knowledge among patients from an urban clinic also concluded that, there is hypertension knowledge deficits in specific content areas among the urban population. Educational programmes focusing on newly diagnosed hypertensive patients and aimed at filling targeted knowledge deficits may be a costeffective approach to increase hypertension knowledge in similar populations. A descriptive, quantitative and transversal study, performed by Lima et al (2015) entitled the patient's knowledge about hypertension: an analysis based on cardiovascular risk attested that people with the highest cardiovascular risk are the ones showing the poorest knowledge about the complications related to hypertension. Abdullahi & Amzat (2016) also conducted a research on knowledge and perceptions related to hypertension, lifestyle, behaviour modifications and challenges that are facing hypertensive patients, of which the authors enunciated that, there is high poor level of knowledge about hypertension and perceptions toward lifestyle-modification. Patients lacked understanding some points of risk factors, manifestation and lifestyle modifications of hypertension. So educational programmes that can enhance patients' awareness regarding hypertension disease are urgently needed among these patients. A cross - sectional study on the levels of knowledge, attitude and preventive practice of hypertension among residents aged 18 years and above in Kampung Baru Ixora, Sarikei in Malaysia also showed that 52.5% of the respondents had adequate knowledge, 57.4% had positive attitude and 61.4% of them had good preventive practices of hypertension (Shaikh et al., 2017). A study conducted in Nigeria among staff of the University of Ibadan by Abdullahi & Amzat (2016) also demonstrated that the majority of the respondents had a fair knowledge about the complications of hypertension. However, knowledge about the risk factors and attitude toward hypertension was very poor (Abdullahi & Amzat, 2016). A study on hypertension knowledge, attitude and practice also concluded that a significant proportion of hypertensive patients have poor knowledge about hypertension (Shaikh et al., 2017). As expected, knowledge of hypertension was appropriate for trained pharmacists. However, it found a small percentage of pharmacists who did not know the guidelines for the treatment of high blood pressure. Knowledge of hypertension was not partial by age, work experience or scope of practice, but by gender. More worrisome was the fact that adequate knowledge of hypertension did not lead to a better attitude towards blood pressure monitoring and awareness, since only a quarter of respondents said they had good blood pressure. Particularly of concern was that pharmacists did not regularly monitor their blood pressure and that about 10% of them never checked their blood pressure. Suboptimal attitude/awareness of hypertension by health professionals has been reported in other studies (Mitwalli et al., 2018). Perception of hypertension management among patients Several studies have further explored the relationship between perception of hypertension management and treatment adherence. One study concluded that patient perception of hypertension management is a significant independent determinant of treatment adherence (Jankowska-Polańska et al. 2016). Likewise, there has been reported significant positive correlation between perception of hypertension and attitude regarding diagnosis, a significant positive correlation between knowledge of hypertension and practices of lifestyle modifications, and a significant fair correlation between attitude and practice (Buang et al. 2019). Studies have also been conducted to explore hypertension perception among impoverished hypertensive adults. The majority of participants associated hypertension with increased blood pressure, but other associations included physical symptoms (i.e., headaches and sweating), and hyperactivity. In a study by Moczygemba et al. (2017), less than half of participants noted the long-term health complications of uncontrolled blood pressure. A limited understanding of hypertension, blood pressure goals and lifestyle modification recommendations was a common theme. Interestingly, the most reported barrier to lifestyle modification recommendations is the transient lifestyle of being homeless (Moczygemba et al. 2017). Oliveria et al., (2015) conducted a descriptive survey to understand the current status of hypertension (HTN) awareness, perception and attitudes in a group of hypertensive patients. Our results suggest that patients are knowledgeable about HTN in general, but are less knowledgeable about specific factors related to their condition, and specifically their own level of BP control. The median duration of HTN was 14 years, suggesting that even though these patients have had this condition for a long duration their knowledge is inadequate. Patients were unaware that SBP is important in BP control and reported that physicians did not emphasize the significance of high SBP levels. Further, many patients (41%) did not know their BP value nor could they accurately report whether it was elevated. Patients were knowledgeable about the meaning of HTN, and the seriousness of the condition to their health. Ninety-six percent knew that lowering BP would improve health and 96% thought that people can do things to lower their high BP. Nearly 70% of patients knew that high BP could lead to congestive heart failure. Almost all patients were aware of their HTN with 91% reporting that a doctor or health care provider had told them that they have HTN. Improved recognition of the importance of SBP has been identified in recent years as one of the major public health and medical challenges in the prevention and treatment of HTN because of the potential impact on the morbidity and mortality associated with cardiovascular disease and stroke. Patients are generally unaware that SBP is important in HTN and BP control. Sixty-five percent of patients were told their optimal BP reading while only about half reported that they were specifically told that the top and bottom numbers are important to keep under control. When asked which measure is more important, 41% reported that diastolic is more important, 13% reported that systolic is more important, while 30% reported that both systolic and diastolic are important, and 17% did not know. Thirty-nine percent did not know the normal level for SBP or reported that normal SBP is 140 mm Hg or greater. Conversely, more than 69% of patients identified normal DBP as less than 90 mm Hg. Patients were knowledgeable about the cut point for DBP, with only 8% reporting that 90 mm Hg or greater was normal. These findings suggest the need for education of patients, physicians, and other health care providers related to the importance of elevated SBP and cardiovascular risk. Many patients did not know their BP level nor could they accurately classify their level as elevated or normal. These findings suggest that patients' perception of their BP level does not reflect their actual readings except for the majority of those with controlled BP. Further, 41% of patients reported that their values were in the normal range, but in fact they were elevated. The importance of hypertension awareness and knowledge and the potential impact of BP education programs have been reported previously. Patients who were aware that elevated BP levels lead to reductions in life expectancy had a higher compliance level with medication use and follow-up visits than patients without this awareness. Surveys of hypertensive patients in three clinical sites showed that lack of knowledge concerning target SBP level was an independent predictor of poor BP control. Reductions in SBP and DBP and improved medication-use compliance have been achieved through an education program that stressed, in part, “knowing high BP.” This research all points to the need to improve hypertension knowledge and awareness in order to increase medication-use compliance and BP control. An opportunity exists to use patient-reported sources for HTN information in order to disseminate HTN information. In aprevious study, physicians, other health care providers, mass media, and print and video materials were important sources of information as reported by the patients. The mass media have also been identified as a major source of patient information in a study by Kjellgren et al., (2019) and represents an important opportunity to influence patient knowledge, awareness, and attitudes toward HTN control. Level of hypertension management among patients According to Shaikh et al., (2016) reported that more than 70% of patients knew that tress, high cholesterol and obesity were the risk factors for hypertension and that 52.7% of them did not know that they were physically active, risk factor for hypertension. In addition, Ali et al. (2016) reported that study participants were aware that stress, excessive salt intake and obesity are risk factors for high blood pressure. But there was little awareness about excessive drinking, smoking and a sedentary lifestyle. In the same line, Akter, et al. (2019) estimated that in a Hispanic study of the community of hypertension on risk factors, treatment, diagnosis and prognosis indicated that only 28% knew the correct definition of hypertension and 3% of unknown etiology. In addition, Ali et al., (2016) who reported that the participants in their study were aware that stress, excessive salt intake and obesity as risk factors of hypertension. But there was poor awareness with regards to excessive alcohol intake, smoking and a sedentary lifestyle. In the same line Akter, et al. (2019) held that in a community study done on Hispanic subjects regarding knowledge about hypertension on risk factors, treatment, diagnosis and prognosis showed that only 28% knew the correct definition of hypertension and 3% aware that etiology was unknown. A median (50%) of people with high BP were aware that they were hypertensive and only a small proportion (10%) of hypertensive individuals had a controlled BP. For example, in a similar sample and population, these numbers are lower than those of African Americans from 1991 to 1993 (93% aware, 83% treated and 68% for BP controlled) or Barbados in 1994 (82% aware, 60% treated and controlled at 52%). In Ghana specific, little is known about prevalence of smoking. Before the year 2018, no National data was available on prevalence of smoking among adults. The 2018 Ghana Demographic and Health Survey estimated smoking prevalence in men aged 15 to 19 to be only 0.7%. Global Youth Tobacco Survey (GYTS) also documented smoking prevalence rate of 4.8% among 1,917 Ghanaian school children between the ages of 11-16 years in 2010. Males smoker were more than females (5.3% versus 3.8 %) (Ghana Demographic and Health Survey, 2019). According to a survey in Portugal (Macedo et al., 2020), the awareness and treatment of hypertension increased between 2003 and 2017 despite a similar prevalence of hypertension. Hypertension increases by 3.8 times. Other studies have shown improved treatment and control of hypertension for decades (Kastarinen et al., 2019; Guo et al., 2017; Gao et al., 2018). In particular, the proportion of hypertensive patients undergoing controlled treatment almost doubled between 2003 and 2017. This progress may be related to increased use of antihypertensive drugs, new therapeutic approaches and overall improvement in blood pressure in patients and of the health system. In the past decade, several campaigns have been launched in Portugal to alert the public to the importance of high blood pressure as the cause of the disease. In addition, it is generally believed that access to primary care has improved significantly in recent years. In terms of treatment, a study indicated that patients with adequate control of hypertension were more often treated with a combination of antihypertensive drugs (65% are fixed combinations) than those with an uncontrolled BP. In addition, this is consistent with other studies that have described a combination of more frequent drug combinations with a progressive increase in adequate control of hypertension. Once again, it is in good agreement with the European directives, Mancia et al., (2018) and American (Chobanian et al., 2018). Over the last ten years, the control of hypertension in 10 years despite the adverse changes in obesity is improving. It is important to improve the control of hypertension from 2003 to 2017 which caused Portugal with a significant reduction of systolic and diastolic blood pressure in hypertensive patients in the range of 12.4 / 8.0 mmHg average. The Portuguese population to be reduced by more than 20% reduction in stroke mortality in 10 years (Lewington et al., 2017) 2.2 Theoretical Framework This study was based on health belief model. In furthering the discussion on hypertension management, the health belief model is effective in explaining health behaviors specific to this condition. The model was developed in the early 1950’s by social scientists in the U.S. Public Health Service to understand the failure of people to adopt disease prevention strategies. According to the model, the foundational components of health-related behavior are the desire to avoid illness and get well if already ill, and the belief that a specific health action will prevent or cure illness. The individual’s behavior depends on their perception of the benefits and barriers related to the health behavior. The health belief model is composed of six facets: perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cue-to-action, and self-efficacy. Perceived susceptibility is how vulnerable an individual feels towards the illness or disease (LaMorte 2019). For example, if a person with hypertension does not believe that they will be greatly affected by the issue, they are less likely to adhere to any treatment plan to control it. Perceived severity is the individual’s feelings about contracting the illness or disease (LaMorte 2019). If an individual does not perceive the consequences of hypertension as severe, they are less likely to adhere to a treatment plan, as opposed to someone who perceives hypertension as severe. Perceived benefits are the perception of the effectiveness of various actions available to reduce the threat of illness or disease (LaMorte 2019). For instance, if an individual perceives dietary changes as effective and can reduce the risk/ severity of hypertension, they are more likely to make the dietary changes. Perceived barriers are the person's feelings regarding the obstacles to performing a recommended health action (LaMorte 2019). Continuing with the previous example, if an individual perceives diet as an important part of their culture, and the recommended dietary changes do not align with their cultural cuisine, they are less likely to make the dietary changes. A different type of perceived barrier could be if an individual does not have the financial means to afford medication, they are less likely to take it. Cue to action is an either internal or external stimulus needed to trigger the decision-making process to accept a recommended health action (LaMorte 2019). In the case of a hypertensive adult, this could be the doctor’s office calling to schedule an appointment. Lastly, self-efficacy is the level of a person's confidence in his or her ability to successfully perform a behavior (LaMorte 2019). For example, if an individual believes they are capable of completing the recommended exercise to manage their hypertension, they are more likely to do it. Application of the theory Several studies have utilized the health belief model to explain hypertension treatment adherence. Kamran et al. (2015) studied determinants of rural patients’ adherence to hypertension medication. Using the health belief model, the respondents who perceived high susceptibility, severity, benefit had better adherence compared to moderate and low susceptibility, severity, and benefit. Likewise, Ross et al. (2004) explored the role of illness perception and treatment beliefs in patient compliance of hypertension management. They found those who perceived medication as beneficial and effective were more likely to be compliant. Self-efficacy also played a significant role in treatment adherence. To further understand how hypertension impacts impoverished individuals, the purpose of this study was to explore the perceptions, knowledge, and attitudes regarding hypertension, and the treatment adherence barriers among impoverished hypertensive adults. The study was a qualitative analysis, making note of limiting factors to treatment adherence, and exploring the disparities between what health care professionals believe they are teaching and what is being retained/ applied by the hypertensive individuals 2.3 Empirical Review. Vaidya et al., (2017) investigated the knowledge and perception of hypertension, therefore, this study aimed to assess the knowledge and perception of hypertension among hypertensive patients at a tertiary hospital in Nepal. This is a hospital based, mixed-method, cross-sectional study which was conducted among 400 hypertensive patients in the outpatient department of Sahid Gangalal National Heart Center, Kathmandu, Nepal. Patients who were diagnosed as hypertensive at least 6 months before were selected by simple random sampling technique and were interviewed using semistructured questionnaire, and interview schedule from March to May 2019. Data were analyzed using descriptive and inferential statistics. The mean age of the respondents was 58.86 ±11.07 years and nearly half (47.8%) of them were in the age group of 60 years and above. More than half, (58%) were male, 77.8% were overweight, about half of them had a significant family history of hypertension with first degree relatives. Regarding the knowledge, the total mean score was 16.16±3.032 and had significant difference with age (p= 0.002), gender (p=.000), education (p=0.002), occupation (p=0.000), and duration of HTN diagnosis (p=0.000). Majority of them perceived hypertension as less serious illness and had significant difference with education level (p=0.001) and duration of HTN diagnosis (p=0.000). Majority of participants had inadequate knowledge of hypertension and they perceived hypertension as less severe illness which might hinder the adherence to treatment recommendations. Hence, mass awareness program strategies might be helpful to increase hypertension related knowledge and perception. Lamptey et al., (2017) investigated the knowledge, awareness, attitudes and perception of hypertension among adults (19-60 years). The study was conducted in the Sunyani Municipality, Brong Ahafo Region, Ghana. A descriptive cross section research survey design with a multistage comprising cluster sampling, systematic sampling, and purposive sampling techniques was used with a sample size of 343 respondents. The following are the major findings; out of 343 respondents 78 were hypertensive. Prevalence for the entire study respondent was 22.7%. There were 221 females and 53 of them were hypertensive. The prevalence for the female respondent was 24.0%. There were 122 males and 25 of them were hypertensive. So the prevalence of the male respondent was 20.5%. The findings of this study showed that hypertension is highly prevalent among adults (19-60 years). Out of the 343 respondent, (62.1%) of them in the present study had heard of hypertension with majority (70.5%) being males. Most of the respondents did not know their current blood pressure status. It was shown that there was significant association between awareness of hypertension and demographic profile (no formal education (p<0.0001; x2 = 22.52), tertiary education (p<0.0001; x2 = 19.3), cigarette smoking (p = 0.0414; x2 = 4.16), shisha smoking (p =0.0009; x2 = 11) and exercise (p < 0.0001; x2 = 36.09). Furthermore, the finding suggests that individuals who had no form of formal education (p<0.0001; x2 = 22.52) are more likely to become hypertensive than those who are educated. This may be attributed to the fact that persons who are educated stand the chance of being enlightened on hypertension and therefore adopt healthy lifestyles to avoid the condition. The study found a significant (p<0.0500) association between the perception that changing lifestyle (such as low salt intake, quit smoking and engaging in exercise) lowers hypertension. Finally, it was shown that there was a higher proportion between the perception that hypertension is an avoidable part of aging and socio-demographic characteristics. A study was conducted by Okechukwu (2017), to determine the knowledge and perception of hypertension with associated factors in Ugep, an urban community in South-southern part of Nigeria. A descriptive cross-sectional study was conducted among adults (18 years and above) residing in Ugep community of Cross River State in South-southern Nigeria. A total of 192 consenting adults were recruited consecutively into the study during a medical outreach organized by Medical and Dental Consultant Association of Nigeria in August, 2017. Majority of the study participants (81.3%) demonstrated poor knowledge of hypertension while only a few of them were still holding wrong perceptions about the causes of hypertension. Among the socio-demographic factors explored, only educational status showed a significant association (p = 0.02) with the knowledge of hypertension among the study participants having no formal education being the poorest (93.0%). The knowledge of hypertension is still low among the Ugep community of CRS with some level of wrong perception about hypertension still persistent. Continuous education of the adult population of Ugep community is advocated in order to improve knowledge and perception of hypertension. Osuala et al., (2019) carried out a descriptive cross-sectional study to assess the knowledge and level of awareness of the disease among hypertensive patients attending the medical outpatient clinic of Olabisi Onabanjo University Teaching Hospital (OOUTH). Hypertensive patients who attended the medical outpatient clinic during the one-year study period and gave their consent were recruited into the study. Response to a questionnaire on various aspects of hypertension was analyzed using the STATA for Windows software. There were 254 hypertensive patients, of which 111 were males and 143 were females, giving a male: female ratio of 1:1.3. The mean age (SD) of the patients was 51 years +/- 12.2; 52.4% of the participants were aware that hypertension was the commonest noncommunicable disease in Nigeria. About one in 10 patients (11.4%) was aware that "nil symptom" is the commonest symptom of hypertension, while 37% were not aware that hypertension could cause renal failure. Only about one-third (35.4%) of the patients knew that hypertension should ideally be treated for life, while 58.3% believed that antihypertensive drugs should be used only when there are symptoms. The remaining 6.3% believed that the treatment of hypertension should be for periods ranging from two weeks to five years but not for life. This study has demonstrated inadequate knowledge of hypertension in patients with hypertension in our study population. Conscious efforts should be made and time set aside to health educate hypertensive patients. Organization of "hypertensive club or society" could be encouraged. These will reduce dissemination of false or inaccurate information by hypertensive patients to the public and its attendant dangers. A study was conducted by Ordinioha (2021) to assess knowledge, attitude, and perception about hypertension among the staff of University of Port Harcourt, Rivers State.  Cross- sectional study was conducted among the staff in July 2019.  256 staff was randomly selected across all the Faculties. Data collected using structured questionnaire include, demographic information, knowledge, perception and attitude about hypertension and statistical analysis carried out with SPSS version 20.  Total 54.7% (140) respondents were academic staff and 45.3% (116) non- academic. 61.7% (158) male, females constitute 38.3% (98). Male academic staff was 67.1% (94); most academic staff, 36.4% (51) was within 50-59 years, 28.6% (40) were between 40-49 years. Total 37.1% (43) non-academic staff  were within 40-49yrs. Respondents have a good knowledge, 87.9%, of hypertension, but only 61% (85) of academic and 47% (54) non-academic staff knew that hypertension can be inherited. Total 40% (56) academic, 44.8% (52) non-academic claimed to have multiple source of information about hypertension. Knowledge on risk factors of hypertension was poor, 20%.  Knowledge level of respondents on hypertension was high, with moderate attitude but poor perception.  CHAPTER THREE RESEARCH METHODOLOGY This chapter deals with the research design, research setting, target population, sample and sampling technique, instrument for data collection, validity of the instrument, reliability of the instruments, method of data collection, method of data analysis and Ethical consideration. 3.1 Research Design This study will adopt the descriptive survey design to determine the knowledge and perception of hypertension management among patients in Ujoelen Health Center Ekpoma. This survey design is considered appropriate, because opinion of a large sample would be sought for and presented in their natural setting to draw inference. 3.2 Research Setting Ujoelen is a community located in Ekpoma town, Esan West Local Government Area, Edo State. Ujoelen lies on the geographical coordinate of latitude 6°45′N6°08′E. The town has an official Post Office, currently Ujoelen is developing with major infrastructures, hospitals, schools, modern eatries and roads. The community is also secured. A large percentage of the economy of Ujoelenis derived from local farming and trading. Ujoelen productive farm output is mainly the result of its situation in a rain forest zone, its loamysoil type and its topography. Apart from farming and trading, other business transactions take place on a daily basis. In Ujoelen, there are many business sectors such as Small Scale Enterprises, Hotels, Hospitals etc (Ikuenobe-Otaigbe, 2016). 3.3 Target Population The population of this study includes all patients who are currently attending Ujoelen Primary Health Centre, Ekpoma Edo State with a population of forty two (42). These patients are made up of men and women who is currently attending Ujoelen Primary Health Centre, Ekpoma for treatment of hypertension. Source: Ujoelen Primary Health Care Report, 2023. 3.4 Sample size Determination The target population for this study will include patients comprising of both men and women who registered with Ujoelen Primary Health Centre and are currently attending with Ujoelen Primary Health Centre for hypertension management with a total population seventy two (72) patients. Source: Field Survey, 2023. The sample size for this study was calculated using Taro Yamane formula (Taro formula, 1967). Taro Yamane’s Formula N=N/1+Ne2 (Taro formula 1967) Where n=sample size N=population size E=error of sampling (0.05) n= 72/1+72 (0.05)2 n=64.8 + 10% of attrition = 7.2 Therefore, the sample size is 72 3.5 Sample and Sampling Techniques A purposive sampling technique will be used to select 72 (100%) of the entire population for the study as the entire population is only 72. The 72 patients in Ujoelen Primary Health Centre, Ekpoma Edo State will be use for the study. 3.6 Instrument for Data Collection The data for the study was collected using questionnaire, developed by the researcher based on the objectives of the study. The questionnaire consisted of four sections. [Section A] consisted of 6 items to explore socio-demographic data, [Section B] consists of 9 items to ascertain the knowledge of hypertension management among patients in Ujoelen Health Center Ekpoma [Section C] consists of 10 items to determine the perception of hypertension management among patients in Ujoelen Health Center Ekpoma and section D: will be to ascertain the level of hypertension management among patients in Ujoelen Health Center Ekpoma 8 items. The questionnaire comprises of 34 items altogether. 3.7 Validity of Instrument The validity of the instrument will be ensured using face and content validity; having constructed the questionnaire that would elicit information for the study in line with the study objectives, the researcher ensured that the validity of the content by presenting it to the supervisor who checked the questionnaire item to make sure it tallied with the research objectives. Ambiguous questions was rephrased to ensure that they measure what they are intend to measure. 3.8 Reliability of Instrument The reliability of the instrument will be tested through test-retest method. The questions was consistently applied to answer the objectives and questions of the research. A study will be carried out on respondents in Ujoelen Primary Health Centre, EKpoma Edo State among couples and will be found reliable based on their positive response. This is to determine the adequacy of the instrument. Data obtained was tested using Pearson Product Moment correlation coefficient test. The result obtained will determined the reliability of the instrument. The reliability index will 0.85 -0.95 The result obtained will be found to be reliable. 3.9 Method of Data Collection The researcher will present herself and her faculty ethical letter of application to the research and Ethics committee chairman of Esan West Local Government Area, Ekpoma Edo State, who eventually will give the researcher a written permission to use the area. A written consent was obtained from the individual respondents, assuring them of confidentiality before embarking on data collection. The questionnaire will be given to those who were willing and give their consent for the study, and it was retrieved back on the spot after completion. Data collection will be done twice a week and 3 weeks was used before the subjects were completed. Respondents will be given one week to fill the questionnaire before collection. This will ensure that they have adequate time at their convenience to answer questions appropriately. 3.10 Method of Data Analysis Data obtained from the field work through the use of questionnaire will be analyzed descriptive statistics to answer the research questions using SPSS version 23.0. The descriptive statistics of table of frequency and percentage will be used to answer research questions. 3.11 Ethical Consideration A letter of identification and introduction will be obtained from the Head of Department, Department of Nursing Science to the Chairman Research and Ethics Committee of Esan West Local Government Area Ekpoma, Edo State in order to allow the researcher collect data from the area. The letter was presented to the chairman who eventually will give his consent by issuing an approval letter to the researcher. The researcher then proceeded with the collection of data. Privacy and confidentiality will be assured as the respondents will represented with numbers instead of their names. This study is self-determination or voluntary participation. The researcher will ensured that the respondents had the right to voluntary decide whether to participate in the study or not, without the risk of incurring any penalty or prejudicial treatment. They were given the right to decide at any point during the study to withdraw their participation or refuse to provide any information on any point that was not clear to them. Plagiarism will avoided in this study. All authors used in the study were appropriately cited both in the body of the work at the reference page. The purpose and benefit of this study will be explained to the respondents to obtain their informed consent. CHAPTER FOUR RESULTS This chapter is concerned with the presentation and analysis of data. The raw data were analyzed critically to extract useful information for making inferences and conclusions. Tables, frequency count and simple percentage were used for data analysis. A total number of 70 copies of questionnaire were administered to respondents and 70 copies of the questionnaire were duly filled, returned and were considered good for analysis. This represented 100% return rate. Presentation of Results Table 4.1 Frequency and percentage analysis distribution on socio-demographic data of the respondents n= (70) Item Category Number of Respondents Percentage 1) Age 16-24 5 (7.1%) 25-29 10 (14.3%) 30-49 55 (78.6%) Total 70 2) Religion Christianity 65 (92.9%) Islam 5 (7.1%) Others 0 (0%) Total 70 3) Occupation Farming 10 (14.3%) Trading 50 (71.4%) Civil Servant 5 (7.1%) Student 5 (7.1%) Total 70 4) Educational Status Primary 5 (7.1%) Secondary 45 (64.3%) Tertiary 20 (28.6%) No Formal Education 0 (0%) Total 70 5) Marital Status Single 5 (7.1%) Married 60 (85.7%) Divorced/Separated 5 (7.1%) Total 70 The result shows that majority of respondents, 5 (7.1%) were in the 16-24 age range, followed by 10 (14.3%) in the 25-29 age range and 55 (78.6%), fall within the 30-49 age range. The dominant religion among respondents is Christianity, with 65 (92.9%) identifying as Christians. Only 5 (7.1%) respondents reported being Muslim, and no respondents indicated following other religions. Farming accounts for 10 (14.3%) of respondents, while civil servants and students each represent 5 (7.1%) of respondents, the largest occupational group among respondents is trading, with 50 (71.4%) engaged in trading activities. Only 5 (7.1%) respondents have primary education, the majority of respondents, 45 (64.3%), have a secondary education, followed by 20 (28.6%) with tertiary education. 5 (7.1%) were single, most respondents, 60 (85.7%), are married, while 5 (7.1%) are divorced or separated. Table 4.2 Frequency and percentage analysis distribution on Knowledge of Hypertension Management among Patients in Ujoelen Health Center Ekpoma Items YES (%) NO (%) 1. Do you know what hypertension is? 701(00%) 0(0%) 2a. What should normal blood pressure levels be? (Top number) <-%) -%) - >140 0(0%) - Don’t know - - 2b. What should normal blood pressure levels be? (Bottom number) <-%) - 90 0(0%) - >90 0(0%) - Don’t know - - 3. Can an unhealthy diet lead to hypertension? 60(85.71%) 10(14.29%) 4. Can overweight lead to hypertension? 60(92.31%) 5(7.69%) 5. Can inactivity affect the management of hypertension? 55(78.57%) 15(21.43%) 6. Does excessive alcohol consumption lead to hypertension? 65(92.86%) 5(7.14%) 7. Does poor eating style lead to hypertension? 70(100%) 0(0%) 8. Does high blood pressure lead to hypertension? 70(100%) 0(0%) 9. Is hypertension dangerous to health? 70(100%) 0(0%) 10. Have you ever been told by your doctor or health care provider that you have hypertension? 50(71.43%) 20(28.57%) 11. Did your doctor or health care provider tell you what your personal blood pressure should be? 70(100%) 0(0%) 12. Can lowering blood pressure even a little bit improve health? 70(100%) 0(0%) The result shows that all participants (100%) are aware of what hypertension is, indicating a high level of basic knowledge regarding the condition. The majority (71.43%) correctly identified 140 as the normal top number for blood pressure. However, a significant portion (28.57%) believes it to be <140. All participants (100%) correctly identified <90 as the normal bottom number for blood pressure. A majority (85.71%) understand that an unhealthy diet can lead to hypertension, but there is still a small group (14.29%) who do not recognize this risk factor. Most participants (92.31%) are aware that being overweight can lead to hypertension, indicating good knowledge of this risk factor. A large proportion (78.57%) recognize that inactivity can affect hypertension management, though there is still a notable minority (21.43%) who are unaware. The vast majority (92.86%) correctly identify excessive alcohol consumption as a risk factor for hypertension. All participants (100%) agree that poor eating habits can lead to hypertension, showing complete awareness of this factor. All participants (100%) understand that high blood pressure is synonymous with hypertension. There is unanimous agreement (100%) that hypertension is dangerous to health, indicating strong awareness of the condition's severity. A significant number (71.43%) have been diagnosed with hypertension by a healthcare provider, reflecting a high prevalence among the participants. All participants (100%) have been informed by their healthcare provider about their personal blood pressure goals, indicating effective communication in patient care. Table 4.3 Frequency and percentage analysis distribution on perception of hypertension management among patients in Ujoelen Health Center Ekpoma Items (YES %) (NO %) 1. Do you think that high blood pressure (hypertension) has a cure? 70 (100%) 0 (0%) 2. Can changing lifestyle help to lower your blood pressure? 60(85.7%) 10(14.3%) 3. Do you think high blood pressure is an avoidable part of aging? 70 (100%) 0 (0%) 4. Do you think taking medication regularly helps to manage hypertension? 70 (100%) 0 (0%) 5. Do you think exercising regularly will help to manage hypertension? 70 (100%) 0 (0%) 6. Do you think less stress will help to manage hypertension? 65(92.9%) 5 (7.1%) 7. Do you think quitting smoking will help to manage hypertension? 70 (100%) 0 (0%) 8. Do you think changing diet (salt intake) will help to manage hypertension? 60(85.7%) 10(14.3%) 9. Do you think reducing alcohol will help to manage hypertension? 65(92.9%) 5 (7.1%) 10. Do you think losing weight will help to manage hypertension? 55(78.6%) 15(21.4%) 11. Do you think taking medication regularly helps to manage hypertension? 65(92.9%) 5 (7.1%) The result show that all respondents (100%) believe that hypertension has a cure, indicating a high level of optimism or possibly misinformation about the chronic nature of hypertension. A significant majority (85.7%) of respondents believe that lifestyle changes can help lower blood pressure, reflecting awareness of the importance of non-pharmacological interventions in managing hypertension. All respondents (100%) think high blood pressure is avoidable with aging, indicating a strong belief in the effectiveness of preventive measures and healthy aging practices. Every respondent (100%) agrees that regular medication helps manage hypertension, highlighting adherence to medical advice and the importance of consistent medication use in controlling blood pressure. All respondents (100%) believe in the efficacy of regular exercise for managing hypertension, showing strong support and recognition of the benefits of physical activity. Most respondents (92.9%) think reducing stress helps manage hypertension, acknowledging the significant role that stress management plays in maintaining healthy blood pressure levels. All respondents (100%) agree that quitting smoking helps manage hypertension, indicating strong awareness of the harmful effects of smoking on blood pressure and overall cardiovascular health. A majority (85.7%) believe that reducing salt intake helps manage hypertension, reflecting good knowledge of the impact of diet on blood pressure control. Most respondents (92.9%) think reducing alcohol intake helps manage hypertension, showing awareness of the benefits of limiting alcohol consumption for blood pressure management. A significant majority (78.6%) believe that losing weight helps manage hypertension, though some remain skeptical, indicating an area for further education on the benefits of weight management. Most respondents (92.9%) agree that regular medication helps manage hypertension, indicating strong trust in pharmacological treatment and adherence to prescribed therapies. Table 4.4 Frequency and percentage analysis distribution on Hypertension management among patients in Ujoelen Health Center Ekpoma Items (YES %) (NO %) 1. Do you take your medication as directed? 60 (85.7%) 10 (14.3%) 2. Do you check your blood pressure regularly? 55 (78.6%) 15 (21.4%) 3. Do you eat food or diet with less salt? 65 (92.9%) 5 (7.1%) 4. Do you get regular physical activity? 30 (42.9%) 40 (57.1%) 5. Do you maintain a healthy weight or losing weight? 63 (90.0%) 7 (10.0%) 6. Do you limit the level of alcohol intake? 68 (97.1%) 2 (2.9%) 7. Do you avoid smoking? 70 (100%) 0 (0%) 8. Do you take enough time to sleep daily? 50 (71.4%) 20 (28.6%) 9. Do you exercise regularly? 54 (77.1%) 16 (22.9%) A majority of respondents (85.7%) take their medication as directed, indicating good adherence to prescribed medication regimens. A significant portion of respondents (78.6%) check their blood pressure regularly, suggesting they are proactive in monitoring their health condition. Most respondents (92.9%) eat a diet with less salt, indicating high awareness and practice of dietary management for hypertension. Less than half of the respondents (42.9%) get regular physical activity, highlighting a potential area for improvement in lifestyle habits related to hypertension management. A high percentage (90.0%) of respondents maintain a healthy weight or are actively losing weight, which is beneficial for managing hypertension. An overwhelming majority (97.1%) limit their alcohol intake, showing strong adherence to recommendations for reducing hypertension risk. All respondents (100%) avoid smoking, which is a very positive finding for hypertension management. A majority (71.4%) take enough time to sleep daily, contributing to better overall health and hypertension control. A substantial proportion (77.1%) of respondents exercise regularly, which is beneficial for managing hypertension. Answering of Research Questions 1. What is the knowledge of hypertension management among patients in Ujoelen Health Center Ekpoma? From the response elicited from table 4.2: The result shows that patients have good knowledge of hypertension management in Ujoelen Health Center Ekpoma. This indicates that all participants (100%) are aware of what hypertension is, indicating a high level basic knowledge regarding the condition. 2. What is the perception of hypertension management among patients in Ujoelen Health Center Ekpoma? From the response elicited from table 4.3: The result shows that patients have good and positive perception of hypertension management in Ujoelen Health Center Ekpoma. This shows that they (100%) believe that hypertension has a cure, believe that lifestyle changes can help lower blood pressure, reflecting awareness of the importance of non-pharmacological interventions in managing hypertension, that regular medication helps manage hypertension, highlighting adherence to medical advice and the importance of consistent medication use in controlling blood pressure, believe in the efficacy of regular exercise for managing hypertension (100%). 3. What is the level of hypertension management among patients in Ujoelen Health Center Ekpoma? From the response elicited from table 4.4: The result shows that level of hypertension management among patients in Ujoelen Health Center Ekpoma was high. This was undecided by respondents (85.7%) who take their medication as directed, check their blood pressure regularly, all responses support which is a very positive finding for hypertension management (100%). CHAPTER FIVE DISCUSSION OF FINDING This chapter includes; key findings, implications of findings with literature support, aligning findings with previous studies cited, the implication of the findings to the nursing profession, limitations of the findings, summary of the study, conclusion, recommendation and suggestions for further study. 5.1 Key findings The result shows that patients have good knowledge of hypertension management in Ujoelen Health Center Ekpoma. This indicates that all participants (100%) are aware of what hypertension is, indicating a high level basic knowledge regarding the condition The result shows that patients have good and positive perception of hypertension management in Ujoelen Health Center Ekpoma. This shows that they (100%) believe that hypertension has a cure, believe that lifestyle changes can help lower blood pressure, reflecting awareness of the importance of non-pharmacological interventions in managing hypertension, that regular medication helps manage hypertension, highlighting adherence to medical advice and the importance of consistent medication use in controlling blood pressure, believe in the efficacy of regular exercise for managing hypertension (100%) The result shows that level of hypertension management among patients in Ujoelen Health Center Ekpoma was high. This was undecided by respondents (85.7%) who take their medication as directed, check their blood pressure regularly, all responses support which is a very positive finding for hypertension management (100%). 5.2 Implication of the findings with Literature support The result shows that patients have good knowledge of hypertension management in Ujoelen Health Center Ekpoma. This indicates that all participants are aware of what hypertension is, indicating a high level of basic knowledge regarding the condition, understand that an unhealthy diet can lead to hypertension, aware that being overweight can lead to hypertension, indicating good knowledge of this risk factor, recognize that inactivity can affect hypertension management, correctly identify excessive alcohol consumption as a risk factor for hypertension and hypertension is dangerous to health, indicating strong awareness of the condition's severity. This agreed with Ghana by Lamptey et al. (2017) to evaluate community-based hypertension improvement programme also affirmed that respondents were highly aware of hypertension, but with very low level of hypertension treatment and control and this requires in-depth investigation of the bottlenecks to treatment and control. A cross sectional survey which employed 529 participants by Sanne et al., (2017) on the topic hypertension knowledge among patients from an urban clinic also concluded that, there is hypertension knowledge deficits in specific content areas among the urban population. Educational programmes focusing on newly diagnosed hypertensive patients and aimed at filling targeted knowledge deficits may be a costeffective approach to increase hypertension knowledge in similar populations. The result shows that patients have good and positive perception of hypertension management in Ujoelen Health Center Ekpoma. This shows that they believe that hypertension has a cure, believe that lifestyle changes can help lower blood pressure, reflecting awareness of the importance of non-pharmacological interventions in managing hypertension, that regular medication helps manage hypertension, highlighting adherence to medical advice and the importance of consistent medication use in controlling blood pressure, believe in the efficacy of regular exercise for managing hypertension, showing strong support and recognition of the benefits of physical activity that quitting smoking helps manage hypertension, indicating strong awareness of the harmful effects of smoking on blood pressure and overall cardiovascular health and that regular medication helps manage hypertension, indicating strong trust in pharmacological treatment and adherence to prescribed therapies. Oliveria et al., (2015) conducted a descriptive survey to understand the current status of hypertension (HTN) awareness, perception and attitudes in a group of hypertensive patients. Our results suggest that patients are knowledgeable about HTN in general, but are less knowledgeable about specific factors related to their condition, and specifically their own level of BP control. The result shows that level of hypertension management among patients in Ujoelen Health Center Ekpoma was high. This shows that respondents take their medication as directed, indicating good adherence to prescribed medication regimens, check their blood pressure regularly, suggesting they are proactive in monitoring their health condition, eat a diet with less salt, indicating high awareness and practice of dietary management for hypertension maintain a healthy weight or are actively losing weight, which is beneficial for managing hypertension, avoid smoking, which is a very positive finding for hypertension management. This agreed with Han et al. (2019) who opined that weight gain is also associated with an increase in hypertension incidence and the age-related rise in systolic blood pressure. In an analysis of four Chicago epidemiological studies, weight gain was associated with an increase in pulse pressure. In the Framingham Heart Study, a 5% weight gain was associated with a 20% to 30% increase in hypertension incidence (Han et al., 2019). 5.4 Aligning findings with findings of previous studies cited The result shows that patients have good knowledge of hypertension management in Ujoelen Health Center Ekpoma. This agreed with Saleem et al., (2018) who stated that knowledge of hypertension is very essential because it contributes enormously to the prevention and management of the condition and also drug adherence. A study conducted in 2017 to assess the knowledge level and management practices of hypertension in pregnancy among health care workers in Moshi urban in Tanzania found out that the level of knowledge of hypertension during pregnancy is too low (Liljevik & Lohre, 2017). A recent study by Siddiqua et al. (2017) in Saudi Arabia in 2017 concluded that a significant proportion of hypertensive patients have good knowledge and attitude towards hypertension but they show moderate levels of practice which can lead to worsening their health condition in time being and resulting in severe complications and damaging of other vital organs also. The result shows that patients have good and positive perception of hypertension management in Ujoelen Health Center Ekpoma. Abdullahi & Amzat (2016) also conducted a research on knowledge and perceptions related to hypertension, lifestyle, behaviour modifications and challenges that are facing hypertensive patients, of which the authors enunciated that, there is high poor level of knowledge about hypertension and perceptions toward lifestyle-modification. Patients lacked understanding some points of risk factors, manifestation and lifestyle modifications of hypertension. In a study by Moczygemba et al. (2017), less than half of participants noted the long-term health complications of uncontrolled blood pressure. A limited understanding of hypertension, blood pressure goals and lifestyle modification recommendations was a common theme. Interestingly, the most reported barrier to lifestyle modification recommendations is the transient lifestyle of being homeless (Moczygemba et al. 2017). The result shows that level of hypertension management among patients in Ujoelen Health Center Ekpoma was high. This agreed with Shaikh et al., (2016) who reported that more than 70% of patients knew that tress, high cholesterol and obesity were the risk factors for hypertension and that 52.7% of them did not know that they were physically active, risk factor for hypertension. In addition, Ali et al. (2016) reported that study participants were aware that stress, excessive salt intake and obesity are risk factors for high blood pressure. But there was little awareness about excessive drinking, smoking and a sedentary lifestyle. In the same line, Akter, et al. (2019) estimated that in a Hispanic study of the community of hypertension on risk factors, treatment, diagnosis and prognosis indicated that only 28% knew the correct definition of hypertension and 3% of unknown etiology. The Centres for Disease Control (CDC, 2019) reported that among the youth in America aged 12 and 13 years, 69% were regularly active. However, the number dropped to 38% for young people between the ages of 18-21 years. A physically inactive child is more likely to become a physically inactive adult, which could lead to chronic diseases including hypertension of lifestyle. 5.5 Implication of the findings to nursing The results of this study have several implications for the nursing profession: 1. Education and Counseling: Nurses should continue to educate patients about the chronic nature of hypertension and the importance of lifestyle changes, including regular physical activity. 2. Regular Monitoring: Emphasis should be placed on the importance of regular blood pressure monitoring and adherence to medication. 3. Lifestyle Interventions: Nurses should advocate for and support lifestyle interventions, including dietary changes and stress management techniques. 4. Physical Activity Promotion: Increased efforts are needed to encourage patients to engage in regular physical activity as part of hypertension management. 5. Patient Communication: Effective communication between nurses and patients is crucial in ensuring patients understand and follow their treatment plans. 6. Addressing Misconceptions: Nurses need to correct any misconceptions about hypertension, such as its curability, to ensure patients have a realistic understanding of the condition. 5.6 Limitations of the Study Some limitations were encountered while carrying out the study, they include; Time constraints; the research time coincides with the researcher’s class lectures and clinical postings and examinations. Finance; financing the project work was a major challenge during the research period. 5.1 Summary This study assessed the knowledge and perception of hypertension management among patients in Ujoelen Health Center Ekpoma. The research design was a descriptive survey designed. The sample size was 70 using purposive sampling technique. The instrument for the study was questionnaire. The data that was collected from this research was analyzed manually and was presented using tables, frequencies and percentages. The validity of the instrument was ensured using face and content validity. The findings indicate a high level of basic knowledge about hypertension, with all participants aware of its definition and the majority correctly identifying key risk factors and management practices. The patients generally perceive lifestyle changes and regular medication as effective management strategies, reflecting a strong adherence to recommended practices. 5.8 Conclusions The study examined knowledge and perception of hypertension management among patients in Ujoelen Health Center Ekpoma and it was concluded that high level of basic knowledge about hypertension, with all participants aware of its definition and the majority correctly identifying key risk factors and management practices. The patients generally perceive lifestyle changes and regular medication as effective management strategies, reflecting a strong adherence to recommended practices. 5.9 Recommendations Base on the findings of the study the following policy recommendations should be considered. 1. It is recommended that continuous patient education programs be implemented to address misconceptions about the curability of hypertension and the chronic nature of the disease. 2. There is a need for enhanced counseling on the importance of regular physical activity as part of hypertension management. 3. It is recommended that healthcare providers develop and promote structured exercise programs tailored to hypertensive patients. 4. There is a need for regular workshops and seminars to educate patients on the importance of diet, stress management, and regular medication in controlling hypertension. 5. It is recommended that patient follow-up systems be strengthened to ensure adherence to blood pressure monitoring and medication regimens. 6. There is a need for targeted interventions to support patients in maintaining a healthy weight and limiting alcohol intake, with personalized counseling and resources. 5.10 Suggestions for further findings More research needs to be done on knowledge and perception of hypertension management and a replicate study should be done on knowledge and perception of hypertension management among patients in another Health Center not captured in the study REFERENCES Abed, Y, & Abu-Haddaf, S. (2018). Risk factors of hypertension at UNRWA primary health care\ centres in Gaza, Palestine. Int Scholarly Res Not Epidemiol, pp1-9. Abdullahi, A. A. & Amzat, J., (2016). Knowledge of Hypertension among the Staff of University of Ibadan, Nigeria, Journal of Public Health and Epidemiology,- Addo, J., Smeeth, L., & Leon, D. A., (2018). Hypertension in Sub-Saharan Africa. A Systematic Review, 50,-. Akter, R., Assadi, R., Singh, H., Abaszadhezouri, M.G., Lamichhane, S., & Ahadi, H. (2019). Sources of Information and Level of Knowledge on Hypertension among Entry Level University Students in Ajman, UAE, American Journal of Research Communication; 2(5): p 17. Ali, S., Sathiakumar, N. & Delzell, E., (2016). Prevalence and socio-demographic dactors associated with tobacco smoking among adult males in rural Sindh, Pakistan, Southeast Asian J. Trop. Med. Public Health, (37), 1054-60. Almas, A, Godil, SS, Lalani, S, Samani, ZA, & Khan, AH, (2017). Good knowledge about hypertension is linked to better control of hypertension; A multicentre cross-sectional study in Karachi. Pakistan BMC Research Notes-. Amoah, A. G. (2018). Hypertension in Ghana: a cross-sectional community prevalence study ingreater Accra. Ethnic Discussion, 13, 310–315. Arno, P., & Viola, D., (2018). Hypertension treatment at the crossroads: a role for economics? Am J Hypertension, 26,- Arredondo, A. & Aviles, R., (2019). Hypertension and Its effects on the economy of the health system for patients and society: Suggestions for developing countries. American Journal of Hypertension, 27, (4), 635–636. Bourne PA, McGrowder DA, Holder-Nevins D (2019). Public health behaviourchange intervention model for jamaicans: charting the way forward in public health. Asian Journal of Medical Sciences 2: 56-6 Brundtland, G. H. (2018). From the World Health Organization. Reducing risks to health, promoting healthy life. JAMA, 288. Cappuccio, F. P, Micah, F.B. & Emmett, L. (2018). Prevalence, detection, management, and control of hypertension in Ashanti, West Africa. Hypertension;-. Centers for Disease Control and Prevention, CDC (2019). Youth Risk Behavior Surveillance –United States, 2019. MMWR 2010, 59; (No. SS-5): 1-142. Davidsson, P., Hulthe, J., Fagerberg, B. & Camejo, G. (2019). Proteomics of apolipoproteins and associated proteins from plasma high-density lipoproteins. Arterioscler Thromb Vasc Biol, 30, 156-63. Elliott, P, Walker, L.L, Little, M.P, Blair-West, J.R, Shade, R.E & Lee, DR. (2016). Change in salt intake affects blood pressure of chimpanzees implications for human populations. Circulation 116:-. Ezzati M., Lopez A., Rodgers A., Vander H.S. & Murray C. (2018) Comparative risk assessment collaborative group: selected major risk factors and global and regional burden of disease. Lancet 360,- Gao, B., Zhang, L., & Wang, H., (2018). Clustering of major cardiovascular risk factors and the association with unhealthy lifestyles in the Chinese adult population. PloS One; 8(1).66-780 Guo, F., He, D., Zhang, W., & Walton, R.G., (2017). Trends in prevalence, awareness, management, and control of hypertension among United States adults, 1999 to 2010. J Am Coll Cardiol, 60(2), 599–606. Hajjar, I., Kotchen, J.M., Kotchen, T.A. (2018). Hypertension: Trends in prevalence, incidence and control. Annu. Rev. Public Health., 27: 465-90, Available from: https://www.researchgate.net/publication/-_Prevalence_and_Determinants_of_Hypertension_among_University_Employees [accessed Aug 02 2018]. Joint, N. C. (2018). The fifth report of the Joint National Committee on Detection, Evaluationand Treatment of High Blood Pressure (JNCV). Arch Intern Medicine, 153, 154–183. Jones, D. W., & Hall, J. E. (2019). Seventh report of the Joint National Committee on Prevention, Detection,Evaluation, and Treatment of High Blood Pressure and evidence from new hypertension trials. Hypertension, 43(1): 1-3. Kastarinen,, M., Antikainen, R., Peltonen, M., Laatikainen, T., Barengo, N. C., Jula, Keith, B., (2015). Hypertension and its pharmacological management. Harvard-MIT Division of Health Sciences and Technology. Department of Anesthesia and Critical Care, MGH Lamptey, P., Laar, A., Adler, A.J., Dirks, R., Caldwell, A., Prieto-Merino, D., Aerts, A., Pearce, N., & Perel, P., (2017). Evaluation of a community-based hypertension improvement program (ComHIP) in Ghana: data from a baseline survey. BMC Public Health-. Koju, R., Manandhar, K., Risal, A., Steiner, T. J., Holen, A., & Linde, M. (2015). Undertreated hypertension and its implications for public health in Nepal: Nationwide population-based survey. Kathmandu University Medical Journal, 13(49), 3–7. Lamptey, P., Laar, A., Adler, A.J., Dirks, R., Caldwell, A., Prieto-Merino, D., Aerts, A., Pearce, N., & Perel, P., (2017). Evaluation of a community-based hypertension improvement program (ComHIP) in Ghana: data from a baseline survey. BMC Public Health-. Li, Y., Zheng, X., Tang, L., Xu, W. & Gong, M. (2018). GLP-1 analogs containing disulfide bond exhibited prolonged half-life in vivo than GLP-1. Peptides, 32, 1303-12. Macedo, M. E., Lima, M. J, Silva, A. O, Alcantara, P, Ramalhinho, V., & Carmona, J., (2015). Prevalence, awareness, treatment and control of hypertension in Portugal: the PAP study. J Hypertens, 23(2),- Mahan, V., Deepa, M., Farooq, S., Datta, M., Deepa, R. (2018). Prevalence, awareness and control of hypertension in Chennai – the Chennai urban rural epidemiology study (CURES – 52). J. Assoc. Physicians India. 55(5): 326-32. Mancia, G, Fagard, R, Narkiewicz, K, Redon, J, Zanchetti, A, Bohm, M, et al., (2018). ESH/ESC guidelines for the management of arterial hypertension: the task force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens; 3(1),- Mandal, A., (2017). Study of prevalence of type 2 diabetes mellitus and hypertension in overweight and obese people. Journal of Family Medicine and Primary Care, 3(1)25-28 Mills, K.T., Bundy, J.D., Kelly, T.N., Reed, J.E., Kearney, P.M., Reynolds, K., et al., (2016). Global disparities of hypertension prevalence and control: a systematic analysis of population based studies from 90 countries. Circulation, 13, (4), 441–50. Morgado. E., & Pedro L. N., (2019). Hypertension and chronic kidney disease: Cause and Consequence-Therapeutic Considerations. Nephrology Department, Hospital of Faro, Portugal Ogah, S.O., Okpechi, I., & Chukwuonye, II., (2017). Blood pressure, prevalence of hypertension and hypertension-related complications in Nigerian Africans: A review. World J Cardiol 4:327-340 Okertchiri J.A. (2016). Ghana needs more Diabetic Educators. Daily Guide, 2018. Nov 16, [Last accessed on 20188 Jan 20]. Available from: http://www.dailyguideghana.com/?p=67402 Ordinioha B (2021). The Prevalence of hypertension and its modifiable risk factors among lecturers in a medical School in Port Harcourt, South-South Nigeria: implication for control effort. Niger J Clin Pract; 16:1-4. Osuala, E.O, Abimbola, O.O & Kadiri S (2019). Knowledge, attitude towards hypertension and life style habits of rural dwellers in Owerri-Nkworji, Imo State, Nigeria. Academic J; 6(1): 48 -51. Okechukwu O (2017). Blood pressure, prevalence of hypertension and hypertension related complications in Nigeria, Africa: A review. World J Cardiol; 4(12): 327–340. Olatunbosun, S. T., Kaufman, J. S., Cooper, R. S., & Bella, A. F. (2017). Hypertension in a Black population: prevalence and biosocial determinants of high blood pressure in a group ofurban Nigerians. Journal Hum Hypertension, 14, 249–257. Saleem, F, Hassali, MA, Shafie, AA, Ul Haq, N, Farooqui, M, Aljadhay, H et al. (2018). Pharmacist intervention in improving hypertension-related knowledge, treatment medication adherence and health-related quality of life: a nonclinical randomized controlled trial. Health Expect;-. Sanne, S.; Muntner, P.; Kawasaki, L.; Hyre, A.; & DeSalvo, K.B. (2017). Hypertension knowledge among patients from an urban clinic. Ethn. Dis. 18, 42-47 Shaikh, R.B., Mathew, E., Sreedharan, J., Muttappallymyalil, J., Sharbatti, S. & Basha, S., (2017). Knowledge regarding risk factors of hypertension among entry year students of a Medical University, J. of Family Community Med., 18(3),124–129. Shrestha, S., Adhikari, B., Poudel, R. S., Thapaliya, K., Kharal, T., Bastakoti, M., & Bhatta, N.K. (2016). Knowledge, attitude and practice on hypertension among antihypertensive medication users. Journal of the Nepal Medical Association, 55(204), 86–92. Siddiqua, GK, Hussein, R, & Dornan, JC. (2017). Dying to give birth: the Pakistan liaison committee’s strategies to improve maternal health in Pakistan. BJOG. 118(2):96–9. Stamler, R., Stamler, J., Gosch, F. C. Civinelli, J., Fishman, J., McKeever, P.,McDonald, A.. & Dyer, A. R. (2018). Primary prevention of hypertension bynutritional hygienic means: Final report of a randomized, controlled trial. Journal of the American Medical Association, 22(13),- Ulasi, II, Ijoma, CK, Onwubere, BJC, Arodiwe, E, Onodugo, O, & Okafor, C., (2016). High prevalence and low awareness of hypertension in a market population in enugu, Nigeria. Int J Hypertens. 86(9):675–9 Vaidya, A., Oli, N., Eiben, G., & Krettek, A. (2017). The heart-health associated research, dissemination and intervention in the community (HARDIC) trial for nepalese mothers regarding diet and physical activity: A process evaluation. Kathmandu University Medical Journal, 15(58), 107–116. Van-de-Vijver, U. (2018). Status report on hypertension in Africa – Consultative review for the 6th Session of the African Union Conference of Ministers of Health on NCDs. PanAfrican Medical Journal,-. WHO. (2017). Health expectancy is more important than life expectancy. Message from the WHO Director General on the World Health Report, 5-6. Geneva, Switzerland: World Health Organization. WHO. (2018). A global brief on Hypertension: Silent killer, global public health crisis. Geneva: WHO. WHO. (2017). Hypertension control. Report of a WHO Expert Committee. World Health Organ Tech Rep Ser., 8(62), 4–52. Word Health Organisation. (2016). Global Health Observatory (GHO) data: Raised blood pressure. http://www.who.int/gho/ncd/risk_factors/blood_pressure_prevalence_text/en/. Accessed 24 Feb 2018. APPENDIX: QUESTIONNAIRE Department of Nursing Sciences, Faculty of Basic Medical Sciences, College of Medical Sciences, Ambrose Alli University, Ekpoma, Edo State, Nigeria. Dear Respondent, I am a final year student of the above named Department and faculty. I am carrying out a research on “knowledge and perception of hypertension management among patients in Ujoelen Health Center Ekpoma”. I will be grateful if you fill out the attached questionnaire. All information provided will be used with utmost confidentiality. Thanks for your anticipated co-operation. Yours faithfully QUESTIONNAIRE ON: KNOWLEDGE AND PERCEPTION OF HYPERTENSION MANAGEMENT AMONG PATIENTS IN UJOELEN HEALTH CENTER EKPOMA SECTION A: DEMOGRAPHIC DATA OF RESPONDENTS You are expected to tick (√) in the appropriate box in section A and Section B. 1) Age: 16-24 [ ] 25– 29 [ ] 30 - 49 [ ] 2) Religion: Christianity [ ] Islam [ ] Others [ ] 3) Occupation: Farming [ ] Trading [ ] Civil Servant [ ] Student [ ] 4) Educational status: Primary [ ] secondary [ ] Tertiary [ ] No formal Education [ ] 5) Marital Status: Single [ ] Married [ ] Divorce/separated [ ] Section B: Knowledge of hypertension management among patients in Ujoelen Health Center Ekpoma 1. Do you know what a hypertension is? Yes [ ] No [ ] 2. What should normal blood pressure levels be? a. Top number? [ ]<140 [ ]140 [ ]>140 [ ]don’t know b. Bottom number? [ ]<90 [ ]90 [ ] >90 [ ]don’t know 3. Can unhealthy diet lead to hypertension? Yes [ ] No [ ] 4. Can over weight leads to hypertension? Yes [ ] No [ ] 5. Can inactivity affect the management of hypertension? Yes [ ] No [ ] 6. Do excessive alcohol consumption leads hypertension? Yes [ ]No [ ] 7. Do poor eating style leads to hypertension? Yes [ ] No [ ] 8. Do high Blood Pressure leads hypertension? Yes [ ] No [ ] 9. Is hypertension dangerous to health? Yes [ ] No [ ] 10. Have you ever been told by your doctor or health care provider that you have hypertension? [ ] Yes [ ] No 11. Did your doctor or health care provider tell you what your personal blood pressure should be? Yes [ ] No [ ] 12. Can lowering blood pressure even a little bit improve health? Yes [ ] No [ ] Section C: Perception of hypertension management among patients in Ujoelen Health Center Ekpoma 1. Do you think that high blood pressure (hypertension) has a cure? Yes [ ] No [ ] 2. Can changing lifestyle help to lower your blood pressure? Yes [ ] No [ ] 3. Do you think high blood pressure is an avoidable part of aging? Yes [ ] No [ ] 4. Do you think taking medication regularly help to manage hypertension? Yes [ ] No [ ] 5. Do you think Exercising regularly will help to manage hypertension? Yes [ ] No [ ] 6. Do you think Less Stress will help to manage hypertension? Yes [ ] No [ ] 7. Do you think quitting Smoking will help to manage hypertension? Yes [ ] No [ ] 8. Do you think Change Diet (Salt Intake) will help to manage hypertension? Yes [ ] No [ ] 9. Do you think Reducing Alcohol will help to manage hypertension? Yes [ ] No [ ] 10. Do you think Losing Weight will help to manage hypertension? Yes [ ] No [ ] 11. Do you think taking medication regularly help to manage hypertension? Yes [ ] No [ ] 12. Do you think taking medication regularly help to manage hypertension? Yes [ ] No [ ] Section D: Hypertension management among patients in Ujoelen Health Center Ekpoma 1. Do you take your medication as directed? Yes [ ] No [ ] 2. Do you check your blood pressure regularly? Yes [ ] No [ ] 3. Do you eat food or diet with less salt? Yes [ ] No [ ] 4. Do you get regular physical activity? Yes [ ] No [ ] 5. Do you maintain a healthy weight or losing weight? Yes [ ] No [ ] 6. Do you limit the level of alcohol intake? Yes [ ] No [ ] 7. Do you avoid smoking? Yes [ ] No [ ] 8. Do you take enough time to sleep daily? Yes [ ] No [ ] 9. Do you exercise regularly? Yes [ ] No [ ]