Hypertension Elderly: Level of Knowledge and Attitudes

Richard Henky unmora

1. Background
Hypertension according to the World Health Organization (WHO) is a condition
where blood vessels have high blood pressure (systolic blood pressure ≥140 mmHg or
diastolic blood pressure ≥90 mm Hg) were stay. Blood pressure is the power of the
blood to fight the pressure of the arterial wall when the blood is pumped by the heart
throughout the body. The higher the blood pressure, the harder the heart works (WHO,
2013).
Based on data from the World Health Organization (WHO) of 70% of
hypertensive sufferers, it is known that only 25% received treatment, and only 12.5%
were treated withadequate treated cases. It is estimated that by 2025 the rate of high
blood pressure will increase by 60 %, and will affect 1.56 billion people worldwide. In
the world, nearly 1 billion people or 1 in 4 adults suffer from hypertension. High blood
pressure is a chronic disease that can damage human organs (MOH, 2007). WHO noted
that in 2013 there were at least 839 million cases of hypertension, estimated to be 1.15
billion in 2025 or around 29% of the total population of the world, where the sufferers
were more in women (30%) than men (29%). About 80% of cases of hypertension
increase occur mainly in developing countries (Triyanto, 2014).
In Indonesia there is an increase in the prevalence of hypertension. Overall the
prevalence of hypertension in Indonesia in 2013 was 26.5% (Riskesdas, 2013). And in
North Sumatra the prevalence of hypertension in 2013 was 24.7% (Riskesdas, 2013).
Data from the Indonesian Hypertension Doctors Association (InaSH) said the death rate
in Indonesia reached 56 million people from 2000-2013. It is known that the highest
factor of death is hypertension, causing death in around 7 million Indonesians (InaSH,
2014). This shows, 76% of cases of hypertension in the community have not been
diagnosed or 76% of people do not know that they suffer from hypertension.

2. Hypertension
 Hypertension is better known as high blood pressure disease. The blood pressure
limit that can be used as a reference to determine the normal or not blood pressure is
systolic and diastolic pressure. Hypertension or high blood pressure is an abnormal
increase in blood pressure in the arteries continuously for more than one period. This
occurs when the arterioles are contricate. Kontriksi arterioles make blood difficult to
flow and increase pressure against the arterial wall. Hypertension adds to the workload
of the heart and arteries which if it continues can cause damage to the heart and blood
vessels (Udjianti, 2011). According to WHO (2013), hypertension is defined as a state
of systolic blood pressure ≥ 140 mmHg and diastolic pressure ≥ 90 mmHg.
Hypertension is often referred to as a dark killer (silent killer), because it is a deadly
disease, without the symptoms first (Vitahealth, 2006).

A. Primary or Essential Hypertension Primary or Essential

Hypertension is an increase in arterial pressure produced by irregularities in the
normal homeostatic control mechanism without a clear subject or unknown cause.
Primary hypertension has a population of about 90% of all hypertensive patients.
Several factors are thought to be related to the development of essential hypertension
such as the following:
1. Genetic
Individuals who have a family history of hypertension, are at high risk of getting this
disease.
2. Gender and age
Men aged 35-50 years and post-menopausal women are at high risk for hypertension.
3. Diet
Consumption of a high-salt or fat diet is directly related to the development of
hypertension. According to Widharto (2007) actually, it is not salt (salt) that is not good
for blood pressure, but the content of sodium (Na) in the blood that can affect one's
blood pressure. However, Na which enters the blood excessively can hold back water,
thereby increasing blood volume. Increasing blood volume results in increased pressure
on the walls of blood vessels so that the work of the heart in pumping blood increases.
Most hypertension is also caused by thickening of arterial walls by fat or cholesterol. If
people with hypertension eat fatty foods, cholesterol levels in their blood can increase
 so that the walls of the blood vessels become thicker. The impact is getting worse, the
blood vessels become blocked.
4. Body weight
Obesity (> 25% above ideal body weight) is associated with the development of
hypertension. People who are overweight, their bodies work hard to burn excess calories
in. This calorie burning requires adequate oxygen supply in the blood. The more
calories burned, the more oxygen supply in the blood. The amount of blood supply
certainly makes the heart work harder. As a result, the blood pressure of obese people
tends to be high (Widharto, 2007).
5. Lifestyle
Smoking and consumption of alcohol can increase blood pressure if the lifestyle is
settled.
B. Secondary hypertension or non-essential
secondary hypertension is hypertension caused by other diseases, namely kidney
damage, diabetes, vascular damage and others. About 10% of hypertensive patients are
classified as secondary hypertension. In about 5-10% of patients with hypertension, the
cause is kidney disease. At around 1-2% the causes are hormonal abnormalities or the
use of certain drugs (such as the use of birth control pills). The trigger factors for the
emergence of secondary hypertension include: oral contraceptive use, coarctation of the
aorta, neurogenic (brain tumors, encephalitis, psychiatric disorders), pregnancy,
increased intravascular volume, burns, and stress (Udjianti, 2011)

3.Knowledge Level
According to (Notoadmodjo, 2012), the stage of knowledge in the cognitive
domain consists of 6 levels, namely:
1. Know (Know)
defined as remembering a material that has been studied before. Included in this level of
knowledge is a recall of the specifics of all materials studied or stimuli that have been
received. Therefore knowing this is the lowest level of knowledge. Verbs to measure
that people know about what they learned include mentioning, deciphering, defining,
expressing, and so on.
2. Understand(Comprehension)
 Understanding is defined as an ability to explain properly about the objects that are in
the know and be able to interpret the material correctly. People have understood the
object or material must be able to explain, mention examples, conclude, predict, and so
on the object being studied.
3. Application (application)
Applications can be interpreted as the ability to use material that has been studied
insituations or conditions real (actually). The application here can be interpreted as an
application or use of laws, formulas, methods, principles, etc. in other contexts or
situations.
4. Analysis (analysis)
Analysis is the ability to describe the material or an object into components, but it is still
within an organizational structure and still has to do with each other. This analytical
ability can be seen from the use of verbs such as being able to describe (make a chart),
differentiate, separate, group, and so on.
5. Synthesis (syntesis)
Synthesis refers to an ability to put or connect parts in a whole new form. In other
words synthesis is an ability to form new formulations from existing formulations. For
example, can arrange, can plan, can summarize, can adjust and so on a theory or
formulation - formulas that already exist.
6. Evaluation (evaluation)
This evaluation is related to the ability to justify or evaluate a material or object. These
assessments are based on a criterion that is self-determined, or uses existing criteria.

3.1 Definition of Attitudes

According to Notoatmodjo (2012) attitude is a reaction or response that is still
closed from someone to a stimulus or object. That attitude cannot be directly seen, but
can only be interpreted in advance from closed behavior. Attitude is a level of affection
that is both positive and in relation to psychological objects. The attitude is also a level
of tendency that is positive or negative related to the object of psychology. Attitude is a
reaction or response of someone who is still closed to the object stimulus and is not
immediately visible which means that someone has the readiness to act, but has not
done activities caused by appreciation of an object. Thomas and Znaniecki in Wawan
and Dewi (2010) state that attitudes are predisposing to do or not do a certain behavior,
so that attitudes are not only internal psychological conditions that are purely from
individuals (purely psychic inner state), but more attitudes are a process of awareness
that is of the nature individual. This means that this process occurs in a subjective and
unique way to each individual. This uniqueness can occur by the existence of individual
differences derived from the values and norms that individuals want to maintain and
manage.
3.2 Factors that Influence Attitudes
According to Azwar (2013), there are several factors that can influence the formation of
attitudes in humans, including:
1. Personal experience.
What we have and are experiencing will shape and influence our appreciation of social
stimulus.
2. The influence of others who are considered important.
Other people around us are among the social components that influence our attitudes.
Someone who is considered important, someone who we hope for approval for every
move, behavior and opinion, someone who does not want us to be disappointed or
someone who means special to us will influence the formation of our attitude towards
something. Example: Parents, peers, close friends, teachers, wives, husbands and others.
3. The influence of culture.
The culture in which we live and grow has a great influence on the formation of our
attitudes. Without realizing it, culture has implanted a line of influence on our attitude
towards various problems.
4. Mass Media
As a means of communication, various forms of mass media such as television, radio,
newspapers, magazines and others have a major influence in forming opinions and
beliefs. The existence of new information about something provides a cognitive
foundation for the formation of attitudes towards it.
5. Educational institutions and religious
institutions Educational institutions and religious institutions as a system have an
influence in forming attitudes because both of them lay the foundation of moral
understanding and concepts in individuals.
 6. Influence of emotional factors
Not all forms of attitude are influenced by environmental situations and personal
experiences, sometimes - sometimes a form of attitude is a statement based on emotions
that serves as a channeling of frustration or transfer of the form of ego defense
mechanisms.

4. Conclusion
Based on the results of the research that has been carried out, the following conclusions
can be drawn:
1. The most age range is 45-54 years, which is 35.7%, the sex of the most respondents is
women, 53.6%, education is the most many are high school, 42.9%, and the most jobs
are as farmers / fishermen / laborers, 37.5%.
2. The level of respondents' knowledge about hypertension is in the good category,
which is 67.9%, respondents have understood many things about hypertension they
suffered.
3. Respondents' attitudes about hypertension were in the sufficient category of 53.6%,
respondents were sufficiently alert to the hypertension they suffered.
4. Respondents' hypertension control efforts were in the sufficient category, namely
64.3%, respondents were still not too accustomed to doing regular exercise and still
consuming meat excessively.
5. Family support and health workers are in the good category 58.9%, family and health
workers provide good motivation for respondents to control their hypertension.
6. There is a significant relationship between education and employment of
hypertensive patients with efforts to control hypertension in the UPTD of the Health
Center in South Gunungsitoli District.
7. There is a significant relationship between the level of knowledge of hypertensive
patients with efforts to control hypertension. A good level of knowledge influences
hypertension control efforts conducted by respondents.
8. There is a significant relationship between the attitude of hypertensive patients with
efforts to
control hypertension. The level of attitudes that sufficiently influence the hypertension
control efforts conducted by respondents.
 9. There is a significant relationship between family support and health workers with
efforts to control hypertension. Family support and good health workers influence the
effort to control hypertension by the respondents to be better.

5. Suggestion

1. For the Gunungsitoli City Health Office through the South UPTD of the Gunungsitoli
District Health Center, it is necessary to improve the communication, information and
education (IEC) program on hypertension and its control through counseling, so that the
community is able to increase knowledge about hypertension right.
2. The Hospital party also needs to improve the Prolanis (Program Chronic Disease
Management) program which aims to encourage participants with chronic diseases to
achieve optimal quality of life with indicators of 75% of registered participants visiting
First Level Health Facilities having "good" results on specific DM disease checks Type
2 and Hypertension are in accordance with the relevant Clinical Guidelines so that they
can prevent the occurrence of complications of the disease.
3. It is hoped that the community will participate in the Program for Living Society
Healthy(GERMAS), which focuses on three activities, namely: doing 30 minutes of
exercise per day, eating fruits and vegetables and checking health regularly. The
community also needs to reduce salt and meat consumption excessively.
4. This research is expected to be used as input data, contribution of thought and
development of knowledge and can examine other factors that can influence the
occurrence of an increase in the incidence of hypertension for future researchers.

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