IOSR Journal of Dental and Medical Sciences (IOSR-JDMS)

e-ISSN: 2279-0853, p-ISSN: 2279-0861.Volume 15, Issue 6 Ver. III (June. 2016), PP 12-17
www.iosrjournals.org

Coping Strategies and Blood Pressure Control among

Hypertensive Patients in a Nigerian Tertiary Health Institution
Aina FO1, Ajayi EA2,Kumolalo FB3Inubile AJ4
1
Consultant Family Physician, Ekiti State University Teaching Hospital, Ado-Ekiti. Nigeria
2
Consultant Cardiologist, Ekiti State University Teaching Hospital, Ado-Ekiti. Nigeria
3
Clinical Psychologist, Ekiti State University Teaching Hospital, Ado-Ekiti. Nigeria
4
Bio-statistician, Ekiti State University Teaching Hospital, Ado-Ekiti. Nigeria

Abstract:
Background:The diagnosis of hypertensive in an individual could be regarded as a major challenge and hence
constitute a stressor. It is therefore expected that such an individual will develop some strategies of coping with
such a challenge. The management outcome will be influenced by the strategies deployed by the patient in
coping with the reality of such a chronic illness. This work was designed to determine the type of coping
strategies employ by the subjects, the relationship with blood pressure control, and identifiable patient
characteristics that my contribute to the choice of coping strategy.
Methods: A descriptive study conducted at the cardiology clinic of Ekiti State University Teaching Hospital,
Ado-Ekiti. A total of 265 subjects were consecutively recruited into the studies out of which 260 were suitable
for analysis using SPSS version 17.
Results: The predominant coping strategies among the subjects were in the positive domain (problem solving
and social contact) with associated lower mean blood pressure. There was anassociationbetween type of coping
strategy and attainment of target BP while marital status and the level of education were correlated with coping
type.
Conclusion: There is low attainment of target BP among the study population. Patients’ factor should be
considered in the management of hypertension in order to achieve better control.
Keywords: coping strategies, hypertensive patients, tertiary health institution

I. Background
Hypertension is a global health problem and an important public health challenge. As at 2000, 26.4%
totaling about 1billion people of the global adult population had hypertension and 29.2% were projected to have
this condition by 2015.1, 2 Hypertension that used to be regarded as a disease of the developed world has since
added to the disease burden of the developing world. Almost three quarters of the people with hypertension are
said to be living in the developing world.3,4
The aim of hypertension management is to attain target blood pressure control; this has however been a
great challenge both in the industrialized and developing countries. 5-15
A systematic review that compared hypertension prevalence in settings with different rate of economic
development showed higher overall prevalence of controlled hypertension in more affluent countries 3, 16.
Various factors have been identified as contributors to this failure17,18,19. One important area that needs to be
researched into is the patients’ factor in the overall control of blood pressure.
One of the most threatening challenges an individual can face in his/her life time is a challenge to his or
her health. The fear of possible disability whenever an individual is diagnosed with chronic illness could be
overwhelming and such bad news usually generates both immediate and delayed response. Having come into
reality with such a stressful life event, a process of coping is set in motion which includes appraising, response
options and implementation.20
In a meta – analysis by Ersek et al among older adults with persistent pain, the most frequently reported
coping strategies were task persistence (maintaining activity for example despite fluctuation of pain intensity),
pacing (activity avoidance), and coping self-statement (a form of conditioning to put a stop for example to
thoughts that lead to anxiety etc and replace them with rational thoughts); the least frequently used strategies
were Asking for Assistance and Relaxation21,22.
In 1981, Folkman and Lazarus developed the Lazarus ways of coping questionnaire to assess coping
thoughts and behaviours in response to a specific stressor. The coping strategies inventory short form (CSI – S)
is a 32 – item self – report questionnaire that was adapted from the Lazarus ways of coping questionnaire by
David L. Tobin in 1985. There are a total of 14 – subscales on the CSI – S which include eight primary scales,
four secondary scales and two tertiary scales. 23

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Coping Strategies and Blood Pressure Control among Hypertensive Patients in a Nigerian Tertiary…

The primary scales consist of specific coping strategies that people use in response to stressful events.
These include; problem solving, cognitive restructuring, social contact, expressed emotions, problem avoidance,
wishful thinking, and social withdrawal.24
The coping strategies employed by hypertensive patients may be an important contributor to the overall
success or otherwise of the management of their hypertension. This is because like most other chronic illnesses,
active participation and motivation is required on the part of the patient for effective management. While those
with positive coping strategies will need encouragement, those with negative form of coping strategies will
require special attention and re – orientation.

II. Methodology
Setting of the study - This cross sectional study was conducted at the general outpatient of clinic and the
cardiology clinic of the Ekiti State Teaching Hospital, Ado – Ekiti among consenting hypertensive patients.

Study Population– All consenting hypertensive patients attending the affected clinic were consecutively
recruited into the study until the required sample size is obtained.

Population Size – The sample size for this study was derived using the formular n = P(1 – P) (z/d)2
Where n is the required sample size, P is the national prevalence of hypertension which is 22%, Z = confidence
level at 95% (standard value of 1.98), d = margin of error at 5% (standard value of 0.05).
The sample size is thus: - n = (0.22) (1 – 0.22) (1.96/0.05)2 = 263.64
The minimum sample size for this study was thus = 263.

Data Collection – Questionnaire was admitted to collect social – demographic information from the
participants. Specific questions were asked to assess their coping strategies in three areas of the primary
subscales, that is, problem solving, problem avoidance, and social contacts. Their blood pressure was measured
on the day of interview twice using conventional method. 25,26,27.The average value of the two readings following
a 5 minute rest interval was taken as the current blood pressure. 27

Data Analysis – Data collected was analyzed using Statistical Package for Social Science version 17 Software
(IBM Corporation, Armonk, NY, USA). Results will be expressed as means, frequencies and percentages.
Comparison of means and frequencies wasdone while chi square wasused to determine the level of significance
with P value < 0.05 considered significant.
A subject who scores at least 10 out of the maximum of 16 points in any of the coping domain is
regarded as having adopted such a coping method. This is not exclusive of each other as subjects were found to
have adopted more than one strategy especially problem solving and social contact. The target blood pressure
was defined as BP<140/90 for those without either diabetes mellitus or chronic kidney disease and BP<130/80
for those with the co-morbid conditions. The subgroups with co-morbidity were not analyzed separately for
coping strategy.

Ethical Consideration- Ethical Approval for this study obtained from the ethics and research committee of the
Ekiti State University Teaching Hospital before stating the study. A written consent was obtained from the
participants.

III. Results
A total of 265 consenting subjects participated in this study but only 260 questionnaires were suitable
for analysis. The mean age of the subjects was 61.96±11.69 and a mean BMI of 27.23±4.35. There were
109(41.9%) males and 151(58.1%) females with male: female ratio of 1:1.39. A large proportion (72.7%) were
married, 41.2% read up to tertiary education level while civil servants and traders accounted for 26.2% each.
The distributions of the subjects among the domains of coping strategies were problem solving
(71.9%), social contact (63.5%), and problem avoidance (19.2%). Some subjects simultaneously adopt two
types of strategies especially problem solving and social contact.
The mean blood pressures among different coping domains (systolic/ diastolic) are problem solving
(134.76/80.32), problem avoidance (149.20/87.00), and social contact (134.55/80.18).
Attainment of target blood pressure (BP) of <140/90 among the coping domains are problem solving
(50.3%), problem avoidance (14.0%), and social contact (50.9%). Among those with either diabetes mellitus
(DM) or chronic kidney disease (CKD) as co-morbidity, 23.1% attained the target blood pressure of <130/80.
There is a statistically significant variation in the systolic blood pressure among the three domains ( p=
0.000) and this was confirmed by levene statistics analysis (0.524) where between groups mean square was

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Coping Strategies and Blood Pressure Control among Hypertensive Patients in a Nigerian Tertiary…

4630.500 and within groups mean square equals 246.925. The diastolic blood pressure follows a similar pattern
(p= 0.000), levene statistics (0.526), mean square between groups (996.557) and within groups (118.109).
The level of blood pressure was inversely correlated with problem solving ( p= 0.000), and social
contact ( p= 0.000) while there is a positive correlation between problem avoidance and the level of blood
pressure.
Some of the patients’ characteristics were noted to be significantly correlated with the type of coping
strategies adopted by the subjects. Marital status bears a positive and significant correlation with problem
solving (p= 0.000) while it was negatively and significantly correlated with problem avoidance (p= 0.000). The
level of education was positively and significantly correlated with problem solving strategy.

TableI:Baseline Characteristics of Subject

Characteristics Frequency %
Marital status
Single 3 1.2
Married 189 72.7
Widowed 49 18.8
Divorced 9 3.5
Separated 10 3.8
Ethnicity
Yoruba 237 91.2
Igbo 21 8.0
Hausa 2 0.8
Level of education
No formal education 35 13.3
Primary 60 23.1
Secondary 58 22.3
Tertiary 107 41.2
Occupation
No regular job 18 6.9
Trading 68 26.2
Farming 24 9.2
Retired 57 21.9
Civil servant 68 26.2
Artisan 25 9.6

Table II: Distribution of Subjects According To the Attainment of Target Blood Pressure
Coping strategy No (%) Target BP NO (%) X2 P value
Problem solving 187 (71.9) 94 (50.3) 29.255 0.000
Problem avoidance 50 (19.2) 7 (14.0) 17.437 0.0000
Social contact 165 (63.5) 84 (50.9) 22.359 0.000

Table III:Blood Pressure Distribution among the Coping Domains

N Minimum Maximum Mean Std. Deviation
Psolv_systolic 187 100 180 134.76 15.565
Psolv_diastolic 187 60 100 80.32 10.969
Pavoid_systolic 50 110 180 149.20 14.824
Pavoid_diastolic 50 70 110 87.00 10.926
Scontact_systolic 165 100 180 134.55 16.134
Scontact_diastolic 165 60 100 80.18 10.734
Valid N (listwise) 50

The significance of blood pressure variation among coping groups

Table IVANOVA
Systolic Sum of squares Df Means square F sig
Between groups 9260.999 2 4630.500 18.753 0.000
Within group 98523.080 399 246.925
Total 107784.080 401
Diastolic
Between groups 1993.114 2 996.557 8.438 0.000
Within groups 47125.294 399 118.109
Total 49118.408 401

Table V LEVENE
Systolic df 1 df 2 Sig
.524 2 399 0.592
Diastolic

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Coping Strategies and Blood Pressure Control among Hypertensive Patients in a Nigerian Tertiary…

.525 2 399 .592

Table VIDUNCAN
Diastolic Systolic
Coping type N Subset alpha =0.05 N Subset alpha =0.05
1 2 1 2
Social contact 185 134.55 165 80.18 2
Problem solving 187 134.75 187 80.32
Problem avoiders 50 149.20 50 87.00
Sig. .925 1.00 .930 1.000

Figure 1: Error bar graph of the mean systolic BP among the groups
1 = problem solving, 2 = problem avoiders, 3 = social contact

Figure 2:Error bar Graph of The Mean Diastolic Bp among Groups

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Coping Strategies and Blood Pressure Control among Hypertensive Patients in a Nigerian Tertiary…

Table VII: Correlation between Patients’ Characteristics and Type of Coping

Marital S. P. Solv P. Avoid S. Contact
Spearman’s rho Marital S Corre. Coeff. 1.000 -.065 .033 .099
Sig. (2-tailed) .300 .595 .111
N 260 260 260 260
Psolving Corre. Coeff. -065 1.000 -.694** .397**
Sig. (2-tailed) .300 . .000 .000
N 260 260 260 260
Pavoidance Corre. Coeff. .033 -694** 1.000 -.420
Sig. (2-tailed) .595 .000 . .000
N 260 260 260 260
Scontact Corre. Coeff. .099 .397** -420 1.000
Sig. (2-tailed) .111 .000 .000 .
N 260 260 260 260
Psolving Pavoidance Scontact Leve.education
Spearman’s rho Psolving Corre. Coeff. 1.000 -694** .397** .144**
Sig. (2-tailed) . .000 .000 .020
N 260 260 260 260
Pavoidance Corre. Coeff. -694** 1.000 -.420** -.046
Sig. (2-tailed) .000 . .000 .456
N 260 260 260 260
Scontact Corre. Coeff. .397** -.420** 1.000 -.019
Sig. (2-tailed) .000 .000 . .766
N 260 260 260 260
Leve.education Corre. Coeff. .144* -.046 -.019 1.000
Sig. (2-tailed) .020 .456 .766 .
N 260 260 260 260
Psolving Pavoidance Scontact BP group
Spearman’s rho Psolving Corre. Coeff. 1.000 -.694 .397 -335**
Sig. (2-tailed) . .000 .000 .000
N 260 260 260 260
Pavoidance Corre. Coeff. -.694** 1.000 -.420** .259**
Sig. (2-tailed) .000 . .000 .000
N 260 260 260 260
Scontact Corre. Coeff. .397** -.420** 1.000 -.239**
Sig. (2-tailed) .000 .000 . .000
N 260 260 260 260
BP group Corre. Coeff. -.335** .259** -.293** 1.000
Sig. (2-tailed) .000 .000 .000 .
N 260 260 260 260

IV. Discussion
Coping strategies adopted by the subjects were mainly problem solving and social contact with the
former slightly higher than the latter. Out of the three coping domains, the problem solving and social contact
are regarded as positive (adaptive) coping strategies, while problem avoidance is negative (mal adaptive).
The mean blood pressure was lowest among the social contact group, closely followed by the problem
solving with the lowest among the problem avoidance group. Attainment of target blood pressure was lowest
among the problem avoidance group. It has been demonstrated by Ariff et al that both diastolic and systolic
blood pressure were negatively correlated with task oriented coping style 28. Endler and Parker defined task-
oriented coping style as a purposeful effort to solve a problem, cognitive restructuring of the problem or attempt
to alter the situation 29. This definition aptly described the problem solving coping strategy.
Thalina et al in their work on lifestyle, coping, and job stress on blood pressure found no direct effect
of perceived stress on resting blood pressure but found an inverse relationship between positive attitudinal
coping mechanism and blood pressure levels. They therefore suggested mediating influences of lifestyle factors
or coping behaviours in the relationship between job stress and blood pressure (BP)30. The target blood pressure
attained by those in the positive domains in this work is comparable with findings by Olanrewaju et al in a
tertiary hospital in Nigeria where the SBP+DBP control was 53.3% while those in the negative coping domain
scored lower. Ernest and Acheing et al also recorded 48.7% and 26.0% attainment of target BP among
hypertensive patients in central Kenya 31,32,33. Attainment of target BP among DM+CKD sub group (32.1%) in
this work is higher than the findings by both Olanrewaju and Ernest et al 32,34.
There is a positive correlation between the level of education and adoption of the problem solving
method of coping in this study (p= 0.000). This may be a reflection of the influence of education on rational
thinking and decision making or an intermediary factor that may be identified in the course of future research.
Marital status also bears positive correlation with problem solving method of coping (p= 0.000) but negatively
correlated with problem avoidance (p= 0.000).

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Various workers have demonstrated the influence of marriage on health. Married people are said to be
more likely to see the doctor for checkups, screening and other early detection than the non-married with the
same symptoms, functioning and general level of health 34,35.

V. Conclusion
This work has demonstrated that the attainment of target BP among hypertensive patients still remains
a challenge among the study population. It has also shown the need to pay attention to psychosocial aspect of
hypertensive management as those with positive coping strategies achieved better BP control.

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