Revista MHSalud® (ISSN: 1659-097X) Vol. 6. No. 1. Julio, 2009.
HYPERTENSION IN PERSONNEL FROM UNIVERSIDAD ESTATAL A DISTANCIA IN COSTA RICA
Hipertensión en el personal de la Universidad Estatal a Distancia de Costa Rica
MSO Lourdes Arce Espinoza1, M.Sc. Julián MongeNájera2
1Nurse, Medical Services, Costa Rican State University for Distance Education
(Universidad Estatal a DistanciaUNED), email@example.com
2Researcher, Office of the Vice President for Research, UNED, firstname.lastname@example.org
San José, Costa Rica
The prevalence of Arterial
Hypertension (AHT) has increased worldwide and preventive measures
areinsufficient since only one third of the population is being
treated. AHT is the primary cause of morbidity andmortality in the
world. In this article is presented the first study on hypertension
levels of personnel of aDistance Education university based on the
analysis of all medical consultations in the Costa Rican
StateUniversity for Distance Education (Universidad Estatal a
Distancia-UNED) as of December 15, 2007 (1,526medical files). The
population studied ranges from 20 to 70 years of age and is comprised
of residents of theGreater Metropolitan Area (Costa Rica) with varied
socioeconomic and academic levels. The StatgraphicsCenturion XV
software and the chi-square test were used to analyze variables such as
treatment administered,sex, age, and type of work. Only 45 patients
knew that they suffered from hypertension prior to theirconsultation
with the university medical service and 136 were treated with Enalapril
and Hydrochlorothiazide.The number of hypertensive patients is higher
among those who have worked at the institution for more than 20years,
especially in those holding higher positions. No marked differences
were found between men andwomen. It is concluded that the existence of
a university medical service has permitted faculty and staff
tosatisfactorily control their blood pressure.
KEYWORDS: Hypertension, outpatient service, distance education, university personnel, Costa Rica.
La prevalencia de la
Hipertensión Arterial (HTA) se ha incrementado en todo el mundo
y las accionespreventivas resultan insuficientes, ya que solamente un
tercio total de esta población está controlada. La HTAes
la primera causa de morbilidad y mortalidad mundial. En este
artículo se presenta el primer estudio sobrelos niveles de
hipertensión en el personal de una universidad a distancia,
mediante el análisis del total deconsultas en la Universidad
Estatal a Distancia de Costa Rica al 15 de diciembre del 2007 (1526
expedientesmédicos). La población estudiada se encuentra
en edades comprendidas entre los 20 a 70 años, residentes
delGran Área Metropolitana, con nivel socioeconómico y
preparación académica variable. Se analizó la
relaciónentre la HTA y las variables tratamiento, sexo, edad y
tipo de trabajo, usando la prueba chi-cuadrado. Solo 45de los pacientes
conocían de su problema de hipertensión antes de llegar a
consulta en el servicio médicoinstitucional y 136 pacientes
reciben tratamientos que incluyen Enalapril e Hidroclorotiazida. La
cantidad depacientes hipertensos es máxima entre quienes tienen
más de 20 años de trabajar en la
institución,especialmente si ocupan altos puestos. No hubo
marcadas diferencias entre mujeres y hombres. Se concluyeque la
existencia de un servicio médico interno ha permitido que la
población de la universidad mantengacontrolada
satisfactoriamente su presión arterial.
PALABRAS CLAVES: hipertensión, consulta externa, educación a distancia, personal de universidad, Costa Rica.
hypertension (AHT) is a chronic disease that is usually asymptomatic
and is characterized by the elevation of the systolic blood pressure
(SBP) above 120 mmHg and/or diastolic blood pressure (DBP) above 80
mmHg. The prevalence of arterial hypertension has increased
between 3% and 18% worldwide
between 1999 and 2002. Preventive programs and
measures are insufficient since only one third of this population is
being treated (Haijar and Kotchen, 2006).
AHT is the primary cause of morbidity and mortality worldwide, with 7.1 million deaths in
(Holguin, Correa, Arrivillaga, Cáceres, and Varela, 2006).
It is caused by the sum of modifiable
(overweight, sodium consumption
above 1.5 grams per
day, alcohol consumption, physical inactivity, smoking, and
a diet rich in fats) as well as nonmodifiable risk factors
(gender, ethnic group, age, and heritage) (Huerta, 2001;
Vásquez, Fernández, Álvarez, Roselló, and
Pérez, 2006; Li et al, 2005).
The presence of AHT,
together with obesity, dyslipidemia, and insulin resistance, is known
as metabolic syndrome (MS). Metabolic disorders and their
relationship with AHT have been widely described
during the last 10 years, as well as the increased
risk of other coronary complications and possible mortality
resulting from different combinations of risk factors (Jarvis et al,
2007; Gao, Nelson, and Tucker, K., 2007; Xiang, Nelson, and Tucker,
It has been statistically
proven that women maintain better control of AHT than men (Plans,
Tesserras, Pardell, and Salleras, 2002), and that with age figures
increase between 20 and 30 mmHg in patients 40 years of age and those
above 60 (whether normotensive or hypertensive). After the
age of 70, normotensive patients have a 90% risk of developing
hypertension due to the hardening of blood vessels (Vásquez et
A total of 16% of
hypertensive patients have not been diagnosed mainly because they have
no access to health care, have low schooling (they are unable to
recognize risk factors for AHT), and exhibit no symptoms (Méndez
and Rosero, 2007). In addition, popular beliefs regarding
treatment and ways to avoid this
pathology significantly lower control rates
(Wilson et al, 2002). Cultural aspects and life styles
continue to be a common problem contributing to morbidity and mortality
in AHT (Han, Kim, Kang, Kim, and Kim, 2007).
Another decisive factor in
AHT is stress. Research suggests that work stress significantly
contributes to AHT because it alters the normal physiological rest and
recovery processes (Yang, Schnall, Jáuregui, Su, and Baker,
2006). Although epidemiological studies relate work
stress with the appearance of AHT,
regardless of the occupation, this
statement requires further study (Rose, Newman, Bennet, and Tyroler,
1999; Rubio, Vallejo, and Martínez, 2000).
Family history or
inheritance is also a determining factor in the appearance of AHT
(Katzmarzyk, Rankinen, Perusse, Rao, and
Bouchard, 2001; Goldstein, Shapiro, and
Guthrie, 2006). In addition, in those cases where there is no
family history of AHT, some authors consider that family can be a
source of stress that produces longterm adverse effects and,
consequently, the appearance of
AHT. Whether due to
inheritance or the stress produced, family could be
responsible for a high percentage of risk in the appearance of AHT
(Huerta, Bautista, Irigoyen, and Arrieta, 2005).
Studies on children and
adolescents with a family history of AHT recognize that, in spite of
the fact that levels were within the normal parameters, their
variability suggests that family history is an important risk factor
and, therefore, plays a significant role in the appearance of AHT
during adulthood (Lawlor et al, 2005; Borges, Peres, and Horta, 2007;
Barton, Gilbert, Baramme, and Granger, 2006; Hulanicka, Lipowicz,
Koziel, and Kowalisko, 2007).
Statistically, stress, ire, anxiety, and depression are strongly related to AHT (Olmos et al,
1999; Jhalani et al, 2005;
Yan et al, 2006). Risk factors are the same in all ethnic groups;
however, the pathology is more aggressive in patients of African
descent. (Hayes et al, 2003; Holmes, Arispe, and Moy, 2005;
Rica arterial hypertension is one
of the most frequent causes for
medical consultation and one of the most expensive pathologies in
outpatient service. By 2060, the
senior population in Costa
Rica is expected to increase to 2 million, together with
the occurrence of chronic diseases and their costs in health care
(Méndez and Rosero, 2007).
In this article is
presented the first study on hypertension levels of personnel of a
Distance Education university. The relationship between sex, age,
and type of work is analyzed for the personnel of the Costa Rican State
University for Distance Education (Universidad Estatal a
DistanciaUNED). No previous studies have been made.
Medical files as a primary source of information CERTIFIED TYCOS sphygmomanometer LITTMANN stethoscope
The latter two used to take blood pressure.
included all UNED outpatients who were seen for AHT between January 14,
2002 and December 14, 2007, totaling 179 hypertensive patients: 95
women and 84 men.
The population studied was
between 20 and 70 years of age (mean: 22.3 years of age) and was
comprised of residents of the Greater Metropolitan Area of Costa Rica
with varied socioeconomic and academic levels
since the study included support
personnel (e.g., janitors), faculty (with Master’s and
PhDs), department heads and other high administrative personnel.
Marital status: 140 married, 29 cohabitating, and 10 single. The
majority of the population has worked in the institution for a period
between 6 months and 30 years (UNED Medical Services Archives).
was collected from the primary source of information in two
stages. The first stage included the review of medical files (a
total of 1,526) to determine which patients had been seen for AHT,
totaling 179 patients. The second stage included entering data in
an Excel file.This record was used to codify and statistically analyze
data (see section on Statistics).
study was approved by the Office of the Vice President for Research at
UNED, the division that oversees the
ethical and administrative aspects of
the research projects conducted at the institution.
Patient consent was not necessary since this was a posteriori analysis
of institutional statistical data in which patients were not subjected
to experimental treatments and no individualized data was used (this
analysis is similar to the institutional statistics published by the
Costa Rican Social Security Administration).
Excel spreadsheet and the Statgraphics Centurion XV statistical
software were used to group and analyze the data. In addition, a
descriptivequantitative methodology was applied to
present the distribution of patients
by sex, age, treatment, and type
of work. The hypothesis was tested through the
chisquare contingency test, which measures relationship between
variables. The mregression was utilized for the relationship
between age, sex, position, and hypertenson.i The rejection value for
the hypothesis was 0.05.
From the 1,526 individuals with a medical file, 179 were seen for AHT (12 %).
Distribution of UNED Personnel by Gender and Arterial Hypertension Background
45 patients knew of their AHT problem before consultation at the
institutional medical service. Ratio does not differ between women and
men (X2=0.05, degrees of freedom=1, p=0.8231; Graph 1).
is a complex variety of administered treatments. From the total
number of patients, 69 men and 67 women receive treatment including
Enalapril, Hydrochlorothiazide or a combination of the two.
The remaining 26 women and 17 men receive other types of treatment
male patients were not treated with beta blockers, which have been
associated with erectile dysfunction, but have rather received a
slightly higher proportion of Enalapril and Hydrochlorothiazide than
women. However, in this respect the difference between women and
men is only slightly significant (Fisher’s Exact Test, p=0.0497;
data grouped in two categories as required by the test: 1=Enalapril,
Hydrochlorothiazide or both; 2=Other. Graph 2).
Relationship between Seniority, Age, Sex, and Hypertension in UNED Personnel
four percent of the patients that
have worked for more than 20 years
in the institution are hypertensive. This value is similar
for those who been less than 10 years (23%) in the University. On
the contrary, hypertension rate does not exceed 8% in those who have
worked at UNED for 11 to 20 years (Table 2). The majority of
hypertensive patients are above 40 years of age. No differences were
found between women and men (Table 2) (X2=1.7, degrees of freedom=2, p=0.4274).
Relationship between Arterial Hypertension and Occupation of UNED Personnel
hypertensive patient ratio is related to the type of occupation (Table
3) since those who are department heads and
hold other high positions have a
higher hypertension rate (X2=6.76,
degrees of freedom=4, p<0.05). The
forgoing is confirmed by a multiple
regression that crossed sex, age, and position as possible predictors
of hypertension, which indicated that position is the associated
variable (R2=0.0487; p 0.001; N=1,526 patients).
percent of UNED hypertensive employees monitor their blood pressure at
least once a month when they receive their check up or when they pick
up their hypertension treatment. A total of 10% check their blood
pressure at least twice a year because they monitor it at other health
institutions and their blood pressure is taken when they go to the
doctor for other reasons (L. Arce, personal observation).
Distribution by Sex and Arterial Hypertension Background
of the AHT cases were detected by the medical service personnel at UNED
as only 45 patients knew of their condition before working
at the University. Their pathology is currently
controlled at UNED. The foregoing
shows an advantage of offering health
services in the institution. Easy access to such services
permitted detection of the majority of the cases and control within the
on the literature, epidemiological data indicates that the risk of
suffering from AHT is higher in men than in women and that the symptoms
for this pathology start to appear at the age of 45 (men) and 55
(women). However, it should be remembered that some cases are
asymptomatic and it is diagnosed by controlling blood pressure (BP)
(Plans et al, 2002). No significant differences were found in
this study in the AHT rate between men and women. A
possibility could be that UNED
female personnel visit the medical
services more frequently for checkups, family planning, prenatal
care, etc., which increases both the probability of discovering this
pathology and women’s recorded AHT rate to the same level as
Antihypertensive Therapy for Men and Women
are many combinations of antihypertensive treatments. These are
prescribed after conducting medical tests and controlling blood
pressure and depend on the person’s physiological response,
medical history, and results from a medical examination.
to Grimm et al (1996), most patients are treated with Enalapril and a
diuretic, or other therapeutic combinations, without any prescription
differences between men and women. Although the use of
antihypertensive medication, specifically beta blockers such as
Propranolol and Atenolol, has been associated with erectile
dysfunction, there exists controversy in this respect. For
instance, the Treatment of Mild Hypertension Study (TOMHS) conducted in
1996 analyzed 902 hypertensives that were taking diuretics, beta
blockers, ACE inhibitors, alpha blockers, or calcium antagonists.
After a fouryear follow up, erectile dysfunction was related to
the age of the patient rather than to the type of drug used (Grimm et
al, 1996). In the case of UNED, only a small percent of the
population uses this medication and none of the patients has reported
it as a side effect.
Seniority, Age, and Sex Ratio
age, individuals tend to gain weight. Aging and the loss of
elasticity in blood vessels, intensified in women by the decreased
levels of estrogens (Molina, 2007), is coherent with the increase in
hypertensive cases after the age of 40.
Occupation and Arterial Hypertension
though AHT is associated with a number of modifiable and
nonmodifiable factors, it is the sum of those factors that causes
this pathology. The stress produced by the complex functions of
being the head of a department (Olmos et al, 1999; Jhalani et al, 2005;
Yan et al, 2006) explains the reason why those who hold these positions
have the highest AHT percentages at UNED.
The following conclusions are drawn from the results obtained:
- Easy access to an
institutional medical service has permitted the detection of a
significant number of previously unknown
hypertensive cases as well as the
adequate treatment for patients.
- Most patients are
treated with Enalapril and Hydrochlorothiazide and no erectile
dysfunction problems have been reported when beta blockers are used.
- There is not a defined pattern indicating that hypertension clearly increases with years of service.
- An important ratio of hypertensive patients is noted for men and women older than 40.
- Department heads present more hypertension cases. Acknowledgements
We would like to thank Carolina Morales and Daniel Villalobos for editing a previous draft.
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Reception date: June 17, 2008.
Correction date: October 23, 2008.
Acceptance date: October 23, 2008.
Publication date: July 31, 2009.
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