Key findings:

Key findings from this study on hypertension in Indonesia among individuals aged 15-64 years include: physical inactivity, smoking, excessive salt consumption, and alcohol intake were significantly associated with the incidence of hypertension. The study emphasizes the importance of health education to prevent hypertension, particularly targeting lifestyle factors like physical activity, smoking, and dietary habits.

What is known and what is new?

The known aspect in this abstract is the increasing prevalence of hypertension in the productive age group due to unhealthy lifestyles. The new contribution is the investigation of specific lifestyle factors, such as physical activity, smoking, salt consumption, and alcohol intake, and their association with hypertension in the Indonesian population aged 15-64 years, providing insights into the modifiable risk factors for hypertension in this age group.

What is the implication, and what should change now?

The implication of this study is the critical role of lifestyle factors like physical activity, smoking, salt consumption, and alcohol intake in the development of hypertension among individuals aged 15-64 in Indonesia. Changes needed include targeted health education programs to raise awareness about the impact of these modifiable factors and promote healthier lifestyle choices to prevent hypertension in this age group.

This hypertension problem is a health challenge not only in Indonesia but almost all over the world. An estimated 1.28% of adults aged 30-79 years worldwide suffer from hypertension, two-thirds of whom live in low- and middle-income countries [1]. Based on WHO data related to the prevalence of hypertension, globally the prevalence of hypertension is 22% of the total world population, while for the prevalence of hypertension based on WHO region, Africa is the region with the highest prevalence of hypertension with a percentage of 27%, then followed by the Eastern Mediterranean with the prevalence of hypertension at 26% and Southeast Asia is third with a percentage of 25% [2]. 

Based on basic health research data in 2018, the prevalence of hypertension based on the results of blood pressure measurements in the ≥18-year-old population in Indonesia, which amounted to 34.11% the prevalence of hypertension in 2013 which was 25.8%. The first highest prevalence of hypertension in Indonesia is in South Kalimantan Province with a prevalence of 44.13% then ranked second with the highest prevalence of hypertension, namely West Java Province with a prevalence of hypertension of 39.6% and for the lowest prevalence of hypertension in Papua Province which is 22.2%. The highest prevalence of hypertension in West Java is in Ciamis Regency with a prevalence of 49.6%, Bandung City itself with a prevalence of 36.79% [3]

The prevalence of hypertension in Indonesia is more prevalent in the age group of ≥75 years with a prevalence of 69.5%, it is because physiologically the higher a person's age, the greater the risk to suffer from hypertension, it is caused by a decrease in organ function in the body [4]. While the prevalence of hypertension in the 18-24 year old age group is 13.2% and in the 25-34 age group of 20.1% where the group is a productive age group, the prevalence of the productive age group tends to increase, compared to 2013 where the prevalence of hypertension in the 15-24 year old age group is 8.7% and in the age group 25-34 by 14.7% 

The tendency to increase the prevalence of hypertension in the productive age group is one of them caused by the level of busyness and an unhealthy lifestyle, thus increasing the risk of hypertension in the productive age group (Kasumayanti & Maharani, 2021). Low healthy living behaviors such as lack of physical activity, lack of fruit and vegetable consumption, smoking habits, drinking alcohol habits, poor diet such as high salt and fat is one of the many lifestyles that cause hypertension including in the productive age group [1].

Previous research conducted the tendency to the incidence of hypertension occurs in those who have an unhealthy lifestyle, such as lack of physical activity, smoking, excessive salt consumption, alcohol consumption, in addition there are other factors such as genetics, obesity, stress, using oil [5-6]. Other studies say that the incidence of hypertension is caused by a family history of hypertension, stress levels, and lifestyle [7].

From the data of the annual report of upt Puskesmas Neglasari Bandung City regarding the top 10 highest diseases, with the most non-specific ISPA disease in the puskesmas. High cases of degenerative diseases such as hypertension caused by behavior. In 2018, the number of cases was 6,031 people with hypertension, almost 50% of visitors at the Neglasari health center were diagnosed with hypertension. Efforts in overcoming cases of hypertension in the Neglasari health center have been widely carried out, ranging from prevention and treatment, namely home visits, socialization and counseling. However, cases of hypertension are still increasing because there are still many people who do not know that they suffer from hypertension and people who have been diagnosed with hypertension do not routinely do health checks and supported by several other factors such as people's lifestyle that is not good such as lack of physical activity, diet that likes to consume hypertension-inducing foods excessively and smoking habits that cannot be stopped properly. The purpose of this study was to analyze the relationship of physical activity, smoking habits, excessive salt consumption and alcohol consumption with the incidence of hypertension at the age of 15-64 years.

The type of research used is quantitative with case control research design [8]. This design is used to analyze the relationship of physical activity, smoking habits, excess salt consumption and alcohol consumption with the incidence of hypertension. This research was conducted in the working area of the Neglasari Health Center. The population in this study is all patients who visit and treat to the general poly recorded in the report register at the Neglasari Health Center. The sample in this study was 400 respondents, consisting of 200 case groups (people with hypertension) and 200 control groups (not suffering from hypertension). Samples were taken using a simple random technique with criteria for people aged 15-64 years.

The study used skunder data and primary data. Skunder data is the data of hypertensive patients and the characteristics of respondents seen from the general poly register book. Primary data is data on physical activity, smoking habits, excess salt consumption and alcohol consumption. The instruments used are check sheets and questionnaires.

The analysis of the data used is a univariate analysis that is to determine the distribution of age, gender, history of hypertension, physical activity, smoking habits, excess salt consumption and alcohol consumption. To find out the relationship between physical activity, smoking habits, excessive salt consumption and alcohol consumption with the incidence of hypertension, the Chi Square (X2) test was used.

Table 1. Characteristics of Respondents

Table 1 explains that the vast majority of respondents were ≥ 45 years old (63.7%), female (61.8%), and more than half of respondents had no history of hypertension (51.2%).

Table 2. Overview of Physical Activity, Smoking Habits, Excess Salt Consumption and Alcohol Consumption

Table 2 explained that more than half of respondents were less physical activity (55.3%), smoking (55.7%), excess salt consumption (58.3%), and alcohol consumption (53.0%).

Tabel 3. Factors associated with the incidence of hypertension at the age of 15-64 years

Table 3 shows that factors found to be significantly associated with the incidence of hypertension are physical activity (p=0.000), smoking (p=0.000), salt (p=0.000 and OR=2.071), and alcohol (p=0.000).

This study proves physical activity is significantly associated with the incidence of hypertension. A person who lacks physical activity has a 5.7 chance of suffering from hypertension. These results are consistent with other studies in the city of Bandung which stated that less physical activity can cause hypertension [9]. In line with several other studies that state that one of the risk factors that cause hypertension is due to lack of physical activity [10].

The results in the field showed that in the group of cases most of them did less physical activity, which was 75.5%. Based on the statements of some respondents they do not do olahraga because of laziness, busy work, so they do not have enough time to do olahraga. Some respondents stated that they do olahraga if they have time, and most respondents only do olahraga once a week, namely on holidays only. Exercise is widely associated with the management of non-communicable diseases, because isotonic and regular exercise can lower peripheral resistance that will lower blood pressure (for hypertension) and train the heart muscle so that it becomes accustomed if the heart has to do more strenuous work due to certain conditions [11].

In addition, this study also examined physical activity that is categorized as being less and enough. Most of the physical activity that respondents did was less physical activity, such as just doing homework, walking in the office environment, Lack of physical activity increased the risk of high blood pressure due to the increased risk of becoming obese. Inactive people tend to have faster heart rates and their heart muscle has to work harder on each contraction, the harder and more often the heart has to pump the greater the force that urges the arteries [12]. Therefore, to avoid the occurrence of hypertension one must do enough physical activity by doing olaraga for 30 minutes or more continuously and done a week 3 times a week [13].

This study proves that smoking is significantly associated with the incidence of hypertension. A person who smokes has a 2-time chance of suffering from hypertension. These results are consistent with research conducted in the city of Bandung, which stated that the incidence of hypertension is more work in people who are active smokers [13]. Other studies also mention that smoking habits can increase a person's risk of suffering from hypertension. [14]

The results on the field showed that more than half of the group of cases had a smoking habit of 53%. Researchers are trying to dig deeper into information to avoid information bias in smoking habits. Some respondents stated that they had had a smoking habit for more than 15 years. So it can be ascertained that smoking habits do not precede the occurrence of hypertension. Smoking has a huge role in increasing blood pressure, this is caused by nicotine contained in cigarettes that triggers the hormone adrenaline which causes blood pressure to increase [15].

Nicotine is absorbed by the blood vessels in the lungs and circulated throughout the other bloodstream so that there is a narrowing of the blood vessels. This causes the work of the heart to increase to pump blood throughout the body through narrow blood vessels [16]. In addition, smoking can increase the heart rate of blood vessels. Damage is also caused by depositing cholesterol in blood vessels, so that the heart works faster [17].

This study proves that excess salt consumption is significantly associated with the incidence of hypertension. A person who consumes excess salt every day has a 2-time chance of suffering from hypertension. These results are consequential with previous studies stating that the incidence of hypertension can be caused by excessive salt consumption [18]. In line with other studies conducted at the productive age, which stated that salt consumption is significantly associated with the incidence of hypertension at productive age [19].

The results on the field showed that most of the case groups consumed excessive salt, which was 67%. Based on the statements of some respondents, they are used to using salt in cooking, because if the food tastes less salty it will be less delicious. In addition, some respondents also stated that they used to consume salted fish, because it was more economical. Salt consumption patterns that can reduce the risk of hypertension. The recommended sodium level is no more than 100 mmol (about 2.4 grams of sodium or 6 grams of salt) per day [20].

Excessive sodium consumption causes the concentration of sodium in the extracellular fluid to increase. To normalize it intracellular fluid is pulled outwards, so that the volume of extracellular fluid increases. The increase in the volume of extracellular fluid causes an increase in blood volume, thus impacting the onset of hypertension [21]. Salt causes a buildup of fluid in the body because it attracts fluid outside the cells so that it is not removed, so it will increase the volume and blood pressure [22].

This study proves that alcohol consumption is significantly associated with the incidence of hypertension. A person who consumes alcohol has a 2-time chance of suffering from hypertension. These results are in line with previous research that stated that alcohol consumption is one of the risk factors for hypertension incidence. [23]

The results in the field showed that most of the case groups consumed alhokol which was 62.5%. Based on the results of observations in the field some respondents stated that they consume alcohol not every day, but usually within two weeks there is consuming alcohol. Drinking alcohol contains a lot of ethanol, the more ethanol it is, the harder the drink. Alcohol can trigger the release of the hormone epinephrine (adrenaline) which can constrict blood vessels.

A factor that has been shown to be significantly associated with the incidence of hypertension is physical activity. A person who lacks physical activity has a 5.7 chance of suffering from hypertension. Smoking habits, a person who smokes has a 2-time chance of suffering from hypertension. Excessive salt consumption, A person who consumes excess salt every day has a 2-time chance of suffering from hypertension. And konsumsi alcohol, a person who consumes alcohol has a 2-time chance of suffering from hypertension. It is recommended to health workers to provide education to the community, especially the productive age about hypertension prevention.

No funding sources.

None declared.

The study was approved by the Institutional Ethics Committee of Bhakti Kencana University.

1. WHO. (2021, August 25). Hypertension. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/hypertension

2. Kemenkes, R. I. "Hipertensi si pembunuh senyap." Kementrian Kesehatan RI 1.5 (2019). https://pusdatin.kemkes.go.id/resources/download/pusdatin/infodatin/infodatin-hipertensi-si-pembunuh-senyap.pdf

3. Kemenkes, R.I. "Hasil Utama Riset Kesehata Dasar (RISKESDAS)." Journal of Physics A: Mathematical and Theoretical, vol. 44, no. 8, (2018), pp. 1-200.

4. Kemenkes, R. I. "Laporan Riset Kesehatan Dasar." Jakarta: Badan Penelitian dan Pengembangan Kesehatan Kementerian Kesehatan Republik Indonesia (2013).

5. Agustina, Riska, and Bambang Budi Raharjo. "Faktor risiko yang berhubungan dengan kejadian hipertensi usia produktif (25-54 tahun)." Unnes Journal of Public Health 4.4 (2015).https://journal.unnes.ac.id/sju/ujph/article/view/9690 

6. Sutriyawan, Agung. "Metodologi Penelitian Kedokteran dan Kesehatan: Dilengkapi Tuntunan Membuat Proposal Penelitian." Bandung: PT Refika Aditama (2021).

7. KASUMAYANTI, ERMA, ZR ZURRAHMI, and MAHARANI MAHARANI. "Faktor-Faktor Yang Berhubungan Dengan Kejadian Hipertensi Usia Produktif Di Desa Pulau Jambu Wilayah Kerja UPTD Puskesmas Kuok." Jurnal Ners 5.1 (2021): 1-7. https://doi.org/10.31004/jn.v5i1.1672 

8. Sutriyawan, Agung, Yusti Endah, and Tenike Gita Miranda. "Relationship between physical activity and routine health checks with incidence of hypertension." Hypertension 44.57 (2021): 9.https://www.researchgate.net/profile/Agung-Sutriyawan/publication/352065044_Relationship_between_Physical_Activity_and_Routine_Health_Checks_with_Incidence_of_Hypertension/links/60b7f593a6fdccb96f4d81c6/Relationship-between-Physical-Activity-and-Routine-Health-Checks-with-Incidence-of-Hypertension.pdf 

9. Sutriyawan, Agung, Reni Apriyani, and Tenike Gita Miranda. "The relationship between lifestyle and hypertension cases at UPT Cibiru Public Health Center Bandung City." Disease Prevention and Public Health Journal 15.1 (2021): 50. https://www.academia.edu/download/106187005/pdf.pdf 

10. Garwahusada, Eganda, and Bambang Wirjatmadi. "Hubungan jenis kelamin, perilaku merokok, aktivitas fisik dengan hipertensi pada pegawai kantor." Media Gizi Indonesia 15.1 (2020): 60-65.https://e-journal.unair.ac.id/MGI/article/download/12314/9068 

11. Ladyani, Festy, et al. "Hubungan antara Olahraga dan Stres dengan Tingkat Hipertensi Pada Lansia." Jurnal Ilmiah Kesehatan Sandi Husada 10.1 (2021): 82-87. https://doi.org/10.35816/jiskh.v10i1.514 

12. Nasution, Lisna Khairani, and Norma Yanti Rambe. "Penyakit Hipertensi Pada Lansia Di Desa Huraba Kecamatan Batang Angkola Kabupaten Tapanuli Selatan Tahun 2020." Jurnal Pengabdian Masyarakat Aufa (JPMA) 2.3 (2020): 49-53. http://jurnal.unar.ac.id/index.php/jamunar/article/view/421 

13. Sutriyawan, Agung. "Relationship Of Smoking Behavior With Hypertension Events In Neglasari Health Center Bandung City: Hubungan Perilaku Merokok Dengan Kejadian Hipertensi Di Puskesmas Neglasari Kota Bandung." Afiasi: Jurnal Kesehatan Masyarakat 4.3 (2019): 97-104.https://doi.org/10.31943/afiasi.v4i3.68 

14. Dismiantoni, Nanang, et al. "Hubungan Merokok Dan Riwayat Keturunan Dengan Kejadian Hipertensi." Jurnal Ilmiah Kesehatan Sandi Husada 9.1 (2020): 30-36. https://doi.org/https://doi.org/10.35816/jiskh.v11i1.214

15. Lia, Meilianingsih, Suheti Tati, and Husni Achmad. "Gambaran Gaya Hidup Sehat pada Klien Hipertensi (Study Literatur Review)." GAMBARAN GAYA HIDUP SEHAT PADA KLIEN HIPERTENSI (STUDY LITERATUR REVIEW) 1.1 (2021): 24-33. https://repo.poltekkesbandung.ac.id/id/eprint/6923 

16. Suharno, Suharno. "Faktor-Faktor Individu Yang Berhubungan Dengan Hipertensi Di Wilayah Kerja UPTD Puskesmas Cigasong Kabupaten Majalengka Tahun 2017." Jurnal Kampus STIKES YPIB Majalengka 6.1 (2018): 1-10.https://e-journal.universitasypib.ac.id/index.php/JK/article/view/8/10 

17. Oktaviani, Elsa, Tika Noor Prastia, and Eny Dwimawati. "Faktor-Faktor Yang Berhubungan Dengan Kejadian Hipertensi Pada Pra Lansia Di Puskesmas Bojonggede Tahun 2021." Promotor 5.2 (2022): 135-147.https://doi.org/10.32832/pro.v5i2.6148 

18. Purwono, Janu, et al. "Pola konsumsi garam dengan kejadian hipertensi pada lansia." Jurnal Wacana Kesehatan 5.1 (2020): 531-542. http://jurnal.akperdharmawacana.ac.id/index.php/wacana/article/view/120 

19. Siswanto, Yuliaji, et al. "Hipertensi pada Remaja di Kabupaten Semarang." Jurnal Penelitian Dan Pengembangan Kesehatan Masyarakat Indonesia 1.1 (2020). https://journal.unnes.ac.id/sju/jppkmi/article/view/41433 

20. Adam, Lusiana. "Determinan hipertensi pada lanjut usia." Jambura Health and Sport Journal 1.2 (2019): 82-89.https://ejurnal.ung.ac.id/index.php/jhsj/article/view/2558 

21. Yulistina, Fera, Sri Maryati Deliana, and Eunike Raffi Rustiana. "Korelasi asupan makanan, stres, dan aktivitas fisik dengan hipertensi pada usia menopause." Unnes Journal of Public Health 6.1 (2017): 35-42. https://journal.unnes.ac.id/sju/ujph/article/view/13695 

22. Jayanti, I. Gusti Ayu Ninik, Ni Ketut Wiradnyani, and I. Gede Ariyasa. "Hubungan pola konsumsi minuman beralkohol terhadap kejadian hipertensi pada tenaga kerja pariwisata di Kelurahan Legian." Jurnal Gizi Indonesia (The Indonesian Journal of Nutrition) 6.1 (2017): 65-70.https://doi.org/10.14710/jgi.6.1.65-70 

Rita, Sopia. "Faktor Yang Mempengaruhi Hipertensi Di RSUD Dr. Rm. Djoelham Kota Binjai." Jurnal Publikasi Kesehatan Masyarakat Indonesia 4.3 (2017): 6. https://ppjp.ulm.ac.id/journal/index.php/JPKMI/article/view/4323