Jurnal Berkala Epidemiologi DOI: 10.20473/jbe.v13i12025.

10 – 17
Volume 13 No 1. Januari 2025. 10 – 17 https://e-journal.unair.ac.id/JBE/index
p-ISSN: 2301-7171; e-ISSN: 2541-092X Email: [email protected] / [email protected]

Jurnal Berkala
EPIDEMIOLOGI
PERIODIC EPIDEMIOLOGY JOURNAL

ORIGINAL ARTICLE

FAMILY HISTORY, KNOWLEDGE, AND RESTING PATTERNS

ASSOCIATED WITH HYPERTENSION: CASE-CONTROL STUDY
Riwayat Keluarga, Pengetahuan, dan Pola Istirahat terkait dengan Hipertensi (Studi Case-Control)

Nadia Rizqiyah Syafitri1 , Eny Qurniyawati2,3 , Renaningtyas Nityasani4 , Geofrey Ssekalembe5

1
Faculty of Public Health, Universitas Airlangga, Indonesia, 60115, [email protected]
2
Department of Epidemiology, Biostatistics, Population Studies, dan Health Promotion, Faculty of Public
Health, Universitas Airlangga, Surabaya, Indonesia, 60115, [email protected]
3
Research Group for Health and Wellbeing of Women and Children, Universitas Airlangga, Indonesia
4
Faculty of Public Health, Universitas Airlangga, Indonesia 60115, renaningtyas.nityasani-
[email protected]
5
Elizabeth Glaser Pediatric AIDS Foundation, Uganda, [email protected]
Corresponding Author: Eny Qurniyawati, [email protected], Department of Epidemiology,
Biostatistics, Population Studies, dan Health Promotion, Faculty of Public Health, Universitas Airlangga,
Surabaya, 60115, Indonesia / Research Group for Health and Wellbeing of Women and Children, Universitas
Airlangga, Indonesia

ARTICLE INFO ABSTRACT

Article History: Background: Non-communicable diseases are the leading cause of death
Received, December, 11h, 2024 worldwide, responsible for approximately 75% of global mortality.
Revised form, December, 21th, 2024 Hypertension, a significant contributor to NCD-related deaths, affects an
Accepted, January, 25th, 2025 estimated 1.28 billion adults globally and is often referred to as "The Silent
Published online, January, 30th, Killer." The increasing prevalence of NCDs, including hypertension, poses
2025 significant challenges to the global health system. In Ponorogo Regency,
hypertension cases surged from 41,841 in 2021 to 126,668 cases in 2023.
Keywords: Analyzing the risk factors of hypertension is essential to mitigate its health
Hypertension; impact on the community. Purpose: To analyze the risk factors of
Cardiovascular risk factors; hypertension cases in the Plosojenar Village, Ponorogo Regency community.
Education quality; Methods: This quantitative study employed a case-control design with 154
Family health Record; participants. The case group comprised 77 individuals with hypertension, and
Rest habits the control group included 77 non-hypertensive individuals, selected through
random sampling at a 1:1 ratio. Data were collected from January to April
Kata Kunci: 2024 using questionnaires. Bivariate analysis was conducted using Chi-square
Hipertensi; and Fisher’s tests. Results: This study found a significant association between
Faktor risiko kardiovaskular; family history OR 13.67 (95%CI = 5.63 - 39.17); p = 0.00, level of knowledge
Kualitas pendidikan; OR 26.25 (95%CI = 3.96 - 1.11); p = 0.05, and rest habits OR 0.18 (95%CI =
Riwayat kesehatan keluarga; 0.03 - 0.70); p = 0.08 to hypertension cases. This study also showed no
Kebiasaan istirahat significant relationship between attitude OR 0.88 (95%CI = 0.32 - 2.37); p =
1 with hypertension cases. Conclusion: Family history, knowledge level, and
rest habits are significantly associated with hypertension. Targeted
interventions addressing these factors may help reduce hypertension cases.

©2025 Jurnal Berkala Epidemiologi. Published by Universitas Airlangga.

This is an open access article under CC-BY-SA license
 11 of 17 Nadia Rizqiyah Syafitri, et al / Jurnal Berkala Epidemiologi, 13 (1) 2025, 10 –17

How to Cite: Syafitri, N. R., ABSTRAK

Qurniyawati, E., Nityasani, R.,
Ssekalembe, G. (2025). Family Latar Belakang: Penyakit tidak menular adalah penyebab utama kematian di
history, knowledge, and resting seluruh dunia, yang bertanggung jawab atas sekitar 75% kematian global.
patterns associated with Hipertensi, kontributor signifikan terhadap kematian terkait PTM,
hypertension: case-control study. mempengaruhi sekitar 1,28 miliar orang dewasa di seluruh dunia dan sering
Jurnal Berkala Epidemiologi, 13(1), disebut sebagai “Pembunuh Diam-Diam”. Meningkatnya prevalensi PTM,
10–17. termasuk hipertensi, menimbulkan tantangan yang signifikan bagi sistem
https://dx.doi.org/10.20473/jbe.v13i kesehatan global. Di Kabupaten Ponorogo, kasus hipertensi melonjak dari
12025.10–17 41.841 pada tahun 2021 menjadi 126.668 kasus pada tahun 2023.
Menganalisis faktor risiko hipertensi sangat penting untuk mengurangi
dampak kesehatan pada masyarakat. Tujuan: Untuk menganalisis faktor
risiko kasus hipertensi pada masyarakat Desa Plosojenar Kabupaten
Ponorogo. Metode: Penelitian kuantitatif ini menggunakan desain kasus-
kontrol dengan 154 partisipan. Kelompok kasus terdiri dari 77 orang dengan
hipertensi, dan kelompok kontrol terdiri dari 77 orang non-hipertensi, yang
dipilih secara acak dengan rasio 1:1. Data dikumpulkan dari Januari hingga
April 2024 dengan menggunakan kuesioner. Analisis bivariat dilakukan
dengan menggunakan uji Chi-square dan Fisher. Hasil: Penelitian ini
menemukan hubungan yang signifikan antara riwayat keluarga OR 13,67
(95%CI = 5,63 - 39,17); p = 0,00, tingkat pengetahuan OR 26,25 (95%CI =
3,96 - 1,11); p = 0,05, dan kebiasaan istirahat OR 0,18 (95%CI = 0,03 - 0,70);
p = 0,08 dengan kejadian hipertensi. Penelitian ini juga menunjukkan tidak
ada hubungan yang signifikan antara sikap OR 0,88 (95%CI = 0,32 - 2,37);
p = 1 dengan kasus hipertensi. Simpulan: Riwayat keluarga, tingkat
pengetahuan, dan kebiasaan istirahat secara signifikan berhubungan dengan
hipertensi. Intervensi yang ditargetkan untuk mengatasi faktor-faktor ini
dapat membantu mengurangi kasus hipertensi.

©2025 Jurnal Berkala Epidemiologi. Penerbit Universitas Airlangga.

Jurnal ini dapat diakses secara terbuka dan memiliki lisensi CC-BY-SA

INTRODUCTION million deaths annually (3). Indonesia, as one of the

middle-income countries and the most populous
Non-communicable diseases (NCDs) are the nation in Southeast Asia, reports that 1 in 3 adults
leading cause of death worldwide, accounting for suffers from hypertension, highlighting its
approximately 75% of all deaths. Among these, exceptionally high prevalence (4). The prevalence
cardiovascular diseases (CVDs) represent the most of hypertension in Indonesia shows significant
significant contributor, claiming an estimated 17,9 differences depending on the diagnostic method
million lives annually (1). Hypertension, a used. Based on a doctor’s diagnosis, the prevalence
significant risk factor for CVDs, is often referred to among individuals aged ≥18 years is 8.60%, while
as "The Silent Killer" due to its asymptomatic measurement-based assessments reveal a much
nature and severe complications if left untreated. higher prevalence of 30.80%. This disparity
Hypertension is diagnosed when blood pressure underscores the importance of improved screening
consistently reaches or exceeds 140/90 mmHg, and diagnostic methods to identify and manage
confirmed through multiple measurements at cases effectively. Furthermore, hypertension is no
different times. If inadequately managed, longer confined to older populations. Data from the
hypertension can lead to chronic kidney disease, SKI report indicate that among individuals aged
heart disease, coronary artery disease, stroke, and 15–24 years, the prevalence of hypertension based
mortality. Globally, an estimated 1.28 billion adults on doctors' diagnoses is 0.30%, but measurement
aged 30–79 years are affected by hypertension, with results show it reaches 9.30%. This shift marks the
two-thirds of these cases found in low- and middle- transition of hypertension from a geriatric condition
income countries (2). to a broader health issue affecting people across
In Southeast Asia (SEA), which consists different age groups (5).
primarily of middle-income countries, East Java is one of the provinces in Indonesia
approximately one-third of adults are diagnosed with the highest prevalence of hypertension,
with hypertension, contributing to around 1,5 recorded at 34.30%. Hypertension also represents
 12 of 17 Nadia Rizqiyah Syafitri, et al / Jurnal Berkala Epidemiologi, 13 (1) 2025, 10 –17

the leading cause of maternal mortality, METHODS

contributing to 9.62% of all maternal deaths in 2021
(6). Consistent with the global and national This research type is quantitative with a case-
escalation in hypertension prevalence, Ponorogo control study design. The case group in the study
Regency demonstrates a significant and increasing was the people of Plosojenar Village who have
burden of hypertension (7). The incidence surged hypertension, with a total number of 77 people.
markedly, rising from 41,841 cases in 2021 to Meanwhile, the control group who did not have
126,668 cases in 202(8–10). Despite this substantial hypertension was 77 taken 77 people. The two
increase, healthcare coverage for hypertension in samples were determined by simple random
Ponorogo Regency in 2023 accounted for only sampling, which gave a total sample of 154
43.40% of the projected 291,738 cases among participants. The dependent variable of this study is
individuals aged ≥15. This disparity between the occurrence of hypertension, both hypertension
estimated and detected cases underscores systemic category level 1 (blood pressure 140/90 - 159/99)
inefficiencies in routine early screening and and hypertension level 2 (blood pressure
highlights the urgent need for targeted and >160/>100). The independent variables include
evidence-based public health interventions. family history (both from the descendants up
Hypertension arises from a combination of (parents), spouses, and descendants down
reversible and irreversible factors. Reversible (children) who suffered from hypertension),
factors include unhealthy diets, physical inactivity, knowledge (categorized into groups of less (score
and smoking habits, which can be mitigated through 4-11) and sound (score 12-18) based on the results
lifestyle changes. Irreversible factors, such as of the questionnaire), attitudes (categorized into
genetics, gender, and age, increase susceptibility negative (score 7-17) and positive (score 18-28)
but cannot be modified. These factors underline the based on the results of the questionnaire data), and
multifactorial nature of hypertension and the resting habits (categorized into negative (score 3-7)
complexity of its management. Previous research and positive (score 8-12) habits based on the results
has highlighted various relationships between these of the questionnaire).
factors and hypertension (11). Other studies show The study used primary data collection
that there is a link between gender, smoking habits, techniques that were structured interviews using the
and hypertension among office employees (12). KAP (knowledge, attitude, practice) questionnaire
There is a a strong association between physical instrument related to hypertension, which consists
activity and hypertension among Minangkabau of 18 knowledge statements, 7 attitude statements,
ethnic women (13). Age and genetic factors play a and 15 behavioral habit statements. This instrument
significant role in hypertension among pregnant used a Guttman scale (correct answer equals 1 point
women (14). and wrong answer gets 0 points) in knowledge and
Building on these findings, a preliminary study a Likert scale in the section on attitude and
using the Survey Mawas Diri (SMD) in Plosojenar behavior. Each value of 1-4 from the Likert scale is
Village, Ponorogo Regency, found that 34.40% of adjusted based on favorable and unfavorable
households sampled had at least one family member statements. The validity test shows that all
suffering from hypertension. This highlights the statements are valid because the R count of each
urgency of addressing hypertension in this statement > R table. Based on the reliability test, it
community, particularly considering the low is known that the average instrument test results
healthcare service coverage and the increasing include moderate reliability with a value of 0.47.
prevalence of complications among younger The analysis of the research study used bivariate
populations. Based on previous research findings, tests with chi-square and Fisher as an alternative if
this study aims to analyze specific risk factors such it does not comply with the requirements of the chi-
as family history, knowledge level, and rest patterns square test. Data analysis used the R studio 4.3.2
contributing to hypertension in Plosojenar Village, application to test the relationship between risk
Ponorogo Regency. This approach addresses gaps factor variables (independent) and hypertension
in understanding the causes of hypertension and cases (dependent variables).
provides evidence-based recommendations to The Universitas Airlangga Faculty of Public
support more effective hypertension management Health Research Ethical Clearance Commission
in the region. approved this study in an approval letter numbered
237/EA/KEPK/2023.
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RESULTS than a high level of knowledge. The extensive range

between the lower and upper levels of CI can be due
Relationship Between Resting Habits and to high data variability or unequal distribution and
Hypertension Cases recall bias because it is a retrospective study.
Based on the practice questionnaire in the
resting habits section, the case group had a more Relationship Between Family History and
excellent average value of 242.33 (more positive Hypertension Cases
attitude) than the control group, which only The characteristics of family history are
amounted to 225. The resting habits analyzed in this grouped into 2 categories: a family history from
study include sleep disorders, daytime nap parents, children, and spouses or no family history
schedule, and the regularity of night sleep. Based on of hypertension. Based on the Chi-square bivariate
the analysis using Fisher's bivariate test, it is clear test in Table 1, the results of the p-value of 0.00
that there is a significant relationship between were analyzed. It can be interpreted that
resting habits and the occurrence of hypertension. respondents who have a family history of
This can be seen from the results of Table 1, which hypertension are 13.67 times more at risk (95%CI =
shows a p-value of 0.008 or <0.05. The result of the 5.63 - 39.17) than respondents without a family
OR value is 0.18 (95%CI = 0.03 - 0.70), so it can be history of hypertension for the incidence of
interpreted that negative rest habits are more hypertension cases.
protective than positive sleep habits towards the
incidence of hypertension. Respondents who Relationship Between Attitude and Prevalence
always experience insomnia > 2 times, always take of Hypertension Cases
a nap > 1 hour every day, and never sleep regularly In this study, the attitudes include the
at night are protective factors for hypertension perceptions or opinions of the respondents related
cases. to routine blood pressure checks, avoiding cigarette
smoke, and compliance with taking anti-
Relationship Between Knowledge Level and hypertensive medicine. The attitudes section
Hypertension Cases consists of 7 statement items with an average value
In the factor analysis of knowledge level, there of 19.71 for the case group and 20.14 for the control
are 18 favorable and unfavorable statement items, group. This indicates that the control group tends to
with the maximum points obtained being 18 while have more positive attitudes regarding the
the minimum value obtained by the respondent is 4. prevention and treatment of hypertension than the
Therefore, the level of knowledge categorization is case group. The results of the bivariate test with
lower, with a score of 4-11, while the good category Fisher analysis in Table 1 show a p-value of 1, so it
scores are 12-18. The average knowledge score of can be interpreted that there is no relationship
the case group was 12.96, while the control group between respondents' attitudes and cases of
was 15.37. It can be indicated that the control group hypertension. The OR value based on the test
had a higher level of knowledge than the case results is 0.88 (95%CI = 0.32 - 2.37), so the
group. Based on the analysis using Fisher's negative attitude of respondents is a more protective
bivariate test, it is found that there is a significant factor than a positive attitude towards the incidence
relationship between the level of knowledge and the of hypertension. However, this result is not
incidence of hypertension. This is based on the statistically significant because the confidence
results of Table 1, which show that the p-value is interval (CI) includes a value of 1 or is interpreted
0.005. The OR analysis results showed a value of as equal between the case and control groups.
26.25 (95%CI = 3.96 – 1.11). It can be interpreted
that a low level of knowledge is 26.25 more risky
 14 of 17 Nadia Rizqiyah Syafitri, et al / Jurnal Berkala Epidemiologi, 13 (1) 2025, 10 –17

Table 1
Risk Factors for Hypertension in Plosojenar Village, Ponorogo Regency in 2024
Hypertension Non-hypertension Total
Variable p-value OR CI
n % n % n %
Resting Habits
Negative 3 3.90 14 18.18 17 11.04 0.03-
0.00* 0.18
Positive 74 96.10 63 81.82 137 88.96 0.70
Knowledge Level
Less 20 25.97 1 1.30 21 13.64 3.96 –
0.01* 26.25
Good 57 74.03 76 98.70 133 86.36 1.11
Family History
Yes 42 54.55 6 7.79 48 31.17 5.63 –
0.00* 13.67
No 35 45.45 71 92.21 106 68.83 39.17
Attitude
Negative 9 11.69 10 12.99 19 12.34 0.32 –
1.00 0.88
Positive 68 88.31 67 87.01 135 87.66 2.37

DISCUSSION answered questions related to ever and never

sleeping 6-8 hours a night regularly. The control
Analysis of the Relationship between Resting group's score on the sleep regularity statement was
Habits and Hypertension Cases higher than the case group. This shows that the
According to the factor analysis of rest habits, control group tends to be more organized when
it is clear that there is a relationship between rest sleeping at night than the case group (17).
habits and the incidence of hypertension cases. Respondents who sleep > 8 hours/day are 30.10%
Surprisingly, negative rest habits appear more more at risk than respondents who usually sleep (6-
protective than positive ones in preventing 8 hours/day) for hypertension.
hypertension. The finding contrasts with the general Given the contradiction between this study's
theoretical framework, which suggests that proper results and existing theories, additional
rest habits, such as regular and adequate sleep, investigation is required to clarify these findings.
reduce the risk of hypertension. This align with the Factors such as individual differences in
research by Salman et al (15), which indicated a physiological responses, confounding variables
significant relationship (p-value = 0.03) between (e.g., stress or medication use), or cultural sleep
rest habits and hypertension cases in the elderly practices in the study population could explain the
(OR 0.58). Adequate rest is emphasized in unexpected protective effect of negative rest habits.
government programs such as CERDIK to prevent Further studies should delve into these aspects to
hypertension by managing risk factors. Poor sleep provide a more comprehensive understanding of the
quality can affect cortisol levels and the role of rest habits in hypertension prevention (18).
sympathetic nervous system, contributing to the
development of hypertension. This variable of rest Analysis of the Relationship between Knowledge
habits includes sleep disturbances, which usually Level Factor and Hypertension Cases
suffered by 2.60% of respondents and are The level of knowledge has a significant
experienced with frequent quantity in 16.88% of relationship with the incidence of hypertension in
respondents in the case group. self-reported Plosojenar Village; those with knowledge levels are
problem sleeping and sleep disorders are correlated 26.25 times more at risk of having hypertension
with the increased risk of hypertension (16). compared to those with good knowledge levels. The
In the statement of taking a nap for >1 hour, 27 results of this study are aligned with a cross-
respondents from the case group answered always sectional study in Lebanon which showed that
and often. napping ≥ 90 minutes/day is associated hypertensive patients at Al Hayat Hospital had a
with a higher risk of incidence, and the risk will limited level of knowledge related to hypertension
decrease if the daytime sleep becomes 1-59 (19). Basic knowledge related to hypertension is
minutes/day. Positive resting habits should be able low among patients in Spanish primary and
to prevent hypertension. A total of 18 respondents specialty health care (20). People with limited
 15 of 17 Nadia Rizqiyah Syafitri, et al / Jurnal Berkala Epidemiologi, 13 (1) 2025, 10 –17

knowledge will find it difficult to know the cause of Analysis of the Relationship between Attitude
increased blood pressure, and they continue to be Factors and Hypertension Cases
exposed to other risk factors without being The analysis of the attitude variable showed
recognized. In addition, there are still many cases of that there was no relationship between the
non-compliance in taking hypertension medicine. respondents' attitudes and hypertension cases.
This is basically because respondents have no Based on the results of the KAP questionnaire in the
adequate knowledge regarding prevention and attitude section, the control group still tends to be
treatment efforts for hypertension. Knowledge is more positive regarding the prevention and
significantly related to adherence to medicine. treatment of hypertension than the case group.
Hence, the results of this study, which are related to Notably, some respondents in the case group were
the level of knowledge of hypertension cases, align identified as rejecting treatment, particularly when
with theory and previous research (21). they perceived themselves as healthier. Individuals
with hypertension often skip their medication
Analysis of the Relationship of Family History schedules, including during travel. This reflects a
Factors to Hypertension Cases rejection attitude toward the lifelong treatment of
The results of the analysis revealed a significant hypertension.
relationship between family history and These findings contrast with a study conducted
hypertension cases. Someone with a family history at Al Hayat Hospital, Lebanon, where hypertensive
of hypertension will increase the risk by 13.67 times patients demonstrated an adequate attitude (19).
compared to having no history of hypertension. Similarly, other studies reported positive attitudes
This result is consistent with other research on 12th- among most hypertensive patients, with one study
grade high school students in Palembang, which revealing a percentage of 83.30% (21). Consistent
shows that adolescents with a family history of with these findings, research in Nepalese hospitals
hypertension will be 2.7 times more at risk than indicated that half of the hypertensive patients had
adolescents without a family history of a positive attitude (27). However, other study
hypertension (22). Research in Pakistan using a presented a contradictory result, suggesting that
case-control study design with a total sample of 400 individuals with a negative attitude had a 2.8 times
respondents also showed a significant relationship higher risk of hypertension compared to those with
between family history and hypertension cases (p- a positive attitude (28).
value <0.05) (23). Another study based on data The lack of valid OR results suggests the
from The Korea National Health and Nutrition possibility of bias or measurement inconsistencies.
Examination Survey confirmed that children who This discrepancy could imply that negative attitudes
have one parent with hypertension would be 2 times may appear protective due to confounding factors
more at risk than those who do not; meanwhile, if not accounted for in the study. Additionally, the
both parents suffer from hypertension, the child will inconsistent findings highlight the need for further
be 4 times more at risk of being affected by analysis to clarify the standard definition of
hypertension than who do not have hypertensive "attitude" and address potential biases, such as the
parents. A family with the same lifestyle will inclusion of the value of 1 in the OR range, which
undoubtedly be exposed to almost the same risk may affect the interpretation of results. Further
factors from their daily activities. From these risk investigation into these aspects is critical to avoid
factors, there is a possibility that the child will misconceptions and provide accurate conclusions
follow the history of hypertension of both parents. regarding the role of attitude in hypertension
The probability of a child or descendant of both management.
parents with hypertension is 50% (24).
Hypertension is associated with the symmetric CONCLUSION
gene that can trigger the formation of the
aldosterone gene, causing increased fluid retention, This study identified a significant relationship
which results in increased blood pressure (25). between family history, knowledge, and rest habits
Hypertension can be inherited in the family due to with the prevalence of hypertension in Plosojenar
the presence of dominant genes; there are various Village, Ponorogo Regency. However, no
genetic syndromes associated with monogenic significant relationship was found between
hypertension (26). respondents' attitudes and hypertension cases. The
attitude factor could not be conclusively interpreted
as a risk or non-risk factor. Similarly, this study did
not provide sufficient evidence to classify resting
 16 of 17 Nadia Rizqiyah Syafitri, et al / Jurnal Berkala Epidemiologi, 13 (1) 2025, 10 –17

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