The Prevalence of High Blood Pressure in Armenia

200 Pages·2017·2.12 MB·English

UCLA
UCLA Electronic Theses and Dissertations
Title
The Prevalence of High Blood Pressure in Armenia
Permalink
https://escholarship.org/uc/item/4pd1k4zs
Author
Akaragian, Salpy Akaragian
Publication Date
2017

Peer reviewed|Thesis/dissertation
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UNIVERSITY OF CALIFORNIA
Los Angeles

The Prevalence of High Blood Pressure in Armenians

A dissertation submitted in partial satisfaction of the
requirements for the degree Doctor of Philosophy
in Nursing

by

Salpy Akaragian

2017
© Copyright by
Salpy Akaragian
2017
ABSTRACT OF THE DISSERTATION

The Prevalence of High Blood Pressure in Armenians

by

Salpy Akaragian

Doctor of Philosophy in Nursing
University of California, Los Angeles, 2017
Professor Deborah Koniak-Griffin, Chair

Hypertension (HTN) is a significant and growing national and international public health
problem that contributes to cardiovascular morbidity and mortality. In Armenia, limited data
exist on the prevalence of the high blood pressure (HBP) or HTN and associated risk factors.
Past research often employs self-report data on blood pressure (BP) or objective measures of BP
that do not follow current Joint National Committee-8 (JNC-8) guidelines. Further, little is
known about the relationship between adherence to antihypertensive medication(s), knowledge
and awareness of HTN, and current BP. The rapid socio-demographic and infrastructural
changes occurring in Armenia create an urgent need for further scientifically rigorous research
on HBP.
The purpose of this descriptive, cross-sectional dissertation study, guided by the Health
Lifestyle Theory, was to examine the prevalence of HBP and selected risk factors associated
ii
with HBP in a convenience sample of Armenian men and women ages 21 and older, living in
Armenia. The risk factors included: demographic, physiologic, health lifestyle behaviors,
socioeconomic and inherited. The study also examined knowledge, awareness, and
attitudes/perceptions related to HBP by awareness, treatment and control categories. The
Morisky Medication Adherence Scale-8 was used to measure adherence.
Participants (n = 200) were predominantly middle-aged, married females, with a high
school education or higher. Blood pressure was measured following JNC-8 guidelines at a single
time point in a community setting.
Over half of the adults of the sample were found to be prehypertensive or hypertensive.
For those diagnosed with HTN, adherence to prescribed antihypertensive medication(s) was low.
The correlation between adherence and awareness scores was not significant. A significant
association was found between HBP and waist-hip ratio, age, body mass index, total cholesterol,
low high density lipoprotein cholesterol, and high low density lipoprotein cholesterol as reported
in past research. Waist circumference was the strongest predictor of HBP, followed by personal
history of HBP, high total cholesterol level, being male, and older age. Findings of this study
have several implications for clinical practice. A similar larger study with a national
representative sample needs to be conducted in Armenia to determine the prevalence and
correlates of HBP.

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The dissertation of Salpy Akaragian is approved.
Felicia Hodge
Donald Morisky
Adeline Nyamathi
Deborah Koniak-Griffin, Committee Chair

University of California, Los Angeles
2017
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Dedication
I wish to express my deepest appreciation and gratitude to the University of California,
Los Angeles, for providing me with an exemplary education in Nursing. My grandfather, a
survivor of the 1915 Armenian Genocide, placed such a great value on education that, orphaned
at the young age of seven, he taught himself to read and write not only in Armenian, but in
several other languages. My parents, the children of genocide survivors, did not have the
financial means to study past the sixth grade, but had a love of education that they passed on to
all four of their children. They made sure we received excellent educations.
Today, all three of my siblings and I are university graduates--many with medical and
juris doctorate degrees. I am exceedingly grateful to my mentors, teachers, and life coaches in
the United States and in Armenia for my education. They have instilled in me the perseverance
and resilience to reach my personal and professional goals. My dream was to receive the highest
possible level of education in Nursing, and I am exceptionally thrilled to have fulfilled my
objectives and attained my vision.
In celebration, I dedicate this dissertation to the many generations of people who value
education; to the many scholars, teachers, administrators, and donors who provide the
opportunity to pursue an education; and to the successes and scholarly pursuits of current and
future students, including my precious grandchildren Alina, Alex, Aiden, Anto, and Vivienne.

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Table of Contents
List of Figures .............................................................................................................................. xiv
List of Tables ................................................................................................................................ xv
Abbreviations and Acronyms ..................................................................................................... xvii
Vita ............................................................................................................................................... xix
Chapter 1: The Prevalence of High Blood Pressure in Armenians ................................................. 1
Prevalence of Hypertension in Race, Ethnicity, Gender, and Age ........................................... 2
Hypertension and Cardiovascular Disease in Armenians ......................................................... 2
Prevalence of and Risk Factors for Hypertension in Non-Armenians ...................................... 4
Knowledge, Awareness and Attitudes/Perceptions .................................................................. 5
Prevalence of HBP by Awareness, Treatment, and Control ..................................................... 6
Adherence to Hypertensive Medications .................................................................................. 7
Purpose of the Study and Aims ................................................................................................. 7
Specific Aim 1 .................................................................................................................... 8
Specific Aim 2 .................................................................................................................... 8
Specific Aim 3 .................................................................................................................... 8
Specific Aim 4 .................................................................................................................... 8
Specific Aim 5 .................................................................................................................... 8
Conceptual Framework ............................................................................................................. 9
Research Design........................................................................................................................ 9
Significance to Nursing Science and Practice ........................................................................ 10
Chapter 2: Literature Review ........................................................................................................ 13
Background of the Literature Search ...................................................................................... 14
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Prevalence of HBP or HTN and Parameters ........................................................................... 15
HBP or HTN in Armenians living in Armenia ....................................................................... 16
HBP or HTN in Armenians Living Outside of Armenia ........................................................ 19
HBP or HTN in Non-Armenians ............................................................................................ 20
Household Health Survey (HHS) in Armenia ........................................................................ 24
Demographic and economic status data ............................................................................ 25
Health status ...................................................................................................................... 26
Health behavior/lifestyle ................................................................................................... 26
Use of Public Health Clinic (PHC)/early diagnostic and prevention services .................. 27
Public awareness of open enrollment (OE), family medicine (FM) and free PHC .......... 27
Knowledge, awareness, and attitudes/perceptions ............................................................ 28
Community involvement .................................................................................................. 28
Summary ................................................................................................................................. 29
Chapter 3: Theoretical Framework ............................................................................................... 31
Health Lifestyle Theory (HLT) ............................................................................................... 32
Class circumstances .......................................................................................................... 33
Age and gender ................................................................................................................. 34
Race/ethnicity ................................................................................................................... 34
Collectivities ..................................................................................................................... 35
Living conditions .............................................................................................................. 36
Socialization and Experience .................................................................................................. 36
Life Choices (Agency) ............................................................................................................ 37
Life Chances (Structure) ......................................................................................................... 37
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Choice and Chance Interplay .................................................................................................. 37
Disposition to Act (Habitus) ................................................................................................... 38
Practices (Action).................................................................................................................... 38
Alcohol use ....................................................................................................................... 39
Smoking ............................................................................................................................ 39
Diet .................................................................................................................................... 39
Checkups ........................................................................................................................... 40
Health Lifestyle (Reproduction) ............................................................................................. 41
Research Support on HLT Structural Variables and Practices ............................................... 41
Russia ................................................................................................................................ 42
Belarus, Russia, and Ukraine ............................................................................................ 43
Kazakhstan and Kyrgyzstan .............................................................................................. 45
Descriptive studies conducted in eight fSU countries ...................................................... 46
Summary ................................................................................................................................. 46
Chapter 4: Methods ....................................................................................................................... 48
Purpose and Specific Aims ..................................................................................................... 48
Specific Aim 1 .................................................................................................................. 48
Specific Aim 2 .................................................................................................................. 49
Specific Aim 3 .................................................................................................................. 49
Specific Aim 4 .................................................................................................................. 49
Specific Aim 5 .................................................................................................................. 49
Research Design...................................................................................................................... 49
Sample..................................................................................................................................... 50
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