Blood Pressure Trends, Demographic Data, Workload, and Lifestyle Factors Among Nurses in the Subcarpathian Region of Poland: A Cross-Sectional Observational Study.
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Abstract
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Blood Pressure Trends, Demographic Data, Workload, and Lifestyle Factors Among Nurses in the Subcarpathian Region of Poland: A Cross-Sectional Observational Study
Abstract
Background
Hypertension is one of the main modifiable risk factors linked to cardiovascular disease and its prevalence is currently increasing in various age groups. This study aimed to evaluate blood pressure, demographic data, workload, and lifestyle factors in nurses employed in hospitals in the Subcarpathian region of southeastern Poland.
Material/Methods
This cross-sectional observational study was conducted among 627 professionally active nurses. Certified devices were used for measurements: body mass analyzer (Tanita MC-980 PLUS MA), automated sphygmomanometer (Welch Allyn 4200B), stadiometer (Seca 213), and tape measure (Seca 201). The frequency of consumption of specific product groups was assessed using a survey method. Analysis using R software (version 4.3.1) employed logistic regression to examine variables affecting hypertension occurrence.
Results
The study found that elevated blood pressure is more prevalent among nurses than they self-report. Logistic regression analysis identified significant predictors for hypertension, including age (odds ratio; OR=1.061; OR=1.045), working more than 1 job (OR=1.579; OR=1.864), and body mass index (OR=1.152; OR=1.113).
Conclusions
Regular monitoring of blood pressure is necessary for early detection and timely intervention of hypertension. Enhancing nurses’ awareness of their own health will encourage proactive preventive measures. Implementing comprehensive education programs focused on the latest advances in cardiovascular disease prevention is essential.
Introduction
Hypertension is a significant health problem worldwide and is a major risk factor for development of cardiovascular diseases, stroke, and chronic kidney diseases [1]. Despite advances in the field of medicine, it remains one of the most commonly diagnosed conditions in the adult population [2]. Factors causing hypertension include genetics, lifestyle, and occupation [3,4].
Multiple studies have assessed the connection between profession and hypertension [4]. Healthcare professionals, particularly nurses and doctors, have higher rates of hypertension than the general population [5,6]. This increased prevalence is attributed to the high-stress environment, long working hours, and often irregular schedules that disrupt circadian rhythms. A study by Cai et al indicated that the prevalence of hypertension among medical professionals in China is high, underlining the impact of job-related stress on health [7]. Teachers also face substantial occupational stress, which can lead to elevated blood pressure. The American Psychological Association (APA) reported that teachers experience high levels of job-related stress, contributing to a greater risk of hypertension [8]. Similarly, police officers and firefighters are at increased risk due to the high-stress nature of their jobs [9]. Ramey et al found that police officers have a higher prevalence of hypertension, which can be attributed to the dangerous and unpredictable nature of their work [9]. Additionally, Kales et al found that firefighters are prone to hypertension due to the physically demanding and stressful aspects of their profession [10]. Office workers and managers, despite often having less physically demanding jobs, are not exempt from this risk [11]. The European Agency for Safety and Health at Work (EU-OSHA) emphasized that long working hours and job-related stress contribute to higher rates of hypertension among white-collar workers [11]. Furthermore, drivers of heavy vehicles and public transport are also identified as a high-risk group [12]. According to Sieber et al, long-haul truck drivers in the U.S. show elevated hypertension prevalence due to extended working hours, sedentary lifestyle, and irregular meal patterns [12]. Employees in call centers face unique challenges, including constant performance monitoring and high-pressure work environments, which significantly impact their psychological well-being and blood pressure [13]. Research by Holman et al demonstrated that call center workers are particularly susceptible to hypertension due to these stressors [13].
Additionally, studies have identified demographic risk factors for hypertension, such as male sex, psychological stress, holding administrative positions, low decision-making autonomy, sleep problems, job insecurity, and a family history of hypertension [4].
Among healthcare professions, nurses are at particularly high risk [14], as they often work long hours, are exposed to stress, and need to make rapid decisions in crisis situations [14,15]. Additionally, the nature of nurses’ work often hinders access to healthy meals and regular physical exercise. Working night shifts disrupts the body’s individual biological rhythm and increases the risk of developing many diseases [16,17]. However, it is precisely through shift work that continuity of care for patients can be ensured. Indeed, many studies indicate that the health status of healthcare workers, especially nurses, is worse compared to the general population [5,6]. A cross-sectional study by Sobrino et al showed that the prevalence of masked hypertension in healthcare workers in Spain is almost 25% [18]. It has been observed that nurses, who are mostly women, are at a greater risk of developing cardiovascular diseases if they work in a shift system [19]. This is mainly because the shift system can disrupt the body’s natural circadian rhythm, leading to sleep disturbances, fatigue, and irregular eating habits [20]. Additionally, the demanding nature of the job, including prolonged standing and physical exertion, can also contribute to an increased risk of hypertension in this professional group. These factors combined can have a significant impact on the health and well-being of nurses, and it is important to raise awareness and take measures to mitigate these risks [21].
The recent Coronavirus Disease 2019 (COVID-19) pandemic has highlighted the importance of healthcare workers in the healthcare system [22]. These events have shown that good physical and mental health of medical personnel is essential for a well-functioning health system [22].
This study aimed to evaluate blood pressure, demographic data, workload, and lifestyle factors in 627 nurses employed in hospitals in the Subcarpathian region of southeastern Poland.
Material and Methods
Ethics Approval
The study participants received verbal and written information about the objectives, risks, and benefits of the study. This study was approved by the Bioethics Committee of the University of Rzeszów (No. 2022/088, from 5 of October 2022) and was conducted in accordance with the ethical standards stated in the most recent version of the Declaration of Helsinki.
Informed Consent
All nurses in the study group were informed about the purpose of the study and its course, and eligibility for the study was possible only after they provided informed written consent. The presented data do not contain any information that allows the respondents to be identified.
Study Participants
An observational study was conducted in 2022 among 627 nurses employed in selected hospitals in the Subcarpathian region, after approval from the hospital directors to conduct measurements among nursing staff. Nonrandom sampling was used, and participants provided their voluntary informed consent in writing before the study began. Precautions were taken to ensure the anonymity of the respondents. Information about the measurements was distributed to all nurses in collaboration with hospital authorities. Those interested in participating signed up on the prepared lists. Recruitment criteria included actively practicing nurses without recent infection symptoms, unaware of existing health problems, and willing to join the project. All eligible participants were included in the study. Data from the measurements of 627 nurses were statistically analyzed.
All applied methods and research procedures were supplemented and precisely described according to the recommendations and guidelines:
Anthropometric Measurements
Participants were measured by body weight and height following a standardized protocol, using calibrated equipment:
Body height was measured in an upright position without footwear, recorded to the nearest 0.1 cm using a portable stadiometer (Seca 213). Participants stood with their feet together, heels, buttocks, and upper back touching the stadiometer, and their head positioned in the Frankfurt plane (an imaginary line from the lower border of the eye socket to the upper border of the ear canal) to ensure accuracy. This positioning ensured that the head was aligned horizontally, providing a standardized and precise measurement.
Body composition was assessed using bioelectric impedance analysis (6.25 kHz, 50 kHz, 90 μA) with a certified and calibrated analyzer (Tanita MC-980 PLUS MA, Tokyo, Japan), which has an accuracy of 0.1 kg/0.1%. The analyzer is equipped with 8 electrodes: 4 embedded in the platform and 4 in the handgrips. To ensure accurate measurements, the device was placed on a level surface according to the manufacturer’s instructions, ensuring that the level indicator was centered on the level meter. Participants stood barefoot on the analyzer platform, wearing light clothing, in an upright, motionless position, with their feet positioned to evenly distribute body weight and maintain contact with the electrodes. Measurements were taken in a standing position, with participants maintaining contact with the electrodes through bare feet and holding their hands away from the body at an angle of 35° to 40°. The Tanita software automatically measured body mass and impedance to determine body fat percentage, using standardized formulas and equations. The Tanita MC-980 PLUS MA device is approved for medical use, meeting NAWI and CLASS III standards, the MDD 93/42/EEC directive, and the CE0122 EU certificate [23].
Body mass index (BMI) was calculated on body composition analysis using a certified and calibrated analyzer (Tanita MC-980 PLUS MA, Tokyo, Japan) and derived as weight in kilograms divided by height in meters squared (kg/m2). Based on standard recommendations, the following BMI categories were adopted: underweight (BMI: 17–18.49), normal body weight (BMI: 18.5–24.99), overweight (BMI: 25–29.99), first-degree obesity (BMI: 30–34.99), second-degree obesity (BMI: 35–39.99), third-degree obesity (BMI: >40). Participants with a BMI below 17 were classified as severely underweight [24].
To calculate the waist-to-hip ratio index (WHR), waist circumference was measured using an ergonomic anthropometric tape (Seca 201) placed precisely between the lower edge of the rib cage and the upper iliac crest. Hip circumference was measured by placing the anthropometric tape at the level of the iliac spine and the widest part of the buttocks. Measurements were taken in duplicate to ensure accuracy, and the average value was used for the calculation. After measurement, the WHR was calculated by dividing the waist circumference by the hip circumference. A score of 0.83 or higher in women and 0.96 or higher in men was considered to indicate an android body type. In contrast, a coefficient of 0.83 or less in women and 0.96 or less in men indicated a gynoid body type [25].
Blood Pressure Measurement Procedure
Systolic and diastolic blood pressure (SBP and DBP) were assessed after participants rested in a seated position for at least 5 minutes with the back supported and the feet on the floor. Measurements were taken in the right arm, with the elbow placed at heart level, using a cuff adjusted to the arm circumference of the participants. A Welch Allyn 4200B device (Aston Abbotts, UK) was utilized for the measurements. According to the guidelines of the European Society of Hypertension experts [26], 3 measurements were performed for each participant, with a 1-2-minute interval between each measurement. During the measurements, participants were instructed to remain silent and not to talk. The average of these 3 measurements was calculated and used in the analysis.
Blood pressure categories were defined as follows: optimal: SBP <120 mmHg and DBP <80 mmHg; normal blood pressure: 120–129 mmHg (SBP) and/or 80–84 mmHg (DBP); normal high pressure: 130–139 mmHg (SBP) and/or 85–89 mmHg (DBP); grade 1 hypertension: 140–159 mmHg (SBP) and/or 90–99 mmHg (DBP); grade 2 hypertension: 160–179 mmHg (SBP) and/or 100–109 mmHg (DBP); grade 3 hypertension: ≥180 mmHg (SBP) and/or ≥110 mmHg (DBP); isolated systolic hypertension ≥140 (SBP) and <90 mmHg (DBP) [27].
Survey and Data Collection
Nurses were asked to complete a brief survey containing questions about sociodemographic information and the frequency of consuming specific products. The questionnaire was provided in a paper format along with an envelope. Once completed, the questionnaires were placed in sealed envelopes to ensure the confidentiality of the responses. The survey questions covered sociodemographic data such as age, sex, workplace, type of work, and level of education. Additional questions addressed the consumption of various food groups, salt intake, participation in preventive tests, weight management, smoking habits, work schedule and self-assessment of health status. To ensure anonymity, the surveys were anonymous, and ID numbers were used to link the responses to blood pressure results and anthropometric measurements without revealing personal identities. The collected data were securely stored and only accessible to authorized researchers to maintain confidentiality
Statistical Analysis
The analysis was performed using R software, version 4.3.1. Descriptive statistics were first calculated to summarize the characteristics of the study sample. These included means (M), standard deviations (SD), medians (Me), interquartile ranges (IGR) for continuous variables, and frequencies (n) with percentages (%) for categorical variables.
Subsequently, both univariate and multiple logistic regression analyses were conducted to assess the influence various factors on the binary outcome variable (occurrence of hypertension) The prevalence of hypertension was not included as a variable in the model. The results were presented as odds ratios (OR) with 95% confidence interval. The variables for multiple analysis were selected based on their significance in single-factor analyses. A significance level of 0.05 was adopted for the analysis, meaning that p-values below 0.05 were considered indicative of significant associations. All statistical tests were two-tailed, meaning that they considered the possibility of relationships in both directions (positive and negative) [28].
Results
Characteristic of Study Group
The measurements involved a total of 627 nurses, consisting of 575 women and 52 men. The average age of the participants was approximately 47.89 years (SD±10.72). More detailed characteristics of the study group can be found in Table 1.
Table 1
General characteristics of the study group (n=627).
| Parameter | Total (n=627) n (%) | |
|---|---|---|
| Sex* | Female | 575 (91.71) |
| Male | 52 (8.29) | |
| Age [years] | Mean (SD) | 47.89 (10.72) |
| Median (quartiles) | 51 (40–55) | |
| Type of work* | Administrative position | 97 (15.47) |
| Hospital ward | 530 (84.53) | |
| Work system* | One shift work [8 h] | 204 (32.54) |
| Shift work and night duty [12 h] | 423 (67.46) | |
| More than one full-time job* | No | 355 (56.62) |
| Yes | 272 (43.38) | |
| Education level* | Basic nursing education | 187 (29.83) |
| Bachelor | 165 (26.32) | |
| MSc | 275 (43.86) | |
| Participation in preventive, non-periodic, examinations* | No | 454 (72.41) |
| Yes | 173 (27.59) | |
| Smoking* | No | 475 (75.76) |
| Yes | 152 (24.24) | |
| Cigarettes [pcs/day]* | Mean (SD) | 3.29 (6.9) |
| Median (quartiles) | 0 (0–0) | |
| Range | 0–40 | |
| Prevalence of hypertension* | I don’t have a problem with hypertension | 549 (87.56) |
| I am undergoing treatment, and regularly taking medications | 78 (12.44) | |
| Salting dishes* | Even without tasting it first | 161 (25.68) |
| When necessary | 374 (59.65) | |
| Rarely | 87 (13.88) | |
| Never | 5 (0.80) | |
| Weight self-control * | Every day | 25 (3.99) |
| Once a week | 85 (13.56) | |
| Once every 2 weeks | 61 (9.73) | |
| Once a month | 147 (23.44) | |
| Less often | 125 (19.94) | |
| Irregularly | 184 (29.35) | |
| BMI [kg/m2]* | Mean (SD) | 27.03 (5.46) |
| Median (quartiles) | 26.4 (23.1–30.1) | |
| Range | 17.4–55 | |
| WHR | Android type | 377 (60.13) |
| Gynoid type | 250 (39.87) | |
| SBP [mmHg] | Mean (SD) | 123.89 (15.75) |
| Median (quartiles) | 122 (112–132) | |
| Range | 96–193 | |
| DBP [mmHg] | Mean (SD) | 75.97 (8.57) |
| Median (quartiles) | 76 (70–81) | |
| Range | 56–108 | |
Data presented as:
SD – standard deviation; BMI – body mass index; WHR – waist hip ratio; SBP – systolic blood pressure; DSB – diastolic blood pressure.
Dietary Habits Among Studied Nurses
Results related consumption of specific food groups among the studied nurses, highlighting key dietary habits. White bread was the most frequently consumed product, with 56.14% of nurses eating it every day. Dark or whole-grain bread was also commonly consumed, although less frequently on a daily basis, with 24.88% of nurses eating it every day and 21.21% consuming it 2–4 times a week. Fish and seafood were among the least frequently consumed daily, with only 1.75% of nurses eating them every day. The majority, 47.05%, consumed fish and seafood a few times a month. Red meat, sausages, and similar products were consumed daily by 21.21% of the nurses. A significant portion, 28.39%, ate them 2–4 times a week. Dairy products were regularly included in the diet, with 26.16% of nurses consuming them every day. Cheese consumption followed a similar pattern, with 25.36% eating it daily. Cottage cheese was consumed by 19.94% of nurses every day, and the highest frequency of consumption was 35.73% for those who ate it 2–4 times a week. Vegetables and fruits were the most frequently consumed healthy food group, with 66.83% of nurses eating them every day, indicating a positive dietary habit. Sweets and salty snacks were consumed daily by 27.43% of the nurses, showing a tendency towards frequent consumption of less healthy snacks. Fast-food products were the least frequently consumed, with only 3.83% of nurses eating them every day and 33.81% never consuming them. These findings illustrate the dietary habits of the nurses, highlighting the variations in consumption patterns across different food groups. The high daily consumption of white bread and the low daily intake of fish and seafood are particularly notable (Table 2).
Table 2
Frequency of consumption of specific food groups among studied nurses.
| Type of product | Frequency of consumption | ||||
|---|---|---|---|---|---|
| Every day n (%) | 2–4 times a week n (%) | Once a week n (%) | A few times a month n (%) | Never n (%) | |
| White bread | 352 (56.14) | 84 (13.40) | 75 (11.96) | 62 (9.89) | 54 (8.61) |
| Dark/wholemeal bread | 156 (24.88) | 133 (21.21) | 121 (19.30) | 107 (17.07) | 110 (17.54) |
| Fish and seafood | 11 (1.75) | 62 (9.89) | 173 (27.59) | 295 (47.05) | 86 (13.72) |
| Red meat, sausages, etc. | 133 (21.21) | 178 (28.39) | 108 (17.22) | 157 (25.04) | 51 (8.13) |
| Dairy products | 164 (26.16) | 180 (28.71) | 124 (19.78) | 92 (14.67) | 67 (10.69) |
| Cheese | 159 (25.36) | 137 (21.85) | 133 (21.21) | 166 (26.48) | 32 (5.10) |
| Cottage cheese | 125 (19.94) | 224 (35.73) | 151 (24.08) | 105 (16.75) | 22 (3.51) |
| Vegetables and fruits | 419 (66.83) | 121 (19.30) | 64 (10.21) | 19 (3.03) | 4 (0.64) |
| Sweets and salty snacks | 172 (27.43) | 206 (32.85) | 134 (21.37) | 96 (15.31) | 19 (3.03) |
| Fast-food products | 24 (3.83) | 66 (10.53) | 62 (9.89) | 263 (41.95) | 212 (33.81) |
Data presented as: n (%).
Blood Pressure Classification Among Studied Nurses
The obtained results show that among the 627 nurses studied, 40.19% (252 nurses) had optimal blood pressure values. Normal blood pressure was observed in 28.07% (176 nurses) of the participants. High normal blood pressure was found in 14.19% (89 nurses) of the group. Additionally, 5.10% (32 nurses) were classified as having grade 1 hypertension, while 1.44% (9 nurses) had grade 2 hypertension. Furthermore, 11.1% (69 nurses) were identified as having isolated systolic hypertension. These findings indicate that while a significant portion of nurses maintained optimal or normal blood pressure, there was a notable prevalence of elevated blood pressure levels within the group (Table 3).
Table 3
Blood pressure values in the study group (n=627).
| Classification of blood pressure values | n | % |
|---|---|---|
| Optimal | 252 | 40.19 |
| Normal | 176 | 28.07 |
| High normal | 89 | 14.19 |
| HT grade 1 | 32 | 5.10 |
| HT grade 2 | 9 | 1.44 |
| Isolated systolic HT | 69 | 11.1 |
Data presented as: n (%); HT – hypertension.
Predictors of Hypertension: Univariate and Multiple Logistic Regression Analysis
The univariate logistic regression analysis identified several significant predictors of hypertension among the studied nurses. Age was a significant predictor, with an odds ratio (OR) of 1.061 per year (95% CI: 1.037–1.085, p<0.001), indicating that older nurses had a higher risk of developing hypertension. Additionally, nurses working more than one full-time job had a significantly higher risk of hypertension (OR=1.579, 95% CI: 1.045–2.387, p=0.03). Education level also played a role; nurses with an MSc had a significantly lower risk of hypertension compared to those with basic nursing education (OR=0.554, 95% CI: 0.337–0.908, p=0.019). BMI was another significant predictor, with an OR of 1.152 per kg/m2 (95% CI: 1.107–1.198, p<0.001). Moreover, the waist-to-hip ratio (WHR) indicated that nurses with a gynoid body type had a significantly lower risk of hypertension compared to those with an android body type (OR=0.277, 95% CI: 0.166–0.464, p<0.001). Dietary habits were also associated with hypertension risk. Nurses who never consumed white bread had a significantly lower risk of hypertension (OR=0.328, 95% CI: 0.115–0.939, p=0.038). Similarly, the consumption of cottage cheese 2–4 times a week significantly reduced the risk of hypertension (OR=0.381, 95% CI: 0.213–0.681, p=0.001). Additionally, sweets and salty snacks consumption once a week significantly reduced the risk of hypertension (OR=0.491, 95% CI: 0.251–0.961, p=0.038). Finally, nurses who consumed fast-food products a few times a month (OR=0.508, 95% CI: 0.291–0.887, p=0.017) or never (OR=0.375, 95% CI: 0.205–0.686, p=0.001) had a significantly lower risk of hypertension compared to those who consumed fast-food 2–4 times a week or more often (Table 4).
Table 4
Predictors of hypertension - Univariate logistic regression.
| Trait | n | HT | OR | 95% CI | p | ||
|---|---|---|---|---|---|---|---|
| Sex | Female | 575 | 103 | 1 | Ref. | ||
| Male | 52 | 7 | 0.713 | 0.313 | 1.626 | 0.421 | |
| Age | [years] | – | – | 1.061 | 1.037 | 1.085 | <0.001* |
| Type of work | Administrative position | 97 | 19 | 1 | Ref | ||
| Hospital ward | 530 | 91 | 0.851 | 0.491 | 1.475 | 0.565 | |
| Work system | One shift work [8 h] | 204 | 34 | 1 | Ref. | ||
| Shift work and night duty [12 h] | 423 | 76 | 1.095 | 0.702 | 1.707 | 0.688 | |
| More than one full-time job | No | 355 | 52 | 1 | Ref. | ||
| Yes | 272 | 58 | 1.579 | 1.045 | 2.387 | 0.03* | |
| Education level | Basic nursing education | 187 | 40 | 1 | Ref. | ||
| Bachelor | 165 | 34 | 0.954 | 0.57 | 1.595 | 0.857 | |
| MSc | 275 | 36 | 0.554 | 0.337 | 0.908 | 0.019* | |
| Participation in preventive, non-periodic, examinations | No | 454 | 74 | 1 | Ref. | ||
| Yes | 173 | 36 | 1.349 | 0.866 | 2.103 | 0.186 | |
| Smoking | No | 475 | 85 | 1 | Ref. | ||
| Yes | 152 | 25 | 0.903 | 0.554 | 1.473 | 0.683 | |
| Cigarettes | [pcs/day] | – | – | 1.007 | 0.978 | 1.036 | 0.656 |
| Salting dishes | Even without tasting it first | 161 | 32 | 1 | Ref. | ||
| When necessary | 374 | 64 | 0.832 | 0.519 | 1.334 | 0.445 | |
| Rarely, never | 92 | 14 | 0.724 | 0.364 | 1.44 | 0.357 | |
| Weight self-control | Once a week or more often | 110 | 14 | 1 | Ref. | ||
| Once every 2 weeks | 61 | 9 | 1.187 | 0.481 | 2.927 | 0.71 | |
| Once a month | 147 | 26 | 1.473 | 0.73 | 2.975 | 0.28 | |
| Less often | 125 | 25 | 1.714 | 0.841 | 3.493 | 0.138 | |
| Irregularly | 184 | 36 | 1.668 | 0.855 | 3.255 | 0.134 | |
| BMI | [kg/m2] | – | – | 1.152 | 1.107 | 1.198 | <0.001* |
| WHR | Android type | 377 | 90 | 1 | Ref. | ||
| Gynoid type | 250 | 20 | 0.277 | 0.166 | 0.464 | <0.001* | |
| White bread | Every day | 352 | 69 | 1 | Ref. | ||
| 2–4 times a week | 84 | 13 | 0.751 | 0.393 | 1.434 | 0.386 | |
| Once a week | 75 | 16 | 1.112 | 0.603 | 2.051 | 0.733 | |
| A few times a month | 62 | 8 | 0.608 | 0.276 | 1.336 | 0.215 | |
| Never | 54 | 4 | 0.328 | 0.115 | 0.939 | 0.038* | |
| Dark/wholemeal bread | Every day | 156 | 30 | 1 | Ref | ||
| 2–4 times a week | 133 | 22 | 0.832 | 0.454 | 1.527 | 0.553 | |
| Once a week | 121 | 17 | 0.687 | 0.359 | 1.314 | 0.256 | |
| A few times a month | 107 | 26 | 1.348 | 0.744 | 2.444 | 0.325 | |
| Never | 110 | 15 | 0.663 | 0.338 | 1.302 | 0.233 | |
| Fish and seafood | 2–4 times a week or more often | 73 | 14 | 1 | Ref. | ||
| Once a week | 173 | 31 | 0.92 | 0.457 | 1.853 | 0.816 | |
| A few times a month | 295 | 50 | 0.86 | 0.446 | 1.66 | 0.653 | |
| Never | 86 | 15 | 0.89 | 0.398 | 1.993 | 0.778 | |
| Red meat, sausages, etc. | Every day | 133 | 27 | 1 | Ref. | ||
| 2–4 times a week | 178 | 30 | 0.796 | 0.447 | 1.417 | 0.438 | |
| Once a week | 108 | 11 | 0.445 | 0.21 | 0.946 | 0.035* | |
| A few times a month | 157 | 31 | 0.966 | 0.542 | 1.72 | 0.906 | |
| Never | 51 | 11 | 1.08 | 0.49 | 2.378 | 0.849 | |
| Dairy products | Every day | 164 | 26 | 1 | Ref. | ||
| 2–4 times a week | 180 | 28 | 0.978 | 0.547 | 1.749 | 0.939 | |
| Once a week | 124 | 21 | 1.082 | 0.577 | 2.03 | 0.806 | |
| A few times a month | 92 | 18 | 1.291 | 0.665 | 2.508 | 0.451 | |
| Never | 67 | 17 | 1.805 | 0.904 | 3.604 | 0.094 | |
| Cheese | Every day | 159 | 36 | 1 | Ref. | ||
| 2–4 times a week | 137 | 26 | 0.8 | 0.454 | 1.409 | 0.44 | |
| Once a week | 133 | 21 | 0.641 | 0.353 | 1.163 | 0.143 | |
| A few times a month | 166 | 24 | 0.577 | 0.327 | 1.021 | 0.059 | |
| Never | 32 | 3 | 0.353 | 0.102 | 1.228 | 0.102 | |
| Cottage cheese | Every day | 125 | 31 | 1 | Ref. | ||
| 2–4 times a week | 224 | 25 | 0.381 | 0.213 | 0.681 | 0.001* | |
| Once a week | 151 | 32 | 0.815 | 0.464 | 1.432 | 0.478 | |
| A few times a month or never | 127 | 22 | 0.635 | 0.344 | 1.173 | 0.147 | |
| Vegetables and fruits | Every day | 419 | 79 | 1 | Ref. | ||
| 2–4 times a week | 121 | 17 | 0.704 | 0.399 | 1.242 | 0.225 | |
| Once a week or less often | 87 | 14 | 0.825 | 0.443 | 1.537 | 0.545 | |
| Sweets and salty snacks | Every day | 172 | 33 | 1 | Ref. | ||
| 2–4 times a week | 206 | 38 | 0.953 | 0.568 | 1.599 | 0.855 | |
| Once a week | 134 | 14 | 0.491 | 0.251 | 0.961 | 0.038* | |
| A few times a month or never | 115 | 25 | 1.17 | 0.653 | 2.097 | 0.598 | |
| Fast-food products | 2–4 times a week or more often | 90 | 26 | 1 | Ref. | ||
| Once a week | 62 | 11 | 0.531 | 0.24 | 1.176 | 0.119 | |
| A few times a month | 263 | 45 | 0.508 | 0.291 | 0.887 | 0.017* | |
| Never | 212 | 28 | 0.375 | 0.205 | 0.686 | 0.001* | |
p - univariate logistic regressions; n – number; OR – odds ratio; CI – confidence interval; OR (95% CI) – odds ratio with a 95% confidence interval; HT – hypertension; BMI – body mass index; WHR – waist hip ratio.
The multiple logistic regression identified several significant predictors of hypertension among the studied nurses. Age was a significant predictor, with an odds ratio (OR) of 1.045 per year (p=0.002). Nurses working more than one full-time job had a higher risk of hypertension (OR=1.864, p=0.009). BMI was also significant (OR=1.113 per kg/m2, p<0.001). While the waist-to-hip ratio (WHR) showed a lower risk for those with a gynoid body type (OR=0.673, p=0.205), this was not statistically significant. Dietary habits significantly affected hypertension risk. Nurses who consumed white bread a few times a month or never had a lower risk of hypertension (OR=0.427, p=0.018). Similarly, consuming red meat once a week reduced the risk (OR=0.366, p=0.005). Consumption of cottage cheese 2–4 times a week (OR=0.497, p=0.011) and sweets and salty snacks once a week (OR=0.342, p=0.001) also reduced hypertension risk. Nurses who consumed fast-food products a few times a month or never had a lower risk of hypertension (OR=0.544, p=0.05), (Table 5).
Table 5
Predictors of hypertension – multiple logistic regression.
| Trait | n | HT | OR | 95% CI | p | ||
|---|---|---|---|---|---|---|---|
| Age | [years] | – | – | 1.045 | 1.016 | 1.075 | 0.002* |
| More than one full-time job | No | 355 | 52 | 1 | Ref. | ||
| Yes | 272 | 58 | 1.864 | 1.169 | 2.974 | 0.009* | |
| Education level | Basic nursing education | 187 | 40 | 1 | Ref. | ||
| Bachelor | 165 | 34 | 1.506 | 0.831 | 2.728 | 0.177 | |
| MSc | 275 | 36 | 1.186 | 0.651 | 2.16 | 0.578 | |
| BMI | [kg/m2] | – | – | 1.113 | 1.061 | 1.168 | <0.001* |
| WHR | Android type | 377 | 90 | 1 | Ref. | ||
| Gynoid type | 250 | 20 | 0.673 | 0.364 | 1.243 | 0.205 | |
| White bread | Once a week or more often | 511 | 98 | 1 | Ref. | ||
| A few times a month or never | 116 | 12 | 0.427 | 0.211 | 0.866 | 0.018* | |
| Red meat, sausages, etc. | Other frequency | 519 | 99 | 1 | Ref. | ||
| Once a week | 108 | 11 | 0.366 | 0.18 | 0.743 | 0.005* | |
| Cottage cheese | Other frequency | 403 | 85 | 1 | Ref. | ||
| 2–4 times a week | 224 | 25 | 0.497 | 0.291 | 0.849 | 0.011* | |
| Sweets and salty snacks | Other frequency | 493 | 96 | 1 | Ref. | ||
| Once a week | 134 | 14 | 0.342 | 0.176 | 0.662 | 0.001* | |
| Fast-food products | 2–4 times a week or more often | 90 | 26 | 1 | Ref. | ||
| Once a week | 62 | 11 | 0.651 | 0.268 | 1.577 | 0.341 | |
| A few times a month or never | 475 | 73 | 0.544 | 0.297 | 0.999 | 0.05* | |
p – multiple logistic regression; n – number; OR – odds ratio; CI – confidence interval; OR (95% CI) – odds ratio with a 95% confidence interval; HT – hypertension; BMI – body mass index; WHR – waist hip ratio.
Discussion
Our study revealed several significant findings regarding the prevalence and predictors of hypertension among nurses in the Subcarpathian region of southeastern Poland. Firstly, we observed that the occurrence of elevated blood pressure values among nurses is more frequent than self-reported, with 31.73% of participants exhibiting elevated blood pressure.
Comparing these findings with previous studies, it becomes evident that hypertension is a series public health problem. Numerous medical studies recognize hypertension as a significant issue, which has been one of the primary and most common causes of stroke, kidney failure, heart attack, and premature mortality for many years [1,29]. According to the European Society of Hypertension, hypertension affects almost 1.3 billion adults worldwide [30]. According to data from the World Health Organisation (WHO), Poland has a significantly higher prevalence of hypertension among adults compared to the global average and other countries [31]. The magnitude of the problem is also evidenced by the first-ever report on the global destructive impact of high blood pressure, published by the WHO along with recommendations on how to win the race against this silent killer [32]. The issue also affects healthcare professionals, including nurses [5]. According to the review by Mohanty et al, the risk factors for the development of noncommunicable diseases and mortality among healthcare workers are much higher than in the general population [6]. Therefore, given the specific nature of nursing work, this group is particularly vulnerable to hypertension [5,6]. This is also confirmed by previous studies assessing the health status of nurses in Poland [33–35]. Taking into account the above and the significant role of nurses in providing healthcare, scientific entities must conduct research in this area. This study aimed to evaluate blood pressure, demographic data, workload, and lifestyle factors in 627 nurses employed in hospitals in the Subcarpathian region of southeastern Poland.
The results showed that the number of nurses with elevated blood pressure values is significantly higher compared to self-reported blood pressure values. In the survey, only 12.44% of the respondents indicated that they are in treatment and taking medication regularly for hypertension; the remaining nurses stated that they have no hypertension issues. This indicates that the scale of this problem is much larger and often goes unnoticed [5,6,32]. According to the WHO report, 46% of adults with hypertension are unaware of their condition and less than half of adults (42%) with hypertension are diagnosed and treated [32]. Based on previous studies, this also applies to nurses [33–35]. In the Manakali study, the prevalence of hypertension among nurses was found to be 52%, which is significantly higher than the reported rates among nurses in South Africa (20%), Brazil (32%), and healthcare professionals in Nigeria (20.1%) [36]. Furthermore, this result surpasses the documented prevalence of hypertension in the general adult population of South Africa [36–38].
The results on the frequency of consuming specific food groups showed that significantly more nurses consume white bread daily compared to dark bread (N=352; 56.14% vs N=156; 24.88%). Furthermore, the surveyed individuals reported infrequent consumption of seafood, while 66.83% incorporate vegetables and fruits into their daily diet. The dietary habits of nurses may stem from the nature of shift work, working in challenging conditions, and experiencing stress [39,40]. Staff shortages and overwork can lead to irregular meals and frequent consumption of sweet snacks [41–43].
The results of univariate and multiple logistic regression models showed that significant factors predisposing to the development of hypertension are age, working more than one job, and BMI. The study by Kurtul et al regarding the prevalence of hypertension among employees of a university hospital in Turkey indicates statistically significant correlation between hypertension and male gender, age and BMI [44]. According to the study by Geniusz-Wojczyk et al, the majority of nurses who reported poor dietary habits were those who worked multiple jobs and nurses with overweight or obesity [45]. Many studies confirm that overweight and obesity are common among nurses, not only compared to the general population but also among other workers in the healthcare sector. The results of an Indian study showed that more than 70% of nurses working in hospitals had abdominal obesity, more than half were obese, and one-fifth were overweight, mainly affecting women over 40 years of age [46]. Similar trends are observed in the United Kingdom, New Zealand, the United States, and Australia [47,48].
The results of the univariate and multiple regression models showed that factors reducing the risk of developing hypertension include the complete absence of white bread consumption, infrequent consumption of red meat and sausages, weekly consumption of sweets and salty snacks, consumption of cottage cheese 2–4 times a week, and rare or no consumption of fast-food products. Furthermore, in the case of univariate regression, it was the type of gynoid body and the higher education (master’s degree) of nurses. Poor dietary habits among nurses are confirmed by other Polish studies [49,50]. According to Kucharska et al, this concerns nurses’ inadequate meal intake and insufficient consumption of fresh fruits and vegetables as a source of minerals, vitamins, fiber, and natural antioxidants [50]. Other researchers indicate that only a small percentage of nurses adhere to national dietary guidelines [51]. Lack of knowledge on the significance and principles of proper nutrition in hypertension lowers the level of motivation to participate in health-promoting actions and hinders the making appropriate dietary choices. Education about hypertension is considered an important intervention in its treatment. According to Hallberg et al and Maslakpak et al, education on hypertension not only increases blood pressure control but also influences decision-making about the effective management of one’s health [52,53]. Researchers highlight the role of healthcare workers who, with their knowledge and high awareness, can conduct educational interventions to help their patients achieve therapeutic goals [52,53]. A Chinese national cohort study evaluating the association between education levels and the risk and control of hypertension found that participants with elementary education or lower had a higher risk of newly diagnosed arterial hypertension and poorer blood pressure control compared to individuals with high school or secondary education [54]. The nature of nurses’ work predisposes them to many health problems. A study by the Cardiovascular Nurses Association indicated that the prevalence of hypertension is common among nurses [55]. Therefore, it is worth implementing monitoring, organizing measurements, and creating initiatives that allow for the early detection of existing abnormalities, thus automatically protecting against complications. Health professionals, including nurses, are an essential asset for every country. Their good health condition guarantees the national security of each country. A prime example of caring for nurses’ health is the major national campaign launched by the American Nurses Association called Healthy Nurse-Healthy Nation. It is an initiative that supports nurses in 6 key areas: mental health, activity, rest, nutrition, quality of life, and safety, introduced in 2017 and already producing very positive results [56].
According to Güneş et al, managing hypertension cannot rely solely on workplace regulations, as many other factors influence our health, such as awareness and education about a healthy lifestyle, and a well-balanced diet with limited salt intake. Additionally, long working hours, shift work, night shifts, chronic noise exposure, and specific work conditions such as altitude, extreme temperatures, and exposure to chemicals significantly impact health. The authors of the study emphasize that due to the complexity and multifactorial nature of the problem, all factors must be considered and tailored to individual predispositions and life and work conditions when developing recommendations [57].
Limitation of the study
Several potential limitations of the study should be acknowledged when interpreting the findings. First, the study was conducted within a limited geographic area and would benefit from expansion to encompass a broader range of medical facilities in different regions. Additionally, as the study is cross-sectional in nature, causal and temporal relationships cannot be inferred. An additional limitation is the lack of a control group. Further research is warranted in larger and more diverse populations across all age groups.
Conclusions
The results of a study indicate that the occurrence of elevated blood pressure values among nurses is more frequent than what they themselves report. This discrepancy may be attributed to a dearth of regular blood pressure measurements, leading to a lack of awareness of the potential health complications associated with arterial hypertension. These findings underscore the importance of regular blood pressure monitoring and the need for nurses to stay vigilant about their health to mitigate the risk of hypertension-related disorders. Nurses reported poor eating habits, which could be the cause of obesity and overweight, and, consequently, hypertension. The findings highlight the significant role of age, job-related factors, BMI, body fat distribution, and specific dietary habits in the risk of hypertension among nurses.
Based on the results obtained, comprehensive education should be implemented, including the latest trends in the prevention of hypertension. Regular check-ups and the promotion of healthy habits are necessary to effectively reduce the frequency of the occurrence of hypertension because the possession of medical knowledge and access to medical resources do not protect nurses from the risk of hypertension. Nursing leaders can play a crucial role in supporting and encouraging preventive measures, promoting a healthy lifestyle and diet. The dietary approach presented should be complemented by a holistic model of a healthy lifestyle. This approach includes regular exercise, stress management, and adequate sleep, as they also play a role in hypertension prevention. By promoting these measures, nursing leaders can significantly impact the overall health and well-being of their staff and patients [58,59].
Footnotes
Conflict of interest: None declared
Department and Institution Where Work Was Done: Institute of Health Sciences, Medical College of Rzeszów University, Rzeszów, Poland.
Financial support: None declared
References
Articles from Medical Science Monitor: International Medical Journal of Experimental and Clinical Research are provided here courtesy of International Scientific Information, Inc.
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