ABSTRACT

Background

Hypertension is a global public health problem highly affect low-income countries and it is a father of other heart and renal diseases and stroke. Stroke is also the sixth leading cause of mortality in Ethiopia.

Enhancing the prevention and control of hypertension through nutritional education is vital to decrease preventable morbidity, mortality and disabilities and to improve the quality of life. Little was known about the effect of nutritional education on hypertension control.

Objective

The aim of this study was to measure the effect of nutritional education on hypertension control.

Methods

An experimental study design with cluster randomized controlled trial was used.

A total of 224(113 (IG) and 111 (CG) known hypertensive patient who were not on anti-hypertensive drug management were selected using probability sampling. Random allocation of intervention and control was used. The intervention group received nutrition education using Health Belief Model and Dietary Approach to Stop Hypertension (DASH) dietary guideline every two weeks for 3 months.

Data were collected using WHO Step wise structured interviews with standard measurement for blood pressure, weight, height and waist circumference. Dietary assessment was done using 24-hour dietary recall and 7-days food frequency questionnaire.  Data was entered to Epi Data version 4.2 and exported to SPSS version 23 for analysis. Independent and paired sample t-test, Generalized Estimating Equation (GEE) and linear mixed effects model (LMM) analysis were used. Mean, adjusted β and AOR with 95% CI and P-value <0.05 was used to measure statistical significance.

Result

There was as significant improvement in most of dietary practices, behavioural factors and constructs of the Health Belief Model. The level of hypertension control in the intervention group was 22.1% compared to 8.1% in control group. After adjusting for age, sex and cluster effect the odds of hypertension control were 3.4 (AOR: 3.404, 95%CI: 1.493, 7.761) times higher in the intervention group than the control group. Significant reduction of mean systolic and diastolic blood pressure in the intervention group was -5.68/-3.37 mmHg lower than the control group with (Adjusted β = -5.68, 95%CI: -6.87, -4.48) and (Adjusted β = -3.37, 95%CI: -4.524, -2.220) respectively.

As an outcome of this research nutritional education program was developed based on the findings and the concepts of implementation science.

Conclusion and recommendation: Nutritional education using the Health Belief Model and DASH dietary guide had significant effect on hypertension control and reducing blood pressure without drug management. Scaling up of nutritional education program implementation at national level is mandatory for effective prevention and control of hypertension and its complications to improve the quality of life.

KEY CONCEPTS: Dietary approach to stop hypertension (DASH) dietary guide; Health Belief Model; hypertension; hypertension control; high blood pressure; implementation science; nutrition education; nutrition education program; randomized controlled trial