The Factors Influence to Incidence of Hypertension in Baucau Municipality, Republica Democratica de Timor Leste

Introduction: Hypertension is a serious problem in public health programs that affects individual health, and can affect the body and kill people. High blood pressure, also called hypertension, is blood pressure that is higher than normal. Blood pressure changes throughout the day based on your activity. Having a blood pressure measurement consistently above normal can lead to a diagnosis of high blood pressure or hypertension. Hypertension is known as a killer disease and a heterogeneous group of diseases. The ministry of health of Timor Leste, stated that the incidence of hypertension was 41.66% and cases of death were 27% of hospitalized patients. Method: this study used quantitative and quantitative methods together, in particular a prospective population study in the municipality of Baucau where interviews with the head of the family or someone else takes the responsibility. Results and discussion: the results of data analysis using Pearson Product Moment with p-value 0.000 <0.05 is a stress factor that affects the cause of hypertension. Also salt consumption is 0.741 between the interval coefficients 0.60 - 0.799 classified as severe hypertension). Other tests also showed that alcohol consumption had an effect on the incidence of hypertension because the p-value was 0.466 > 0.05. based on the results of data analysis, stress factors, salt and alcohol consumption have an effect on the incidence of hypertension in the people of Baucau city, Timor Leste.


Introduction
Blood pressure is the force exerted by circulating blood against the walls of the body's arteries, the major blood vessels in the body. Hypertension is when blood pressure is too high. Blood pressure is written as two numbers namely the first (systolic) number represents the pressure in blood vessels when the heart contracts or beats. The second (diastolic) number represents the pressure in the vessels when the heart rests between beats. Hypertension is diagnosed if, when it is measured on two different days, the systolic blood pressure readings on both days is ≥140 mmHg and/or the diastolic blood pressure readings on both days is ≥90 mmHg.The hipertention is a serious medical condition that significantly increases the risks of heart, brain, kidney and other diseases so that needed prevention (Ernawati et al.,2020) Also the Report of World Health Organization (2016), cardiovascular disease caused mortality rate about 17 millions in each year because complicated by hyipertension is 9,4 millions in worldwide of adult (18 year) about 22%, and estimated 29% from population with elderly is 1.56 millions so that need a better planning for non communicable disease prevention, such hypertension because caused of sudden death and asymtomatic 2. Stress factor contribute to incidence mortalidade hyptertention in ASEAN region about 1,5 millions and 1/3 from population adult mayority with hipertention and hypertention cases include Timor Leste is 36% 3 . Also report WHO about hipertention is a seriously problem and need maximum attention because a serious problem and caused mortality rate the population in the workdwide about 1.13 millions. The number of adults with hypertension increased from 594 million in 1975 to 1.13 billion in 2015, with the increase seen largely in low-and middle-income countries. This increase is due mainly to a rise in hypertension risk factors in those populations The report from American Hearth Association (AHA) the population caused hypertention with male 49% and female 51% (Badan Litbangkes Kementerian Kesehatan RI, 2018) and report from Indonesia Basic Research, non communicable disease in Indonesia about 25,8% with hypertention (WHO, 2015). Also the Ministry of Health Timor Leste (MoH, 2016) announced incidence hipertension and caused by stress 4,166% and 27 of patients death from inpatients in the hospital. The result of survey by MoH-TL and University National Timor Loro Sae (2014) showed the risk factor caused incidence hypertension is stress and obesitas is 10,3%, alcohol comsuption is 57,7%, salt comsumption or add salt when lunch or dinner is 78%. Another important factor contributed increased incidence hypertention in Timor Leste was tabacco comsumption in the aged of population 18 -44 years old is 43,0% and from aged 45-69 with 63,1%. (WHO, 2015) The recomendation of WHO to provides evidence-based recommendations for the initiation of treatment of hypertension, and recommended intervals for follow-up. The document also includes target blood pressure to be achieved for control, and information on who, in the health-care system, can initiate treatment. Also to support the governments Joaquim Pinto, Ostelino da Silva Belo, Alexandra Maria Pires, Manuel da Costa Fernandes, Acacio Guteres Pereira, Eduardo C. Gaio, Serafina Casilda Freitas Belo/

KESANS The Factors Influence to Incidence of Hypertension in Baucau Municipality, Republica Democratica de Timor Leste
in strengthening the prevention and control of cardiovascular disease. Also provide Healthy-lifestyle counselling, evidence-based treatment protocols, access to essential medicines and technology, risk-based management, team-based care, and systems for monitoring, provide a strategic approach to improve cardiovascular health in countries across the world (WHO, 2021). According to the reported from The Health information System Baucau Municipality showed the incidence cases of hypertension increased from time to time because in 14,90% in 2018 and up to 44,4% in 2020. According to the reported from The Health information System Laga showed the incidence cases of hypertention increased in 2018 (44,43% and decreased in 2019 (25,41%).

Method
This explanatory, descriptive study used both quantitative and qualitative methods in conjunction with each other to generate more-in-depth understanding of the quantitative results (Creswell & Creswell, 2017). The two methods included a crosssectional study of simple random sampling and interviews with the population (Sugiyono, 2018) and meansured blood pressure with aged 35 th -90 th years old.From the total of 101 samples population who agreed interview and measure BP in Baucau Municipality. The total population distributed at there are 2522 and selected 20% (n=101) using a simple random sampling. The inclusion criteria for the population with aged 35 th -90 th year's avaiable to participated of study. Ethical clearance was obtained from the Technical and Ethical Committee of the National Institute of Health for Ethical Review prior to data collection. Confidentiality was maintained throughout the study. Data collected from the interview and BP measured where focused on population with aged 35 th -90 th and lived in subdistrict Laga, Baucau municipality and agreed to participate of study. Case file review data were coded on the basis of yes/no responses and entered into the statistic package for social sciences (SPSS) (Pallant, 2020)

Results and Discussion
Results of the study are presented according to factor stress, salt comsuption, alcohol and tabaco comsumption as below: The population agreed to participated of the study was 101 from 2.522 distributed in 4 areas selected in Baucau Municipality is 50.5% of 50-69 years old and minim participation was 11.9% of 70-90. According to sex have a balance of participated because 52.5% of male and 47.5% of female. Its mean the participated of eldery needed to educate or counseling more for importance of health. According to goverment Decre Law N0. 25 /2017 of 26 July to regulated legality of institute social solidarity to protected of elderly and provide submission $50 each month and waranty all health conditions based to Timor Leste constitute.

Stress Factor
Stress factor can cause hypertension through repeated blood pressure elevations as well as by stimulation of the nervous system to produce large amounts of vasoconstricting hormones that increase blood pressure. Factor affecting blood pressure through stress include white coat hypertension, job strain, race, social environment, and emotional distress. when one risk factor is coupled with other stress producing factors, the effect on blood pressure is multiplied (Kulkarni et al., 1998) The resulted of study show that the stress more contributed of incidence hypertension because 41% of the population in Baucau municipality suffered mid stress, moderate 26,7% and 5% to category severe stress. The prevention of hypertension needed comfortable and relaxation, mediation, acupressure and music therapy. According to report Thomson H.X (2002) showed In 95% of these cases, the cause of hypertension is unknown and they are categorized as "essential" hypertension (Thompson et al., 2002). When did screening at community level the mayority of population not present sings and symptoms of hypertension.

Table 6
The factor stress inluenced to incidence hypertention in Baucau munipality The analysed bivariate used person prodact moment with P-Value=0,000. Significant P-Value=0,000<0,05 maka Hₒ accepted and rejected in Ha. And value correlation (r) = 0,278, mean stress factor influenced incidence hypertension with category less correlation because between 0,20 -0,399. Cardiovascular disease (CVD), and hypertension as one of its major components, is a major cause of morbidity and mortality in modern society (Rosenthal & Alter, 2012). Occupational strain or stress is Joaquim Pinto, Ostelino da Silva Belo, Alexandra Maria Pires, Manuel da Costa Fernandes, Acacio Guteres Pereira, Eduardo C. Gaio, Serafina Casilda Freitas Belo/ KESANS The Factors Influence to Incidence of Hypertension in Baucau Municipality, Republica Democratica de Timor Leste considered one of factor to contribute hypertension because the study the show that factor stress influenced to incidence hypertension in Baucau municipality.

Salt Consumptions
Sodium is the main cation (positively charged ion) in the extracellular fluid while chloride is the main anion (negatively charged ion). Sodium is important for many cellular functions and together with chloride, they are responsible for the osmolarity of the extracellular fluid. In addition, sodium is essential for the excitation of nerve and muscle cells, acid-base balance and the secretion of some digestive enzymes (Rust & Ekmekcioglu, 2016)  The analysed data show that the population lived in Baucau Municipality is maioritas comsumption sodium is 71,3% and moderate is 28,7% from total population. The result of tested by statistic person product moment showed P-Value=0,000. Significant P-Value=0,000<0,05 with test hypotesis was accepted. Its mean factor comsumtion of salt contributed incidence hypertension in Baucau Munipality. The value (r) = 0,741 or 74,1% of the salt comsumption directly contributed incidence hypertension. The publication of R. Ghada Sayed high salt intake is deleterious to the cardiovascular system both in normo-as well as in hypertensive individuals. Many food products contain salt, and one should be aware of the salt content in their diet to avoid high consumption (Youssef, 2022)

Alcohol Consumptions
High-dose alcohol consumption has a biphasic effect on BP; it decreases BP up to 12 hours after consumption and increases BP > 13 hours after consumption. High-dose alcohol increases BP at all times up to 24 hours.