Determinants of Hypertension Occurrence in Women of Reproductive Age (15-49 Years) in the Working Area of the Sungai Tering Community

The incidence of hypertension is increasing in the world. Many factors cause hypertension both socio-demographic factors, behavior, physical and history of the disease. The purpose of this study was to analyze the determinants of the incidence of hypertension in women of childbearing age (15-49 years) in the Working Area of the Sungai Tering Public Health Center, East Tanjung Jabung Regency in 2022. This study used a cross sectional design. The research variables were age, family history, obesity, physical activity, seafood consumption, and hormonal contraception. Data collection used a questionnaire by conducting interviews, measuring blood pressure, measuring body weight and height. Sampling used Stratified random sampling, 120 samples of women of childbearing age were analyzed using the Cox-Regression test. The proportion of hypertension in the Sungai Tering Health Center working area is 43.35%. Factors associated with the incidence of hypertension in women of childbearing age are family history, physical activity, and consumption of seafood. Factors that are not related are age, obesity, and hormonal contraception. Healthy lifestyle behaviors such as a balanced diet, diligent physical activity, and regular health checks reduce the risk of developing hypertension.

The incidence of hypertension is increasing in the world. Many factors cause hypertension both socio-demographic factors, behavior, physical and history of the disease. The purpose of this study was to analyze the determinants of the incidence of hypertension in women of childbearing age (15-49 years) in the Working Area of the Sungai Tering Public Health Center, East Tanjung Jabung Regency in 2022. This study used a cross sectional design. The research variables were age, family history, obesity, physical activity, seafood consumption, and hormonal contraception. Data collection used a questionnaire by conducting interviews, measuring blood pressure, measuring body weight and height. Sampling used Stratified random sampling, 120 samples of women of childbearing age were analyzed using the Cox-Regression test. The proportion of hypertension in the Sungai Tering Health Center working area is 43.35%. Factors associated with the incidence of hypertension in women of childbearing age are family history, physical activity, and consumption of seafood. Factors that are not related are age, obesity, and hormonal contraception. Healthy lifestyle behaviors such as a balanced diet, diligent physical activity, and regular health checks reduce the risk of developing hypertension.
This study aims to determine the proportion and analyze the factors associated with the incidence of hypertension in women of childbearing age (15-49 years) which include age, family history, obesity, physical activity, consumption of seafood, and hormonal contraception in the working area of the Puskesmas. Tering River East Tanjung Jabung Regency in 2022.

THEORETICAL REVIEW Hypertension
Hypertension comes from the Latin hyper and tension. Hyper can be interpreted as excessive pressure and tension can be interpreted as tension. So that hypertension can be defined as a condition where there is a long-term increase in blood pressure which can be painful and ultimately fatal for a person (Ainurrafiq et al., 2019). A blood vessel condition called hypertension can prevent blood from carrying necessary nutrients and oxygen to the body's tissues. Hypertension is a well-known cardiovascular disease that affects a large proportion of the population (Kartika & Mirsiyanto, 2021). According to the 2018 Riskesdas, if a person's measurement results meet the JNC VII criteria and their systolic or diastolic pressure is 140 mmHg or 90 mmHg, they are considered to have hypertension (Ministry of Health RI, 2018).

Hypertension Classification
To be able to diagnose hypertension, it is necessary to have at least two blood measurements with an interval of 1 week. Hypertension according to JNC 7 is an increase in systolic blood pressure > 120 mmHg and an increase in diastolic blood pressure > 80 mmHg (U.S. Department Of Health And Human Services, 2004). Classification of hypertension based on the severity of the disease, as shown in Table 1 below.

METODOLOGI
This study used an analytic cross sectional research design. The population in this study were all women of childbearing age in the Working Area of the Sungai Tering Health Center with the research sample being women of childbearing age in the working area of the Sungai Tering Health Center who met the inclusion and exclusion criteria of 120 samples. In this study, the sampling was distinguished based on the location of the sample consisting of 44 respondents in Sungai Tering Village, 24 respondents in Pemusiran Village, 25 respondents in Teluk Kijing Village, and 27 respondents in Sungai Raya Village. Data analysis was performed bivariately using Chi-Square and multivariately using Cox-Regression. Based on Table 3 it can be seen that the proportion of hypertension is greater in respondents aged ≥ 35 years (53.7%) compared to respondents aged <35 years (21.1%). The results of the chi-square statistical test obtained a value (P = 0.002, PR = 2.549, 95% CI: 1.334-4.871), meaning that there is a significant relationship between age and the incidence of hypertension in the working area of the Sungai Tering Health Center, Tanjung Jabung Timur Regency. Someone aged ≥ 35 years has a risk of 2,549 times suffering from hypertension compared to those aged <35 years.

RESULTS
In the family history variable, it can be seen that the proportion of hypertension is greater in respondents who have a family history (73.6%) compared to those who do not have a family history (19.4%). The results of the chi-square statistical test obtained a value (P = 0.000, PR = 3.792, 95% CI: 2.268-6.341), meaning that there is a significant relationship between family history and the incidence of hypertension in the working area of the Sungai Tering Health Center, Tanjung Jabung Timur Regency. Respondents who have a family history are at risk of 3.792 times suffering from hypertension compared to those who do not have a family history.
In the obesity variable, it can be seen that the proportion of hypertension is greater in respondents who are obese (61.9%) compared to those who are not obese (33.3%). The results of the chi-square statistical test obtained a value (P = 0.005, PR = 1.857, 95% CI: 1.253-2.752), meaning that there is a significant relationship between obesity and the incidence of hypertension in the working area of the Sungai Tering Health Center, Tanjung Jabung Timur Regency. Respondents who are obese are at risk of 1.857 times suffering from hypertension compared to those who are not obese.
In the physical activity variable, it can be seen that the proportion of hypertension is greater in respondents with moderate physical activity (72.7%) compared to those with strenuous physical activity (32.2%). The results of the chi-square statistical test obtained a value (P = 0.000, PR = 2.260, 95% CI: 1.561-3.271), meaning that there is a significant relationship between physical activity and the incidence of hypertension in the working area of the Sungai Tering Health Center, Tanjung Jabung Timur Regency. Respondents who have moderate physical activity are at risk of 2,260 times suffering from hypertension compared to those who have strenuous physical activity.
In the seafood consumption variable, it can be seen that the proportion of hypertension is greater in respondents who consume seafood in the high category (72.7%) compared to respondents who consume seafood in the lessmoderate category (20.8%). The results of the chi-square statistical test obtained values (P = 0.000, PR = 2.800, 95% CI: 1.560-5.026), meaning that there is a significant relationship between seafood consumption and the incidence of hypertension in the working area of the Sungai Tering Public Health Center, Tanjung Jabung Timur Regency. Respondents who consumed seafood in the high category had a 2,800 times risk of suffering from hypertension compared to those who consumed seafood in the less-moderate category.
Regarding the hormonal contraception variable, it can be seen that the proportion of hypertension was greater in respondents who did not use hormonal contraception (46.2%) compared to those who used hormonal contraception (43.0%). The results of the chi-square test statistic obtained a value (P = 1.000, PR = 0.931, 95% CI: 0.498-1.743), meaning that there was no significant relationship between the use of hormonal contraception and the incidence of hypertension in the working area of the Sungai Tering Public Health Center, Tanjung Jabung Timur Regency. Based on table 4 it is known that the factors of family history (aPR = 2.933; 95% CI: 1.531 to 5.620), physical activity (aPR = 2.062; 95% CI: 1.178 to 3.610), and consumption of seafood (aPR = 1.826; 95% CI : 1.037 to 3.216) proved to be significantly related and a risk factor for the incidence of hypertension in WUS in the Sungai Tering Health Center work area. Based on the results of multivariate analysis using Cox regression, it is also known that the most dominant factor influencing hypertension in WUS is family history. Women of childbearing age who have a family history of hypertension have a 3 times higher risk of experiencing hypertension compared to WUS who do not have a family history of hypertension, after controlling for physical activity and seafood consumption.

Family History
The results of the study found that there was a significant relationship between family history and the incidence of hypertension in the working area of the Sungai Tering Health Center. From the results of the multivariate analysis, it was found that family history was the most dominant risk factor influencing the incidence of hypertension in WUS. Women of childbearing age who have a family history of hypertension have a 2.93 times higher risk of experiencing hypertension than those who do not have a family history of hypertension, after controlling for physical activity and seafood consumption variables. This is in line with research conducted by Lawalata (2021) which showed a relationship between the incidence of hypertension and genetics with a p-value = 0.03 (p≤0.05) OR=4.046 meaning that respondents who have a family history of hypertension have a 4.046 chance times to get hypertension (95% CI = 1.203-13.613). Based on research conducted by Cuffee et al., (2022) also found that family history had an effect on the incidence of hypertension (AOR = 4.5, 95% CI: 1.70-11.76) Research conducted by Ondimu et al., (2019) also showed that a person with a BMI≥25 was 3.05 times more likely to suffer from hypertension (OR: 3.05, 95% CI 1.26, 7.40; p=0.014).
Based on the results of the study, it was found that there was a significant relationship between family history and the incidence of hypertension. In this study it was found that the proportion of respondents who had a family history of hypertension was 44.2% with family ties from parents (32.5%) and from grandparents (11.7%). Of these, 73.6% had hypertension. According to Mendel's Law, hypertension can be caused by a single inherited genetic mutation. This is in line with the theory that hypertension tends to be a hereditary disease, if both of our parents have hypertension then there is a 60% chance that we will get the disease (Maulidina et al., 2019). Parents with high blood pressure increase a person's risk of developing high blood pressure two times compared to people who have no family history of this condition (Muhamad Ridwan, 2017).

Physical Activity
The results of the study found that there was a significant relationship between physical activity variables and the incidence of hypertension in the working area of the Sungai Tering Health Center, from the results of the multivariate analysis it was found that moderate physical activity had a risk of 2.06 times the incidence of hypertension in the Sungai Tering Health Center work area. This research is in line with research conducted by Rihiantoro & Widodo (2018) which showed that light physical activity has a risk of suffering from hypertension by 2.26 times compared to those who do moderate and heavy physical activity. Based on research conducted by Zou et al., (2021) physical activity can reduce the risk of hypertension by 8% mild, moderate 28%, and severe 30% respectively. Physical activity in women can lower blood pressure and reduce the risk of hypertension caused by hormones possessed by women, this is inversely proportional to men. The results of a study conducted by Macdonald et al., (2020) which was conducted on women aged (40-65 years) also showed the same results that physical activity in the high category had a significant relationship with reducing the risk of hypertension but low activity had no results effective in reducing the risk of hypertension.
Physical activity greatly affects the stability of blood pressure. In people who are not actively doing activities tend to have a higher heart rate frequency. This causes the heart muscle to work harder with each contraction. The harder the heart muscle is in pumping blood, the greater the pressure on the arterial walls so that the peripheral resistance causes an increase in blood pressure. Lack of physical activity can also increase the risk of being overweight which will increase the risk of hypertension (R. A. Harahap et al., 2018).

Consumption of Seafood
The results of the study found that there was a significant relationship between the variables of seafood consumption and the incidence of hypertension in the working area of the Sungai Tering Health Center, from the results of the multivariate analysis it was found that seafood consumption had a risk of 1.83 times the incidence of hypertension in the Sungai Tering Health Center work area. This research is in line with the research of Cahyani et al., (2019) which found a significant relationship between seafood consumption and the incidence of hypertension in coastal communities in the working area of the Mangkang Health Center, Semarang City. This is also supported by previous research by Masengi et al., (2013) which showed that there was a significant relationship between seafood consumption and the incidence of hypertension (p=0.001). Research conducted by Rusliafa, et al (2014) in H. S. Harahap et al., (2022) shows that hypertension is more common in coastal communities. This is due to the high consumption of sodium in salted processed seafood.
The high prevalence of hypertension in the population in coastal areas in theory cannot be separated from the high daily sodium intake of the population, both through food products from seafood, for example sea fish, which contain high levels of salt and through the use of salt in food processing for human needs. daily. This is in line with research conducted by Demmalewa & Abadi (2022) which states that food consumption patterns in society are influenced by the environment where they live, especially for people who live in coastal areas, they often consume seafood. One of the risk factors for hypertension is fat content in the body as it is stated that hypercholesterolemia is a risk factor for hypertension. Meanwhile, the cholesterol content of fresh water fish tissue is generally lower than that of sea fish. High consumption of seafood and hypercholesterolemia play a role in predisposing to hypertension, especially in coastal areas. The habit of consuming large amounts of salt and cholesterol in coastal communities is a tendency for the development of high blood pressure in coastal areas.

Age
The results of the study found that there was no significant relationship between the age variable and the incidence of hypertension in the Sungai Tering Health Center work area, from the results of the multivariate analysis it was found that the age variable was not a risk factor for the incidence of hypertension in the Sungai Tering Health Center work area. This study is in line with research by Utara et al., (2023) which showed that there was no relationship between age and the incidence of hypertension. This study is not in line with this theory which based on the statistical test results obtained a pvalue of 0.837 and a significance value of > 0.05 and is in line with research conducted by Ruqaiyah, (2018) that there is no relationship between maternal age and the incidence of hypertension in pregnant women at Haji Makassar Hospital in 2018. This is also supported by research which shows no significant relationship between age ≥35 years and the incidence of hypertension with a pvalue of 0.549.
The results of this study are not in line with Yuniarti and Rosyada (2021) who found in their research results that there is a relationship between age and the incidence of hypertension with a p-value of 0.000 and a PR value of 2.226 (95% CI: 2.065 -2.399), which means that people aged ≥ 35 years have 2.226 times the risk of developing hypertension compared to <35 years. This is also in line with research conducted by Kiber et al., (2019) which showed that increasing age had a 3.31 times greater likelihood of experiencing hypertension (AOR 3.31, CI 1.00, 10.99). In this study, this was possible because a relatively older age is more likely to be affected by non-communicable diseases, including the possibility of developing hypertension among hypertensive women. Research conducted by Rezaianzadeh et al., (2021) also showed that there was a relationship between age and the incidence of hypertension in Khrameh (OR = 1.03, p <0.001).
Age is a risk factor for hypertension that cannot be changed. In old age inflammation will be difficult to overcome. This is related to increased concentrations of interleukin-6 (IL-6), C-reactive protein (CRP), and tumor necrosis factor alpha (TNF-α) which can increase the risk of cardiovascular disease (Ramona et al., n.d.). As a person ages, a person's blood pressure will also increase, due to natural changes in the body that affect the elasticity of the blood vessels decreases and decreases the body's resistance. ).

Obesity
The results of the study found that there was no significant relationship between the obesity variable and the incidence of hypertension in the Sungai Tering Health Center work area. The results of the multivariate analysis found that the obesity variable was not a risk factor for the incidence of hypertension in the Sungai Tering Health Center work area. This is in line with the study of Arifin et al., (2016) which showed that there was no significant relationship between obesity and the incidence of hypertension and was supported by Khotimah et al., (2021) which showed that there was no significant relationship between obesity status and risk hypertension with a p-value = 0.575 (p-value ≥ 0.05).
This study is not in line with the research of Maulidina et al (2019) which showed that there was a relationship between obesity and the incidence of hypertension (p-value = 0.003) and it was found that someone who was obese had a 1.820 times greater risk of developing hypertension than someone who was not obese. The same study also conducted in Southwest China showed that nearly 40% of hypertensive patients had obesity-related hypertension (Zhang et al., 2019). The results of other studies also show that obesity is very closely related to the incidence of hypertension which is a study conducted on adults in Debre Markos Town, Northwest Ethiopia which shows that people who are obese are at almost five times more risk than those who are not obese (Kiber et al., 2019).
Being overweight increases heart rate and insulin levels in the blood. Obesity can directly result in increased cardiac output. This is because the greater the body mass, the greater the amount of circulating blood and this causes cardiac output to increase. Meanwhile, indirectly, obesity occurs through stimulation of the activity of the sympathetic nervous system and the Renin Angiotensin Aldosterone System (RAAS) by mediators such as cytokines, hormones and adipokines. The hormone aldosterone is one that is closely related to water and sodium retention which can increase blood volume (Tiara, 2020).
Weight loss is the most important element in the prevention and treatment of hypertension. Hypertensive patients are encouraged to lose weight if they are obese and this will have an effect on reducing blood pressure. Losing weight is expected to reduce blood pressure, because the work of the heart to pump blood can decrease (Putri et al., 2021).

Hormonal Contraception
The results of the study found that there was no significant relationship between hormonal contraceptive variables and the incidence of hypertension in the Sungai Tering Health Center work area. The results of the multivariate analysis found that hormonal contraceptive variables were not a risk factor for the incidence of hypertension in the Sungai Tering Health Center work area. This is in line with research conducted by (Norlita et al., 2018) which showed that there was no significant relationship between the use of injectable contraceptives and blood pressure in injecting family planning acceptors at the Harapan Raya Health Center in Pekanbaru. In the study (Setyorini et al., 2022) also showed the use of injectable contraception was not associated with an increase in blood pressure.
However, research conducted by Widyaningsih & Isfaizah (2019) showed different results, it was found that there was a relationship between the use of injectable contraceptives and systolic blood pressure. Research conducted by Hutasoit & Azwar (2019) also showed that the results of the Chi-square test obtained a p-value of 0.045, meaning that there is a relationship between the use of hormonal contraception and increased blood pressure. The use of hormonal contraception is also at risk of increasing blood pressure 5 times compared to non-hormonal contraception.
The theory presented by Bustan (2007) is that the estrogen content in hormonal contraceptives affects blood vessels resulting in arteriolar hypertrophy and vasoconstriction. Estrogen also affects the Renin-Aldosterone-Angiostenin system resulting in changes in fluid and electrolyte balance. Estrogen is a hormone that can increase kidney electrolyte retention, resulting in increased reabsorption of sodium and water which causes hypervolemia so that cardiac output increases and results in increased blood pressure (Widyaningsih & Isfaizah, 2019).
Based on research conducted by Chrisandra and Alexis (2020) it is said that choosing hormonal contraceptives for women can increase the risk of developing hypertension. This is because hypertension can be a relative contraindication. Therefore, the choice of hormonal contraception must be adjusted to the patient's age and level of hypertension (Shufelt & Levee, 2020). This is also supported by the research of Gunaratne et al., (2021) which said hormonal contraception can cause an average increase in systolic blood pressure by 4mm Hg, diastolic blood pressure by 1mm Hg and increase in average arterial pressure.

CONCLUSION AND SUGGESTION
Based on the results of the research and discussion, the following conclusions can be drawn: (1) The proportion of hypertension in women of childbearing age in the working area of the Sungai Tering Health Center is 43.35%, (2) There is a relationship between family history, physical activity, and consumption of seafood with the incidence of hypertension in women of childbearing age in the working area of the Sungai Tering Health Center in 2022. There is no relationship between age, obesity, and hormonal contraception with the incidence of hypertension in women of childbearing age in the working area of the Sungai Tering Health Center in 2022.
Based on the above conclusions, the suggestions from this study are: (1) It is hoped that the Sungai Tering Health Center will be more aggressive in optimizing posbindu activities in their working area and conducting outreach or to prevent hypertension by adopting a healthy lifestyle, (2) It is hoped that the community can control their lifestyle a healthier life and can balance consumption patterns with daily physical activities.

FURTHER STUDY
The researcher realizes that this research still has shortcomings due to the limitations of the research it faces. The limitations of this study are that this research was only examined at one time so that the conditions before and after the research was carried out could not be observed. This study also only examined 120 samples from all women of childbearing age with several limited variables. Therefore, it is hoped that future researchers will conduct more indepth research on the factors associated with hypertension in women of childbearing age by examining other variables such as smoking, alcohol consumption, sodium and fat consumption, as well as stress variables that cause hypertension.

ACKNOWLEDGMENT
Thank you to the Public Health Study Program, Faculty of Medicine and Health Sciences, Jambi University for the support and assistance that has been given, to my beloved parents and siblings who always provide extraordinary motivation.