Blood Pressure Trends, Demographic Data, Workload, and Lifestyle Factors Among Nurses in the Subcarpathian Region of Poland: A Cross-Sectional Observational Study

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.

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).

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).

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).

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).

Discussion

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].