Hypertension Factors Analysis of the Denkeslap Kesdam V/Brawijaya Malang

Hypertension is a degenerative disease which is a serious problem nowadays. Hypertension is categorized as the silent disease or the silent killer because the sufferer does not know he has hypertension or does not know before checking his blood pressure. The aim of this study was to find out the factors that affected hypertension of the Indonesian Army, Denkeslap Kesdam V / Brawijaya Malang. The research was conducted on 11-14 November 2018 at DENKESLAP Kesdam V / Brawijaya Malang, Observational study design with cross sectional approach. The total population is 65 people and a sample of 56 people with a random sampling technique. Data collection of independent variables and dependent variables by means of observations and questionnaires. Data analysis using logistic regression test. Based on the results of the logistic regression test, the stress variable p value is 0.027; anxiety 0.033 and sleep pattern 0.39 at α: 0.05, the incidence of hypertension is significantly affected by stress, anxiety and sleep patterns. The dominant factors affecting hypertension are stress. Stress is a condition or condition of the body that is disturbed due to psychological stress. The relationship between stress and the incidence of hypertension occurs through sympathetic nerve activity. Increased nerves can increase blood pressure intermittently (erratic). So that prolonged stress can result in high sedentary blood pressure. Stress will increase peripheral vascular resistance and cardiac output so it will stimulate sympathetic nerve activity. Soldiers are advised to adopt a healthy lifestyle, exercise and maintain a diet, avoiding things that can become stressors so as to minimize hypertension.


METHODS
The design of this study is the Cross Sectional. The population is TNI soldiers AD Denkeslap Kesdam V / Brawijaya Malang on 65. The number of samples is 56 respondents using a simple random sampling technique. The dependent variable in this study is hypertension and the independent variables are stress, anxiety and sleep patterns. The instrument in this study used quitionare with logistic regression statistical tests with a significance level of p value ≤ 0.05. Based on research data it is known that more than half of the respondents had hypertension as many as 31 respondents (55.4%)

A. Effect of stress on hypertension Soldier DENKESLAP Kesdam V / Brawijaya Malang
Based on the results of the Wald test, partially, getting stress has a p-value of 0.027 because the p-value <α (0.05) then H1 is accepted, so it can be concluded that there is a significant relationship between stress and hypertension. Stress is a condition or condition of the body that is disturbed due to psychological stress and usually stress is associated with psychological illness (Mumpuni, 2011). The relationship between stress and the incidence of hypertension occurs through sympathetic nerve activity. Increased nerves can increase blood pressure intermittently (erratic). So that prolonged stress can result in high sedentary blood pressure. Stress will increase peripheral vascular resistance and cardiac output so it will stimulate sympathetic nerve activity (Dewi, 2010).
Everyone experiences stress from time to time, and generally can adapt long-term stress or face short-term stress until the stress has passed. This condition can cause stress, called a stressor. Internal stressors originate from within a person, for example: fever, infectious disease, physical trauma, malnutrition, physical fatigue, continuous disorder of biological functions. Meanwhile, external stressors come from outside of someone. Examples such as meaningful changes in an environment, changes in roles and social, learning processes, shelter, work and interpersonal relationships Specifically, the effect of stress on the physiology of the body is on the nervous system. When stressed, the physical and psychological will change the source of energy to the position of preparation for threats, known as the "fight or flight" response. The sympathetic nerve will stimulate the adrenal gland to release adrenaline and cortisol. These hormones will cause the heart to beat faster, increase blood pressure, change the digestive process and glucose levels in the blood. Stress also affects the cardiovascular system, where acute stress causes an increase in heart rate and stronger contractions of the heart muscle. Blood vessels that lead to large muscles and the heart are dilated to increase blood supply. Repeated episodes of acute stress can cause inflammation in the coronary arteries and become a heart attack. The digestive system can also be affected by stress, stress can make the sufferer eat far more or less. If sufferers consume alcohol and cigarettes will also cause heartburn or reflux in the esophagus. In addition, the stomach becomes uncomfortable and can trigger nausea and vomiting, even pain. In the intestine, absorption and peristalsis can occur causing constipation or diarrhea.
Stress on TNI AD soldiers can be influenced by military discipline where generally commanders are absolute (prerogative). Schultz & Schultz (2016) revealed that leadership patterns are one of the stressors. Individuals will experience distress if they feel they do not have the ability to solve problems that are considered important to him so that they see the problem as a threat. Conversely, individuals will experience eustress if they feel able to solve problems that are considered important so that they see the problem as a challenge that can motivate themselves (Schultz & Schultz, 2014). Establishing positive and warm relationships with others is inseparable from the ability of a soldier to master his environment. Environmental control in this case relates to the extent to which the soldiers are able to manage various external activities, are able to take advantage of existing opportunities, are able to choose and have the competency to manage the environment that suits their personal needs. Whereas in reality the TNI members cannot choose an environment that matches their personal needs, where the environment of members has been set up or formed in a structured and organized manner. This right can result in the inability of TNI members to develop their own potential to cause stress. Even so, on the other hand the members have demonstrated their ability to manage their external activities, which are a condition for physical and psychological pressure as part of the responsibility in realizing peace, maintaining national security and achieving the national development goals of the NKRI.

B. Effect of anxiety on hypertension Soldier DENKESLAP Kesdam V / Brawijaya Malang
Based on the results of the Wald test partially in getting anxiety has a p-value of 0.033 because p-value <α (0.05) then H1 is accepted, so it can be concluded that there is a significant relationship between anxiety with hypertension Nevid Jeffrey S, Rathus Spencer A, & Greene Beverly (2015) provides an understanding of anxiety as an emotional state that has physiological arousal characteristics, unpleasant tense feelings, and concerns that something bad will happen. Anxiety is a feeling of worry, fear that is not clear why. Anxiety is also a big force in moving behavior, both deviant and disturbed behavior. The results of the study are in accordance with previous studies entitled "Relationship to anxiety with the incidence of hypertension in the elderly at the posyandu in the Pundong Bantul Community Health Center working area 2009" Based on the results of the study there was a significant positive relationship between anxiety and hypertension in the elderly, and an effective contribution of 7 , 07%.
Measurement of anxiety using the Hamilton Anxiety Rating Scale (HARS) questionnaire. The HARS scale is a measure of anxiety based on the appearance of symptoms in individuals who experience anxiety. According to the HARS scale there are 14 syptoms that appear in individuals who experience anxiety. Each observed item is given 5 levels of scores (Likert scale) between 0 (Zero Present) to 4 (severe). The HARS scale was first used in 1959, which was introduced by Max Hamilton and now has become a standard in measuring anxiety, especially in trial clinic research. The HARS scale has been proven to have high validity and reliability to measure anxiety in the clinical trial study of 0.93 and 0.97. This condition shows that measuring anxiety using the HARS scale will obtain valid and reliable results.
Anxiety serves as a sign of the danger that will occur, a threat to the ego that must be avoided or resisted. In this case the ego must reduce the conflict between the wishes of the Id and the Superego. This conflict will always exist in human life because according to Freud, instincts will always seek satisfaction while the social and moral environment limits the satisfaction. So according to Freud a defense will always operate widely in terms of human life.
Anxiety experienced by respondents in the study was classified as moderate anxiety. Moderate anxiety is anxiety that arises for a moment where it is normal for an individual due to threatening situations and the individual cannot overcome it, resulting in anxiety. This anxiety will be beneficial for individuals to be more careful in facing similar situations in the future.

C. Effect of sleep patterns on hypertension of DENKESLAP Soldiers in Military District V / Brawijaya Malang
Based on the results of the Wald test partially in getting the sleep pattern has a p-value of 0.039 because the p-value <α (0.05) then H1 is accepted, so it can be concluded that there is a significant relationship between sleep patterns and hypertension. The results of this study are in accordance with previous studies by Olivia Rahmadani (2017) where it was found that there was a significant relationship between sleep patterns to blood pressure in high school adolescents at Al-Munawwir Krapyak Islamic Boarding School in Yogyakarta. Most santri have irregular or bad sleep patterns, which are 32 respondents (71.1%) and blood pressure in santri with normal-high categories, namely 25 respondents (55.6%). The results of the chi square test obtained p-value of 0.033 < (0.05) therefore preventing hypertension is necessary to maintain a good and sufficient sleep pattern.
Sleep is one of the physiological needs that has an influence on quality and life balance. Someone who experiences a disruption in the sleep cycle, the other physiological functions of the body can also be disrupted or changed. Failure to maintain a normal individual sleep-wake cycle can affect one's health (Potter & Perry, 2010). Sleep physiology is an arrangement of activities involving the cerebral mechanism. Sleep is a condition where the body is unconscious and does not react to the environment. When sleeping, a person can be awakened again with senses or sufficient stimulation (Potter & Perry, 2010). Sleep occurs when a person closes his eyes and does not respond to his environment then sleep will end with the return of awareness of the surrounding conditions. Poor sleep quality is a risk factor for physical and psychological problems. Physical problems that can be caused include increased glucose levels and are risk factors for cardiovascular disorders such as increased blood pressure in children, adolescents, and adults. Javaheri, Isser, Rosen & Redline (2008) conducted a study to determine the relationship between poor sleep quality and prehypertension or hypertension in adolescents. Based on these studies it is known that there is a significant relationship between poor sleep quality and prehypertension in adolescents (p <0.001). Where from the results of these studies there is an increase in systolic and diastolic blood pressure in adolescents who have poor sleep quality.
Respondents in this study were soldiers who were accustomed to rigorous physical training and poor sleep patterns, this is likely to be the cause of hypertension. DENKESLAP Warriors of Military District V / Brawijaya Malang. This is in accordance with Gangwich's discussion (2006) that sleep patterns are one of the risk factors for hypertension. Inadequate sleep patterns and poor quality of sleep can cause physiological and psychological balance disorders in a person. In addition, the duration of short sleep for long periods of time can cause hypertension due to an increase in 24-hour blood pressure and heart rate, increased sympathetic nervous system, and increased salt retention. Furthermore, it will cause structural adaptation of the cardiovascular system so that blood pressure becomes high. The conditions experienced by individuals can affect their sleep patterns, several factors that affect sleep patterns, namely stress, physical environment, diet, drugs, physical exercise, illness, and lifestyle. Changes in age can also affect a person's sleep patterns, actually what happens is not a change in the total amount of sleep, but the quality of sleep that will change, there will be a decrease in REM sleep episodes that will tend to shorten Slow-wave sleep is a deep sleep condition (stages 3 and 4 or N3 sleep) which is also called "deep sleep" which is characterized by "vagal tone" which is increased activity in the parasympathetic nerve and reduced "sympathetic vagal" which is decreased activity in the sympathetic nerve, and consequently a decrease in heart rate and blood pressure. In addition, deep sleep sleep suppression in humans provides support for the role of deep sleep in glucose homeostasis and nocturnal fluctuations in blood pressure. This shows the low proportion of deep sleep associated with the possibility of hypertension The relationship between sleep and hypertension occurs due to sympathetic activity in blood vessels so that a person will experience significant changes in cardiac output at night. A decrease in peripheral vascular resistance causes a normal nocturnal decrease in arterial pressure. Sympathetic nerve activity during sleep significantly increases and varies greatly during REM compared to waking up. Blood pressure approaches the level of wakefulness as long as the component in the REM phase is missed, and new sensitivity increases during sleep. However, such conditions are more effective at increasing guarding of blood pressure during REM episodes occurring at the end of the sleep period than the night before. This is related to sleep patterns. Abnormal sleep is involved in the pathogenensis of non-dipping prehypertension and then in hypertensive disorders in sleep quality causes hypertension. This condition occurs because sleep can have an influence on the nervous system and other organs of the human body physiologically. Some components in the body including the nervous system that has been used to carry out various activities, to restore it is necessary to sleep as a means of rest. Sleep also plays a role in the process of protein synthesis, psychologically alone, sleep is also important because someone who has a number of hours of sleep that is not enough will tend to be emotionally irritable, poor concentration, and have difficulty making decisions

D. Dominant factors that influence hypertension of DENKESLAP in Military District V / Brawijaya Malang
The results of the study showed that stress was the most influencing factor in the hypertension of the Soldiers of DENKESLAP in the Military V / Brawijaya Malang with a p value of 0.027. Stress makes the brain release stress hormones such as adrenaline, cortisol, and norepinephrine which causes an increase in heart rate and widening of blood vessel diameter. As a result, blood pressure increases by 30-40% even if only temporarily. This tension increase will not last long, because the heart rate, blood vessel diameter, and blood pressure will return to normal after the stress hormone disappears. People with severe anxiety disorders may not necessarily experience chronic hypertension due to their anxiety. Anxiety is not the cause of long-term hypertension. Even so, a sudden surge in high blood pressure even if it only lasts for a while remains just as dangerous as chronic high blood pressure. Damage that occurs in blood vessels, heart and kidneys can also occur in different situations. This is in accordance with Jefrrey's (2012) theory of stress is the body's non-specific response to any load demands on it. This concept is formulated in General Adaptation Syndrome (GAS). This GAS functions as an automatic response, physical response, and emotional response to an individual. Selye argues that our bodies react equally to various unpleasant stressors, both sources of stress in the form of bacterial microscopy, organism-related diseases, divorce or flooding. The GAS model states that in a stressful state, our body is like a clock with an alarm system that does not stop until the energy runs out Severe stress is a cause of hypertension, both elderly, young adults and middle age. As a reduced risk of damage to organs such as the kidneys, heart and others can be done by reducing salt consumption, as well as providing motivation to relieve stress or make a comfortable situation that can be conditioned to reduce stress levels for people with hypertension (International journal of hypertension, 2011). American Heart Association (AHA) hypertension which is a medical condition that increases blood pressure for a long time with systolic blood pressure ≥ 140 mmHg and diastolic pressure ≥ 90 mmHg. Hypertension is an increase in blood pressure more than 140 \ 90 mmHg according to the Joint National Committee ( JNC) VII, blood pressure in adults (over 18 years). Hypertension or often referred to as the "silent disease" because sufferers often do not know the symptoms or disorders that are often not realized.

CONCLUSION
There is influence of stress with hypertension. Soldier DENKESLAP Regional Military V / Brawijaya Malang where the result is p value 0.027 <α = 0.05. There is an influence of anxiety with hypertension. Soldier DENKESLAP Regional Military V / Brawijaya Malang where the results of p value 0.033> α = 0.05. There is the influence of sleep patterns with hypertension. Soldier DENKESLAP Kesdam V / Brawijaya Malang where the result is p value 0.039> α = 0.05.