Document Type : Research articles


1 1 Department of Management and Health Policy, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran

2 2 Department of Management and Health Policy, School of Health Services Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran

3 3 Health Services Management Research Centre, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran

4 4 Social Determinants of Health Research Centre, Health Management and Safety Promotion Research Institute, Department of Community and Family Medicine, Tabriz Medical School, Tabriz University of Medical Sciences, Tabriz, Iran

5 5 Student Research Committee, Department of Health Management, Policy and Economics, School of Management and Medical Informatics, Kerman University of Medical Sciences, Kerman, Iran

6 6 Department of Management and Health Policy, School of Health Services Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran


Background: Human life is tied with the stress caused by economic, political, social, and cultural problems, which may lead to physical and mental diseases. In such stressful conditions, people make lifestyle changes that put them at high risk for developing hypertension.
Objectives: Accordingly, this study investigated the prevention and management of hypertension as a major public health challenge in Iran.
Methods: Semi-structured interviews were conducted with managers, health policymakers, social medicine specialists, and faculty members. All interviews were recorded, transcribed verbatim, and analyzed using thematic content analysis. The MAXQDA18 software was applied to facilitate the organization of codes and themes.
Results: Interviews were conducted with 17 participants. The analyses resulted in five themes including, educational policies, cultural policies, urban transport policies, organizational policies, and economic policies. A total of 13 subthemes were also extracted from the data.
Conclusion: Findings have indicated the stressors factors, stemming from macro-policies and mismanagement of government. To reduce the burden of hypertension and improve people's living conditions, health-oriented policies should be designed and implemented in all sectors.


  1. Awuah RB, de-Graft Aikins A, Dodoo FN, Meeks KA, Beune EJ, Klipstein-Grobusch K, et al. Psychosocial factors and hypertension prevalence among Ghanaians in Ghana and Ghanaian migrants in Europe: The RODAM study. Health Psychol Open. 2019;6(2):2055102919885752. doi: 10.1177/2055102919885752. [PubMed: 31763049].
  2. Jongen VW, Lalla-Edward ST, Vos AG, Godijk NG, Tempelman H, Grobbee DE, et al. Hypertension in a rural community in South Africa: what they know, what they think they know and what they recommend. BMC Public Health. 2019;19(1):341. doi: 10.1186/s12889-019-6642-3. [PubMed: 30909905].
  3. Hu B, Liu X, Yin S, Fan H, Feng F, Yuan J. Effects of psychological stress on hypertension in middle-aged Chinese: a cross-sectional study. PLoS One. 2015;10(6):e0129163. doi: 10.1371/journal.pone.0129163. [PubMed: 26043027].
  4. Carey RM, Muntner P, Bosworth HB, Whelton PK. Reprint of: prevention and control of hypertension: JACC Health Promotion Series. J Am Coll Cardiol. 2018;72(23):2996-3011. doi: 10.1016/j.jacc.2018.10.022. [PubMed: 30522633].
  5. Havranek EP, Mujahid MS, Barr DA, Blair IV, Cohen MS, Cruz-Flores S, et al. Social Determinants of Risk and Outcomes for Cardiovascular Disease: A Scientific Statement From the American Heart Association. Circulation. 2015;132(9):873-98. doi: 10.1161/CIR.0000000000000228. [PubMed: 26240271].
  6. Daniel H, Bornstein SS, Kane GC. Addressing social determinants to improve patient care and promote health equity: an American College of Physicians Position Paper. Ann Intern Med. 2018;168(8):577-8. doi: 10.7326/M17-2441. [PubMed: 29677265].
  7. Liu MY, Li N, Li WA, Khan H. Association between psychosocial stress and hypertension: a systematic review and meta-analysis. Neurol Res. 2017;39(6):573-80. doi: 10.1080/01616412.2017.1317904. [PubMed: 28415916].
  8. Amiri P, Vahedi-Notash G, Naseri P, Khalili D, Nazari SS, Mehrabi Y, et al. National trends of pre-hypertension and hypertension among Iranian adolescents across urban and rural areas (2007–2011). Biol Sex Differ. 2019;10(1):15. doi: 10.1186/s13293-019-0230-1. [PubMed: 30922399].
  9. Lu X, Juon HS, He X, Dallal CM, Wang MQ, Lee S. The association between perceived stress and hypertension among asian americans: does social support and social network make a difference? J Community Health. 2019;44(3):451-62. doi: 10.1007/s10900-018-00612-7. [PubMed: 30604222].
  10. Tabrizi JS, Sadeghi-Bazargani H, Farahbakhsh M, Nikniaz L, Nikniaz Z. Prevalence and associated factors of prehypertension and hypertension in Iranian population: the lifestyle promotion project (LPP). PloS One. 2016;11(10):e0165264. doi: 10.1371/journal.pone.0165264. [PubMed: 27783691].
  11. Mohsenzadeh Y, Motedayen M, Hemmati F, Sayehmiri K, Sarokhani MT, Sarokhani D. Investigating the prevalence rate of hypertension in Iranian men and women: a study of systematic review and meta-analysis. J Basic Res Med Sci. 2017;4(1):53-62. doi: 10.18869/acadpub.jbrms.4.1.53.
  12. Sadeghi M, Haghdoost AA, Bahrampour A, Dehghani M. Modeling the burden of cardiovascular diseases in Iran from 2005 to 2025: The impact of demographic changes. Iran J Public Health. 2017;46(4):506-16. [PubMed: 28540267].
  13. Tan ST, Quek RY, Haldane V, Koh JJ, Han EK, Ong SE, et al. The social determinants of chronic disease management: perspectives of elderly patients with hypertension from low socio-economic background in Singapore. Int J Equity Health. 2019;18(1):1. doi: 10.1186/s12939-018-0897-7. [PubMed: 30606218].
  14. Cuspidi C, Tadic M, Grassi G, Mancia G. Treatment of hypertension: the ESH/ESC guidelines recommendations. Pharmacol Res. 2018;128:315-21. doi: 10.1016/j.phrs.2017.10.003. [PubMed: 29080798].
  15. Saunders B, Sim J, Kingstone T, Baker S, Waterfield J, Bartlam B, et al. Saturation in qualitative research: exploring its conceptualization and operationalization. Qual Quant. 2018;52(4):1893-907. doi: 10.1007/s11135-017-0574-8. [PubMed: 29937585].
  16. Lee JE, Kim YJ, Park HJ, Park S, Kim H, Kwon O. Association of recommended food score with depression, anxiety, and quality of life in Korean adults: the 2014–2015 National Fitness Award Project. BMC Public Health. 2019;19(1):956. doi: 10.1186/s12889-019-7298-8. [PubMed: 31315605].
  17. Jung ES, Choi SK, Baek YS. Factors influencing the quality of life of community residents. J Digital Converg. 2015;13(11):231-9. doi: 10.14400/JDC.2015.13.11.231.
  18. Sivertsen H, Bjørkløf GH, Engedal K, Selbæk G, Helvik AS. Depression and quality of life in older persons: a review. Dement Geriatr Cogn Disord. 2015;40(5-6):311-39. doi: 10.1159/000437299. [PubMed: 26360014].
  19. Aloosh M, Salavati A, Aloosh A. Economic sanctions threaten population health: the case of Iran. Public Health. 2019;169:10-3. doi: 10.1016/j.puhe.2019.01.006. [PubMed: 30771721].
  20. Mattioli AV, Nasi M, Cocchi C, Farinetti A. COVID-19 outbreak: impact of the quarantine-induced stress on cardiovascular disease risk burden. Future Med. 2020;16(6):539-42. doi: 10.2217/fca-2020-0055. [PubMed: 32351128].
  21. 21        Algren MH, Ekholm O, Nielsen L, Ersbøll AK, Bak CK, Andersen PT. Associations between perceived stress, socioeconomic status, and health-risk behaviour in deprived neighbourhoods in Denmark: a cross-sectional study. BMC Public Health. 2018;18(1):250. doi: 10.1186/s12889-018-5170-x. [PubMed: 29439681].
  22. Espejo M, Magabo S, Rivera-Castro A, Faiz M, Ramirez L, Robles C, et al. Qualitative Study of knowledge, perception, and behavior related to hypertension and cardiovascular disease risk reduction among hypertensive African-Americans in urban inner city of South Bronx, New York. J Racial Ethn Health Disparities. 2019;6(1):197-206. doi: 10.1007/s40615-018-0514-x. [PubMed: 30117092].
  23. Al-Jundi SA, Shuhaiber A, Al-Emara SS. The effect of culture and organisational culture on administrative corruption. Int J Econ Bus Res. 2019;18(4):436-51. doi: 10.1504/IJEBR.2019.103096.
  24. Hosseinkhani Z, Nedjat S, Hassanabadi HR, Parsaeian M. Academic stress from the viewpoint of Iranian adolescents: a qualitative study. J Educ Health Promot. 2019;8:13. doi: 10.4103/jehp.jehp_202_18. [PubMed: 30815484].
  25. Noury R, Kelishadi R, Ziaoddini H. Study of common stresses among students in Tehran. J Isfahan Med Sch. 2010;28(105):1-12.
  26. Sung YT, Chao TY, Tseng FL. Reexamining the relationship between test anxiety and learning achievement: an individual-differences perspective. Contemp Educ Psychol. 2016;46:241-52. doi: 10.1016/j.cedpsych.2016.07.001.
  27. Khanehkeshi A. A comparative study of the academic stress and depression among high school girl and boy students. J Educ Psychol. 2012;6(1):11-20. doi: 10.26634/JPSY.6.1.1878.
  28. Jafarigiv S, Peyman N. The effect of life skills training with health literacy strategies on self-esteem and self-efficacy in female students during puberty. Int J Adolesc Med Health. 2019;20:121. doi: 10.1515/ijamh-2019-0121. [PubMed: 31539358].
  29. Jalali F, Hashemi SF. Group life skills training for promoting mental health in women after released from prison: a randomized pilot efficacy trial. Health Care Women Int. 2019;40(3):314-27. doi: 10.1080/07399332.2018.1547385. [PubMed: 30860958].
  30. Naeim M, Rahimi HR, Soltani F, Farazandeh F, Nejad FM, Sharafi MR, et al. The role of life skills and self-efficacy in mental health among male students in High school. Int J Med Res Health Sci. 2016;5(7S):118-26.
  31. Nadrian H, Taghdisi MH, Aghemiri M, Khazaee-Pool M, Shojaeizadeh D. Impacts of urban traffic jams on physical health of residents from the inhabitants ‘perspective in Sanandaj city (a qualitative study). Iran J Health Educ Health Promot. 2017;5(4):345-58. doi: ‎10.30699/acadpub.ijhehp.5.4.345.
  32. Moeini B, Barati M, Farhadian M, Ara MH. The association between social support and happiness among elderly in Iran. Korean J Fam Med. 2018;39(4):260-5. doi: 10.4082/kjfm.17.0121. [PubMed: 29972894].