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a
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n
d
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h
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p
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ten
sio
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c
o
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tro
l
li
tera
c
y
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To
a
n
a
ly
z
e
th
e
e
ffe
c
ti
v
e
n
e
ss
o
f
th
e
An
d
r
o
i
d
-
b
a
se
d
hy
p
e
rten
sio
n
a
n
d
o
b
e
sit
y
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n
fo
rm
a
ti
o
n
sy
ste
m
(
HIPO
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a
p
p
li
c
a
ti
o
n
i
n
imp
ro
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i
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g
h
y
p
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o
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tr
o
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li
tera
c
y
a
m
o
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g
o
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e
se
p
a
ti
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n
ts.
T
h
is
q
u
a
si
-
e
x
p
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ri
m
e
n
tal
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p
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g
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p
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o
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d
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h
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l
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p
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c
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t
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C
o
m
m
u
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it
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a
lt
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u
ra
k
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fr
o
m
Ju
n
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De
c
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b
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2
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2
5
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e
v
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ty
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si
x
re
sp
o
n
d
e
n
ts
we
re
se
lec
ted
th
ro
u
g
h
p
u
r
p
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v
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m
p
li
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m
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ti
n
g
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y
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n
d
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h
e
in
terv
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t
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n
i
n
v
o
lv
e
d
fo
u
r
we
e
k
s
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f
HI
P
O
a
p
p
li
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a
ti
o
n
u
s
e
.
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ta
we
re
a
n
a
ly
z
e
d
u
sin
g
t
h
e
Wi
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o
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ig
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k
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sp
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ts
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m
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le
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g
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4
6
–
5
5
y
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rs
(3
1
.
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8
%
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,
with
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g
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e
ti
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p
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d
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o
siti
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y
p
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(5
7
.
8
9
%
).
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y
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o
li
c
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l
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o
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p
re
ss
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re
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n
ifi
c
a
n
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y
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re
a
se
d
fro
m
1
5
9
.
5
3
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1
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o
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n
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ias
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li
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m
9
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2
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5
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o
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8
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±
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.
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n
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re
a
se
d
fro
m
3
5
.
5
3
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to
5
5
.
2
6
%
,
a
n
d
g
o
o
d
h
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n
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o
n
tr
o
l
in
c
re
a
se
d
fro
m
3
5
.
5
3
%
t
o
6
1
.
8
4
%
.
T
h
e
HIPO
a
p
p
l
ica
ti
o
n
si
g
n
ifi
c
a
n
t
ly
imp
ro
v
e
d
b
l
o
o
d
p
re
ss
u
re
,
k
n
o
wle
d
g
e
,
a
n
d
h
y
p
e
rten
sio
n
c
o
n
tro
l.
H
o
we
v
e
r,
th
e
a
b
se
n
c
e
o
f
a
c
o
n
tr
o
l
g
r
o
u
p
li
m
it
s
c
a
u
sa
l
in
fe
re
n
c
e
.
Th
is
a
p
p
li
c
a
ti
o
n
m
a
y
se
rv
e
a
s
a
su
p
p
lem
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n
tary
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d
u
c
a
ti
o
n
a
l
to
o
l
i
n
p
rima
ry
h
e
a
lt
h
c
a
re
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h
ro
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ic
d
ise
a
se
m
a
n
a
g
e
m
e
n
t
p
ro
g
ra
m
s.
K
ey
w
o
r
d
s
:
Bl
o
o
d
p
r
ess
u
r
e
co
n
tr
o
l
Hea
lth
liter
ac
y
Hy
p
er
ten
s
io
n
Mo
b
ile
ap
p
licatio
n
Ob
esit
y
T
h
is i
s
a
n
o
p
e
n
a
c
c
e
ss
a
rticle
u
n
d
e
r th
e
CC B
Y
-
SA
li
c
e
n
se
.
C
o
r
r
e
s
p
o
nd
ing
A
uth
o
r
:
R
o
s
E
n
d
ah
Hap
p
y
Patr
iy
an
i
Dep
ar
tm
en
t o
f
Nu
r
s
in
g
,
Po
lte
k
k
es Ke
m
en
k
es Su
r
ak
a
r
ta
Su
r
ak
ar
ta,
I
n
d
o
n
esia
E
m
ail:
r
o
s
en
d
ah
h
a
p
p
y
p
atr
iy
an
i@
g
m
ail.
co
m
1.
I
NT
RO
D
UCT
I
O
N
Hy
p
er
ten
s
io
n
is
o
n
e
o
f
th
e
ch
r
o
n
ic
d
is
ea
s
es
with
th
e
h
ig
h
est
p
r
ev
alen
ce
th
at
th
r
ea
ten
s
th
e
ca
r
d
io
v
ascu
lar
a
n
d
ce
r
eb
r
o
v
ascu
lar
h
ea
lth
o
f
th
e
g
lo
b
al
p
o
p
u
latio
n
[
1
]
.
T
h
is
co
n
d
itio
n
h
as
b
ec
o
m
e
a
s
ig
n
if
ican
t
p
u
b
lic
h
ea
lth
p
r
o
b
lem
,
a
f
f
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tin
g
m
o
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a
q
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a
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ter
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u
lt
p
o
p
u
latio
n
in
d
ev
elo
p
ed
c
o
u
n
tr
ies
[
2
]
.
Ob
esit
y
an
d
h
y
p
er
te
n
s
io
n
a
r
e
two
n
o
n
-
co
m
m
u
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ica
b
le
d
is
ea
s
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th
at
ar
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in
ter
r
elate
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n
tr
ib
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te
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ig
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if
ican
tly
to
g
lo
b
al
m
o
r
b
id
ity
an
d
m
o
r
tality
[
3
]
.
T
h
e
lo
n
g
-
k
n
o
wn
lin
k
b
etwe
en
o
b
esit
y
an
d
a
s
ig
n
i
f
ican
t
in
cr
ea
s
e
in
c
ar
d
i
o
v
ascu
lar
d
is
ea
s
e,
in
clu
d
in
g
h
y
p
er
ten
s
io
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,
h
as b
ee
n
well
estab
lis
h
ed
in
n
u
m
er
o
u
s
s
tu
d
ies [
4
]
.
T
h
e
p
ath
o
p
h
y
s
io
lo
g
ical
m
ec
h
an
is
m
s
u
n
d
er
ly
in
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r
elatio
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s
h
ip
b
etwe
en
o
b
esit
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an
d
h
y
p
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ten
s
io
n
in
v
o
lv
e
m
u
ltip
le
co
m
p
le
x
f
a
cto
r
s
.
Ob
esit
y
-
r
elate
d
h
y
p
er
t
en
s
io
n
is
ch
ar
ac
ter
ized
b
y
s
tim
u
latio
n
o
f
th
e
s
y
m
p
ath
etic
n
e
r
v
o
u
s
s
y
s
tem
,
ac
tiv
atio
n
o
f
th
e
r
e
n
in
-
an
g
io
te
n
s
in
s
y
s
tem
(
R
AS)
,
an
d
s
o
d
iu
m
r
eten
tio
n
,
a
m
o
n
g
o
th
er
a
b
n
o
r
m
alities
[
5
]
.
M
u
ltip
le
f
ac
to
r
s
,
i
n
clu
d
in
g
th
e
s
y
m
p
ath
etic
n
er
v
o
u
s
s
y
s
tem
,
th
e
r
en
in
-
a
n
g
io
ten
s
in
-
ald
o
s
ter
o
n
e
s
y
s
tem
,
a
n
d
i
n
f
la
m
m
ato
r
y
p
ath
way
s
,
a
r
e
in
tr
ica
tely
in
v
o
lv
e
d
in
th
e
p
ath
o
g
en
e
s
is
o
f
o
b
esit
y
-
r
elate
d
Evaluation Warning : The document was created with Spire.PDF for Python.
I
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Hea
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8
8
0
6
E
ffective
n
ess
o
f H
I
P
O
a
n
d
r
o
id
-
b
a
s
ed
a
p
p
lica
tio
n
in
imp
r
o
v
in
g
…
(
R
o
s
E
n
d
a
h
Ha
p
p
y
P
a
t
r
iya
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i
)
409
h
y
p
er
ten
s
io
n
[
6
]
.
A
n
ew
ap
p
r
o
ac
h
to
th
e
r
en
in
-
a
n
g
io
ten
s
i
n
-
ald
o
s
ter
o
n
e
s
y
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tem
(
R
AAS)
ad
d
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ess
es
th
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two
o
p
p
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s
in
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p
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way
s
in
wh
ic
h
a
s
tate
o
f
eq
u
ilib
r
i
u
m
d
ev
el
o
p
s
[
7
]
.
Ob
esit
y
-
r
elate
d
h
y
p
er
ten
s
io
n
is
a
m
ajo
r
ch
allen
g
e
f
o
r
h
ea
lth
ca
r
e
s
y
s
tem
s
d
u
e
to
th
e
r
ap
id
i
n
cr
ea
s
e
in
th
e
p
r
ev
alen
ce
o
f
o
b
esit
y
wo
r
l
d
wid
e
[
8
]
,
[
9
]
.
Ho
wev
e
r
,
its
tr
ea
tm
en
t
is
s
til
l
n
o
t
s
p
ec
if
ically
a
d
d
r
ess
ed
b
y
cu
r
r
en
t
g
u
id
elin
es.
W
eig
h
t
lo
s
s
p
er
s
e
r
ed
u
ce
s
b
lo
o
d
p
r
ess
u
r
e
an
d
im
p
r
o
v
es
p
atien
t
r
esp
o
n
s
iv
en
e
s
s
to
b
lo
o
d
p
r
ess
u
r
e
-
lo
wer
in
g
m
ed
icatio
n
s
.
T
h
er
ef
o
r
e,
a
weig
h
t
-
ce
n
ter
ed
ap
p
r
o
a
ch
is
cr
u
cial
f
o
r
th
e
tr
ea
tm
en
t
o
f
o
b
esit
y
-
r
elate
d
h
y
p
er
ten
s
io
n
.
Diet
an
d
p
h
y
s
ical
ac
tiv
ity
ar
e
k
e
y
co
m
p
o
n
e
n
ts
o
f
life
s
ty
le
in
ter
v
e
n
tio
n
s
f
o
r
o
b
esit
y
-
r
elate
d
h
y
p
er
ten
s
io
n
,
b
u
t
t
h
eir
ef
f
ec
tiv
en
ess
in
r
ea
l
-
life
s
ettin
g
s
is
lim
ited
[
1
0
]
.
Un
h
ea
lth
y
ea
ti
n
g
h
a
b
its
an
d
in
ad
eq
u
ate
p
h
y
s
ical
ac
tiv
ity
ar
e
m
ajo
r
co
n
tr
ib
u
to
r
s
to
o
b
esit
y
,
wh
ich
in
tu
r
n
in
cr
ea
s
es
th
e
lik
elih
o
o
d
o
f
h
y
p
er
te
n
s
io
n
[
1
1
]
.
Per
s
is
ten
t
h
y
p
er
ten
s
io
n
af
ter
6
-
1
2
m
o
n
t
h
s
d
esp
ite
a
h
ea
lth
y
li
f
esty
le
r
eq
u
ir
es
ad
d
itio
n
al
tr
ea
tm
en
t
[
1
2
]
.
Prim
ar
y
h
ea
lth
ca
r
e
s
tan
d
s
as a
s
tr
ateg
ic
lev
el
f
o
r
o
r
g
a
n
izin
g
ca
r
e
an
d
u
s
er
m
an
ag
e
m
en
t in
th
is
s
er
v
i
ce
[
1
3
]
.
Desp
ite
th
e
well
-
es
tab
lis
h
ed
p
ath
o
p
h
y
s
io
lo
g
ical
lin
k
b
etwe
en
o
b
esit
y
an
d
h
y
p
er
ten
s
io
n
,
ex
is
tin
g
m
Hea
lth
in
ter
v
en
tio
n
s
h
a
v
e
l
ar
g
ely
a
d
d
r
ess
ed
th
ese
c
o
n
d
it
io
n
s
s
ep
ar
ately
r
ath
er
t
h
an
as
co
m
o
r
b
id
en
titi
es.
W
h
ile
m
Hea
lth
ap
p
licatio
n
s
h
av
e
s
h
o
wn
p
r
o
m
is
e
in
im
p
r
o
v
i
n
g
b
lo
o
d
p
r
ess
u
r
e
co
n
tr
o
l,
s
elf
-
ca
r
e
b
eh
av
io
r
s
,
an
d
s
elf
-
ef
f
icac
y
am
o
n
g
h
y
p
e
r
ten
s
iv
e
p
atien
ts
[
1
4
]
.
Stu
d
ies
in
I
n
d
o
n
esia
r
em
ain
p
a
r
ticu
lar
l
y
s
ca
r
ce
,
with
f
ew
An
d
r
o
id
-
b
ased
in
ter
v
e
n
tio
n
s
d
ev
elo
p
ed
f
r
o
m
l
o
ca
l
p
atien
t
n
e
ed
s
ass
es
s
m
en
t
[
1
5
]
.
C
r
itically
,
n
o
p
r
io
r
s
tu
d
y
h
as
ev
alu
ated
an
ap
p
licatio
n
co
m
b
in
in
g
h
y
p
er
ten
s
io
n
ed
u
ca
tio
n
with
o
b
esit
y
-
s
p
ec
if
ic
co
n
ten
t
to
s
im
u
ltan
eo
u
s
ly
im
p
r
o
v
e
h
ea
lth
liter
ac
y
,
k
n
o
w
led
g
e,
an
d
b
lo
o
d
p
r
ess
u
r
e
o
u
t
co
m
es
in
th
is
h
ig
h
-
r
is
k
p
o
p
u
la
tio
n
,
h
ig
h
lig
h
tin
g
a
s
ig
n
if
ican
t r
esear
ch
g
a
p
war
r
a
n
tin
g
in
v
es
tig
atio
n
.
Desp
ite
ex
ten
s
iv
e
r
esear
ch
o
n
th
e
r
elatio
n
s
h
ip
b
etwe
en
o
b
esit
y
an
d
h
y
p
er
te
n
s
io
n
an
d
t
h
e
d
e
v
elo
p
m
en
t
o
f
m
o
b
ile
ap
p
licatio
n
s
f
o
r
h
y
p
er
ten
s
io
n
m
an
a
g
em
en
t,
a
liter
atu
r
e
g
ap
r
em
ain
s
r
eg
a
r
d
in
g
th
e
ef
f
ec
tiv
en
ess
o
f
An
d
r
o
id
-
b
ased
ap
p
licatio
n
s
s
p
ec
if
icall
y
d
esig
n
ed
t
o
im
p
r
o
v
e
h
y
p
er
ten
s
io
n
co
n
tr
o
l
liter
ac
y
am
o
n
g
o
b
ese
p
atien
ts
.
T
h
is
s
tu
d
y
aim
s
to
e
v
alu
ate
th
e
e
f
f
ec
tiv
en
ess
o
f
t
h
e
h
y
p
er
ten
s
io
n
an
d
o
b
esit
y
i
n
f
o
r
m
atio
n
s
y
s
tem
(
HI
PO)
ap
p
licatio
n
in
en
h
an
ci
n
g
o
b
ese
p
atien
ts
'
u
n
d
er
s
tan
d
in
g
an
d
ab
ilit
y
to
m
an
a
g
e
t
h
eir
h
y
p
er
ten
s
io
n
.
T
h
is
q
u
asi
-
ex
p
er
im
e
n
tal
s
tu
d
y
is
ex
p
ec
ted
to
p
r
o
v
id
e
em
p
ir
ica
l
ev
id
en
ce
o
n
th
e
b
e
n
ef
its
o
f
tech
n
o
lo
g
y
-
b
ased
in
ter
v
en
tio
n
s
in
im
p
r
o
v
in
g
h
ea
lth
liter
ac
y
,
p
o
ten
tially
c
o
n
tr
ib
u
tin
g
s
ig
n
i
f
ican
tly
to
h
y
p
er
ten
s
io
n
co
n
tr
o
l
s
tr
ateg
ies
f
o
r
o
b
esit
y
-
r
elate
d
h
y
p
er
ten
s
io
n
b
o
th
in
I
n
d
o
n
esia
an
d
g
lo
b
ally
th
r
o
u
g
h
a
p
atien
t
-
ce
n
ter
ed
,
ac
ce
s
s
ib
le
tech
n
o
lo
g
ical
a
p
p
r
o
a
ch
.
2.
M
E
T
H
O
D
T
h
is
s
tu
d
y
u
s
es
a
q
u
asi
-
ex
p
er
i
m
en
tal
d
esig
n
with
a
o
n
e
-
g
r
o
u
p
p
r
etest
-
p
o
s
ttes
t
d
esig
n
ap
p
r
o
ac
h
.
I
n
th
is
d
esig
n
,
o
n
e
g
r
o
u
p
o
f
r
esp
o
n
d
e
n
ts
was
m
ea
s
u
r
ed
f
o
r
th
eir
d
ep
en
d
en
t
v
ar
iab
les
b
ef
o
r
e
th
e
in
ter
v
en
tio
n
(
p
r
etest),
th
en
g
i
v
en
a
n
i
n
ter
v
en
tio
n
in
t
h
e
f
o
r
m
o
f
u
s
in
g
th
e
An
d
r
o
i
d
-
b
ased
HI
PO a
p
p
licatio
n
,
a
n
d
th
en
m
ea
s
u
r
ed
a
g
ain
af
ter
th
e
in
ter
v
e
n
tio
n
(
p
o
s
ttes
t)
to
ev
alu
ate
th
e
c
h
an
g
es
th
at
o
c
cu
r
r
e
d
.
T
h
e
o
n
e
-
g
r
o
u
p
p
r
et
est
-
p
o
s
ttes
t
d
esig
n
with
o
u
t
a
co
n
tr
o
l
g
r
o
u
p
was
ch
o
s
en
b
ased
o
n
eth
ical
an
d
p
r
ac
t
ical
co
n
s
id
er
atio
n
s
.
E
th
ically
,
co
n
d
u
ctin
g
a
h
ea
lth
ed
u
ca
tio
n
in
ter
v
en
tio
n
f
o
r
h
y
p
er
ten
s
iv
e
p
atien
ts
with
o
b
esit
y
wh
o
r
eq
u
i
r
e
o
p
tim
al
m
an
a
g
e
m
en
t
is
c
o
n
s
id
er
ed
u
n
eth
ical
b
ec
a
u
s
e
it
co
u
ld
h
ar
m
th
e
r
esp
o
n
d
en
ts
'
h
ea
lth
.
Pra
ctica
lly
,
th
e
n
u
m
b
e
r
o
f
h
y
p
er
t
en
s
iv
e
p
atien
ts
with
o
b
esit
y
wh
o
m
et
all
i
n
clu
s
io
n
cr
iter
ia
in
th
e
Sib
ela
C
o
m
m
u
n
ity
Hea
lth
C
en
ter
'
s
wo
r
k
ar
ea
was
lim
ited
,
s
o
d
iv
id
in
g
th
e
s
tu
d
y
in
to
two
g
r
o
u
p
s
r
is
k
ed
r
ed
u
cin
g
t
h
e
s
tu
d
y
'
s
s
tatis
tical
p
o
wer
.
Fu
r
th
er
m
o
r
e,
u
s
in
g
th
e
p
r
etest
as
a
b
aselin
e
m
ea
s
u
r
em
en
t
all
o
wed
ea
ch
r
esp
o
n
d
e
n
t
to
ac
t
as
th
eir
o
w
n
c
o
n
tr
o
l,
th
u
s
m
i
n
im
izin
g
i
n
d
iv
id
u
al
d
if
f
er
en
ce
s
.
T
h
is
r
esear
ch
was
co
n
d
u
cted
i
n
th
e
wo
r
k
i
n
g
ar
ea
o
f
t
he
Sib
el
a
C
o
m
m
u
n
ity
Hea
lth
C
en
ter
in
Su
r
ak
ar
ta,
a
p
r
im
ar
y
h
ea
lth
ca
r
e
f
ac
ilit
y
with
a
ch
r
o
n
ic
d
is
ea
s
e
m
an
ag
em
en
t
p
r
o
g
r
am
(
P
r
o
la
n
is
)
f
o
r
h
y
p
er
ten
s
io
n
.
T
h
e
lo
ca
tio
n
was
s
elec
ted
b
ased
o
n
th
e
c
o
n
s
id
er
atio
n
th
at
th
e
co
m
m
u
n
ity
h
ea
lth
ce
n
ter
h
a
d
a
s
u
f
f
icien
t
n
u
m
b
e
r
o
f
h
y
p
er
ten
s
iv
e
p
atien
ts
with
o
b
esit
y
to
m
ee
t
th
e
r
esear
ch
s
am
p
le
r
eq
u
ir
e
m
en
ts
.
T
h
e
s
tu
d
y
p
er
io
d
last
ed
f
o
r
7
m
o
n
th
s
,
s
tar
tin
g
f
r
o
m
J
u
n
e
t
o
Dec
em
b
er
2
0
2
5
,
c
o
v
er
in
g
th
e
p
r
e
p
ar
atio
n
p
h
ase,
p
r
et
est
d
ata
co
llectio
n
,
in
ter
v
en
tio
n
im
p
lem
en
tatio
n
,
an
d
p
o
s
ttes
t
d
ata
co
llectio
n
.
T
h
e
p
o
p
u
latio
n
in
th
is
s
tu
d
y
was
all
p
atien
ts
d
iag
n
o
s
ed
with
h
y
p
er
ten
s
io
n
with
o
b
esit
y
co
n
d
itio
n
s
wh
o
wer
e
r
eg
is
ter
ed
an
d
ac
tiv
ely
v
i
s
itin
g
th
e
co
m
m
u
n
ity
h
ea
lth
ce
n
ter
.
T
h
e
tar
g
et
p
o
p
u
latio
n
in
cl
u
d
ed
ad
u
lt
p
atien
ts
d
iag
n
o
s
ed
with
p
r
im
a
r
y
h
y
p
er
t
en
s
io
n
an
d
a
b
o
d
y
m
ass
in
d
ex
(
B
MI
)
≥
2
5
k
g
/m
².
T
h
e
s
tu
d
y
s
am
p
le
co
n
s
is
ted
o
f
7
6
r
esp
o
n
d
e
n
ts
s
elec
ted
u
s
in
g
a
p
u
r
p
o
s
iv
e
s
am
p
lin
g
tech
n
iq
u
e.
T
h
e
s
am
p
le
s
ize
was
d
eter
m
in
ed
u
s
in
g
a
p
r
o
p
o
r
tio
n
esti
m
atio
n
f
o
r
m
u
la
,
co
n
s
id
er
in
g
a
9
5
%
co
n
f
id
e
n
ce
lev
el,
a
1
0
%
m
ar
g
in
o
f
er
r
o
r
,
an
d
p
o
p
u
latio
n
p
r
o
p
o
r
tio
n
s
b
ased
o
n
p
r
ev
io
u
s
r
esear
ch
.
I
n
clu
s
io
n
cr
iter
ia
in
clu
d
e
d
:
i
)
P
atien
ts
d
iag
n
o
s
ed
with
p
r
im
ar
y
h
y
p
er
ten
s
io
n
b
ased
o
n
J
NC
VI
I
I
cr
iter
ia
with
s
y
s
to
lic
b
lo
o
d
p
r
ess
u
r
e
≥
1
4
0
m
m
Hg
an
d
/
o
r
d
iast
o
lic
≥
9
0
m
m
Hg
;
ii
)
B
MI
≥
2
5
k
g
/m
²
b
ased
o
n
th
e
Asi
a
-
Pacif
ic
class
if
icat
io
n
;
iii
)
ag
ed
≥
2
6
y
ea
r
s
;
iv
)
O
wn
in
g
an
An
d
r
o
id
s
m
ar
tp
h
o
n
e
with
at
least
v
er
s
io
n
5
.
0
;
v
)
ab
le
to
o
p
e
r
ate
th
e
m
o
b
ile
ap
p
licatio
n
in
d
e
p
en
d
e
n
tly
;
vi
)
W
illi
n
g
to
s
ig
n
a
n
i
n
f
o
r
m
ed
c
o
n
s
en
t;
v
ii
)
a
b
le
to
co
m
m
u
n
icate
in
I
n
d
o
n
esian
;
a
n
d
v
iii
)
R
eg
is
ter
ed
as
an
ac
t
iv
e
p
atien
t
at
th
e
co
m
m
u
n
ity
h
ea
lth
ce
n
ter
f
o
r
at
least
3
m
o
n
t
h
s
.
E
x
clu
s
io
n
cr
iter
ia
i
n
clu
d
ed
p
atien
ts
with
s
ec
o
n
d
ar
y
h
y
p
er
te
n
s
io
n
,
s
ev
er
e
c
o
m
p
lica
tio
n
s
(
s
tr
o
k
e,
h
ea
r
t
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
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:
2
2
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n
t J Pu
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Hea
lth
Sci
,
Vo
l.
15
,
No
.
2
,
J
u
n
e
20
26
:
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0
8
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410
f
ailu
r
e,
ad
v
a
n
ce
d
r
en
al
f
ailu
r
e)
,
co
g
n
itiv
e
o
r
p
s
y
ch
iatr
ic
d
is
o
r
d
er
s
,
p
r
eg
n
an
cy
,
p
ar
ticip
atio
n
in
a
s
im
ilar
in
ter
v
en
tio
n
p
r
o
g
r
am
,
o
r
n
o
t
h
av
in
g
a
d
eq
u
ate
i
n
ter
n
et
ac
ce
s
s
.
Dr
o
p
o
u
t
cr
iter
ia
wer
e
s
et
f
o
r
r
esp
o
n
d
en
ts
wh
o
with
d
r
ew,
u
s
ed
th
e
Si
HI
PO
ap
p
licatio
n
f
o
r
less
th
an
8
0
%
o
f
th
e
i
n
ter
v
en
tio
n
tim
e,
ex
p
er
ien
ce
d
w
o
r
s
en
in
g
h
ea
lth
co
n
d
itio
n
s
,
o
r
c
o
u
ld
n
o
t
b
e
co
n
tacte
d
d
u
r
i
n
g
th
e
p
o
s
ttes
t m
ea
s
u
r
em
en
t.
T
h
is
s
tu
d
y
u
s
ed
t
h
r
ee
m
ai
n
v
a
r
iab
le
ca
teg
o
r
ies.
T
h
e
in
d
ep
en
d
en
t
v
ar
ia
b
le
was
a
h
y
p
er
ten
s
i
o
n
co
n
tr
o
l
liter
ac
y
in
ter
v
en
tio
n
u
s
in
g
th
e
An
d
r
o
id
-
b
ased
Si
HI
PO
ap
p
licatio
n
,
wh
ich
is
a
d
ig
ital
ed
u
ca
tio
n
al
m
e
d
ia
s
p
ec
if
ically
d
esig
n
ed
to
im
p
r
o
v
e
k
n
o
wled
g
e
a
n
d
a
b
ilit
y
to
c
o
n
tr
o
l
h
y
p
e
r
ten
s
io
n
in
p
atien
t
s
with
o
b
esit
y
.
T
h
e
d
ep
en
d
e
n
t
v
ar
iab
les
in
th
is
s
tu
d
y
in
cl
u
d
ed
f
iv
e
c
o
m
p
o
n
en
ts
,
n
am
ely
:
i
)
S
y
s
to
lic
b
lo
o
d
p
r
ess
u
r
e,
wh
ich
is
th
e
b
lo
o
d
p
r
ess
u
r
e
wh
e
n
th
e
h
ea
r
t
co
n
tr
ac
ts
an
d
is
m
ea
s
u
r
ed
in
m
illi
m
eter
s
o
f
m
er
cu
r
y
(
m
m
Hg
)
;
ii
)
D
iast
o
lic
b
lo
o
d
p
r
ess
u
r
e,
wh
ich
is
th
e
b
lo
o
d
p
r
ess
u
r
e
wh
en
t
h
e
h
ea
r
t
r
elax
es
an
d
is
also
m
e
asu
r
ed
in
m
m
H
g
;
iii
)
B
MI
w
h
ich
is
th
e
r
atio
b
etwe
en
b
o
d
y
weig
h
t
in
k
ilo
g
r
am
s
an
d
th
e
s
q
u
ar
e
o
f
b
o
d
y
h
eig
h
t
in
m
eter
s
;
iv
)
K
n
o
wled
g
e
ab
o
u
t
h
y
p
er
ten
s
io
n
,
in
clu
d
in
g
u
n
d
er
s
tan
d
in
g
th
e
d
e
f
in
itio
n
,
ca
u
s
es,
r
is
k
f
ac
to
r
s
,
co
m
p
licatio
n
s
,
an
d
m
an
ag
em
e
n
t;
an
d
v
)
H
y
p
e
r
ten
s
io
n
co
n
tr
o
l,
wh
i
ch
in
clu
d
es
th
e
ab
ilit
y
to
m
o
d
if
y
life
s
ty
le,
m
e
d
icatio
n
a
d
h
er
en
ce
,
an
d
s
elf
-
m
o
n
ito
r
in
g
.
T
h
e
co
n
f
o
u
n
d
in
g
v
ar
iab
les
id
en
tifie
d
an
d
co
n
tr
o
lled
in
clu
d
ed
g
en
d
er
,
a
g
e,
g
e
n
etic
f
ac
to
r
s
(
f
am
ily
h
is
to
r
y
o
f
h
y
p
er
ten
s
io
n
)
,
m
ar
i
tal
s
tatu
s
,
ed
u
ca
tio
n
lev
el,
em
p
lo
y
m
en
t
s
tatu
s
,
s
m
o
k
in
g
h
a
b
its
,
ex
er
cise
h
ab
its
,
d
u
r
atio
n
o
f
h
y
p
er
ten
s
io
n
,
a
n
d
ad
h
er
en
ce
to
an
ti
h
y
p
er
ten
s
iv
e
m
ed
icatio
n
.
T
h
is
s
tu
d
y
u
s
ed
1
6
v
ar
iab
les
co
n
s
is
tin
g
o
f
in
d
ep
e
n
d
en
t
v
a
r
iab
les,
d
ep
en
d
en
t
v
a
r
iab
les,
an
d
r
esp
o
n
d
en
t
ch
ar
ac
ter
is
tics
.
T
h
e
in
d
ep
en
d
en
t
v
ar
iab
le
was th
e
HI
PO
ap
p
lica
tio
n
in
ter
v
en
tio
n
,
wh
ich
p
r
o
v
i
d
ed
h
ea
lth
e
d
u
ca
tio
n
o
n
h
y
p
er
ten
s
io
n
an
d
o
b
esit
y
co
n
tr
o
l
t
h
r
o
u
g
h
a
n
An
d
r
o
id
-
b
ased
ap
p
licatio
n
c
o
n
tain
in
g
ed
u
ca
tio
n
al
m
ater
ials
,
m
e
d
icatio
n
r
em
in
d
er
s
,
b
l
o
o
d
p
r
ess
u
r
e
m
o
n
ito
r
in
g
,
a
n
d
h
ea
lth
y
life
s
ty
le
tip
s
,
m
ea
s
u
r
ed
o
n
a
n
o
m
in
al
s
ca
le
(
d
o
n
e/n
o
t d
o
n
e)
.
Dep
en
d
en
t
v
ar
iab
les
in
cl
u
d
ed
s
y
s
to
lic
an
d
d
iast
o
lic
b
l
o
o
d
p
r
ess
u
r
e
m
ea
s
u
r
ed
u
s
in
g
a
ca
lib
r
ated
d
ig
ital
s
p
h
y
g
m
o
m
an
o
m
ete
r
af
ter
r
es
p
o
n
d
e
n
ts
h
ad
r
ested
f
o
r
at
lea
s
t
5
m
in
u
tes
in
a
s
itti
n
g
p
o
s
iti
o
n
,
with
an
o
r
d
in
al
s
ca
le
b
ased
o
n
h
y
p
er
ten
s
io
n
c
lass
if
icatio
n
.
B
MI
was
ca
lcu
l
ated
u
s
in
g
th
e
f
o
r
m
u
la
B
B
(
k
g
)
/TB²
(
m
²)
u
s
in
g
a
d
ig
ital
s
ca
le
an
d
s
tad
io
m
eter
.
Hy
p
er
ten
s
io
n
k
n
o
wled
g
e
an
d
co
n
t
r
o
l
wer
e
m
ea
s
u
r
ed
th
r
o
u
g
h
a
q
u
esti
o
n
n
air
e
with
ca
teg
o
r
ies
o
f
g
o
o
d
(
7
6
-
1
0
0
%),
s
u
f
f
icien
t
(
5
6
-
7
5
%),
an
d
p
o
o
r
(
<
5
5
%).
C
h
ar
ac
ter
is
tic
v
ar
iab
les
in
clu
d
ed
g
en
d
er
,
ag
e
,
g
en
etic
f
ac
t
o
r
s
,
m
ar
ital statu
s
,
ed
u
ca
tio
n
,
o
cc
u
p
atio
n
,
s
m
o
k
in
g
h
ab
its
,
e
x
er
cise h
ab
its
,
d
u
r
atio
n
o
f
h
y
p
er
ten
s
io
n
,
a
n
d
m
ed
icatio
n
ad
h
er
en
ce
,
m
ea
s
u
r
e
d
u
s
in
g
t
h
e
Mo
r
is
k
y
Me
d
icatio
n
Ad
h
e
r
e
n
ce
Scale
(
MM
AS
-
8
)
with
ca
teg
o
r
ies o
f
ad
h
er
en
t
(
s
co
r
e
≥
6
)
an
d
n
o
n
-
ad
h
e
r
en
t (
s
co
r
e
<
6
)
.
T
h
is
s
tu
d
y
u
s
ed
s
ev
en
m
ain
in
s
tr
u
m
en
ts
th
at
h
ad
u
n
d
er
g
o
n
e
a
v
alid
atio
n
p
r
o
ce
s
s
to
en
s
u
r
e
th
e
ac
cu
r
ac
y
o
f
th
e
m
ea
s
u
r
em
e
n
t
o
f
th
e
r
es
ea
r
ch
v
ar
iab
les.
T
h
e
HI
PO
ap
p
licatio
n
is
an
An
d
r
o
id
-
b
ased
m
o
b
ile
ap
p
licatio
n
s
p
ec
if
ically
d
ev
elo
p
ed
as
a
h
e
alth
liter
ac
y
in
ter
v
en
tio
n
m
ed
iu
m
b
y
ap
p
ly
in
g
th
e
p
r
in
cip
le
s
o
f
h
ea
lth
liter
ac
y
an
d
u
s
er
-
ce
n
ter
ed
d
esig
n
.
T
h
is
ap
p
licatio
n
h
as
f
iv
e
m
ain
f
ea
tu
r
es:
a
n
e
d
u
ca
tio
n
al
m
o
d
u
le
(
m
ater
ials
o
n
h
y
p
er
ten
s
io
n
,
th
e
DASH
d
iet,
p
h
y
s
ical
ac
tiv
ity
,
an
d
s
tr
ess
m
an
ag
em
en
t)
,
a
m
o
n
ito
r
i
n
g
f
e
at
u
r
e
(
b
lo
o
d
p
r
ess
u
r
e
an
d
weig
h
t
r
ec
o
r
d
in
g
)
,
a
r
em
i
n
d
er
f
ea
tu
r
e
(
m
ed
icatio
n
r
em
i
n
d
er
s
an
d
co
n
t
r
o
l
s
ch
ed
u
les),
in
ter
ac
tiv
e
f
ea
tu
r
es
(
q
u
izze
s
an
d
B
MI
ca
lcu
lato
r
s
)
,
an
d
a
co
n
s
u
ltatio
n
f
ea
tu
r
e.
T
h
e
ap
p
licatio
n
d
ev
elo
p
m
en
t
wen
t
th
r
o
u
g
h
s
ix
s
tag
es:
n
ee
d
s
an
aly
s
i
s
,
d
esig
n
,
d
ev
elo
p
m
e
n
t
u
s
in
g
An
d
r
o
id
Stu
d
io
,
co
n
ten
t
v
alid
atio
n
b
y
th
r
ee
ex
p
e
r
ts
with
a
co
n
ten
t
v
alid
ity
i
n
d
ex
≥
0
.
8
0
,
u
s
ab
ilit
y
test
in
g
u
s
in
g
th
e
s
y
s
tem
u
s
ab
ilit
y
s
ca
le
with
a
s
co
r
e
o
f
≥
6
8
,
a
n
d
f
ield
tr
ials
o
n
1
5
r
esp
o
n
d
en
ts
.
C
lin
ical
m
ea
s
u
r
em
en
ts
wer
e
co
n
d
u
cted
u
s
in
g
a
ca
lib
r
ated
d
i
g
ital
s
p
h
y
g
m
o
m
an
o
m
ete
r
ac
co
r
d
in
g
to
th
e
E
u
r
o
p
ea
n
So
ciety
o
f
Hy
p
er
ten
s
io
n
p
r
o
to
co
l
with
an
ac
cu
r
ac
y
o
f
±
3
m
m
Hg
,
a
d
ig
ital
s
ca
le
(
ac
cu
r
ac
y
o
f
0
.
1
k
g
)
,
an
d
a
s
tad
io
m
eter
(
ac
cu
r
ac
y
o
f
0
.
1
c
m
)
.
T
h
e
m
ea
s
u
r
em
en
t
p
r
o
ce
d
u
r
e
f
o
llo
wed
s
tr
ict
p
r
o
to
co
l
s
tan
d
ar
d
s
to
en
s
u
r
e
t
h
e
v
alid
ity
o
f
th
e
r
esu
lts
.
T
h
e
q
u
esti
o
n
n
air
e
in
s
tr
u
m
en
ts
i
n
clu
d
ed
:
a
r
esp
o
n
d
e
n
t
ch
ar
ac
ter
is
tics
q
u
esti
o
n
n
air
e,
a
h
y
p
er
ten
s
io
n
k
n
o
wled
g
e
q
u
esti
o
n
n
air
e
(
2
0
m
u
ltip
le
-
ch
o
ice
item
s
)
,
a
h
y
p
er
ten
s
io
n
co
n
tr
o
l
q
u
esti
o
n
n
air
e
(
2
5
L
ik
er
t
-
s
ca
le
item
s
)
,
an
d
th
e
MM
AS
-
8
f
o
r
m
ed
icat
io
n
ad
h
er
en
ce
.
All
q
u
esti
o
n
n
air
es we
r
e
test
ed
f
o
r
v
alid
ity
an
d
r
eliab
ilit
y
with
a
C
r
o
n
b
ac
h
'
s
Alp
h
a
v
alu
e
o
f
>
0
.
7
0
.
T
h
e
d
ata
co
llectio
n
p
r
o
ce
d
u
r
e
in
th
is
s
tu
d
y
was
ca
r
r
ied
o
u
t
th
r
o
u
g
h
th
r
ee
m
ain
s
tag
es:
p
r
ep
ar
atio
n
,
im
p
lem
en
tatio
n
,
an
d
ev
alu
at
io
n
.
T
h
e
p
r
ep
ar
atio
n
s
tag
e
in
clu
d
ed
o
b
tain
in
g
r
esear
ch
p
er
m
its
,
in
cl
u
d
in
g
s
u
b
m
itti
n
g
eth
ical
clea
r
an
ce
to
th
e
Hea
lth
R
esear
ch
E
th
ics
C
o
m
m
is
s
io
n
,
an
d
r
e
q
u
esti
n
g
p
er
m
its
f
r
o
m
th
e
Hea
lth
Of
f
ice
an
d
th
e
Hea
d
o
f
th
e
lo
ca
l
co
m
m
u
n
ity
h
ea
lth
ce
n
ter
.
Nex
t,
i
n
s
tr
u
m
en
t
p
r
ep
a
r
atio
n
was
ca
r
r
ie
d
o
u
t
,
in
clu
d
in
g
f
in
alizin
g
t
h
e
Si
HI
PO
ap
p
licatio
n
,
ca
lib
r
atin
g
m
ea
s
u
r
in
g
in
s
tr
u
m
e
n
ts
(
s
p
h
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8
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(
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411
T
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ata
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llected
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d
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ter
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iv
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G
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Ex
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44
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N
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M
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d
26
3
4
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2
1
Ed
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c
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t
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o
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n
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O
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s
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No
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S
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3
No
55
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3
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Ex
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Fo
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I
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ased
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DIS
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An
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b
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le
im
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e
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[
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.
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[
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ly
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wh
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ag
em
en
t.
E
d
u
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a
l a
t
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in
m
en
t v
ar
i
ed
a
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s
a
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w
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t p
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g
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le
ted
Evaluation Warning : The document was created with Spire.PDF for Python.
I
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t J Pu
b
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Hea
lth
Sci
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N:
2252
-
8
8
0
6
E
ffective
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o
f H
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id
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a
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imp
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…
(
R
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s
E
n
d
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h
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p
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P
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t
r
iya
n
i
)
413
s
en
io
r
h
ig
h
s
ch
o
o
l
ed
u
ca
tio
n
(
4
4
.
7
4
%),
wh
il
e
e
q
u
a
l
p
r
o
p
o
r
tio
n
s
h
ad
ju
n
io
r
h
ig
h
s
ch
o
o
l
an
d
u
n
i
v
er
s
ity
ed
u
ca
t
io
n
(
2
6
.
3
2
%
ea
ch
)
.
T
h
i
s
ed
u
c
at
io
n
al
d
iv
er
s
i
ty
i
s
i
m
p
o
r
tan
t
to
co
n
s
id
er
wh
en
ev
alu
at
in
g
h
ea
lth
li
ter
ac
y
in
t
er
v
en
t
io
n
s
,
a
s
ed
u
c
at
io
n
al
b
ac
k
g
r
o
u
n
d
s
ig
n
if
ic
an
t
ly
in
f
lu
en
ce
s
h
ea
lth
in
f
o
r
m
a
tio
n
co
m
p
r
eh
en
s
io
n
an
d
ap
p
l
ic
at
i
o
n
[
2
1
]
,
[
2
2
]
.
R
eg
ar
d
in
g
li
f
e
s
ty
le
f
a
cto
r
s
,
t
h
e
m
a
jo
r
it
y
o
f
p
ar
ti
cip
an
t
s
w
er
e
n
o
n
-
s
m
o
k
e
r
s
(
7
2
.
3
7
%
)
,
wh
i
ch
is
a
p
o
s
it
iv
e
f
i
n
d
in
g
g
i
v
en
th
e
s
y
n
er
g
i
s
ti
c
ca
r
d
io
v
a
s
cu
l
ar
r
i
s
k
s
o
f
s
m
o
k
in
g
an
d
h
y
p
e
r
te
n
s
io
n
.
E
x
er
c
i
s
e
h
ab
it
s
s
h
o
wed
a
r
e
la
tiv
ely
f
av
o
r
ab
le
d
i
s
tr
ib
u
ti
o
n
,
wi
th
2
8
.
9
5
%
r
ep
o
r
tin
g
a
l
way
s
ex
e
r
c
is
in
g
,
4
3
.
4
2
%
o
f
t
en
ex
er
ci
s
in
g
,
an
d
2
7
.
6
3
%
r
ar
e
ly
ex
er
c
i
s
in
g
.
T
h
e
s
e
li
f
e
s
t
y
l
e
ch
ar
ac
ter
i
s
t
ic
s
p
r
o
v
id
e
i
m
p
o
r
t
an
t c
o
n
t
ex
t
f
o
r
u
n
d
er
s
tan
d
in
g
th
e
in
t
er
v
en
t
io
n
's
ef
f
ec
tiv
en
e
s
s
,
as
h
e
al
th
p
r
o
m
o
tio
n
p
r
o
g
r
am
s
ta
r
g
e
tin
g
h
y
p
er
t
e
n
s
io
n
m
u
s
t
ad
d
r
e
s
s
m
u
l
t
ip
l
e
m
o
d
if
iab
le
r
i
s
k
f
ac
to
r
s
[
2
0
]
,
[
2
3
]
.
T
h
e
d
u
r
a
tio
n
o
f
h
y
p
er
ten
s
i
o
n
am
o
n
g
p
ar
t
ic
ip
an
t
s
v
ar
ied
c
o
n
s
id
er
ab
ly
,
w
ith
t
h
e
m
a
jo
r
it
y
(
5
7
.
8
9
%
)
h
av
in
g
b
ee
n
d
i
ag
n
o
s
ed
f
o
r
1
-
5
y
ea
r
s
,
f
o
llo
wed
b
y
6
-
1
0
y
e
ar
s
(
2
1
.
0
5
%)
an
d
m
o
r
e
th
an
1
1
y
ea
r
s
(
1
9
.
7
4
%)
.
T
h
i
s
d
i
s
t
r
ib
u
ti
o
n
s
u
g
g
es
t
s
th
a
t
th
e
s
t
u
d
y
ca
p
tu
r
ed
p
a
t
ien
t
s
a
t
v
ar
io
u
s
s
tag
es
o
f
th
eir
d
is
ea
s
e
t
r
a
jec
to
r
y
,
wh
i
ch
is
im
p
o
r
tan
t
f
o
r
u
n
d
er
s
t
an
d
in
g
h
o
w
d
i
s
ea
s
e
d
u
r
a
tio
n
m
ay
in
f
lu
e
n
ce
r
e
s
p
o
n
s
iv
en
e
s
s
to
ed
u
ca
ti
o
n
a
l
in
t
er
v
en
t
io
n
s
.
N
o
t
ab
ly
,
m
ed
ic
at
io
n
co
m
p
l
ian
ce
wa
s
r
el
at
iv
ely
h
ig
h
,
wi
th
6
7
.
1
1
%
o
f
p
a
r
ti
cip
an
t
s
r
ep
o
r
tin
g
ad
h
er
en
ce
to
t
h
e
ir
p
r
e
s
cr
ib
e
d
r
eg
im
en
s
.
T
h
i
s
b
a
s
e
l
in
e
c
o
m
p
l
ian
c
e
r
a
te
i
s
en
c
o
u
r
ag
i
n
g
,
a
s
m
ed
ic
at
io
n
ad
h
er
en
ce
i
s
a
c
r
i
ti
ca
l d
e
te
r
m
i
n
an
t o
f
b
lo
o
d
p
r
e
s
s
u
r
e
co
n
tr
o
l
[
2
4
]
,
[
2
5
]
.
T
h
e
W
i
lco
x
o
n
t
es
t a
n
aly
s
i
s
r
e
v
ea
l
ed
s
t
at
i
s
t
ic
al
ly
s
ig
n
if
ica
n
t
r
ed
u
c
tio
n
s
in
b
o
th
s
y
s
to
l
ic
an
d
d
ia
s
t
o
l
ic
b
lo
o
d
p
r
e
s
s
u
r
e
f
o
llo
wi
n
g
th
e
in
ter
v
en
t
io
n
(
p
=
0
.
0
0
0
f
o
r
b
o
th
m
e
a
s
u
r
e
s
)
.
M
ea
n
s
y
s
to
li
c
b
lo
o
d
p
r
e
s
s
u
r
e
d
ec
r
e
a
s
ed
f
r
o
m
1
5
9
.
5
3
m
m
H
g
(
SD
=
1
4
.
1
9
)
b
ef
o
r
e
th
e
in
t
er
v
en
tio
n
to
1
4
4
.
4
8
m
m
Hg
(
S
D
=
1
1
.
4
4
)
af
te
r
th
e
in
t
er
v
en
t
io
n
,
r
ep
r
e
s
en
t
in
g
a
c
l
in
i
ca
lly
m
ea
n
in
g
f
u
l
r
ed
u
c
t
io
n
o
f
ap
p
r
o
x
im
at
ely
1
5
m
m
Hg
.
T
h
e
m
ed
i
an
s
y
s
to
l
ic
b
lo
o
d
p
r
e
s
s
u
r
e
al
s
o
s
h
o
w
ed
i
m
p
r
o
v
em
en
t
,
d
e
cr
e
a
s
in
g
f
r
o
m
1
5
4
.
5
0
m
m
Hg
to
1
4
5
.
5
0
m
m
Hg
.
T
h
e
c
at
eg
o
r
ica
l
d
i
s
tr
ib
u
tio
n
o
f
s
y
s
to
l
ic
b
lo
o
d
p
r
e
s
s
u
r
e
s
h
o
wed
m
o
d
e
s
t
s
h
if
t
s
,
w
i
th
th
e
p
r
o
p
o
r
t
io
n
o
f
p
at
ien
t
s
in
th
e
m
i
ld
h
y
p
er
ten
s
io
n
ca
teg
o
r
y
(
1
4
0
-
1
5
9
m
m
Hg
)
d
e
cr
e
a
s
in
g
f
r
o
m
4
8
.
6
8
%
to
4
3
.
4
2
%
.
Ho
wev
er
,
th
er
e
wer
e
s
lig
h
t
in
cr
e
a
s
e
s
in
th
e
m
o
d
e
r
a
te
(
2
7
.
6
3
%
to
3
1
.
5
8
%)
an
d
s
ev
er
e
(
2
3
.
6
8
%
to
2
5
.
0
0
%
)
ca
teg
o
r
ie
s
,
wh
i
ch
war
r
an
ts
c
ar
ef
u
l
in
ter
p
r
eta
t
io
n
.
T
h
e
s
e
s
e
em
in
g
ly
co
n
t
r
ad
i
cto
r
y
f
in
d
i
n
g
s
m
ay
r
ef
l
ec
t
th
e
co
m
p
l
ex
i
ty
o
f
b
lo
o
d
p
r
e
s
s
u
r
e
m
an
ag
em
en
t
in
o
b
e
s
e
p
a
t
ien
t
s
an
d
th
e
n
e
ed
f
o
r
lo
n
g
er
in
te
r
v
en
tio
n
p
er
io
d
s
t
o
ac
h
i
ev
e
s
u
s
ta
in
e
d
im
p
r
o
v
em
en
t
s
a
cr
o
s
s
a
l
l
s
ev
er
ity
ca
teg
o
r
i
es
[
2
6
]
.
T
h
e
ca
teg
o
r
i
ca
l
an
a
ly
s
i
s
o
f
d
i
a
s
t
o
l
ic
b
lo
o
d
p
r
e
s
s
u
r
e
r
ev
ea
l
ed
n
o
t
ab
l
e
im
p
r
o
v
em
en
ts
,
w
it
h
th
e
p
r
o
p
o
r
t
io
n
o
f
p
at
ien
t
s
in
th
e
n
o
r
m
a
l
r
an
g
e
(
8
5
-
8
9
m
m
H
g
)
in
cr
ea
s
i
n
g
s
u
b
s
ta
n
t
ia
lly
f
r
o
m
1
1
.
8
4
%
to
2
8
.
9
5
%.
C
o
r
r
e
s
p
o
n
d
in
g
ly
,
th
e
p
r
o
p
o
r
t
i
o
n
i
n
th
e
m
ild
h
y
p
er
ten
s
i
o
n
ca
t
eg
o
r
y
(
9
0
-
9
9
m
m
Hg
)
d
ec
r
ea
s
ed
d
r
am
a
ti
ca
lly
f
r
o
m
5
3
.
9
5
%
t
o
1
8
.
4
2
%.
T
h
e
in
ter
v
en
t
io
n
d
e
m
o
n
s
tr
at
ed
m
o
d
e
s
t
ef
f
e
ct
s
o
n
B
MI
,
wi
th
th
e
p
r
o
p
o
r
t
io
n
o
f
p
ar
t
ic
ip
an
t
s
cl
a
s
s
if
ied
a
s
o
b
e
s
e
d
e
cr
e
a
s
in
g
f
r
o
m
6
9
.
7
4
%
t
o
6
4
.
4
7
%,
wh
i
le
th
o
s
e
cl
a
s
s
i
f
ied
a
s
o
v
er
we
ig
h
t
in
cr
ea
s
ed
f
r
o
m
3
0
.
2
6
%
to
3
5
.
5
3
%.
On
e
o
f
th
e
m
o
s
t st
r
ik
in
g
f
in
d
i
n
g
s
o
f
th
i
s
s
tu
d
y
w
a
s
th
e
s
u
b
s
t
an
t
ia
l
im
p
r
o
v
em
en
t
in
k
n
o
w
le
d
g
e
l
ev
e
ls
f
o
llo
w
in
g
th
e
in
te
r
v
en
tio
n
.
T
h
e
p
r
o
p
o
r
t
io
n
o
f
p
a
r
t
ic
ip
an
t
s
wi
th
g
o
o
d
k
n
o
wl
ed
g
e
(
7
6
-
1
0
0
%)
in
cr
e
as
ed
f
r
o
m
3
5
.
5
3
%
to
5
5
.
2
6
%,
r
ep
r
es
en
ti
n
g
a
n
e
ar
ly
2
0
p
er
c
en
t
ag
e
p
o
in
t
i
m
p
r
o
v
e
m
en
t.
C
o
n
cu
r
r
en
t
ly
,
th
e
p
r
o
p
o
r
tio
n
w
ith
m
o
d
er
a
te
k
n
o
w
led
g
e
(
5
6
-
7
5
%)
d
e
cr
e
a
s
ed
f
r
o
m
4
0
.
7
9
%
to
2
8
.
9
5
%
,
an
d
th
o
s
e
w
i
th
p
o
o
r
k
n
o
wl
ed
g
e
(
<5
5
%)
d
ec
r
e
a
s
ed
f
r
o
m
2
3
.
6
8
%
to
1
5
.
7
9
%.
T
h
e
s
e
im
p
r
o
v
em
en
t
s
in
k
n
o
wl
ed
g
e
ar
e
co
n
s
i
s
ten
t
wi
th
f
in
d
in
g
s
f
r
o
m
o
th
e
r
s
t
u
d
i
es
ev
alu
at
in
g
ed
u
c
at
io
n
a
l
in
t
er
v
en
t
io
n
s
f
o
r
h
y
p
e
r
t
en
s
io
n
[
2
7
]
-
[
2
9
]
.
On
l
in
e
h
ea
lt
h
ed
u
ca
tio
n
s
ig
n
if
i
ca
n
tl
y
in
f
lu
e
n
ce
s
k
n
o
w
le
d
g
e,
a
tt
i
tu
d
e
s
,
an
d
p
r
ac
ti
ce
s
r
eg
ar
d
in
g
h
y
p
er
t
en
s
io
n
a
wa
r
en
es
s
in
p
r
o
d
u
ct
iv
e
-
ag
e
p
o
p
u
la
tio
n
s
,
s
u
p
p
o
r
t
in
g
th
e
ef
f
ec
t
iv
en
es
s
o
f
d
ig
it
a
l
ed
u
ca
ti
o
n
a
l
ap
p
r
o
a
ch
e
s
.
Hea
l
th
ed
u
c
at
io
n
p
r
o
g
r
am
s
ef
f
ec
tiv
el
y
im
p
r
o
v
ed
k
n
o
w
led
g
e
an
d
p
e
r
ce
p
t
io
n
ab
o
u
t
h
y
p
er
t
en
s
io
n
am
o
n
g
u
n
i
v
er
s
ity
s
tu
d
en
ts
,
al
t
h
o
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g
h
th
e
ir
s
tu
d
y
f
o
cu
s
ed
o
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r
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n
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cy
-
in
d
u
c
ed
h
y
p
er
ten
s
i
o
n
[
2
8
]
.
T
h
e
f
am
i
ly
m
en
to
r
in
g
m
o
d
e
l
ev
a
lu
at
ed
b
y
I
b
n
u
et
a
l
.
[
2
7
]
a
ls
o
s
h
o
we
d
ef
f
ec
t
iv
en
es
s
in
i
m
p
r
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v
in
g
k
n
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g
e
,
a
tt
itu
d
e
s
,
an
d
b
eh
av
io
r
s
r
e
la
ted
to
h
y
p
e
r
ten
s
io
n
tr
ea
t
m
en
t,
h
ig
h
l
ig
h
t
i
n
g
th
e
im
p
o
r
ta
n
ce
o
f
ed
u
ca
tio
n
al
in
ter
v
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tio
n
s
in
ch
r
o
n
i
c
d
i
s
ea
s
e
m
an
ag
em
en
t.
T
h
e
im
p
r
o
v
em
en
t
s
in
h
y
p
er
t
en
s
io
n
co
n
tr
o
l
l
it
er
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cy
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e
ev
en
m
o
r
e
p
r
o
n
o
u
n
c
ed
th
an
k
n
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g
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ain
s
alo
n
e.
T
h
e
p
r
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p
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t
io
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p
ar
ti
cip
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t
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em
o
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tr
a
ti
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g
g
o
o
d
h
y
p
e
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io
n
co
n
tr
o
l
(
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%
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cr
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s
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s
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tia
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a
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h
e
p
r
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p
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tio
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tr
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d
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3
7
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e
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<5
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e
cr
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r
o
m
2
2
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3
7
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1
5
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7
9
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T
h
e
s
e
f
in
d
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g
s
s
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g
g
e
s
t
th
at
t
h
e
HI
P
O
a
p
p
li
ca
tio
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s
p
ar
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l
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f
f
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tr
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k
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to
p
r
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ti
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l h
y
p
e
r
ten
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io
n
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o
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tr
o
l b
e
h
av
io
r
s
.
T
h
e
im
p
r
o
v
em
en
ts
o
b
s
er
v
ed
i
n
th
is
s
tu
d
y
s
u
g
g
est
th
at
th
e
A
n
d
r
o
id
-
b
ased
ap
p
licatio
n
f
o
r
m
at
m
ay
b
e
p
ar
ticu
lar
ly
ef
f
ec
tiv
e
i
n
en
h
an
cin
g
h
ea
lth
liter
ac
y
,
p
o
s
s
ib
ly
d
u
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to
its
ac
ce
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ilit
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,
in
ter
ac
tiv
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d
ab
ilit
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o
p
r
o
v
id
e
p
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s
o
n
alize
d
in
f
o
r
m
at
io
n
[
3
0
]
.
T
h
e
ab
ilit
y
o
f
m
Hea
lth
in
ter
v
en
tio
n
s
to
p
r
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o
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atio
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p
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t self
-
m
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ag
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t b
eh
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i
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r
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ar
ticu
lar
ly
v
alu
ab
le
f
o
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ch
r
o
n
ic
co
n
d
itio
n
s
lik
e
h
y
p
er
ten
s
io
n
[
3
1
]
,
[
3
2
]
.
Mo
b
ile
-
b
ased
ed
u
ca
tio
n
al
in
ter
v
en
t
io
n
s
ef
f
ec
tiv
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im
p
r
o
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m
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d
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h
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liter
ac
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am
o
n
g
a
d
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lts
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s
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g
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esti
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th
at
th
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m
o
b
ile
p
latf
o
r
m
its
elf
m
ay
co
n
f
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ad
v
a
n
tag
es f
o
r
h
ea
lth
ed
u
ca
tio
n
d
eliv
er
y
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
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2
2
5
2
-
8
8
0
6
I
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t J Pu
b
lic
Hea
lth
Sci
,
Vo
l.
15
,
No
.
2
,
J
u
n
e
20
26
:
4
0
8
-
4
1
6
414
T
h
e
ac
ce
s
s
ib
ilit
y
an
d
co
n
v
en
i
en
ce
o
f
s
m
ar
tp
h
o
n
e
ap
p
licatio
n
s
m
ay
f
ac
ilit
ate
m
o
r
e
f
r
eq
u
e
n
t
en
g
ag
em
e
n
t
with
h
ea
lth
in
f
o
r
m
atio
n
c
o
m
p
ar
e
d
t
o
tr
ad
itio
n
al
clin
ic
-
b
ased
ed
u
c
atio
n
[
3
3
]
,
[
3
4
]
.
5.
CO
NCLU
SI
O
N
T
h
is
q
u
asi
-
ex
p
er
im
en
tal
s
tu
d
y
d
em
o
n
s
tr
ates
th
at
th
e
HI
PO
An
d
r
o
id
-
b
ased
ap
p
licatio
n
is
ef
f
ec
tiv
e
in
im
p
r
o
v
in
g
h
y
p
er
ten
s
io
n
c
o
n
tr
o
l
liter
ac
y
an
d
ac
h
ie
v
in
g
cli
n
ically
m
ea
n
in
g
f
u
l
r
ed
u
ctio
n
s
in
b
lo
o
d
p
r
ess
u
r
e
am
o
n
g
o
b
ese
p
atien
ts
.
T
h
e
s
ig
n
if
ican
t
im
p
r
o
v
em
en
ts
in
k
n
o
wled
g
e
(
f
r
o
m
3
5
.
5
3
%
to
5
5
.
2
6
%
with
g
o
o
d
k
n
o
wled
g
e
)
an
d
h
y
p
e
r
ten
s
io
n
co
n
tr
o
l
(
f
r
o
m
3
5
.
5
3
%
t
o
6
1
.
8
4
%
with
g
o
o
d
co
n
tr
o
l)
h
ig
h
l
ig
h
t
th
e
p
o
ten
tial
o
f
m
o
b
ile
h
ea
lth
in
ter
v
e
n
tio
n
s
f
o
r
ch
r
o
n
ic
d
is
ea
s
e
m
an
ag
em
e
n
t.
T
h
e
s
tatis
tically
s
ig
n
if
ican
t
r
ed
u
ctio
n
s
in
b
o
t
h
s
y
s
to
lic
(
1
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9
.
5
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to
1
4
4
.
4
8
m
m
Hg
)
an
d
d
iast
o
lic
(
9
5
.
2
0
to
8
8
.
5
0
m
m
Hg
)
b
l
o
o
d
p
r
ess
u
r
e
f
u
r
th
er
s
u
p
p
o
r
t
th
e
clin
ical
u
tili
ty
o
f
th
is
in
ter
v
en
tio
n
.
T
h
e
f
in
d
in
g
s
alig
n
with
th
e
g
r
o
win
g
b
o
d
y
o
f
e
v
id
en
ce
s
u
p
p
o
r
tin
g
tech
n
o
lo
g
y
-
b
ased
h
ea
lth
ed
u
c
atio
n
in
ter
v
en
tio
n
s
f
o
r
h
y
p
er
te
n
s
io
n
m
an
ag
e
m
en
t.
Fu
tu
r
e
r
esear
ch
s
h
o
u
ld
ex
p
l
o
r
e
m
e
d
iatin
g
an
d
m
o
d
er
atin
g
v
ar
ia
b
les,
s
u
ch
as
ap
p
licatio
n
u
s
ag
e
ad
h
er
en
ce
,
f
a
m
ily
s
u
p
p
o
r
t,
d
ie
tar
y
p
atter
n
s
,
an
d
p
h
y
s
ical
ac
tiv
ity
lev
els,
to
b
etter
u
n
d
er
s
tan
d
th
e
m
ec
h
an
is
m
s
u
n
d
er
ly
i
n
g
t
h
e
in
ter
v
en
tio
n
'
s
ef
f
ec
tiv
en
ess
.
Fu
r
th
er
m
o
r
e,
in
teg
r
atin
g
a
d
d
itio
n
al
f
ea
tu
r
es
i
n
to
th
e
ap
p
licatio
n
,
in
clu
d
in
g
r
ea
l
-
tim
e
telec
o
n
s
u
lt
atio
n
an
d
p
er
s
o
n
alize
d
lif
esty
l
e
m
o
d
if
icatio
n
p
r
o
g
r
am
s
,
war
r
an
ts
in
v
esti
g
atio
n
.
Fin
ally
,
co
s
t
-
ef
f
ec
tiv
en
ess
an
a
ly
s
es
ar
e
ess
en
tial
to
ass
es
s
th
e
f
ea
s
ib
ilit
y
o
f
s
ca
lin
g
th
e
HI
PO
ap
p
licatio
n
with
in
p
r
im
ar
y
h
ea
lth
ca
r
e
s
y
s
tem
s
.
T
h
is
s
tu
d
y
h
as sev
er
al
lim
itatio
n
s
,
in
clu
d
i
n
g
t
h
at
th
e
8
0
%
ap
p
u
s
ag
e
t
h
r
esh
o
ld
f
o
r
d
r
o
p
o
u
t
d
o
es
n
o
t
ac
co
u
n
t
f
o
r
q
u
alitativ
e
d
if
f
er
en
ce
s
in
u
s
er
en
g
ag
em
e
n
t
with
s
p
ec
if
ic
ap
p
f
ea
tu
r
es.
Fin
ally
,
th
e
lack
o
f
f
o
llo
w
-
u
p
ass
ess
m
en
ts
b
ey
o
n
d
th
e
p
o
s
t
-
test
p
er
io
d
p
r
ec
lu
d
es e
v
alu
atin
g
th
e
lo
n
g
-
te
r
m
s
u
s
tain
ab
ilit
y
o
f
th
e
in
t
er
v
en
tio
n
.
ACK
NO
WL
E
DG
M
E
N
T
S
T
h
e
au
th
o
r
s
wo
u
ld
l
ik
e
to
ex
p
r
es
s
s
i
n
ce
r
e
g
r
a
ti
tu
d
e
to
th
e
D
i
r
ec
to
r
o
f
Po
l
tek
k
es
Kem
en
k
e
s
Su
r
ak
ar
t
a
f
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p
r
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v
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in
s
ti
tu
t
io
n
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l
s
u
p
p
o
r
t
a
n
d
r
e
s
ea
r
ch
f
u
n
d
in
g
f
o
r
t
h
i
s
s
tu
d
y
.
W
e
ex
t
en
d
o
u
r
ap
p
r
ec
i
at
io
n
to
th
e
He
ad
o
f
th
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Sib
el
a
C
o
m
m
u
n
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ty
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en
te
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in
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r
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f
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o
f
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il
it
at
ed
t
h
e
r
e
s
ea
r
ch
im
p
l
em
en
t
at
io
n
.
S
p
ec
ia
l
th
a
n
k
s
ar
e
d
u
e
to
al
l
r
e
s
p
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en
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wh
o
p
ar
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cip
at
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in
th
is
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d
d
i
li
g
en
tly
u
s
ed
th
e
H
I
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ap
p
l
ica
ti
o
n
th
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o
u
g
h
o
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t
th
e
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ter
v
en
t
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n
p
e
r
io
d
.
W
e
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l
s
o
a
ck
n
o
w
le
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o
n
tr
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at
io
n
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p
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e
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am
wh
o
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i
s
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ed
in
c
r
ea
t
in
g
an
d
m
ain
ta
in
in
g
th
e
An
d
r
o
id
-
b
as
e
d
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y
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te
m
.
F
UNDING
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ta
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