THE LIFESTYLE ASSOCIATED WITH THE CONTROL OF ARTERIAL HYPERTENSION AND DIABETES MELLITUS IN A CARE CENTER IN LIMA, DURING THE COVID-19 PANDEMIC

ABSTRACT

Palabras clave: Estilo de vida, hipertensión arterial, diabetes mellitus, pandemia,control  to the new SARS-COV 2 coronavirus .In our country, the rst infected person was con rmed on March 6, 2020, rapidly increasing the number of cases, presenting the rst fatalities on March 19 .Therefore, a state of emergency was declared at the national level .
The containment measures allowed the exclusive gender was more affected (4.3% vs. 3.4% in men) .
Th e s e c h a n g e s i n ro u t i n e, i n c re a s e d s t re s s, unemployment, social isolation, fear of being infected by COVID-19 when attending laboratories for routine examinations, and lack of access to their usual medications can generate negative behaviors in patients' lifestyle and in the management of their diseases.On the contrary, the greater availability of time to spend with the family, cook healthily and carry out On the other hand, lifestyle is an important pillar in the prevention and treatment of NCDs.Mainly HT and DM include lifestyle modi cation in non-pharmacological treatment, especially in terms of exercise and diet.In addition, it is known that a healthy lifestyle reduces the number and doses of drugs used to manage these (3) diseases and prevent future complications .
As this issue is a worldwide concern, different countries conducted studies in the last year covering the other side of the COVID-19 pandemic, in this case, the impact that quarantine could have as a determining factor in the change in the style of life, eating habits, physical activity and routine disease control, in those patients (7,11) with chronic non-communicable diseases .In the context of the situation above, we set the following objective: To determine the association between lifestyle and the control of chronic non-communicable diseases: arterial hypertension and diabetes mellitus during the COVID-19 pandemic in patients from an Urgent Care Center.physical activity could improve the lifestyle and the (7) control of these pathologies .
An obser vational, cross-sec tional, analytical, quantitative study was carried out in an emergency care center in Lima.The Urgent Care Center (CAU) -Emergency Control Unit (UCE), is a non-pro t organization attended by patients with chronic diseases not related to COVID-19.

Variables and instruments
The main variables were: lifestyle (independent variable) and control of arterial hypertension or diabetes mellitus (dependent variable).To assess lifestyle, two types of questionnaires were used, the Lifestyle Pro le of Nola Pender, in 1987 (PEPS I), adapted (13) by Arrioja in patients with arterial hypertension, This study includes all adult patients between 30 and 79 with arterial hypertension or diabetes mellitus who attended the CAU-UCE.Those patients who had only one chronic non-communicable disease were included: arterial hypertension or diabetes mellitus who had fasting blood pressure and glucose data on their control charts.Those with both diseases were excluded.The sample size was determined using the nite population formula, for which the work of Samaneh Akbarpour,et (12) al , showing a total of 158 patients.Statistical power of 80% and a con dence level of 95% were used.A nonprobabilistic sampling was carried out because the study units have been selected for convenience, from the CAU-UCE, in the district of Lince.

INTRODUCTION
The present study was prepared to consider the ethical

Statistical Analysis
To evaluate the association between the qualitative variables, the Chi-square test of independence was used.The prevalence ratio (PR) with its respective 95% con dence inter val was used to evaluate the association between lifestyle and disease control.Of the total of 158 respondents, it is observed that 51.3% of the population is made up of the male gender; 57.6% have a married marital status, and 51.9% have a higher educational level.Regarding the age of the patients, it is observed that the age was 39-79 years, the mean was 60.9 and with a standard deviation of 9.8.
(Table 1) Control of the disease was re ected in 55.7% of the general population; It can also be shown that the majority of hypertensive patients have a healthy lifestyle (84.8%), in contrast to diabetic patients who have a higher percentage of an unhealthy lifestyle (72.2%).(Graph 1) With regard to BMI, overweight prevails in the population with 48.7% and an abdominal circumference with high risk in 36.7%.(Table 1) spreadsheet, where validation criteria were included to avoid possible typing errors.
The quantitative variables were analyzed through measures of central tendencies, such as the mean.The measures of dispersion used to evaluate the frequency distribution of the variables were the mean and standard deviation when the distribution approached a normal one.For the qualitative variables, tables of frequencies and contingency were constructed.
which consists of 36 questions, showing a nal score, where a score of 36 to 58 quali es as unhealthy and from 59 to 144 as healthy.The general scale had Cronbach's Alpha 0.90, which is why it is considered (14) acceptable .Likewise, the questionnaire "Instrument to Measure the Lifestyle in Diabetics" (IMEVID) applied in patients with type 2 diabetes mellitus was used in a study carried out by Guzman and Ttupa, where a Cronbach's Alpha was obtained from 0.85 total instruments.( fteen) This questionnaire consists of 25 questions, showing a nal summation, where 0 to 74 points are considered unhealthy, and from 75 to 100 points is considered healthy.
To interpret and classify the results of the clinical variables related to the control of the disease in patients with HT and / or DM, the Ministry of Health's Clinical Practice Guide for the Diagnosis, Treatment and Control of hypertensive arterial disease and diabetes mellitus was used.Those who presented the last 6 blood pressure measurements <= 140/90 mmHg in the case of Other variables studied were: age group, gender, marital status, educational level, length of illness, personal history of COVID-19, family history of COVID-19, and comorbidity.Likewise, during triage, the abdominal perimeter was measured, classifying the patient as normal risk (women <82cm, men <95 cm), high (women 82-87 cm, men 95-101 cm), and very high (women > 87 cm, males> 101 cm), height and weight were measured to obtain the calculation of the body mass index (BMI).The values were noted on the data collection form.

Procedures
Participation was openly voluntary, and written informed consent was requested from each participant w h o m e t t h e s t u d y 's i n c l u s i o n c r i t e r i a .T h e questionnaires were applied to the patients during the waiting time for their appointment in the general medical office, from 9:00 a.m. to 3:00 p.m., between October and November of 2020.Weight and height measurements were carried out, and abdominal girth using a smart scale and tape measures.Subsequently, the data collected was stored in a Microsoft Excel hypertensive patients were classi ed as "controlled patients"; and the last 2 fasting blood glucose measurements <= 130 mg / dL in the case of the diabetic patient.2) Regarding comorbidities, 43.7% of the population does present some other disease, the most frequent being: dyslipidemia, osteoarthritis and migraine.

Gender
In the bivariate analysis of patients with arterial hypertension, it is evident that the variables that showed a signi cant association with the lack of control

DISCUSSION
In the present study, a signi cant association between unhealthy lifestyle and non-control of HT and DM2 was determined in patients who attended the Emergency Care Center -UCE, during the COVID-19 pandemic.
Within the population with arterial hypertension, the prevalence of non-control of NCD was 1.5 times more in patients with an unhealthy lifestyle than those with a healthy lifestyle (PR = 2.538; p = 0.000; 95% CI = 1.608-

4.006). A study carried out by Hernández et al., in
Mexico, in 306 hypertensive patients obtained similar results.They concluded that there is a signi cant association between lifestyle and control of hypertension, demonstrating that patients with worse lifestyles do not present control of disease (p = (16) 0.0001) .Yokokawa et al, in a study conducted in Japan in hypertensive patients, revealed that maintaining a healthy lifestyle was a signi cant protective factor to in achieving target blood pressure: (17) <140/90 mmHg (OR = .51;95% CI = 0.36-0.72) .
In the present investigation, it was obtained that the population of patients with type 2 diabetes mellitus shows a signi cant association between an unhealthy lifestyle and the lack of control of the diabetic disease (PR = 5.498; p = 0.013; 95% CI = 1, 995).In a study similar to ours, carried out in Cajamarca by Asenjo, in a total of 102 patients with DM2, it was concluded that there is a direct and signi cant relationship between It is known that con nement generates high levels of stress, which affects the balance in the sympatheticp a r a s y m p a t h e t i c n e r v o u s s y s t e m a n d t h e hypothalamic-pituitary-adrenal axis, causing direct cardio-stimulatory effects (positive chronotrope and inotrope), vasopressor effects, increased insulin resistance, increased lipolysis and acceleration of the atherosclerotic process, negatively affecting the (11) cardiovascular and metabolic system .Likewise, Laura In the context of conducting this study in the midst of a pandemic in conjunction with those described above, Mattioli et al. emphasize that the change in lifestyle and routine activities are consequences of stress related to con nement, which includes changes in nutritional habits, which may be due to less availability of products in the market, limited access to stores due to changes in their opening hours and the preference for unhealthy foods (processed foods, packaged foods) for their longer duration, as the large amounts of salt, sugar or (11) trans fats they contain increase their life span useful .(18) lifestyle and metabolic control (p <0.001) .Likewise, the study carried out by Vásquez et al.In Mexico, a sample of 330 patients with DM2 was taken, it was found that a good lifestyle is a protective factor for glycemic control (OR = 0.026; p = 0.001; 95% CI = 0.009-0.077),unlike our study In this, HbA1c <7% was used as (19) a glycemic control parameter .(20) associated with adequate glycemic control .On the other hand, Vásquez et al., evidence in their study that the increase in BMI is signi cantly associated with the increased risk of glycemic uncontrol in patients with (19) DM2 (OR = 2.70; p = 0.001; 95% CI =2.00-3.65) .
In the present study, the history of COVID-19 is divided into two categories, one indicates the personal history of having had the disease, and the other indicates the history that a relative who lives with the patient presented the disease.According to this, it is evident that there is no signi cant association between this variable and the control of the disease.It is known that those people who suffer from CNCD and become infected with COVID-19 have a high probability of progressing to severe disease, with a signi cant increase in mortality, with arterial hypertension and d i a b e t e s m e l l i t u s b e i n g t h e m o s t f r e q u e n t comorbidities in patients hospitalized for COVID-19.

CONCLUSIONS
A healthy lifestyle is signi cantly associated with the control of arterial hypertension and also with type 2 diabetes mellitus in adult patients during the COVID-19 pandemic.On the other hand, non-control of diabetes mellitus is 1.6 times more prevalent in diabetic patients with abnormal abdominal girth than in diabetic patients with normal abdominal girth.Finally, the sociodemographic factors (age group, gender, marital status, educational level) did not signi cantly affect hypertension and Dm2.
This would be consistent with a study carried out virtually by Chudasama on 202 health professionals in 47 different countries, most of them belonging to the European continent (47%), where it is evidenced that most of the patients had a negative impact on the routine care of their chronic diseases since the beginning of the pandemic (46%), and 47.8% of the population was affected by the shortage of medicines; also reports that diabetes and arterial hypertension (30%) were the two comorbidities for which care was (10) most affected in this quarantine period .
Likewise, the present study shows that in the population with type 2 diabetes mellitus, the abdominal girth of pathological risk and glycemic lack of control were shown to have a signi cant association (p = 0.038), with a prevalence of non-control of the disease of 1.6 times more in those patients with pathological risk abdominal girth compared to patients with normal abdominal girth (OR = 2.623; 95% CI =1.057-6.508).It is known that multiple factors intervene in the control of the disease, one of the most studied is the anthropometric values (BMI and abdominal circumference).Obesity (BMI> 30) is considered a pro-in ammatory state; Likewise, the increased abdominal girth is considered a marker of insulin resistance.Both parameters are usually Di Renzo et al., in their study carried out on 3,533 people in Italy, observed that 37.3% of the population had modi cations in their lifestyle and eating habits during the quarantine pandemic by where (8) 16.7% made positive modi cations .In the same way, in the study by Cancello et al, carried out in northern Italy, in a sample of 490 adults, it is concluded that more than a third of the people were able to make a positive change in their styles life during (7) home quarantine .In contrast to this, Muhammad's study applied to 181 participants in Pakistan shows that 45% of the population had a negative effect on their health, pointing out certain challenges due to quarantine: difficulty exercising (66%), missing to their routine check-ups (53%) and to miss their regular (9) laboratory tests (42%) .
principles for medical research in human beings of the Declaration of Helsinki of the World Medical Association and its subsequent amendments.It was developed in the INICIB thesis degree course and had the approval of the Research Ethics Committee of the Faculty of Human Medicine of the Ricardo Palma University.
Finally, the adjusted PRs were calculated through a Poisson regression model.The processing, recoding and validation, and statistical analysis were carried out in SPSS version 25.
hypertension.DM: Type 2 diabetes mellitus Figure1.Lifestyle frequency according to arterial hypertension and type 2 diabetes mellitus.

Finally
, in the multivariate analysis of the diabetic population, a signi cant association was obtained between the non-control of diabetes mellitus with the following variables: unhealthy lifestyle (PR = 5.498; p glucémico, presión arterial.

Table 1 .
General characteristics of the population in an Emergency Care Center, period October -December 2020.
Multivariate analysis of patients with type 2 diabetes mellitus in theEmergency Care Center, October -December 2020.