Knowledge, dietary habits, and perception of hypertension risk factors among undergraduates in Owerri

 Corresponding author: Ngozi Victoria Akam Copyright © 2025 Author(s) retain the copyright of this article. This article is published under the terms of the Creative Commons Attribution Liscense 4.0. Knowledge, dietary habits, and perception of hypertension risk factors among undergraduates in Owerri Ngozi Victoria Akam *, Precious Ogadinma Ebinike, Chiamaka Judith Ezenwa, Joy Nkechinyere Osuoji, Eleanor Nneka Asuzu and Joy Adaku Mbachu Department of Public Health, Federal University of Technology Owerri, Imo State, Nigeria. World Journal of Biology Pharmacy and Health Sciences, 2025, 23(03), 218–238 Publication history: Received on 30 July 2025; revised on 11 September 2025; accepted on 13 September 2025 Article DOI: https://doi.org/10.30574/wjbphs.2025.23.3.0817 Abstract Hypertension is a major global health challenge and a leading cause of cardiovascular morbidity and mortality. This study examined dietary practices, knowledge, and perceptions of hypertension among 438 undergraduate students at the Federal University of Technology, Owerri, using a structured questionnaire. Knowledge about hypertension was high (89%), but misconceptions persisted, with 69.6% believing hypertension presents with early symptoms. Informal sources were the predominant means of knowledge acquisition (62.6%), raising concerns about accuracy. Dietary patterns revealed frequent consumption of starchy foods, sugary beverages, and energy drinks, which are linked to increased hypertension risk, alongside moderate intake of fruits and vegetables. Positive perceptions regarding salt reduction (92.4%) and exercise (80.8%) suggest effective public health messaging, yet gaps remain concerning processed foods and beverage-related risks. No significant association was found between starch and beverage consumption and knowledge levels across genders. However, a significant association was observed between dietary practices and perceptions among females (p = 0.005), suggesting gender differences in how diet influences attitudes towards hypertension. These findings emphasize that awareness alone does not consistently translate into healthier practices. Targeted, gender-sensitive interventions that integrate accurate health education with behavioral strategies, environmental supports, and access to affordable healthy foods are needed. Strengthening campus-based health promotion programs to correct misconceptions and encourage healthier eating behaviors is critical for reducing hypertension risk and improving long-term health outcomes among university students. Keywords: Hypertension; Risk Factors; Perception; Dietary Habits 1. Introduction Hypertension, commonly referred to as high blood pressure, is a condition characterized by persistently elevated pressure within the blood vessels. Blood is circulated from the heart to the rest of the body through these vessels, and with each heartbeat, the heart generates pressure by pumping blood into the arteries. Blood pressure results from the force exerted by circulating blood against arterial walls, and excessive pressure increases the workload of the heart. Hypertension is a major medical concern as it significantly raises the risk of cardiovascular, cerebrovascular, renal, and other systemic diseases. Globally, it is one of the leading causes of premature mortality, affecting more than one billion people, approximately one in four men and one in five women. Lowand middle-income countries bear the greatest burden, accounting for nearly two-thirds of cases, a trend linked to the rising prevalence of modifiable risk factors in these populations (1). The current definition of hypertension (HTN) is systolic blood pressure (SBP) values of 130 mm Hg or more and/or diastolic blood pressure (DBP) of more than 80 mm Hg) (2). As one of the most important contributors to cardiovascular World Journal of Biology Pharmacy and Health Sciences, 2025, 23(03), 218–238 219 and renal diseases worldwide, hypertension accounts for more than 10 million deaths annually. In Nigeria, its prevalence has been rising steadily over recent decades, with regional estimates ranging from 22% to 44% (3). The university setting in Nigeria represents a critical developmental stage, where young adults transition to independent living and begin making autonomous lifestyle choices, including dietary habits (4). These changes often foster unhealthy behaviors that increase susceptibility to hypertension. Beyond lifestyle factors, the level of knowledge and perception of hypertension within this demographic also strongly influences risk. As a chronic non-communicable disease, hypertension presents a substantial public health challenge both globally and in Nigeria. Recent evidence highlights the growing prevalence among young adults, including undergraduate students in Nigerian universities. The increasing adoption of unhealthy dietary practices, compounded by limited awareness of hypertension and its associated risks, may be driving this trend. While dietary behavior is a critical determinant in the development and management of hypertension (5), there remains a limited understanding of how undergraduate students in Nigerian universities perceive the condition and how their knowledge and dietary practices shape their risk. This study aimed to explore the dietary habits, knowledge, and perception of risk factors of hypertension among undergraduate students at the Federal University of Technology, Owerri. 1.1. Research Hypothesis H0 (Null Hypothesis): There is no significant association between knowledge of hypertension risk factors and dietary habits of undergraduate students in Owerri. HA (Alternate Hypothesis): There is a significant association between knowledge of hypertension risk factors and dietary habits of undergraduate students in Owerri. 2. Materials and Methods This study was a cross-sectional descriptive study. The Federal University of Technology Owerri (FUTO) is a Federal Government-owned University in Owerri West, Owerri, the capital of Imo State, Nigeria. The National Universities Commission's recommendation that a minimum area of ten thousand (10,000) acres, or 4,048 hectares, should be obtained based on the location, the relative lack of human settlements within the area, and other pertinent factors served as the basis for the site's selection. It is situated 25 kilometers south of Owerri. The sample size was determined using Taro Yamane’s formula, n = N∕1+N(e2) Sample size calculated with 10% non-response rate was 438. Multi-stage simple random sampling procedure was used for this study. 2.1. Stage 1: Selection of Faculties Simple random sampling was used to select 5 faculties out of the 11 in the University. This was done via balloting without replacement to give every faculty in the university an equal chance of being selected. 2.2. Stage 2: Selection of departments Simple random sampling was used to select 2 departments from each of the 5 faculties that were randomly selected in the study area. This was done via balloting without replacement to give every department an equal chance of being selected. 2.3. Stage 3: Selection of level/ year of study Simple random sampling was used to select 3 levels from each of the 2 departments previously selected. This was done via balloting without replacement to give every level an equal chance of being selected. 2.4. Stage 4: Selection of respondents In each of the selected levels, respondents who gave consent were included in the study until the desired number was reached. World Journal of Biology Pharmacy and Health Sciences, 2025, 23(03), 218–238 220 The instrument for data collection was a structured, validated self-administered questionnaire. A total of four hundred and thirty-eight (438) copies of questionnaires were distributed to the students and the same number were retrieved. The questionnaire was divided into four sections: (Section A: Socio-demographic characteristics; Section B: Knowledge about hypertension risk factors; Section C: Perception toward hypertension; and Section D: Dietary habits of respondents). The purpose of the research was explained to each respondent, and verbal informed consent was obtained from them before inclusion in the study. Also, the anonymity of the respondents was ensured. The confidentiality of the information they gave was maintained. The Statistical Package for the Social Sciences (SPSS) version 22 was used in the analysis of the data obtained from the study. 3. Results Table 1 below shows the socio-demographic characteristics of respondents. Among the respondents, 282 are female, constituting the majority at 64.4%, while 156 are male, making up 35.6% of the sample. The majority of respondents, 263, fall within the 21-26 age group, comprising 60.0% of the sample. 137 respondents are aged 15-20, representing 31.3%, while only 38 respondents, or 8.7%, are 27 years and above. The highest representation is from 500-level students, with 158 respondents, accounting for 36.1% of the sample. 116 respondents from 300 level constitute 26.5%. A vast majority of respondents, 422, are single, making up 96.3% of the sample. Only 13 respondents are married, representing 3.0%. The largest group of respondents, 52.5% hail from Imo State. Several respondents, 206, have a monthly allowance of less than 20,000 Naira, comprising 47.0% of the sample. 45 respondents have an allowance above 50,000 Naira, making up 10.3%. The majority of respondents, 309, occupy positions within the first to third birth order in their families, accounting for 70.5% of the sample. 129 respondents, or 29.5%, are from the fourth birth order and above. Table 1 Socio-demographic characteristics of respondents Variable Frequency Percent Cumulative Percent Gender Female 282 64.4 64.4 Male 156 35.6 100.0 Total 438 100.0 100.0 Age 15-20 137 31.3 31.3 21-26 263 60.0 91.3 27 and above 38 8.7 100.0 Total 438 100.0 100.0 Current level 100 L 61 13.9 13.9 200 L 51 11.6 25.6 300 L 116 26.5 52.1 400 L 49 11.2 63.2 500 L 158 36.1 99.3 600 L 3 0.7 100.0 Total 438 100.0 100.0 Marital status World Journal of Biology Pharmacy and Health Sciences, 2025, 23(03), 218–238 221 Married 13 3.0 3.0 Single 422 96.3 99.3 Widowed 3 0.7 100.0 Total 438 100.0 100.0 Monthly allowance 20,000 - 30,000 117 26.7 26.7 30,001 - 40,000 52 11.9 38.6 40,001 - 50,000 18 4.1 42.7 Above 50,000 45 10.3 53.0 Less than 20,000 206 47.0 100.0 Total 438 100.0 100.0 Position in the family 1st - 3rd 309 70.5 70.5 4th & above 129 29.5 100.0 Total 438 100.0 100.0 Table 2 below summarizes findings on the knowledge of hypertension risk factors and causes. The findings indicate that a substantial majority of respondents (89%) have heard of hypertension, whereas only 11% reported no prior knowledge. This high awareness level suggests that public health education and general exposure to information about hypertension have been somewhat effective. However, the presence of individuals who remain unaware highlights the need for continued awareness campaigns, particularly targeting vulnerable or less-informed populations. Analysis of the sources of information about hypertension revealed that the most common source was categorized as “Others” (62.6%), likely encompassing interpersonal communication through family, friends, and community networks. Formal education accounted for 20% of awareness, while social media (9.2%) and internet resources (8.2%) were less frequently cited. These findings imply that informal social channels play a predominant role in knowledge dissemination. While this may enhance reach, it also increases the potential for misinformation. Consequently, there is an urgent need to integrate accurate health information into both formal education and digital media platforms to strengthen the reliability of information available to the public. Respondents’ knowledge regarding specific characteristics of hypertension varied considerably: The majority (86.1%) recognized that hypertension is linked to several risk factors, although a small proportion (3%) disagreed, and 10.9% were uncertain, suggesting incomplete understanding among some individuals. While 74.2% correctly identified hypertension as a chronic disease, 14.8% disagreed, reflecting a misconception that could impact treatment adherence. A significant proportion (80.4%) understood the relationship between hypertension and cardiovascular complications. However, 8.7% did not recognize this association, indicating a need for enhanced cardiovascular risk education. Nearly universal awareness (88.4%) was observed regarding the fact that hypertension affects both men and women, signifying a strong general understanding in this domain. Awareness that hypertension can be hereditary was reported by 74.2% of respondents, whereas 14.2% disagreed and 11.6% were uncertain, highlighting confusion about genetic predisposition. Approximately 71.5% identified a sedentary lifestyle as a contributing factor, yet 15.5% disagreed, underscoring a lack of recognition of behavioral risk factors. Over half (56.6%) believed that hypertension can be cured, while 31.7% disagreed. This reflects a critical misconception, as hypertension is generally a lifelong condition that can be managed rather than cured. World Journal of Biology Pharmacy and Health Sciences, 2025, 23(03), 218–238 222 A majority (69.6%) believed that hypertension presents symptoms at an early stage, which is inaccurate for many cases. This misunderstanding could lead to delayed diagnosis and treatment, given that hypertension is often asymptomatic in its initial stages. A high proportion (85.2%) correctly acknowledged that hypertension can lead to sudden death, demonstrating awareness of its severity. Overall, the data demonstrate a relatively high level of awareness regarding hypertension, with strong knowledge of its seriousness and association with heart disease. However, several misconceptions persist, particularly concerning its curability, asymptomatic nature, and genetic basis. These gaps in understanding have significant implications for preventive strategies and treatment adherence. Table 2 Knowledge about Hypertension Risk Factors Variable Response Frequency Percent Hypertension Heard of Hypertension No 48 11.0 Yes 390 89.0 Total 438 100.0 Source of Information School 78 20.0 Social media 36 9.2 Internet 32 8.2 Others 244 62.6 No response 48 10.9 Total 438 100.0 Hypertension Factors Hypertension is Linked to Many Factors No 13 3.0 Yes 377 86.1 Uncertain 48 10.9 Total 438 100.0 Hypertension is a Chronic Disease No 65 14.8 Yes 325 74.2 Uncertain 48 10.9 Total 438 100.0 Hypertension is Associated with Heart Disease No 38 8.7 Yes 352 80.4 Uncertain 48 10.9 Total 438 100.0 Hypertension Can Affect Both Genders No 3 0.7 Yes 387 88.4 World Journal of Biology Pharmacy and Health Sciences, 2025, 23(03), 218–238 223 Uncertain 48 10.9 Total 438 100.0 Hypertension Can Be Genetic No 62 14.2 Yes 325 74.2 Uncertain 51 11.6 Total 438 100.0 Hypertension is Linked to Sedentary Lifestyle No 68 15.5 Yes 313 71.5 Uncertain 57 13.0 Total 438 100.0 Hypertension Can Be Cured No 139 31.7 Yes 248 56.6 Uncertain 51 11.6 Total 438 100.0 Hypertension Has Symptoms at the Early Stage No 82 18.7 Yes 305 69.6 Uncertain 51 11.6 Total 438 100.0 Hypertension Can Lead to Sudden Death No 17 3.9 Yes 373 85.2 Uncertain 48 10.9 Total 438 100.0 Table 3 below summarizes the respondents' perception of hypertension. 47% positive perception means that less than half of respondents disagree that “Hypertension is not a disease.” This suggests a significant misconception: many people may not view hypertension as a serious medical condition, which could affect early detection and treatment. Only 18.9% positive perception for “Hypertension is found in only older people” indicates that most respondents think hypertension is mainly an old-age problem, which is a misconception. This perception can result in an underestimation of risk in younger adults, delaying prevention strategies. 92.4% positive perception on reducing salt intake is very high, showing strong awareness of dietary risk factors. This is encouraging and suggests that public health messages on salt reduction are effective. World Journal of Biology Pharmacy and Health Sciences, 2025, 23(03), 218–238 224 60% positive perception for “Hypertension is more common among rich people” means that many people still associate it with affluence. While historically considered a “disease of affluence,” this is outdated because hypertension now affects all social classes. Misconception here could lead to risk neglect in lower-income groups. 53.1% positive perception about processed food causing hypertension shows moderate awareness. Nearly half are unsure or disagree, which means that more education is needed about processed foods and salt content. 80.8% positive perception that exercise reduces BP is very high. This reflects a good understanding of lifestyle interventions, although about 20% still doubt this, which is concerning. A 72.4% positive perception indicates that most people correctly associate fried foods with an increased risk of hypertension. This is positive, but 21.5% neutrality or disagreement suggests some gaps in awareness. A 68.9% positive perception indicates that a majority believe fruits and vegetables are beneficial, but a significant 31% either agree they are not or are neutral, which is a major misconception. A 53.2% positive perception indicates a mixed understanding of the relationship between seasoning cubes and blood pressure. This is a critical gap, as seasoning cubes are common in many diets and are high in sodium, which can increase blood pressure. Table 3 Perception of Hypertension Hypertension is not a disease Response Frequency Percent Strongly Agree 73 16.7 Agree 99 22.6 Neutral 60 13.7 Disagree 124 28.3 Strongly Disagree 82 18.7 Total 438 100 Positive perception: 47% Hypertension is found only in older people Response Frequency Percent Strongly Agree 118 26.9 Agree 160 36.5 Neutral 77 17.6 Disagree 64 14.6 Strongly Disagree 19 4.3 Total 438 100 Positive perception: 18.9% World Journal of Biology Pharmacy and Health Sciences, 2025, 23(03), 218–238 225 Reducing salt intake is good Response Frequency Percent Strongly Disagree 3 0.7 Disagree 6 1.4 Neutral 24 5.5 Agree 157 35.8 Strongly Agree 248 56.6 Total 438 100 Positive perception: 92.4% Hypertension is more common among rich people Response Frequency Percent Strongly Agree 15 3.4 Agree 24 5.5 Neutral 136 31.1 Disagree 163 37.2 Strongly Disagree 100 22.8 Total 438 100 Positive perception: 60% Eating processed canned food causes Hypertension Response Frequency Percent Strongly Disagree 12 2.7 Disagree 68 15.5 Neutral 125 28.5 Agree 143 32.6 Strongly Agree 90 20.5 Total 438 100 Positive perception: 53.1% Exercise can reduce blood pressure Response Frequency Percent Strongly Disagree 9 2.1 Disagree 27 6.2 Neutral 48 11.0 Agree 190 43.4 Strongly Agree 164 37.4 Total 438 100 Positive perception: 80.8% World Journal of Biology Pharmacy and Health Sciences, 2025, 23(03), 218–238 226 Fried foods increase risk of hypertension Response Frequency Percent Strongly Disagree 6 1.4 Disagree 21 4.8 Neutral 94 21.5 Agree 223 50.9 Strongly Agree 94 21.5 Total 438 100 Positive perception: 72.4% Fruits and vegetables cannot help blood pressure Response Frequency Percent Strongly Agree 57 13.0 Agree 21 4.8 Neutral 58 13.2 Disagree 185 42.2 Strongly Disagree 117 26.7 Total 438 100 Positive perception: 68.9% Use of seasoning (i.e., Knorr cubes) increases blood pressure Response Frequency Percent Strongly Disagree 9 2.1 Disagree 56 12.8 Neutral 140 32.0 Agree 163 37.2 Strongly Agree 70 16.0 Total 438 100 Positive perception: 53.2% Tables 4 A, B, C, and D give details on the dietary behavior of the respondents in this study. The analysis of seven common starchy foods (n = 438) in Table 4A below shows different consumption patterns. The results highlight strong preferences for both traditional and modern foods. Rice is the most consumed food in the diet. Almost all people (88.1%) eat rice at least twice a week. A large number (18.0%) eat it every day. This shows that rice is a fundamental part of the diet, likely because it is versatile, and widely accepted. Spaghetti and Noodles (like Indomie) are often eaten. Spaghetti is consumed multiple times a week by 44.5% of people, and noodles by 27.2%. This shows that these modern, wheat-based foods are not just occasional meals. They are now a regular part of the weekly diet, reflecting changing tastes and convenience. Traditional foods like beans, yams, and potatoes are usually eaten only once a week.61.2% eat beans once a week, 62.8% eat yam once a week, while 78.3% eat potatoes once a week. This suggests these foods are no longer everyday staples. World Journal of Biology Pharmacy and Health Sciences, 2025, 23(03), 218–238 233 Soft Drinks Daily 43 9.8 9.8 2-6 times a week 206 47.0 56.8 Once a week 171 39.0 95.8 Rarely 18 4.1 100.0 Total 438 100.0 100.0 Energy Drinks Daily 38 8.7 8.7 2-6 times a week 77 17.6 26.3 Once a week 272 62.1 88.4 Rarely 51 11.6 100.0 Total 438 100.0 100.0 Caffeinated Drinks Daily 25 5.7 5.7 2-6 times a week 65 14.8 20.5 Once a week 255 58.2 78.7 Rarely 93 21.2 100.0 Total 438 100.0 100.0 Alcohol Daily 15 3.4 3.4 2-6 times a week 21 4.8 8.2 Once a week 198 45.2 53.4 Rarely 204 46.6 100.0 Total 438 100.0 100.0 Table 5 below shows the association between dietary behavior and level of knowledge across genders. A high score indicates that the individual consumes starchy foods and takes beverages almost on a daily basis, while a low score communicates otherwise. Female respondents (n = 282): Among those with high starch & beverage scores (n = 170), 94 had high knowledge, 19 had low knowledge, and 57 had moderate knowledge. For those with low starch & beverage scores (n = 112), 73 had high knowledge, 6 had low knowledge, and 33 had moderate knowledge. The association was not statistically significant (p = 0.132). Male respondents (n = 156): Among those with high starch & beverage scores (n = 90), 46 had high knowledge, 13 had low knowledge, and 31 had moderate knowledge. For those with low scores (n = 66), 29 had high knowledge, 13 had low knowledge, and 24 had moderate knowledge. This association was also not statistically significant (p = 0.583). World Journal of Biology Pharmacy and Health Sciences, 2025, 23(03), 218–238 234 Overall (n = 438): Respondents with high starch & beverage scores (n = 260) recorded 140 with high knowledge, 32 with low knowledge, and 88 with moderate knowledge. Those with low scores (n = 178) had 102 with high knowledge, 19 with low knowledge, and 57 with moderate knowledge. Overall, the association was not statistically significant (p = 0.749). Across all comparisons, there was no significant association (NS) between starch & beverage score levels and knowledge level among both male and female respondents. Table 5 Association between dietary behavior and knowledge level Gender Knowledge Level Total High Low Moderate p-value Decision Female Starch & Beverage score level High 94 19 57 170 0.132 NS Low 73 6 33 112 Total 167 25 90 282 Male Starch & Beverage score level High 46 13 31 90 0.583 NS Low 29 13 24 66 Total 75 26 55 156 Total Starch & Beverage score level High 140 32 88 260 0.749 NS Low 102 19 57 178 Total 242 51 145 438 Female respondents (n = 282): Among females with high starch & beverage scores (n = 170), 12 had high perception, 34 had low perception, and 124 had moderate perception. For those with low scores (n = 112), 17 had high perception, 9 had low perception, and 86 had moderate perception. The association was statistically significant (p = 0.005), indicating that starch & beverage score level influences perception level among females. Male respondents (n = 156): Among males with high scores (n = 90), 4 had high perception, 14 had low perception, and 72 had moderate perception. For those with low scores (n = 66), 3 had high perception, 17 had low perception, and 46 had moderate perception. This association was not statistically significant (p = 0.282). Overall (n = 438): Respondents with high scores (n = 260) recorded 16 with high perception, 48 with low perception, and 196 with moderate perception. Those with low scores (n = 178) had 20 with high perception, 26 with low perception, and 132 with moderate perception. Overall, the association was not statistically significant (p = 0.118). There was a significant association among females between starch & beverage score level and perception level, but no significant association among males. Table 6 Association between dietary behavior and perception level across genders. Gender Perception level Total High Low Moderate p-value Decision Female Starch & Beverage score level High 12 34 124 170 0.005 S Low 17 9 86 112 Total 29 43 210 282 Male Starch & Beverage score level High 4 14 72 90 0.282 NS Low 3 17 46 66 World Journal of Biology Pharmacy and Health Sciences, 2025, 23(03), 218–238 235 Total 7 31 118 156 Total Starch & Beverage score level High 16 48 196 260 0.118 NS Low 20 26 132 178 Total 36 74 328 438 4. Discussion This study found that 89% of participants had heard of hypertension, while 11% were unaware, highlighting a generally high level of baseline awareness. This aligns with a comprehensive Nigerian survey that reported awareness rates around 60%, with signs of improvement over time, notably closing the urban–rural gap (Awareness: 62.2% urban vs. 56.6% rural) (6). However, awareness alone is insufficient; the results suggest that knowledge quality varies by source. The predominance of informal sources (“Others” – 62.6%) over formal education (20%) or digital media (social media 9.2%, internet 8.2%) raises concerns about information accuracy. This trend confirms findings from other LMIC contexts, where reliance on informal networks can perpetuate myths (e.g., beliefs in traditional cures) and impede evidencebased understanding (7). A majority (69.6%) incorrectly believed hypertension manifests symptoms early. This is problematic given that hypertension is often a silent condition. Globally, around 46% of people with hypertension remain unaware of their condition. Misconceptions about symptoms may reduce screening uptake and delay diagnosis. In another study, only 40.1% recognized that hypertension might be asymptomatic (8). The strong positive perception regarding salt reduction (92.4%) and exercise (80.8%) echoes the effectiveness of public health messaging around these modifiable risk factors. Salt-reduction interventions, including education, behavioral programs, and self-monitoring have demonstrated effectiveness in lowering both systolic and diastolic blood pressure in different places (9) The moderate-to-high positive perceptions associated with fried foods (72.4%) and fruits and vegetables (68.9%) also reflect partial recognition of dietary impacts. The Dietary Approaches to Stop Hypertension (DASH) diet, rich in fruits, vegetables, and low-fat dairy, has been proven to significantly reduce blood pressure among individuals (10). The belief that hypertension is more common among rich people (60% positive perception by disagreement) points to a shift from outdated paradigms. However, it underestimates current data showing that low socioeconomic status groups often bear a disproportionate hypertension burden. The moderate awareness of processed or canned foods (53.1%) and seasoning (53.2%) as risk factors suggest these are underemphasized in public messaging. Given the high sodium content of such items, especially seasoning cubes, which are prevalent in some cultures, these knowledge gaps are concerning. The high consumption of processed fruit juices, soft drinks, and energy drinks seen in the study reinforces the need for efforts to promote healthy beverage choices and limit the intake of sugary beverages, which are known contributors to hypertension risk. Meta-analytic data from cohort and cross-sectional studies highlight a consistent positive association between sugar-sweetened beverage consumption and hypertension (11). The hypertensive effect of energy drinks is acute and well-documented, primarily due to the combination of high caffeine and sugar. A randomized controlled trial demonstrated that consuming 32 oz of a commercial energy drink resulted in a markedly higher elevation in blood pressure over 24 hours compared to a control caffeine beverage with the same amount of caffeine (12). The dietary patterns observed among respondents in this study provide valuable insights into potential risk factors for hypertension. The majority of respondents consume rice and yam frequently, with substantial proportions consuming them 2-6 times a week or daily. Both rice and yam are starchy carbohydrates that can contribute to elevated blood glucose levels if consumed in large quantities. Excessive carbohydrate intake, especially refined carbohydrates, has been associated with insulin resistance and hypertension risk. The consumption of fruits such as oranges, bananas, watermelon, pineapples, and vegetables like cucumber and leafy greens is relatively high among respondents. These World Journal of Biology Pharmacy and Health Sciences, 2025, 23(03), 218–238 236 foods are essential components of a balanced diet and are associated with lower hypertension risk due to their fiber, potassium, and antioxidant content. The study revealed no statistically significant association between starch & beverage score levels and knowledge levels across gender groups (p > 0.05). While respondents with high starch & beverage scores appeared to have slightly higher proportions of high knowledge compared to those with low scores, these differences lacked statistical significance. This suggests that dietary patterns related to starch and beverage consumption may not be strongly influenced by knowledge of hypertension or nutrition. Similar findings have been reported in studies where nutritional knowledge did not necessarily translate into healthier eating behaviors, indicating a gap between knowledge and practice (13;14). Interestingly, previous research suggests that gender often influences nutrition knowledge and health-seeking behavior, with women typically exhibiting higher health literacy and healthier dietary choices (15,16). However, the current findings demonstrate that when starch & beverage scores were considered, gender did not modify the relationship between diet and knowledge level. This aligns with studies that emphasize the role of cultural, socioeconomic, and environmental factors over biological gender differences in shaping dietary behaviors and knowledge (17). The lack of association may also reflect behavioral theories that knowledge alone is insufficient to change behavior. Factors such as taste preferences, food affordability, convenience, and cultural norms play a significant role in shaping dietary habits, regardless of knowledge level (14). This highlights the need for interventions that combine education with behavioral strategies, environmental changes, and affordability measures to encourage healthier food choices. The findings revealed a significant association among females (p = 0.005) between starch & beverage score levels and perception levels, while the association among males (p = 0.282) and the overall population (p = 0.118) was not significant. This suggests that dietary patterns, specifically starch and beverage consumption, may influence perception toward hypertension and related health behaviors in women more than in men. This result aligns with prior research indicating that women are often more responsive to health education and dietrelated interventions compared to men (15). Women’s greater involvement in meal preparation and household nutrition decisions could explain why their perceptions are more sensitive to dietary factors (17). However, the lack of association among males and in the combined sample indicates that perception is influenced by multiple determinants beyond diet, including cultural norms, education, and socioeconomic status (14). The predominance of moderate perception levels (328 respondents overall) suggests that while awareness exists, it may not be strong enough to translate into consistently positive attitudes and behaviors toward hypertension prevention. The significant relationship in females could reflect higher health consciousness and nutritional awareness among women, as observed in studies from similar contexts (15). On the other hand, the absence of such a relationship in men might point to a gender gap in how dietary practices shape perceptions. This gap underscores the need for gendersensitive health promotion strategies that consider behavioral and social factors influencing perception. Furthermore, the findings suggest that dietary interventions should integrate perception-shaping strategies, particularly among males, who may require more targeted communication to link their eating habits with health outcomes. 5. Conclusion This study highlights both encouraging and concerning patterns regarding hypertension awareness, knowledge, and dietary behaviors. While awareness of hypertension was generally high, misconceptions, particularly the widespread belief that hypertension presents with early symptoms, pose a significant barrier to timely detection and management. The reliance on informal information sources over formal education or digital media further underscores the need for accurate, evidence-based health communication. Positive perceptions regarding salt reduction, exercise, and healthy food choices demonstrate the effectiveness of public health messaging in some areas. However, gaps remain in the understanding of risk factors such as processed foods, sugary beverages, and energy drinks, which continue to be widely consumed despite their well-documented links to hypertension. Dietary patterns revealed frequent consumption of starchy carbohydrates alongside moderate intake of fruits and vegetables, suggesting both risks and protective factors within current eating habits. Importantly, the lack of a World Journal of Biology Pharmacy and Health Sciences, 2025, 23(03), 218–238 237 significant association between starch and beverage consumption with knowledge levels indicates that awareness alone may not drive healthier choices. Gender differences in perception suggest that women may be more responsive to dietary influences on hypertension-related attitudes, pointing to the value of gender-sensitive interventions. Overall, the findings affirm that improving hypertension outcomes requires more than raising awareness. Interventions must go beyond knowledge dissemination to address behavioral, cultural, and socioeconomic determinants of diet and health. Multi-faceted strategies, including accurate public messaging, affordability measures, behavioral support, and gender-tailored approaches, are essential for strengthening both knowledge and practice in hypertension prevention and control. Compliance with ethical standards Disclosure of conflict of interest There is no conflict of interest to be disclosed. Statement of informed consent The purpose of the research was explained to each respondent and verbal informed consent obtained from them before inclusion into the study. 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