effects of lifestyle modification to hypertensive patients

7/28/2019 effects of lifestyle modification to hypertensive patients

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UNIVERSITY OF PERPETUAL HELP SYSTEM - JONELTA

Sto. Nio, Bian, Laguna

COLLEGE OF NURSINGSince 1976

Chapter 1

THE PROBLEM AND ITS BACKGROUND

Introduction

High blood pressure (BP) is a major public health problem in our country

and elsewhere. It is a major cardiovascular risk factor and contributes

significantly to cardiovascular mortality. Prospective Studies Collaboration hasreported that reducing BP can substantially decrease cardiovascular risk and

cardiovascular as well as all-cause mortality. This risk reduction is steeper in

younger subjects than in the older subjects and is more when baseline blood

pressure levels are high. In a meta-analysis of 61 studies involving more than a

million patients with hypertension and 12.7 million years of follow up it was

observed that reducing systolic as well as diastolic BP reduced cardiovascular

events. At ages 40-69 yr, each difference of 20 mmHg systolic BP or 10 mm Hg

diastolic BP was associated with more than a two-fold difference in the stroke

death rate, and with two-fold differences in the death rates from coronary heart

disease and other vascular causes. All of these proportional differences in

vascular mortality were about half as extreme at ages 80-89 yr as at ages 40-

49 yr, but the annual absolute differences in risk were greater in old age.

High blood pressure (BP) prevalence is rapidly increasing among urban

and rural populations. Reducing systolic and diastolic BP can decrease


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2UNIVERSITY OF PERPETUAL HELP SYSTEM - JONELTA


COLLEGE OF NURSINGSince 1976

cardiovascular risk and this can be achieved by non-pharmacological (lifestyle

measures) as well as pharmacological means. Lifestyle changes should be

the initial approach to hypertension management and include dietary

interventions (reducing salt, increasing potassium, alcohol avoidance, and

multifactorial diet control), weight reduction, tobacco cessation, physical

exercise, and stress management. A number of pharmaceutical agents, well

evidenced by large randomized clinical trials, are available for initial treatment

of high BP. These include older molecules such as thiazide diuretics and beta-

blocking agents and newer molecules, dihydropyridine calcium channel

blockers (CCB), angiotensin converting enzyme (ACE) inhibitors, and

angiotensin receptor blockers (ARB). In view of the recent clinical trials data,

some international guidelines suggest that CCB, ACE inhibitors or ARB and

not beta-blockers or diuretics should be the initial therapy in hypertension

management. Comprehensive hypertension management focuses on reducing

overall cardiovascular risk by lifestyle measures, BP lowering and lipid

management and should be the preferred initial treatment approach.

There is, therefore, a need to lower BP in all groups of patients. This


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UNIVERSITY OF PERPETUAL HELP SYSTEM -

JONELTA


COLLEGE OF NURSING Since 1976

can be achieved by non-pharmacological (lifestyle measures) as well as

pharmacological means. Lifestyle changes include dietary interventions,

weight control, tobacco cessation, exercise, and stress management. A

number of pharmaceutical agents, well evidenced by large randomized clinical

trials, are available for initial treatment of high BP. These include oldermolecules such as thiazide diuretics and beta-blocking agents, and newer

molecules such as dihydropyridine calcium channel blockers (CCB),

angiotensin converting enzyme (ACE) inhibitors, and angiotensin receptor

blockers (ARB). Comprehensive hypertension management focuses on

reducing overall cardiovascular risk and should be the preferred approach for

initial management of hypertension. This article focuses on initial management

strategies in hypertension using non-pharmacological as well as

pharmacological approaches.

The researchers, therefore, determined to pursue this study with the

main objective of finding out the effects of lifestyle modification in the

management of hypertension.

Theoretical framework of the study

This study was anchored on the theory of Orems Self-care deficit and

on Jean Watsons Philosophy of Nursing.

OREM's self-care deficit theory comprises those activities performed


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independently by an individual to promote and maintain personal well-being

throughout life. The individuals ability to perform self-care activities. and the

actions or measures used to provide self-care.

Jean Watson's Philosophy of Nursing (human science and human

care.). Nursing is concerned with promoting health, preventing illness, caringfor the sick and restoring health. It focuses on health promotion and treatment

of disease. She believes that holistic health care is central to the practice of

caring in nursing. The effectiveness of Watson's Caring Model on the quality of

life and blood pressure of patients with hypertension.

Conceptual Framework

The conceptual framework discussed the problems posited in the

study.For the variables used in the study, the Researchers utilized the daily

Blood Pressure reading of the respondents before and after lifestyle

modification in 15 days. The researchers determined to find a significant

difference in the initial and final blood pressure reading of the respondents.

Blood Pressure

Reading Before

Lifestyle

Modification

Effects of lifestyle

modification in the Blood

pressure reading of the

respondents 15 days

after.


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Figure 1. The effects of short term lifestyle modification on hypertensive

patient.

Statement of the problem

The researchers determined at finding the effects of lifestyle

modification in the management of hypertension.

Specifically they sought at finding the answers to the following questions.

1. What is the Initial BP reading of the respondents before the start ofLifestyle modification?

2. What is the effect of Lifestyle modification in the Blood Pressure

reading of the respondents 15 days after?

3. Is there a significant difference in the effect of lifestyle modification in

the Blood Pressure reading before and 15 days after it started?

Statement of Hypothesis

The following hypothesis was tested in the study.

Ho: There is no significant difference in the effect of lifestyle modification in

the Blood Pressure reading before and 15 days after it started


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Scope and delimitation of the study

This study focused on the effects of lifestyle modification in the

management of hypertension based on the Blood Pressure reading of the

respondents during 15 days of observation. The study was conducted in

selected areas in Laguna and Cavite. This study involved, interviews and

observations of the respondents regarding their lifestyle and history of

hypertension regardless of whether they are under maintenance or

medication. The study aimed to get at least 15 respondents who underwent an

experimental procedure of modifying their lifestyle. The respondents were not

forced to continue with the experiment if they wish to stop.

This study was conducted for 15 days with intervals of two times a day

of blood pressure taking. The respondents were closely monitored by the

researchers who assumed the veracity of the information given to them.

Significance of the study

The result of this study could be of great significance to the following

people:

To health practitioners. This study can be a big help for other

members of the health care providers in rendering their care to other people.

They can use this study to give health teachings to their patient especially


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those who are at risk in developing persistent hypertension

To respondents. This study serves as an eye opener for them to

continue modifying their lifestyle for their own good. Maximum and optimum

state of health can be achieved if they learn to take care of themselves.

To the families as a whole. This study will help them realize the

significance of lifestyle modification towards hypertension management and

help promote wellness among their relatives and significant others.

To researchers. The result of this study gives the researchers more

information about lifestyle modification in the management of hypertension

among hypertensive individuals. And hopefully in the future the researchers

can include in their health teachings the value of having a clean lifestyle in the

maintenance of their health

To future researcher. Results of the study may serve as a basis of

information for future or similar researches with stress on the need to changes

in lifestyle to hypertension management.

Definition of terms

To have a thorough understanding of the terms used in this study, the

following terms were operationally defined:

Blood pressure (BP) is the pressure exerted by circulating blood upon

the walls ofblood vessels, and is one of the principal vital signs.
http://en.wikipedia.org/wiki/Pressurehttp://en.wikipedia.org/wiki/Bloodhttp://en.wikipedia.org/wiki/Blood_vesselhttp://en.wikipedia.org/wiki/Vital_signshttp://en.wikipedia.org/wiki/Pressurehttp://en.wikipedia.org/wiki/Bloodhttp://en.wikipedia.org/wiki/Blood_vesselhttp://en.wikipedia.org/wiki/Vital_signs


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Cholesterol is a waxy steroid of fat that is produced in the liver or

intestines

Diastole is the period of time when the heart fills with blood aftersystole

(contraction)

Drinker is a person who drinks, especially a person who drinks alcoholhabitually.

Economic Status or income is the consumption and savings opportunity

gained by an entity within a specified time frame, which is generally expressed

in monetary terms.

Educational attainment is a term commonly used by statisticians to refer

to the highest degree of education an individual has completed.

Effects is something brought about by a cause or agent; a result. The

power to produce an outcome or achieve a result.

Fats consist of a wide group of compounds that are generally soluble in

organic solvents and generally insoluble in water.

Hypertension or high blood pressure is a cardiac chronic medical

condition in which the systemic arterial blood pressure is elevated.Lifestyle is the way a person lives to ones own ability.

Vasoconstriction is the narrowing of the blood vessels resulting from

contraction of the muscular wall of the vessels, particularly the large arteries,

small arterioles and veins.
http://en.wikipedia.org/wiki/Steroidhttp://en.wikipedia.org/wiki/Systole_(medicine)http://en.wikipedia.org/wiki/Steroidhttp://en.wikipedia.org/wiki/Systole_(medicine)


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Chapter 2

REVIEW OF RELATED LITERATURE AND STUDIES

This chapter provides pertinent related literature and studies that

contributed information from sedentary lifestyle. The researchers gathered this

information to know the effects of life style and how does hypertensive is one

of the most risk factor.

Related Studies

(Rafael Castillo, MD 2008), says the group would deploy hypertension

specialists nationwide to establish screening sites and referral centers,

especially for high-risk patients or those at risk to develop heart attack and

stroke.The PSH consists of 1,500 members nationwide, 350 of which are

hypertension specialists.Castillo said that even apparently healthy, no-

symptom individuals should have their BPs checked as visible or felt


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symptoms appear late.

(Nelson S. Abelardo, MD 2008), said in a PSH statement that the 2008

initiative aims to produce a report which would simplify further the approaches

to hypertension while maintaining the high quality of the evidence through

scientific interactions from various sectors of the medical specialties.It is also

hoped that the resulting report would address concerns of local Filipino

practitioners, the academe, training institutions, paramedical professionals,

patients and other stakeholders.Abelardo said the reevaluation of the clinical

practice guidelines for the detection and management of hypertension in the

Philippines is dictated by the changes with time.

Abelardo said that since then, guidelines have been formulated.

Examples of these are the JNC 7, the WHO-ISH Guidelines, The ESC/ESH

Guidelines, the BHS Guidelines and other Asian guidelines attempting

to harmonize various aspects of hypertension care.

In the Philippines, the prevalence of hypertension has increased, and is

now at 17.2 percent of the adult population, or roughly more than 7 million

people (NNHeS 2003). However, PSH has noted no significant changes in the

awareness, treatment and control of hypertension in the population. Today, as

cardiovascular diseases (of which hypertension and its related complications

are part of) rank as the leading cause of mortality and morbidity, there is a real


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need to revisit such guidelines.

The New York Times stated that healthy lifestyle changes are an

important first step for lowering blood pressure. Current guidelines

recommend that people should exercise at least 30 minutes a day, maintain

normal weight, reduce sodium (salt) intake, increase potassium intake, limit

alcohol

consumption to no more than one or two drinks a day, consume a diet rich in

fruits, vegetables, and low-fat dairy products while reducing total and

saturated fat intake. (The DASH diet is one way of achieving such a dietary

plan.) and quit smoking.

The salt-restrictive DASH diet (Dietary Approaches to Stop

Hypertension) is proven to help lower blood pressure, and may have

additional

benefits for preventing heart disease and stroke. Effects on blood pressure are

sometimes seen within a few weeks. This diet is not only rich in important

nutrients and fiber but also includes foods that contain far more potassium

(4,700 mg/day), calcium (1,250 mg/day), and magnesium (500 mg/day) and

much less sodium (salt) than are found in the average American diet.

DASH diet recommends to limit sodium (salt) intake to no more than


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2,300 mg a day (a maximum intake of 1,500 mg a day is an even better goal),

reduce saturated fat to no more than 6% of daily calories and total fat to 27%

of daily calories. (But, include dairy products that are non- or low-fat. Low-fat

dairy products appear to be especially beneficial for lowering systolic blood

pressure).When choosing fats, select monounsaturated oils, such as olive or

canola oils. Choose whole grains over white flour or pasta products. Choosefresh fruits and vegetables every day. Many of these foods are rich in

potassium, fiber, or both, possibly helping lower blood pressure. Include nuts,

seeds, or legumes (dried beans or peas) daily. Choose modest amounts of

protein (no more than 18% of total daily calories). Fish, skinless poultry, and

soy products are the best protein sources. Other daily nutrient goals in the

DASH diet include limiting carbohydrates to 55% of daily calories and dietary

cholesterol to 150 mg. Patients should try to get at least 30 g of daily fiber.

Some sodium (salt) is necessary for health, but the amount is vastly

lower than that found in the average American diet. High salt intake is

associated with high blood pressure (hypertension). It is a good idea for

everyone to restrict their salt intake to less than 2,300 mg (about 1 teaspoon)

a day. Some people over age 50, or who have high blood pressure, may need

to reduce sodium intake to less than 1,500 mg daily. This lowering of blood

pressure may also help protect against heart failure and heart disease.


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Some people (especially African-Americans, older adults, and people

with diabetes, overweight people, and people with a family history of

hypertension) are salt sensitive, which means their blood pressure responds

much more to salt than other people. People with salt sensitivity have a higher

than average risk of developing high blood pressure as well as other heart

problems.

Salt substitutes, such as Nusalt and Mrs. Dash, (which contain mixtures

of potassium, sodium, and magnesium) are available, but they can be risky for

people with kidney disease or those who take blood pressure medication that

causes potassium retention.

A potassium-rich diet is important for reducing blood pressure. For

people without risks for potassium excess, potassium-rich foods can help

offset dietary salt intake. These foods include bananas, oranges, pears,

prunes, cantaloupes, tomatoes, dried peas and beans, nuts, potatoes, and

avocados. For people without risk factors for excess potassium levels, the

recommended daily intake of potassium is 3,500 mg a day.

Some patients may need to take potassium supplements. However,

people who take medications that limit the kidney's ability to excrete

potassium, such as ACE inhibitors, dogixin or potassium-sparing diuretics,

should not take potassium supplements and should be aware of excess


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potassium in their diet.

Increasing fiber in the diet may help reduce blood pressure levels. Fish

Oil andOmega 3 fatty acids (docosahexaenoic and eicosapentaneoic acids)

are found in oily fish. Studies indicate that they may have specific benefits for

many medical conditions, including heart disease and hypertension. They

appear to help keep blood vessels flexible and may help protect the nervous

system. Fatty acids are also available in supplements, but their long-term

effects on blood pressure are unknown.

Calcium regulates the tone of the smooth muscles lining blood vessels.

Studies have found that people who have sufficient dietary calcium have lower

blood pressure than those who do not. Hypertension itself increases calcium

loss from the body. The effects of extra calcium on blood pressure, however,

are mixed, with some even showing higher pressure.

Even modest weight loss in overweight people, particularly in the

abdominal area, can immediately lower blood pressure. Weight loss,

especially when accompanied by salt restriction, may allow patients with mild

hypertension to safely reduce or go off medications. The benefits of weight

loss on blood pressure are long-lasting.

Regular exercise helps keep arteries elastic, even in older people,

which in turn ensures blood flow and normal blood pressure. Doctors


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recommend at least 30 minutes of exercise on most days.

High-intensity exercise may not lower blood pressure as effectively as

moderate intensity exercise and may be dangerous in people with

hypertension. Older people and those with uncontrolled hypertension or other

serious medical conditions should check with their doctors before starting an

exercise program.

Certain sleep disorders, especially sleep apnea, are associated with

hypertension. Even chronic, insufficient sleep may raise blood pressure in

patients with hypertension, placing them at increased risk of heart disease and

death. Stress hormone levels increase with sleeplessness, which can activate

the sympathetic nervous system, a strong player in hypertension. Patients who

have chronic insomnia or other severe sleep disturbances (particularly sleep

apnea) may want to consult a sleep expert. Patients with hypertension who

are habitually poor sleepers should consider long-acting blood pressure

medications to help counteract the increase in blood pressure that occurs in

the early morning hours.

Stress reduction may help blood pressure control. Yoga, tai chi, and

relaxation techniques such as meditation may be beneficial.

According to (JASN) Journal of the American Society of Nephrology, the

relationship between high alcohol intake (typically three or more drinks per


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day) and elevated BP has been documented in many epidemiologic studies.

Trials have also reported that reductions in alcohol intake can lower BP in

normotensive and hypertensive men who are heavy drinkers. In the

Prevention and Treatment of Hypertension Study, which studied moderate-to-

heavy drinkers, a reduction in alcohol intake lowered BP to a small,

nonsignificant extent. In aggregate, available evidence supports arecommendation to limit alcohol intake to no more than two drinks per day

(men) and one drink per day (women) among those who drink.

Healthy lifestyle changes are an important first step for lowering blood

pressure. Current guidelines recommend that people should: Exercise at least

30 minutes a day, Maintain normal weight, Reduce sodium (salt) intake,

Increase potassium intake, Limit alcohol consumption to no more than one or

two drinks a day, Consume a diet rich in fruits, vegetables, and low-fat dairy

products while reducing total and saturated fat intake. (The DASH diet is one

way of achieving such a dietary plan.), Quit smoking.

The salt-restrictive DASH diet (Dietary Approaches to Stop

Hypertension) is proven to help lower blood pressure, and may have

additional benefits for preventing heart disease and stroke. Effects on blood

pressure are sometimes seen within a few weeks. This diet is not only rich in

important nutrients and fiber but also includes foods that contain far more


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potassium (4,700 mg/day), calcium (1,250 mg/day), and magnesium (500

mg/day) and much less sodium (salt) than are found in the average American

diet.

A diet that is effective in lowering blood pressure is called Dietary

Approaches to Stop Hypertension (DASH).

Limit sodium (salt) intake to no more than 2,300 mg a day (a maximum

intake of 1,500 mg a day is an even better goal), reduce saturated fat to no

more than 6% of daily calories and total fat to 27% of daily calories. (But,

include dairy products that are non- or low-fat. Low-fat dairy products appear

to be especially beneficial for lowering systolic blood pressure), When

choosing fats, select monounsaturated oils, such as olive or canola oils,

Choose whole grains over white flour or pasta products, Choose fresh fruits

and vegetables every day. Many of these foods are rich in potassium, fiber, or

both, possibly helping lower blood pressure, Include nuts, seeds, or legumes

(dried beans or peas) daily Choose modest amounts of protein (no more than

18% of total daily calories). Fish, skinless poultry, and soy products are the

best protein sources, Other daily nutrient goals in the DASH diet include

limiting carbohydrates to 55% of daily calories and dietary cholesterol to 150

mg. Patients should try to get at least 30 g of daily fiber.

Some sodium (salt) is necessary for health, but the amount is vastly


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lower than that found in the average American diet. High salt intake is

associated with high blood pressure (hypertension). It is a good idea for

everyone to restrict their salt intake to less than 2,300 mg (about 1 teaspoon)

a day. Some people over age 50, or who have high blood pressure, may need

to reduce sodium intake to less than 1,500 mg daily. This lowering of blood

pressure may also help protect against heart failure and heart disease.

Some people (especially African-Americans, older adults, and people

with diabetes, overweight people, and people with a family history of

hypertension) are salt sensitive, which means their blood pressure responds

much more to salt than other people. People with salt sensitivity have a higher

than average risks of developing high blood pressure as well as other heart

problems. Salt substitutes, such as Nusalt and Mrs. Dash, (which contain

mixtures of potassium, sodium, and magnesium) are available, but they can

be risky for people with kidney disease or those who take blood pressure

medication that causes potassium retention.

A potassium-rich diet is important for reducing blood pressure. For

people without risks for potassium excess, potassium-rich foods can help

offset dietary salt intake. These foods include bananas, oranges, pears,

prunes, cantaloupes, tomatoes, dried peas and beans, nuts, potatoes, and


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avocados. For people without risk factors for excess potassium levels, the

recommended daily intake of potassium is 3,500 mg a day.

Some patients may need to take potassium supplements. However,

people who take medications that limit the kidney's ability to excrete

potassium, such as ACE inhibitors, dogixin or potassium-sparing diuretics,

should not take potassium supplements and should be aware of excess

potassium in their diet.

Increasing fiber in the diet may help reduce blood pressure levels.

Omega 3 fatty acids (docosahexaenoic and eicosapentaneoic acids) are found

in oily fish. Studies indicate that they may have specific benefits for many

medical conditions, including heart disease and hypertension. They appear to

help keep blood vessels flexible and may help protect the nervous system.

Fatty acids are also available in supplements, but their long-term effects on

blood pressure are unknown.

Calcium regulates the tone of the smooth muscles lining blood vessels.

Studies have found that people who have sufficient dietary calcium have lower

blood pressure than those who do not. Hypertension itself increases calcium

loss from the body. The effects of extra calcium on blood pressure, however,

are mixed, with some even showing higher pressure.

Even modest weight loss in overweight people, particularly in the


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abdominal area, can immediately lower blood pressure. Weight loss,

especially when accompanied by salt restriction, may allow patients with mild

hypertension to safely reduce or go off medications. The benefits of weight

loss on blood pressure are long-lasting.

Regular exercise helps keep arteries elastic, even in older people,

which in turn ensures blood flow and normal blood pressure. Doctors

recommend at least 30 minutes of exercise on most days.

High-intensity exercise may not lower blood pressure as effectively as

moderate intensity exercise and may be dangerous in people with

hypertension. Older people and those with uncontrolled hypertension or other

serious medical conditions should check with their doctors before starting an

exercise program.

Certain sleep disorders, especially sleep apnea, are associated with

hypertension. Even chronic, insufficient sleep may raise blood pressure in

patients with hypertension, placing them at increased risk of heart disease and

death. Stress hormone levels increase with sleeplessness, which can activate

the sympathetic nervous system, a strong player in hypertension. Patients who

have chronic insomnia or other severe sleep disturbances (particularly sleep

apnea) may want to consult a sleep expert. Patients with hypertension who

are habitually poor sleepers should consider long-acting blood pressure


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medications to help counteract the increase in blood pressure that occurs in

the early morning hours. Stress reduction may help blood pressure control.

Yoga, tai chi, and relaxation techniques such as meditation may be beneficial.

A study carried out with the objective of evaluating Orem's nursing self-

care theory (TDAC) in women with hypertension. Four hypertensive women in

an outpatient clinic were interviewed using a form with open and multiple-choice questions on conditioning factors and self-care requirements. The data

were analyzed according to the TDAC theoretical framework. Based on the

self-care requirements for hypertensive people, the existence or non-existence

of adjustment between self-care capacity and self-care need as well as the

inhibitors and enhancers of such adjustment were identified. It was concluded

that TDAC allowed identifying important aspects related to hypertensive

people who must be dealt with by nurses

According to Jean Watson's Philosophy of Nursing-human science and

human care nursing is concerned with promoting health, preventing illness,

caring for the sick and restoring health. It focuses on health promotion and

treatment of disease. She believes that holistic health care is central to the

practice of caring in nursing. The effectiveness of Watson's Caring Model on

the quality of life and blood pressure of patients with hypertension.

Related Literature

According to (Gajewska, Danuta, Niegowska, Joannaand Kucharska
http://www.refdoc.fr/?traduire=en&FormRechercher=submit&FormRechercher_Txt_Recherche_name_attr=auteursNom:%20(NIEGOWSKA)http://www.refdoc.fr/?traduire=en&FormRechercher=submit&FormRechercher_Txt_Recherche_name_attr=auteursNom:%20(NIEGOWSKA)


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Alicja, 2005) lifestyle modification, including dietary changes, is very important

in the prevention and treatment of hypertension. It has been well documented

that DASH (Dietary Approaches to Stop Hypertension) diet has the potential to

lower blood pressure and to improve patients' overall health.

According to DASH diet, very high intakes of saturated fat and

cholesterol, as well as a high intake of total fat were found. The intakes of

hypotensive minerals such as calcium, potassium and magnesium were below

the levels recommended by DASH diet. Daily intake of fiber was only 25.6

10.3 g among men and 21.66.5 g among women (70-80% of recommended

value). This diet profile may contribute to an increased risk of cardiovascular

diseases. Most of the hypertensive patients on DASH diet require major

dietary changes. A comprehensive, tailored nutritional education, provided by

dietitian, should be offered for motivated patients.

(Russell, 2007) explained that cholesterol is necessary part of all the

cell membranes in the body so people cannot simply eliminate it from the dietand body. It is essential for the proper functioning of all cells in the body. The

issue with cholesterol is balancing the consumption. High levels of ldl (bad

cholesterol) will cause calcium, fatty acids and cholesterol to build up inside

arteries. These deposits are commonly called plaque. As human arteries get

smaller, the heart has to work intensively to keep up proper blood supply to
http://www.refdoc.fr/?traduire=en&FormRechercher=submit&FormRechercher_Txt_Recherche_name_attr=auteursNom:%20(KUCHARSKA)http://www.refdoc.fr/?traduire=en&FormRechercher=submit&FormRechercher_Txt_Recherche_name_attr=auteursNom:%20(KUCHARSKA)


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the rest of the body which also increases blood pressure. There are lots of

things that we can do to maintain a healthy cholesterol level. Almost all of it

comes under the heading of keeping to healthy diet, maintaining a healthy life

style and exercising regularly. Fast food equals bad food as far as bad

cholesterol levels are concerned.

Patient should always follow a routine of well balanced diet, exerciseand rest religiously. Diet is primary importance. The consumption of fruits and

vegetables has been widely believed to promote good health, evidence related

to their protective effect of hypertension. This fruits and vegetables are

protective diet. Dietary intake of fats and sodium strongly influences the risk of

hypertension in our society.

(Williams,2007) stated that there is no question that nutritional therapy

plays a large role in the treatment of hypertension, although some controversy

centers on the restriction of sodium. Most hypertensive persons respond to

some degree of sodium restriction and are called sodium sensitive

.Adequate potassium levels relate to blood pressure control mainly through itselectrolyte balance with sodium and its replacement need when potassium-

losing diuretics are used. Studies on the influence of calcium on hypertension

show variable results. It is difficult at this time to identify the amount of calcium

that would be adequate to prevent hypertension, and the mechanism involved

in a calcium effect on blood pressure remains unclear. In general, the current


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focus of nutritional therapy is on weight management, sodium control, general

nutrient balance, and an individualized food plan.

According to the Philippine Heart Association (PHA) president Dr. Efren

Vicaldo,(2008) pointed out that hypertensive patients do not die of

hypertension but from the complications. He said that Filipinos tend to be

complacent in watching their lifestyle in the absence of clear symptoms ofhypertension, which is generally asymptomatic or does not exhibit signs.

Vicaldo maintained that hypertension was not difficult to treat.

A lifestyle change is part and parcel of controlling the condition? But he

stressed that there was inadequate control in the country, pointing out that

barely 10 percent of hypertension cases were under control through

maintenance medication and regular checkups.

(Yolanda Oliveros, MD 2008), director of the Department of Health

National Center for Disease Prevention and Control, said that based on 2003

mortality data, heart and vascular diseases, often caused by hypertension,

were the top two causes of death in all age groups in the country. She said

that 90 percent of Filipinos have one or more risk factors or combinations.

These risk factors, Oliveros said, include: smoking; obesity; lack of exercise;

dangerously low consumption of fruits and vegetables; heredity.

The government, she said, was undertaking measures to reduce the


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exposure of the population to some of the risk factors particularly smoking,

unhealthy diet, and lack of physical activity, through population-based

interventions.

(Abarquez 2008), as a remedy to avoid hypertension, Abarquez

suggested that lifestyle modifications within the family or household should

start before hypertension develops.

"It is difficult to quit smoking, lose weight or exercise and eat

appropriate balanced meals if other family members or neighborhoods or

office mates will not do the same? He said.

The doctor revealed that PSH studies show that children, including

adolescents, have strong chances of influencing their parents to alter their

lifestyles. He pointed out that mothers, particularly in light of the Philippines

Matriarchal society, should lead lifestyle modifications in the family.

(Dante Morales, MD 2008), PSH trustee and the main proponent of the

NNHeS 2003-2004 said that one of the important applications of the NNHeS

data is in the formulation and implementation of appropriate intervention

programs of government and private sectors such as lifestyle modification

programs, nutrition labeling and healthy diet campaigns for the prevention and

control of lifestyle and nutrition related risk factors and diseases.

(Cabral 2008), the PSH and PLS aim to stimulate research in


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hypertension, cholesterol problems and the clogging of blood vessels or

atherosclerosis. We aim to increase awareness of the risks posed by

hypertension and cholesterol problems and to improve the management of

these conditions by specialists and primary care physicians alike, Dr. Cabral

said.

State of the Art

The literatures presented in this chapter were obtained in journals,

articles and internet. All these are related to the concept of lifestyle of people

and what hypertensive does if not managed properly.

Synthesis of the States of the Arts

The following authors have said similar concepts on lifestyle

modification.

According to Gajewska, Danuta, Niegowska, Joannaand Kucharska

Alicja, lifestyle modification, including dietary changes, is very important in the

prevention and treatment of hypertension. It has been well documented that

DASH (Dietary Approaches to Stop Hypertension) diet has the potential to

lower blood pressure and to improve patients' overall health.

According to Russell, Patient should always follow a routine of well

balanced diet, exercise and rest religiously.

On the other hand Abarquez said it is a remedy to avoid hypertension,
http://www.refdoc.fr/?traduire=en&FormRechercher=submit&FormRechercher_Txt_Recherche_name_attr=auteursNom:%20(NIEGOWSKA)http://www.refdoc.fr/?traduire=en&FormRechercher=submit&FormRechercher_Txt_Recherche_name_attr=auteursNom:%20(NIEGOWSKA)http://www.refdoc.fr/?traduire=en&FormRechercher=submit&FormRechercher_Txt_Recherche_name_attr=auteursNom:%20(KUCHARSKA)http://www.refdoc.fr/?traduire=en&FormRechercher=submit&FormRechercher_Txt_Recherche_name_attr=auteursNom:%20(NIEGOWSKA)http://www.refdoc.fr/?traduire=en&FormRechercher=submit&FormRechercher_Txt_Recherche_name_attr=auteursNom:%20(KUCHARSKA)


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Abarquez suggested that lifestyle modifications within the family or household

should start before hypertension develops.

According to Dr. Dante Morales PSH trustee and the main proponent of

the NNHeS 2003-2004 said that one of the important applications of the

NNHeS data is in the formulation and implementation of appropriate

intervention programs of government and private sectors such as lifestyle

modification programs, nutrition labeling and healthy diet campaigns for the

prevention and control of lifestyle and nutrition related risk factors and

diseases.

Chapter 3

RESEARCH DESIGN AND METHODOLOGY

This chapter focuses on the elaboration of the methods used in this

research, the respondents of the study, the different sources of data and the

statistical techniques to be employed as well as the gathering procedures.

Research Design

The research design implemented in this research is experimental by

observation, through an Overt observational research the researchers

identify themselves as researchers and explain the purpose of their


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observations. The problem with this approach is subjects may modify their

behaviour when they know they are being watched. They portray their ideal

self rather than their true self. The advantage that the overt approach has

over the covert approach is that there is no deception.

Experimental approach according to James P. Key is an attempt by the

researcher to maintain control over all factors that may affect the result of anexperiment. In doing this, the researcher attempts to determine or predict what

may occur.

Respondents of the Study

The respondents of the study were determined through purposive

sampling. Purposive sampling targets a particular group of people. When the

desired population for the study is rare or very difficult to locate and recruit for

a study.

Fifteen respondents were gathered and subjected to a process ofsimple experimentation which is modifying their lifestyle as their blood

pressure is monitored twice daily.

Sources of Data

The researchers made use of primary and secondary sources of data;


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wherein the primary data were taken from the respondents themselves and

the secondary data were taken from books, journals, thesis and informations

from the internet.

Instrumentation and Validation

The researchers subjected the respondents to a process of simpleexperimentation and observation. For 15 days, the respondents lifestyle was

modified and they agreed not to drink alcohol, smoke and take coffee. Aside

from which they also modified their diet, the respondents have to sleep early

and drink plenty of water.

The procedure was validated by the researchers adviser who is a

physician himself. The BP reading of the respondents were taken twice daily

for 15 days. Their present medication was still continued as it was only their

lifestyle that has to be modified to see its effect in the management of the

respondents hypertension.

Data gathering procedure

Prior to the start of the experiment, the researchers requested the Dean

of the College of Nursing for the permission to start. They also sought the

instruction of their adviser on how to proceed with the experiment. An informed

consent was also requested from the respondents who underwent the


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experiment in order to avoid any legal implications that may arise out of it.

Statistical treatment of Data

t-Test (Dependent/Correlated) was utilized by the researchers to

compare the mean of the pre-test and the post test regarding lifestyle

modification in the management of Hypertension.t=___D_____

D - (D)n

n(n-1)

Where:

D- The mean Difference between the pre-test and post-test

D- The sum of the square of the difference between the pre-

test and the post-test

D- The summation of the difference between the pre-test and

post-testn- Total sample size


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Chapter 4

PRESENTATION, ANALYSIS AND INTERPRETATION

This chapter focuses on the presentation of data, its analysis and

corresponding interpretation.

Table 1

Initial and Final Blood Pressure Reading of the Respondents before and

after Lifestyle Modification

Subjects Initial BP reading Final BP readingsSystole Diastole Systole Diastole

1.N.A 150 100 120 80


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2.E.L 120 90 120 903.A.N 140 90 110 904.S.B 130 80 130 705.F.O 130 60 130 606.L.F 140 70 130 807.U.D 140 70 90 608.R.D 120 80 110 809.S.R 140 70 110 6010.S.L 200 160 180 160

11.J.R 140 100 130 9012.N.R 140 90 120 9013. L.S 130 90 130 9014. N.L 150 90 130 8015. O.M 190 100 190 100

As shown in table 1, the blood pressure readings of the respondents

before lifestyle modification ranges from as low as 120/90 for subject E.L and

as high as 200/160 for subject S.L. Majority of the respondents registered

above normal blood pressure reading. And they were either alcohol drinkers,

smokers, eating unhealthy diet, no exercise and coffee drinkers. Not all the

respondents take medication for their hypertension.This also shows the final reading of the blood pressure of the

respondents after 15 days of lifestyle modification. It is very evident that

majority of the respondents experienced remarkable changes in their blood

pressure reading. They were subjected to no alcohol drinking, no cigarette,

healthy diet and no coffee. Subject S.L and subject O.M on the other hand


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experienced very slight lowering down of their blood pressure reading. Their

Diastole remained the same despite modifying their lifestyle and the

medication that they take.

Results show that with strict adherence to a good lifestyle, any person

suffering from hypertension will be able to manage it thus maintaining good

health and balance in his life.According to Abarquez (2008), as a remedy to avoid hypertension,

Abarquez suggested that lifestyle modifications within the family or household

should start before hypertension develops.

Table 2

Difference in the Blood Pressure Reading of the Respondents Before

and After Lifestyle Modification in the Management of Hypertension

PARAMETERMEAN 1

PREMEAN 2POST

MEANDIFFERENCE

COMPUTEDt-VALUE

INTER-PRETATION

SYSTOLIC 145.33 127.33 -18.00 4.89 SIGNIFICANT

DIASTOLIC 89.33 79.33 -10.00 1.49NOT

SIGNIFICANT

0.05 level of significance n1=15 n2=15

Critical t-value= 2.145

Degree of freedom= 14


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As shown in the table, for the difference in the blood pressure reading

of the respondents as to systolic, computed t- value of 4.89 was obtained

which was higher than the critical t- value of 2.145 at 0.05 level of significance.

This shows significant difference which means that the more the Lifestyle of

the respondents is modified the more their blood pressure reading may godown.

As to the difference in the blood pressure reading of the respondents as

to diastolic, computed t- value of 1.49 which is lower than the critical t-value of

2.145 at 0.05 level of significance was obtained. This shows a not significant

difference. This means that with or without lifestyle modification, the diastolic

reading of the respondents may or may not go down.


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Chapter 5

SUMMARY OF FINDINGS, CONCLUSION, RECOMMENDATION

This chapter is consisting of the findings of the study as summarized,

the conclusion drawn from the findings and the researchers recommendation.

Summary of findings

The findings of the study were summarized as posited in the statement

of the problem.

The blood pressure reading of the respondents remarkably lowered down

except for some subjects who experienced slight change only in their systole

and the same reading in their diastole.


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As to the difference in the systolic reading before and after lifestyle

modification result shows a significant difference. This shows significant

difference which means that the more the Lifestyle of the respondents in

modified the more their blood pressure reading may go down. As to the

difference in the diastolic reading it shows that there is no significant

difference.This shows a not significant difference. This means that with or without

lifestyle modification, the diastolic reading of the respondents may or may not

go down.

Conclusion

The following conclusions were drawn based on the findings of the

study.

1. Majority of the respondents remarkably lowered down their blood

pressure reading which indicates that with strict adherence to a good

lifestyle, any person suffering from hypertension are able to manage itthus maintaining good health and balance in his life.

2. There is a significant difference in the systolic reading of the

respondents but obtained a not significant difference in their diastolic

reading after lifestyle modification.


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Recommendation

1. The proponents recommend that the respondents should adhere to

lifestyle modification in lowering their blood pressure.

2. The proponents noticed that majority of the respondents lowered

down their blood pressure reading, and they recommend to therespondents to maintain lifestyle modification.

3. For future researchers to categorize what lifestyle modification

would be beneficial to hypertensive patients.


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BIBLIOGRAPHY

Bibliography

A. Books

Williams, SD. (2003). Nutrition and Diet Therapy Sixth Edition, California,

Mosby

B. Magazine & Newspaper Articles

Kearney P, Whelton M, Reynolds K, Muntner P, Whelton PK, He J. (2005)

Global burden of hypertension: analysis of worldwide data. Lancet, 365, 217-

223.


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Gupta R, Al-Odat NA, Gupta VP. (1996). Hypertension epidemiology in India:

meta-analysis of 50 year prevalence rates and blood pressure trends. J Hum

Hypertens, 10, 465472.

Gupta R. (2004). Trends in hypertension epidemiology in India. J Hum

Hypertens, 18, 7378.

Murray CJ, Lopez AD. (1997). Alternative projections of mortality and disability

by cause 1990-2020: Global burden of disease study, Lancet, 349, 1498

1504.

Kannel WB, Dawber TR, Kagan A, Revotskie N, Stokes J. (1961). 3rd Factors

of risk in the development of coronary heart disease- six year follow-up

experience. The Framingham Study. Ann Intern Med, 55, 3350.

Stamler J, Stamler R, Neaton JD. (1993). Blood pressure, systolic and

diastolic, and cardiovascular risks: US population data.Arch Intern Med, 153,

598615.

Vasan RS, Larson MG, Leip EP, Evans JC, ODonnell CJ, Kannell WB. (2001).

Impact of high normal blood pressure on the risk of cardiovascular disease. N

Engl J Med, 345, 12911297.

Rodgers A, Lawes C, MacMahon S. (2000). Reducing the global burden of


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blood pressure related cardiovascular disease. J Hypertens, 18, S3S6.

Gaziano T, Reddy KS, Paccaud F, Horton S, Chaturvedi V. Cardiovascular

disease. In: Jamison DT, Breman JG, Measham AR, Alleyene G, Cleason M,

Evans DB, Jha P, Mills A, Musgrove P. (2006) editors.Disease control priorities

in developing world. Oxford: Oxford University Press, 645662.

Lewington S, Clarke R, Qizilbash N, Peto R, Collins R. (2002). Prospective

Studies Collaboration Age-specific relevance of usual blood pressure to

vascular mortality: a meta-analysis of individual data for one million adults in

61 prospective studies. Lancet, 360, 19031913.

Turnbull F, Neal B, Algert C, Chalmers J, Chapman N, Cutler J. (2005). Blood

Pressure Lowering Treatment Trialists Collaboration. Effects of different blood

pressure-lowering regimens on major cardiovascular events in individuals with

and without diabetes mellitus: results of prospectively designed overviews of

randomized trials.Arch Intern Med, 165, 14101419.

C.Internet

Appel, L. (july 1, 2003). Lifestyle Modification as a means to prevent and Treat

High Blood Pressure, retrieved August 3, 2012, from Journal of the American

Society of Neprhrology, from http://jasn.asnjournals.org/content/14/suppl_2/S
http://jasn.asnjournals.org/content/14/suppl_2/S%2099.longhttp://jasn.asnjournals.org/content/14/suppl_2/S%2099.long


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99.long

Gajewska D, Nieyoska J, Kucharska A. (1992). DASH diet. Retrieved August

15, 2012, from http://cat.inist.fr/?aModele=afficheN&cpsidt=22508764

Adrade J. (May 16, 2008). Many Filipinos unaware they are hypertensive,

study shows. Retrieved July 8, 2012, from unquirer.net website:

http://www.inquirer.net/specialreports/mindandbody/healthbeat/view.php?

db=1&article=20080516-137019&pageID=2

Simon H. (May 5, 2011). Lifestyle Changes. Retrieved August 27, 2012, from

the New York Times, from http://health.nytimes.com/health/guides/disease/

hypertension/lifestyle-changes.html
http://jasn.asnjournals.org/content/14/suppl_2/S%2099.longhttp://cat.inist.fr/?aModele=afficheN&cpsidt=22508764http://www.inquirer.net/specialreports/mindandbody/healthbeat/view.php?db=1&article=20080516-137019&pageID=2http://www.inquirer.net/specialreports/mindandbody/healthbeat/view.php?db=1&article=20080516-137019&pageID=2http://health.nytimes.com/health/guides/disease/%20hypertension/lifestyle-changes.htmlhttp://health.nytimes.com/health/guides/disease/%20hypertension/lifestyle-changes.htmlhttp://jasn.asnjournals.org/content/14/suppl_2/S%2099.longhttp://cat.inist.fr/?aModele=afficheN&cpsidt=22508764http://www.inquirer.net/specialreports/mindandbody/healthbeat/view.php?db=1&article=20080516-137019&pageID=2http://www.inquirer.net/specialreports/mindandbody/healthbeat/view.php?db=1&article=20080516-137019&pageID=2http://health.nytimes.com/health/guides/disease/%20hypertension/lifestyle-changes.htmlhttp://health.nytimes.com/health/guides/disease/%20hypertension/lifestyle-changes.html


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APPENDIX A

(Systolic and Diastolic BP Reading before

and after Lifestyle Modification)


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Figure 1

Systolic Reading of subjects Before and After

Lifestyle Modification

0 100 200 300

NA

EL

AN

SB

OF

LF

UD

RD

SR

SO

JR

NA

SU

NL

OA

Subjects

Systolic Reading

BEFORE-SYSTOLIC

AFTER-SYSTOLIC


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APPENDIX B

Figure 2

Diastolic Reading of Subjects Before and After

Lifstyle Modificaton

0 50 100 150 200

NA

EL

AN

SB

OF

LF

UD

RD

SR

SO

JR

NA

SU

NL

OA

Subjects

Diastolic Reading

BEFORE-DIASTOLIC

AFTER-DIASTOLIC


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(Sample Consent Form)

(Sample of Information Sheet)

UNIVERSITY OF PERPETUAL HELP SYSTEM LAGUNA

Sto. Nio, City of Bian, Laguna

College of Nursing

Consent Form

Dear Maam/Sir,I,_________________, is agreeing to be one of the fifteen participants of the

Thesis to be conductive by fourth year students of University of the Perpetual

Help System Laguna with regards to short term lifestyle modification on the

hypertensive patient.

By signing this consent form, I confirm that I have read and understood the


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information and procedure and have had the opportunity to ask questions. I

understand that my responses will be kept anonymous should I wish. I

understand that my participation is voluntary and that I am free to withdraw at

any time, without giving a reason and without cost. I understand that I will be

given a copy of this consent form. I voluntarily agree to take part in this study.

Signature ______________________________________Date________________

Information Sheet

THE EFFECTS OF SHORT TERM LIFESTYLE MODIFICATION ON

HYPERTENSIVE PATIENT

Dear Respondents,

We, the researchers, would like to solicit your support by filling up the

information sheet which contains questions pertinent to the present study.

Rest assures that all information will be treated with full confidentiality and will

be use only for the purpose of data gathering.


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Name: ______________________

Age: __________

Gender: __________

Educational Attainment: _________

Economic Status: ______________

Date: _______________

Lifestyle:

Smoker

Alcoholic Drinker

Coffee Drinker

Unhealthy Diet

No exercise

effects of lifestyle modification to hypertensive patients

Documents