EFFECT OF LIFESTYLE MODIFICATIONS ON BLOOD PRESSURE IN HYPERTENSIVE PATIENTSHTML Full Text
EFFECT OF LIFESTYLE MODIFICATIONS ON BLOOD PRESSURE IN HYPERTENSIVE PATIENTS
D. Guru Prasanna *1, C. Gopinath 1, K.B. Yadavender Reddy 2, D. Giri Rajasekhar 1, P. Chandrakanth 1 and S. Sravanakumari 1
Department of Pharmaceutical Chemistry, Annamacharya College of Pharmacy, Rajampet- 516126, Andhrapradesh, India
Department of General medicine 2, Rajiv Gandhi institute of medical sciences (RIMS) Government Hospital, Kadapa-516001, Andhrapradesh, India
ABSTRACT: Aim: The aim of the study is to assess effect of lifestyle modifications and implementation of DASH diet in daily life on blood pressure in hypertensive patients. Method: A prospective observational study was conducted for a period of six months from Dec- 2013 to May-2014. The data was collected by self prepared form and analyzed using descriptive statistics. Counselling on lifestyle changes and implementation of The DASH diet were given to the study population and post counseling changes were collected at visit 2. The significant difference in systolic and diastolic blood pressure was calculated by unpaired t-test. Results: A total of 186 patients were enrolled in the study, the mean (SD) age was 55.89(9.44), the percentage distribution of the study population showed that 103(55.37%) females and males 83(44.62%). The current study showed that overall effect of life style changes and implementation of the DASH diet in their daily life had a significant decrease in systolic (p<0.0001) and diastolic blood (P<0.0001) pressure of the study population. There was significant difference in the systolic (P value- 0.001) and diastolic blood pressure (P value-0.001) changes between the two groups of varied physical activity weekly once group and daily 1 hour group. Conclusion: In hypertensive individuals, lifestyle modifications and DASH diet can serve as an important and effective first-line treatment strategy adjunct to medication in person’s already on drug therapy and enhance anti hypertensive drug efficacy, and decrease cardiovascular risk.
Hypertension, Dietary Approaches to Stop Hypertension (DASH), life style modifications, blood pressure.
INTRODUCTION: In developing countries, high blood pressure is one of the risk factors for cardiovascular diseases, and the estimated 7.1 million Deaths, especially among middle, and old-age adults is due to high BP 1. Hypertension is a major risk factor for stroke and coronary heart disease, and is a major contributor to the onset and progression of chronic heart failure and chronic kidney failure 2.
Lifestyle interventions of reduced sodium intake and other dietary modifications (increased consumption of fiber, fruits, vegetables, and low fat dairy; reduced consumption of saturated and total fat) and increased physical activity and weight loss have resulted in significant BP reduction 3.
The DASH (Dietary Approaches to Stop Hypertension) diet, which was developed specifically to address hypertension and traditionally referenced as the recommended dietary guideline along with other DASH-like diets, is very similar (although not identical) to the current recommendations found in “Eating Well with Canada’s Food Guide” and CHEP 4. The combined effect of the DASH diet and lowering sodium intake to 1,500 mg was a reduction of 8.9/4.5 mm Hg (7.1/3.7 mm Hg in non hypertensive subjects and 11.5/5.7 mm Hg in hypertensive subjects). 5 Adopting low-risk dietary and lifestyle factors has the potential to prevent a large proportion of new-onset hypertension occurring among young women 6.
The aim of the study is to assess effect of lifestyle modifications in blood pressure in hypertensive patients.
Objective of the study:
- Primary Objective: To unfold the diverse groups of people can adopt multiple lifestyle changes that can lead to improved BP control and reduced CVD risk.
- Secondary Objective: To provide suggestions on lifestyle modifications to prevent and control blood pressure in hypertensive patients.
Study design: It is a prospective observational study.
Study period: The present study was carried out for a period of six months from Dec-2013 to May-2014.
Study site: The present study was conducted at Rajiv Gandhi Institute of Medical Sciences (RIMS) at the out -patient department, Kadapa.
Source of data:
All the patients satisfying the inclusion criteria were selected from medical outpatient departments in Rajiv Gandhi institute of medical sciences (RIMS) Government Hospital, Kadapa. All the required Data were collected from patients through personal interview and prescriptions.
During the study period of six months of this study, the total sample size was 186.
- Patients diagnosed with hypertension were included.
- Patients≥ 20 years of age were included in this study.
- Patients of both genders.
- Target organ damage and/or diabetes.
- Prior cardiovascular events like Heart failure, angina.
- Pregnancy and lactation women.
- Other co-morbidities.
Method of collection of data:
All the patients satisfying the inclusion criteria were selected from medical outpatient departments in Rajiv Gandhi institute of medical sciences (RIMS) Government Hospital, Kadapa. All the patients were given counselling on lifestyle changes and implementation of The DASH diet in their daily life.
The data collected from the participants were entered into Microsoft excel spreadsheet and descriptive statistics were used. The mean and standard deviation (SD) and P values were calculated using a graph pad prism. P-value less than or equal 0.05 were considered significant.
Sample distribution based on gender: A total of 186 patients were enrolled in the study, the mean (SD) age was 55.89 (9.44%), the percentage distribution of the study population showed that 103 (55.37%) females and males 83(44.62%) which were represented Table 1, Fig. 1.
TABLE 1: PERCENTAGE DISTRIBUTION BASED ON SEX
|Total No. of Patients with HTN||No. of Male Patients (%)||No. of Female Patients (%)|
Fig .1: PERCENTAGE DISTRIBUTION BASED ON SEX
Graphical representation of different age groups in the study sample:
Total distribution of patients with respect to age group shows that majority of patients were found in between the age group 40-60 years 114(61.29%), followed by 59(31.72%) in between the age group 60-80 years, 13(6.98%) in between the age group 20-40 years were represented in Table 2, Fig .2.
TABLE 2: PERCENTAGE DISTRIBUTION OF PATIENTS BASED ON AGE GROUP
|Age Group (yrs)||No. of Male Patients with HTN (%)||No. of Female Patients with HTN (%)||Total No. of Patients (%)|
|20-40||6 (7.22%)||7 (6.79%)||13 (6.98%)|
|40-60||43 (51.80%)||71 (68.93%)||114 (61.29%)|
|60-80||34 (40.96%)||25 (24.27%)||59(31.72%)|
Fig. 2: BASED ON AGE GROUP
In the present study the overall effect of lifestyle changes and implementation of DASH diet in their daily life had significant decrease in systolic (p<0.0001) and diastolic blood (p<0.0001) pressure of the study population were represented in Table 3.
TABLE 3: EFFECT OF LIFESTYLE MODIFICATIONS AND DASH DIET ON BLOOD PRESSURE
|Blood pressure change(mm Hg)||Visit 1mean(SD)||Visit 2mean(SD)||Changemean(SD)||P value|
|Systolic blood pressure||135.38(6.25)||128.89(5.96)||6.53(3.45)||0.0001|
|Diastolic blood pressure||86.89(4.99)||81.78(3.38)||5.10(4.6)||0.0001|
Comparing the effect of physical exercise on blood pressure:
The habit of physical exercise was calculated in the study population where 128 patients do it once in a week and 58 patients does it on a daily basis for one hour. The mean (SD) decrease in the systolic blood pressure was found to be 4.5(2.57) mm of Hg in once in a week and 6.86(3.51) mm of Hg in daily basis for one hour; decrease in the diastolic blood pressure was found to be 4.01(4.02) mm of Hg in once in a week and 6.79(4.61) mm of Hg in daily basis for one hour patients respectively were represented in Table 4.Both the systolic (p value- 0.001) and diastolic blood pressure (p value- 0.001) changes were found to be statistically significant.
TABLE 4: COMPARING THE EFFECT OF PHYSICAL EXERCISE ON BLOOD PRESSURE
|Blood pressure change(mm Hg)||Weekly once mean(SD) n=128||Daily 1 hour mean(SD) n=58||P value|
Comparing the blood pressure based on duration of hypertension:
In the study population based on duration of hypertension patients who were diagnosed as hypertension with a duration period of < 1 year are 118 and >1 year are 68 in number.
The mean (SD) decrease in the systolic blood pressure was found to be 7(5.55) mm of Hg in <1 year diagnosed and 5.55(3.75) mm of Hg in >1 year duration of diagnosed patients; decrease in the diastolic blood pressure was found to be 6.55 (4.74) mm of Hg in <1 year diagnosed and 5.02(4.64) mm of Hg in >1 year duration of diagnosed patients respectively were represented in Table 5.
Both the systolic (p value- 0.012) and diastolic blood pressure (p value-0.034) changes were found to be statistically significant.
TABLE 5: COMPARING THE BLOOD PRESSURE BASED ON DURATION OF HYPERTENSION
|Blood pressure change(mm Hg)||<1 Year mean(SD)n=118||>1year mean(SD)n=68||P value|
DISCUSSION: In the present study the overall effect of lifestyle changes and implementation of DASH diet in their daily life had a significant decrease in systolic (p<0.0001) and diastolic blood (P<0.0001) pressure of the study population. This study demonstrated that lifestyle changes and DASH dietary approaches can Favorably affect blood pressure in adults with The average systolic blood pressure of less than 140mm Hg and diastolic blood pressure of 80 to 95mm Hg. The most commonly affected age group with hypertension is 40-60 yrs in the total study population which accounts for 114 patients.
In the study population based on duration of hypertension patients who were diagnosed as hypertension with a duration period of <1 year are 118 and >1 year are 68 in number. Irrespective of duration of Hypertension, significant reduction in blood pressure was seen. Lifestyle modification is indicated for all patients with hypertension, regardless of drug therapy, because it may reduce or even abolish the need for antihypertensive drugs. In addition to the immediate goal of lowering blood pressure, the recommended lifestyle changes confer a range of health benefits, including better outcomes of common chronic diseases.
Limitation of the Study:
Only one follow up was performed to study the effect of life style changes and implementation of DASH diet within the limited time period of the study to observe the blood pressure changes in the participants.
CONCLUSION: Management of hypertension recommends lifestyle modification as an important and effective first-line treatment strategy. In addition to the significant lowering of blood pressure achieved through changes to eating patterns (DASH diet), and adopting changes in life style like moderating alcohol intake, weight loss, regular physical activity and smoking cessation can
confer with other significant cardiovascular health benefits. Regardless of other treatments indicated, all patients who need to lower their blood pressure should be given advice and support to achieve and maintain healthy behaviors.
In hypertensive individuals, lifestyle modifications can serve as an adjunct to medication in a person’s already on drug therapy and enhance anti hypertensive drug efficacy, and decrease Cardiovascular risk.
Special care and education is needed to control blood pressure in special cases as they have shown random variation in systolic and diastolic readings and they are prone to develop end organ damage. Regular check up by patients and periodic monitoring of the patient’s prognosis by physicians is necessary to avoid CV morbidities and risk.
It is the responsibility of all health care professionals to educate the patients regarding lifestyle modifications, which improves the community health status.
COMPETING INTERESTS: The authors declare that they have no competing interest.
ACKNOWLEDGEMENTS: I take this golden opportunity to express my humble gratitude and respect to my research guide. Dr. C. Gopinath, M. Pharm, Ph.D, FIC, FAGE, principal Annamacharya College of pharmacy, and Dr. K.B. Yadavender Reddy M.D., General Medicine, Associate professor RIMS, Kadapa and Dr. D. Giri Rajasekhar Pharm.D (PB) for his inspiring guidance, constant encouragement and intellectual suggestions throughout the project work.
- K. Mungreiphy, Satwanti Kapoor, Rashmi Sinha: Association between BMI, Blood Pressure, and Age: Study among Tangkhul Naga Tribal Males of Northeast India. Journal of Anthropology 2011; 1-6.
- Nancy Huang, Karen Duggan, Jenni Harman: Lifestyle management of hypertension. Australian prescriber 2008; 31: 150-153.
- Senaida Fernandez, Jonathan N Tobin, Andrea Cassells, Marleny Diaz Gloster, Chamanara Kalida, Gbenga Ogedegbe: The counseling african americans to control hypertension (caatch) trial: baseline demographic,clinical, psychosocial, and behavioral characteristics. Implementation Science 2011; 6:1-13.
- Zena L. Simces, Susan E. Ross, Simon W. Rabkin: Diagnosis of hypertension and lifestyle modifications for its management. BC medical journal 2012; 54(8): 392-398.
- Njeri karanja, T.P. Erlinger, Lin Pao Hwa, Edgar R. Miller, George A. Bray: The DASH diet for high blood pressure: From clinical trial to dinner table. Cleveland clinic journal of medicine 2004; 71: 745-753.
- John P. Forman, Meir J. Stampfer, and Gary C. Curhan: Diet and Lifestyle Risk Factors Associated With Incident Hypertension in Women. Journal of American Medical Association 2009; 302(4): 401-411.
How to cite this article:
Prasanna DG, Gopinath C, Reddy KBY, Rajasekhar DG, Chandrakanth P and Sravanakumari S: Effect of Lifestyle Modifications on Blood Pressure in Hypertensive Patients. Int J Pharm Sci Res 2015; 6(12): 5159-63.doi: 10.13040/IJPSR.0975-8232.6(12).5159-63.
All © 2013 are reserved by International Journal of Pharmaceutical Sciences and Research. This Journal licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 3.0 Unported License.
D. Guru Prasanna *, C. Gopinath, K.B. Yadavender Reddy, D. Giri Rajasekhar, P. Chandrakanth and S. Sravanakumari
Department of Pharmaceutical Chemistry, Annamacharya College of Pharmacy, Rajampet, Andhrapradesh, India
21 May, 2015
01 September, 2015
30 September, 2015
01 December, 2015