TABLE OF CONTENTS PAGE
Title Page i
Certification ii
Approval Page iii
Dedication iv
Acknowledgement v
Table of Contents vi
List of Tables ix
List of Figures x
Abstract xi
CHAPTER ONE: INTRODUCTION
Background to the Study 1
Statement of the Problem 3
Purpose of the Study 4
Objectives of the Study 4
Research Questions 5
Hypotheses
Significance of the Study 5
Scope of the Study 6
Operational Definition of Terms 6
CHAPTER TWO: REVIEW OF RELATED LITERATURE
Conceptual Review 7
Pathophysiology 7
Diagnosis 9
Prevention 12
Management of Hypertension 12
Lifestyle Modifications 15
Resistant Hypertension 15
Epidemiology 16
Exploring Alternative Ideas: Shifting Focus to Elements with Greatest
Impact on Public Health 18
PAGE
Hypertensive Patients Who Exercise Have Lower Death Risk 19
Implications of hypertensive disease in surgical patients 20
Observation period 23
Causes of high blood pressure (hypertension) 24
How Common High Blood Pressure (Hypertension) is 24
Having blood pressure check 25
Cardiovascular Diseases 25
Risk Factors for Cardiovascular Diseases 25
Assessing (calculating) your cardiovascular health risk 26
Lowering Blood Pressure 27
Lifestyle Treatments to Lower High Blood Pressure (Hypertension) 27
National Institute of Health Guide to Lowering Blood Pressure with 29
Dietary Approaches to Stop Hypertension DASH (2014).
The DASH Eating Plan 30
DASH Tips for Gradual Change 31
Lifestyle – in Summary 32
DRI Estimations 32
Calculating the RDA 33
Dieting as a cure to Hypertension 33
Dieting as a Solution to Overweight and Hypertension 34
Types of Diets 35
Nutrition 37
How the Body Eliminates Fat 37
Weight Loss Groups 37
Food Diary 37
Diuretics 37
Possible weight Loss Effects of Drinking Water Prior to Meals 38
Fasting 38
Dietary Compliance
Dietary Self-Efficacy: Determinant of Compliance Behaviours and
Biochemical Outcomes in Haemodialysis Patients 39
Spike in Blood and Hypertensive Crisis 40
PAGE
Theoretical Review 41
Empirical Review 43
Summary of Literature Review 52
CHAPTER THREE: RESEARCH METHOD
Research Design 53
Area of Study 53
Population of Study 53
Sample 54
Sampling Procedure
Inclusion Criteria 54
Instrument for Data Collection 54
Validity of Instrument 55
Reliability of Instrument 55
Ethical Considerations 55
Procedure for Data Collection 55
Method of Data Analysis 56
CHAPTER FOUR: PRESENTATION OF RESULTS 57
Research Question One: What are the eating practices adopted by hypertensive
patients attending UNTH Clinic? ` 58
Research Question Two: What is extent of Compliance with dietary 59
modification among hypertensive patients attending UNTH Clinic?
Research Question Three: What is the extent of compliance with physical
exercises activities among hypertensive patients in UNTH? 60
Research Question Four: What is the relationship between demographic
factors and 62
compliance to modification to dietary practices and physical
exercise activities among hypertensive patients in UNTH?
Summary of Findings 63
Testing of Hypotheses
PAGE
CHAPTER FIVE: DISCUSSION
Discussion of Major Findings 64
Conclusion 66
Implication to Nursing 67
Limitations of Study 67
Suggestion for Further Studies 67
Summary 67
Recommendations 68
References 69
Appendices
Appendix I: Questionnaire
Appendix II: Informed Consent Form
Appendix III: Letter of Introduction
Appendix IV: Ethical Approval
Appendix V: Calculation of Sample Size
LIST OF TABLES PAGE
Table 1: Demographic characteristics of respondents 57
Table 2: Distribution of respondents’ dietary practices 58
Table 3: Distribution of respondents who complied to dietary modification 59
Table 4: Distribution of respondents based on their compliance with
specific dietary modification 59
Table 5: Distribution of respondents who engaged in physical exercises 60
Table 6: Distribution of respondents based on their compliance with specific
physical exercise 60
Table 7: Distribution of respondents based on their compliance with specific
areas of physical exercise 61
Table 8: Relationship between demographic factors and compliance with
Lifestyle modifications among the study participants 62
LIST OF FIGURES PAGE
Fig. 1: Classification of Blood Pressure for Adult (JNC7) 10
Fig. 2. The Health Belief Model (HBM) 43
ABSTRACT
The management of hypertension is tripartite in nature: medication, physical exercise and dietary modification. While medication is curative, physical exercise and dietary modification are both preventive and curative. Dietary and lifestyle changes can improve blood pressure control and decrease the risk of health complications, although treatment with medication is still often necessary in people for whom lifestyle changes are not enough. Physical exercise regimes which are shown to reduce blood pressure include isometric resistance exercises, aerobic exercise, resistance exercise etc. However, substantial literature and research have shown that hypertensive patients rarely comply with these lifestyle changes with the resultant effect that even the medication does not seem to have effect in the long run. Hence the purpose of the study is to assess compliance with dietary modification and physical exercise among hypertensive patients attending Medical Out-Patient Clinic in UNTH. The objectives were to: identify dietary practices adopted by hypertensive patients in the study area; determine the extent of compliance with dietary modification among hypertensive patients that attend UNTH Medical Outpatient Clinic; determine the extent of compliance with physical exercises among hypertensive patients in UNTH, and establish the relationship between demographic factors and compliance to modifications in dietary practices and physical exercise activities. A cross-sectional descriptive survey research design was employed and a sample of 240 hypertensive patients was drawn from patients attending Out Patient Clinic in UNTH. Descriptive statistics and Chi-square statistical test were used for data analyses. Findings revealed that 56(23.3%), 142(59.20%) and 65(27.08%) of respondents complied with dietary modification, dietary practices and physical exercises activities respectively. The study concluded that there was poor compliance to dietary modification, and physical exercises among the study population. It is therefore recommended that health care providers should intensify health education on the need for dietary compliance and physical exercises as primary strategies to control blood pressure and reduce the risk of cardiovascular problems.
CHAPTER ONE
INTRODUCTION
Background to the Study
Hypertension is fast emerging as a modern epidemic in the world, Developed countries are considering it as a leading cause of death but even developing countries do not lag behind being affected by it. Hypertension is classified as either primary (essential) or secondary. It is a killer disease associated with the blood pressure that occurs due to over contraction or over relaxation of the ventricles. Many carriers of this disease are unaware of it because there is no immediate symptom which makes the carriers get along without knowing it. The danger, according to Aburto, Hansan, Gulierrez, Hooper, Elliott Cappuccio, (2013) comes when the unchecked, resultant effect usually called cardiovascular accident attacks which results to cardiac arrest, stroke, constant fainting, and continuous loss of energy. Blood pressure is expressed by two measurements, the systolic and diastolic pressures, which are the maximum and minimum pressures, respectively, in the arterial system. The systolic pressure occurs when the left ventricle is most contracted; the diastolic pressure occurs when the left ventricle is most relaxed prior to the next contraction. Normal blood pressure at rest according to Arguedas, Leiva & Wright (2013), is within the range of 100–140 mmHg systolic and 60–90 mmHg diastolic. Hypertension is present if the blood pressure is persistently at or above 140/90 millimeters of mercury (mmHg) for most adults; different criteria apply to children.
Hypertension according to Basiotis, Carlson, Gerrior, Juan & Lino (2012), usually does not cause symptoms initially, but sustained hypertension over time is a major risk factor for hypertensive heart disease, coronary artery disease, stroke, aortic aneurysm, peripheral artery disease, and chronic kidney disease. Even though hypertension is one of the leading cardiovascular disease and is called “a silent killer” (Bhavnager, 2009), it is however easily detectable and manageable. It is linked with changes in diet and life style factors and poor knowledge about the management of the disorder (Verma, 2007). A healthy life style is one in which individuals are aware of risks to their health and can make informed choices for maintenance. These choices include stopping smoking, consuming little quantity of alcoholic drinks per day, weight reduction and regular exercises. In addition, a diet with low sodium, low fat and plenty of fresh fruit and vegetable are required (Peltzer, 2002).
Dietary and lifestyle changes can improve blood pressure control and decrease the risk of health complications, although treatment with medication is still often necessary in people for whom lifestyle changes are not enough or not effective. Losing some excess weight can make a big difference. Blood pressure according to Ilo et al (2014) can fall by up to 2.5/1.5 mmHg for each excess kilogram which is lost. Losing excess weight has other health benefits too. For example brisk walking, swimming, cycling, dancing etc. Regular activity can lower blood pressure in addition to giving other health benefits. Physical exercise regimes which are shown to reduce blood pressure include isometric resistance exercises, aerobic exercise, resistance exercise and device-guided breathing (Brook, Appel, Reubenfire et al, 2013). Regular moderate exercise such as walking briskly or performing aerobic exercise (lasting for at least 30 minutes, at least three times per week) can lower systolic blood pressure considerably (Miller et al, 2002). The reductive effect is synergistic with other modifiable factors such as dietary modification and a reduction in alcohol consumption. Whelton et al, (2002) found that regular physical exercise alone can lead to a reduction in systolic blood pressure by 4 -9mmHg.
Dietary compliance as it concerns a hypertensive patient looks at strict adherence to food regulations given by experts on diets to regulate the health of the patient, to avoid complications arising from careless eating, to ensure that medications on hypertension go as prescribed by the medical expert Kearny, Whelton & Reymolds (2004).
The symptoms of hypertension include headache, heaviness in the head, sluggish movements, general redness and warm to touch feel of the body, prominent distended and tense vessels, fullness of the pulse, coloured and concentrated urine, loss of appetite, weak sight, impairment of thinking, yawning, drowsiness, vascular rupture and haemorrhagic stroke, law, Wald &Morris (2003). The therapeutic approach for the treatment of hypertensive disease according to Lewington et al (2002), included changes in lifestyle and dietary programme for patients (avoiding the consumption of wine, meat and pastries, reducing the quantity of food in a meal, maintaining a low energy diet and the dietary usage of spinach and vinegar).
According to Kotchen (2011), treatment of hypertension was chiefly medical in medieval times. As times progressed it became clear that dietary modification and physical exercises could be used as preventive or curative measures. Compliance to dietary modification and physical exercise as a treatment of Hypertension is evaluated by this research among patients attending outpatient clinic of University of Nigeria Teaching Hospital, Ituku-Ozalla.
Statement of the Problem
