Lifestyle Modification after Diagnosis of Hypertension in Patients Visiting Lumbini Medical College Teaching Hospital Parbati Nepal,a,c Bina Dhunganab,c —–————————————————————————————————————————————— ABSTRACT: Introduction: Lifestyle modifications is an important aspect of hypertension therapy. However, studies on this non- pharmacological approach of hypertension management and its impact is very limited in a developing country like Nepal. The objective of the present study was to determine the life style of patients after diagnosis of hypertension. Methods: A descriptive cross sectional study design was conducted in Lumbini Medical College Teaching Hospital (LMCTH). A total of 63 patients attending Medical outpatient clinic of Lumbini Medical College who were diagnosed as hypertensive at least two months before the interview were included. Data were collected from 22nd February 2015 to 21st March 2015 by interview method using a questionnaire consisting of a combination of structured and semi- structured questions. Results: This study revealed that non-vegetarian decreased from 95.2% to 74.6% after diagnosis. Lifestyle modification criteria like amount of salt intake, smoking, and alcohol consumption were significantly reduced whereas physical exercise and stress reduction activity were significant increased. Conclusion: Majority of respondents has changed their lifestyle after diagnosis of hypertension. Keywords: healthy diet • healthy lifestyle • hypertension • lifestyle • sedentary lifestyle ——————————————————————————————————————————————— ___________________________________________________________________________________ a - Lecturer, Department of Nursing b - Nursing Officer c - Lumbini Medical College Teaching Hospital, Palpa, Nepal Corresponding Author: Parbati Nepal e-mail: kirparu@gmail.com How to cite this article: Nepal P, Dhungana B. Lifestyle modification after diagnosis of hypertension in patients visiting Lumbini Medical College Teaching Hospital. Journal of Lumbini Medical College, 2015;3(1):12-5. doi: 10.22502/jlmc.v3i1.62. ___________________________________________________________________________________ J. Lumbini. Med. Coll. Vol 3, No 1, Jan-June 2015 Original Research Article jlmc.edu.np https://doi.org/10.22502/jlmc.v3i1.62 INTRODUCTION: Hypertension is defined as a systolic blood pressure (SBP) greater than 140 mm Hg and diastolic pressure greater (DBP) than 90 mm Hg based on average of two or more accurate blood pressure measurements taken during two or more contacts with a health care provider.1 The World Health Organization (WHO) estimates that more than one billion population worldwide is affected by high blood pressure with prevalence of hypertension in one in every three adults. Overall 26.4% adult world population was estimated to have hypertension in the year 2000, a number that was projected to increase to 29.2% by 2025.2 Globally cardiovascular disease accounts for approximately 17 million deaths a year, nearly one third of the total deaths. Of these, complications of hypertension account for 9.4 million deaths worldwide every year.3 Hypertension is responsible for at least 45% of deaths due to heart disease (total ischemic heart disease) and 51% of deaths due to stroke.4 Overweight, sedentary behavior, excessive alcohol intake, higher social class, additional salt intake, diabetes mellitus, and smoking are risk factors for hypertension in most of the countries of Asia.5 Lifestyle modification, previously termed nonpharmacologic therapy, has important roles in hypertensive as well as non-hypertensive individuals.6,7 In hypertensive individuals, lifestyle modifications can serve as initial treatment before the start of drug therapy and as an adjunct to medication in persons already on drug therapy. In hypertensive 12 J. Lumbini. Med. Coll. Vol 3, No 1, Jan-June 2015 jlmc.edu.np Nepal P. et al. Lifestyle modification after diagnosis of hypertension in patients visiting Lumbini Medical College Teaching Hospital. individuals with medication-controlled blood pressure (BP), these therapies can facilitate drug step-down and drug withdrawal in highly motivated individuals who achieve and sustain lifestyle changes. Even an apparently small reduction in BP, if applied to an entire population, could have an enormous beneficial effect on cardiovascular events. For instance, a three mm Hg reduction in systolic BP should lead to an eight percent reduction in stroke mortality and a five percent reduction in mortality from coronary heart disease.7 The Dietary Approaches to Stop Hypertension (DASH) diet is a diet rich in fish, lean meat, low-fat dairy, fruits, vegetables, whole grains, legumes, nuts, and seeds. DASH diet lowered SBP for hypertensive patients by an average of 11 mm Hg and DBP by an average of 5.5 mm Hg compared with the control group.8 Reduction of three g/d in salt intake would lower blood pressure by 2.5/1.4 mm Hg, which would reduce strokes by 12 to 14% and ischemic heart disease by nine percent to 10%.5 Regular aerobic physical activity has been demonstrated to be beneficial both for prevention and treatment of hypertension.9 There are meager studies related to the change in pattern of lifestyle after diagnosis of hypertension in our part of world. Thereby, this study was carried out to explore whether lifestyle modifications were implemented after the diagnosis of hypertension and to find out the relationships, if existed, between them. METHODS: A descriptive cross sectional study was conducted in medical outpatient clinic of Lumbini Medical College Teaching Hospital. A total of 63 hypertensive patients who were diagnosed more than two months back were included in the study. The study was done from 22nd of January 2015 to 21st of March 2015. Data were collected by face to face interview technique. Special care was taken for maintaining ethical issue during the time of data collection and anonymity of all participants was maintained. Data were analyzed with SPSS 17. Various tests such as frequency distribution, Chi- square test were applied. RESULTS: Socio-demographic profile of patient included in the study is shown in Table 1. It shows that the majority (46%) of the respondents were above 60 years of age. Both genders were almost equally affected. Most (66.7%) of respondents were educated. Table 2 shows frequency distribution of participants according to hypertension related variables. It depicts that majority (60.3%) of the respondents were suffering from hypertension for more than two years. Fifty four percent of respondents had the habit of visiting hospital once in a month. Before diagnosis, there were fewer vegetarian individuals (4.8%), but after they were diagnosed to have hypertension, the number of vegetarian rose to 74.6%. This difference was significant, X2 (N=63, df=1) = 10.47, p = 0.001. Distribution of respondents according to type of meat consumed and frequency of consumption before and after the diagnosis of hypertension is shown in Table 3. It shows that consumers of mutton, chicken, fish, and eggs all decreased after the diagnosis of hypertension. Table 4 shows the distribution of respondents according to type of fats consumption before and after the diagnosis of hypertension. It shows that the users of ghee (saturated fat) were decreased. There was also a decrease in daily users of mustard oil, but there was increase in the uses of sunflower oil. Amount Table 1: Socio-demographic profile of the participants Variables n % Age 30-40 Years 5 7.9 40-50 years 11 17.5 50-60 years 18 28.6 Above 60 29 46 Gender Male 32 50.8 Female 31 49.2 Educational status Illiterate 21 33.3 Literate 42 66.7 Among literate Primary 14 22.2 Secondary 18 28.6 Higher secondary 3 4.8 Informal education 7 11.1 Ethnicity Brahmin 20 31.7 Chhetri 12 19 Janajati 21 33.3 Dalit 10 15.9 13 J. Lumbini. Med. Coll. Vol 3, No 1, Jan-June 2015 Nepal P. et al. Lifestyle modification after diagnosis of hypertension in patients visiting Lumbini Medical College Teaching Hospital. jlmc.edu.np of salt taken before and after the diagnosis of hypertension is shown in Table 5. It shows that there was decrease in the amount of salt consumed. Table 6 shows the distribution of study population with lifestyle risk factors before and after the diagnosis of hypertension. There was significant reduction in frequency of smoking and alcohol consumption; whereas, there was significant increase in physical activities and stress reduction activities. DISCUSSION: The results of this study showed most of Table 2: Frequency Distribution of participants according to hypertension related variables Table 3: Distribution of respondents according to type of meat consumed and frequency of consumption before and after diagnosis of hypertension the respondents (95.2%) were non-vegetarian and 4.8% were vegetarian before diagnosis, whereas after the diagnosis of hypertension vegetarian were found to have increased from 4.8 % to 25.4%. This finding is supported by the study done by Acharya R. et al. in Kathmandu, which also showed 90% were non-vegetarian and only 10% were vegetarian before diagnosis but after diagnosis the vegetarian increased from 10% to 20%.9 The consumption habit of non-vegetarian items such as mutton, buff, pork, chicken, fish and Table 4: distribution of respondents according to type of fats consumption before and after diagnosis of hypertension Table 5: Amount of salt taken before and after the diagnosis of hypertension Table 6: Lifestyle risk factors before and after the diagnosis of hypertension Variables n % Duration of hypertension 2 month-1 year 11 17.5 1 year- 2 years 14 22.2 More than 2 years 38 60.3 Duration of hospital visit Once in a month 34 54 Once in a three month 8 12.7 According to doctors instruction 13 20.6 While facing problem 8 12.7 Frequency of consumption Ty pe o f m ea t/ eg g D ai ly n (% ) W ee kl y n (% ) M on th ly n (% ) O cc as io na lly n (% ) Mutton Before 1(1.6) 25(39.7) 10(15.9) 22(34.9) After 0 6(9.5) 3(4.8) 25(39.7) Pork Before 1(1.6) 7(11.1) 4(6.3) 11(17.5) After 1(1.6) 0 2(3.2) 10(15.9) Chicken Before 5(7.9) 15(23.8) 7(11.1) 23(36.5) After 0 8(12.7) 3(4.8) 29(46) Fish Before 0 2(3.2) 5(7.9) 37(58.7) After 0 0 3(4.8) 28(44.4) Egg Before 18(28.6) 5(7.9) 1(1.6 19(30.2) After 1(1.6) 4(6.3) 1(1.6) 27(42.9) Frequency of consumption n(%) Ty pe o f G he e/ O il D ai ly W ee kl y M on th ly O cc a- si on al ly N on -u se r Ghee Before 26(41.3) 5(7.9) 0 28(44.4) 4(6.3) After 2(3.2) 2(3.2) 0 16(25.4) 43(68.3) Mustard Oil Before 56(88.9) 1(1.6) 1(1.6) 5(7.9) 0 After 33(52.4) 0 0 27(42.9) 3(4.8) Soybean Oil Before 4(6.3) 1(1.6) 2(3.2) 45(71.4) 11(17.5) After 7(11.1) 0 1(1.6) 43(68.3) 12(19) Sunflower Oil Before 0 0 0 43(68.3) 20(31.7) After 21(33.3) 1(1.6) 1(1.6) 29(46) 11(17.5) Low Normal Additional Before 5(7.9) 42(66.7) 16(25.4) After 54(85.7) 9(14.3) 0 Alterations in lifestyle risk factors Before n(%) After n(%) Smoking 24(38.1) 8 (12.7) X 2=8, p=.005 Alcohol consumption 29(46) 8 (12.7) X2=11.9, p<.001 Physical Activity 9(14.3) 29 (46) X2=10.53, p=.001 Stress reduction activity 13 (20.6) 41 (65.1) X2=14.5, p<.001 14 J. Lumbini. Med. Coll. Vol 3, No 1, Jan-June 2015 Nepal P. et al. Lifestyle modification after diagnosis of hypertension in patients visiting Lumbini Medical College Teaching Hospital. jlmc.edu.np eggs were taken into account while collecting the data in this study. This study showed that there was a reduction in the consumption of meat items after diagnosis of hypertension. There was decline in consumption of items like mutton, chicken, and eggs. This finding was supported by a similar study by Acharya R. et al. in which there was also statistically significant decline in consumption of those items.2 Finding of this study revealed that the number of respondents involved in smoking and drinking alcohol decreased significantly after diagnosis of hypertension which is consistent with other studies.9,10 Physical workout has been taken as one of the associated factors for the hypertension. After the diagnosis of hypertension, the number of respondents doing physical exercise increased significantly from 14.3% to 46% which is supported by study done by WHO in 2006. That study revealed that very few respondents (14%) had gone through stress reduction activities before diagnosis but after that number increased to 39%.11 Similarly, salt restriction, regular exercise, stress reduction, unsaturated oil reduction, alcohol moderation strategies has been adopted to control blood pressure by different hypertensive patients in different counties.9,11,12 CONCLUSION: Lifestyle modification strategies have been implemented by majority of the respondents after diagnosis of hypertension which is good sign of hypertension management. Proper counseling by healthcare professionals regarding lifestyle modification is of utmost necessity to assure long normal life of the hypertensive patients. REFERENCES: 1. Smeltzer SC, Bare B. Brunner and Suddarth’s Textbook of Medical Surgical Nursing. 12 ed. New Delhi: Wolter’s Kluwer; 2012. 889-900 p. 2 vol. 2. WHO: High Blood Pressure a Silent Killer [Internet]. WHO. 2013 – [cited 2015 Jan 15]. Available from http:// www.voanews.com/a/world-health-organizationhypertens ion/1636429.html 3. Lim SS, Vos T, Flaxman AD, Danaei G, Adair-rohani H, Amann M. et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990-2010 : a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380(9859):2224-60. doi: 10.1016/S0140- 6736(12)61766-8. 4. WHO. Global status report on noncommunicable diseases 2010. World Health Organization. http://www.who. int/nmh/publications/ncd_report2010/en/. Accessed February 17, 2015. 5. Kim K, Kang H, Shin E, Kim SH. Prevention and management of hypertension for older Adults. J community Nutrition. 2004;6(1):26-34. 6. Elmer PJ, Obarzanek E, Vollmer WM, Simons-Morton D, Stevens VJ, Young DR, et al. Effects of Comprehensive Lifestyle Modification on Diet, Weight, Physical Fitness, and Blood Pressure Control: 18-Month Results of a Randomized Trial. Ann Intern Med. 2006;144:485-495. doi: 10.7326/0003-4819-144-7-200604040-00007 7. Appel LJ. Lifestyle Modification as a Means to Prevent and Treat High Blood Pressure. Journal of American society of nephrology. 2003;14(2):99-102. 8. Effects of comprehensive lifestyle modification on blood pressure control. JAMA. 2003;289(16). doi:10.1001/ jama.289.16.2083. 9. Acharya R, Chalise HN. Lifestyle of patients before and after diagnosis of hypertension in Kathmandu. Health. 2011; 3(8);490-7. 10. Neutel CI, Campbell NR. Changes in lifestyle after hypertension diagnosis in Canada. The Can J Cardiol. 2008;24(3):199-204. 11. World Health Organization. Focus in Priorities, WHO Report. 2005 [cited – January 26, 2015]. Available at www. who.org. 12. 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