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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
7/28/2019 effects of lifestyle modification to hypertensive patients
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2UNIVERSITY OF PERPETUAL HELP SYSTEM - JONELTA
Sto. Nio, Bian, Laguna
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
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 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
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 NURSING Since 1976
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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UNIVERSITY OF PERPETUAL HELP SYSTEM -
JONELTA
Sto. Nio, Bian, Laguna
COLLEGE OF NURSING Since 1976
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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UNIVERSITY OF PERPETUAL HELP SYSTEM -
JONELTA
Sto. Nio, Bian, Laguna
COLLEGE OF NURSING Since 1976
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
7/28/2019 effects of lifestyle modification to hypertensive patients
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7
UNIVERSITY OF PERPETUAL HELP SYSTEM -
JONELTA
Sto. Nio, Bian, Laguna
COLLEGE OF NURSING Since 1976
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_signs7/28/2019 effects of lifestyle modification to hypertensive patients
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UNIVERSITY OF PERPETUAL HELP SYSTEM -
JONELTA
Sto. Nio, Bian, Laguna
COLLEGE OF NURSING Since 1976
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)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 NURSING Since 1976
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
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 NURSING Since 1976
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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UNIVERSITY OF PERPETUAL HELP SYSTEM -
JONELTA
Sto. Nio, Bian, Laguna
COLLEGE OF NURSING Since 1976
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
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 NURSING Since 1976
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.
7/28/2019 effects of lifestyle modification to hypertensive patients
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13
UNIVERSITY OF PERPETUAL HELP SYSTEM -
JONELTA
Sto. Nio, Bian, Laguna
COLLEGE OF NURSING Since 1976
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
7/28/2019 effects of lifestyle modification to hypertensive patients
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14
UNIVERSITY OF PERPETUAL HELP SYSTEM -
JONELTA
Sto. Nio, Bian, Laguna
COLLEGE OF NURSING Since 1976
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
7/28/2019 effects of lifestyle modification to hypertensive patients
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15
UNIVERSITY OF PERPETUAL HELP SYSTEM -
JONELTA
Sto. Nio, Bian, Laguna
COLLEGE OF NURSING Since 1976
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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UNIVERSITY OF PERPETUAL HELP SYSTEM -
JONELTA
Sto. Nio, Bian, Laguna
COLLEGE OF NURSING Since 1976
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
7/28/2019 effects of lifestyle modification to hypertensive patients
17/47
17
UNIVERSITY OF PERPETUAL HELP SYSTEM -
JONELTA
Sto. Nio, Bian, Laguna
COLLEGE OF NURSING Since 1976
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
7/28/2019 effects of lifestyle modification to hypertensive patients
18/47
18
UNIVERSITY OF PERPETUAL HELP SYSTEM -
JONELTA
Sto. Nio, Bian, Laguna
COLLEGE OF NURSING Since 1976
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
7/28/2019 effects of lifestyle modification to hypertensive patients
19/47
19
UNIVERSITY OF PERPETUAL HELP SYSTEM -
JONELTA
Sto. Nio, Bian, Laguna
COLLEGE OF NURSING Since 1976
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
7/28/2019 effects of lifestyle modification to hypertensive patients
20/47
20
UNIVERSITY OF PERPETUAL HELP SYSTEM -
JONELTA
Sto. Nio, Bian, Laguna
COLLEGE OF NURSING Since 1976
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
7/28/2019 effects of lifestyle modification to hypertensive patients
21/47
21
UNIVERSITY OF PERPETUAL HELP SYSTEM -
JONELTA
Sto. Nio, Bian, Laguna
COLLEGE OF NURSING Since 1976
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)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 NURSING Since 1976
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)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 NURSING Since 1976
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)7/28/2019 effects of lifestyle modification to hypertensive patients
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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.long7/28/2019 effects of lifestyle modification to hypertensive patients
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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.html7/28/2019 effects of lifestyle modification to hypertensive patients
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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
Recommended