UNIVERSITY OF PERPETUAL HELP SYSTEM - JONEL TA

Sto. Nio, Bian, Laguna

COLLEGE OF NURSING
Since 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 has reported 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 4049 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

UNIVERSITY OF PERPETUAL HELP SYSTEM - JONEL TA 2

Sto. Nio, Bian, Laguna

COLLEGE OF NURSING
Since 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 betablocking 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

3 UNIVERSITY OF PERPETUAL HELP SYSTEM -

JONEL TA
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 older molecules 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

4 UNIVERSITY OF PERPETUAL HELP SYSTEM -

JONEL TA
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, 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.

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.

5 UNIVERSITY OF PERPETUAL HELP SYSTEM -

JONEL TA
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 of Lifestyle 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

6 UNIVERSITY OF PERPETUAL HELP SYSTEM -

JONEL TA
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 UNIVERSITY OF PERPETUAL HELP SYSTEM -

JONEL TA
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 of blood vessels, and is one of the principal vital signs.

8 UNIVERSITY OF PERPETUAL HELP SYSTEM -

JONEL TA
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 after systole (contraction) Drinker is a person who drinks, especially a person who drinks alcohol habitually. 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.

9 UNIVERSITY OF PERPETUAL HELP SYSTEM -

JONEL TA
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, nosymptom individuals should have their BPs checked as visible or felt

10 UNIVERSITY OF PERPETUAL HELP SYSTEM -

JONEL TA
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

11 UNIVERSITY OF PERPETUAL HELP SYSTEM -

JONEL TA
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

12 UNIVERSITY OF PERPETUAL HELP SYSTEM -

JONEL TA
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. 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 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.

13 UNIVERSITY OF PERPETUAL HELP SYSTEM -

JONEL TA
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

14 UNIVERSITY OF PERPETUAL HELP SYSTEM -

JONEL TA
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 and 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 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

15 UNIVERSITY OF PERPETUAL HELP SYSTEM -

JONEL TA
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

16 UNIVERSITY OF PERPETUAL HELP SYSTEM -

JONEL TA
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-toheavy drinkers, a reduction in alcohol intake lowered BP to a small, nonsignificant extent. In aggregate, available evidence supports a

recommendation 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

17 UNIVERSITY OF PERPETUAL HELP SYSTEM -

JONEL TA
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

18 UNIVERSITY OF PERPETUAL HELP SYSTEM -

JONEL TA
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

19 UNIVERSITY OF PERPETUAL HELP SYSTEM -

JONEL TA
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

20 UNIVERSITY OF PERPETUAL HELP SYSTEM -

JONEL TA
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

21 UNIVERSITY OF PERPETUAL HELP SYSTEM -

JONEL TA
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 selfcare theory (TDAC) in women with hypertension. Four hypertensive women in an outpatient clinic were interviewed using a form with open and multiplechoice 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, Joanna and Kucharska

22 UNIVERSITY OF PERPETUAL HELP SYSTEM -

JONEL TA
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 diet and 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

23 UNIVERSITY OF PERPETUAL HELP SYSTEM -

JONEL TA
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, exercise and 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 its electrolyte balance with sodium and its replacement need when potassiumlosing 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

24 UNIVERSITY OF PERPETUAL HELP SYSTEM -

JONEL TA
Sto. Nio, Bian, Laguna

COLLEGE OF NURSING
Since 1976 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 of hypertension, 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

25 UNIVERSITY OF PERPETUAL HELP SYSTEM -

JONEL TA
Sto. Nio, Bian, Laguna

COLLEGE OF NURSING
Since 1976 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

26 UNIVERSITY OF PERPETUAL HELP SYSTEM -

JONEL TA
Sto. Nio, Bian, Laguna

COLLEGE OF NURSING
Since 1976 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, Joanna and 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,

27 UNIVERSITY OF PERPETUAL HELP SYSTEM -

JONEL TA
Sto. Nio, Bian, Laguna

COLLEGE OF NURSING
Since 1976 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

28 UNIVERSITY OF PERPETUAL HELP SYSTEM -

JONEL TA
Sto. Nio, Bian, Laguna

COLLEGE OF NURSING
Since 1976 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 an experiment. 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 of simple 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;

29 UNIVERSITY OF PERPETUAL HELP SYSTEM -

JONEL TA
Sto. Nio, Bian, Laguna

COLLEGE OF NURSING
Since 1976 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 simple experimentation 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

30 UNIVERSITY OF PERPETUAL HELP SYSTEM -

JONEL TA
Sto. Nio, Bian, Laguna

COLLEGE OF NURSING
Since 1976 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 pretest and the post-test D- The summation of the difference between the pre-test and post-test n- Total sample size

31 UNIVERSITY OF PERPETUAL HELP SYSTEM -

JONEL TA
Sto. Nio, Bian, Laguna

COLLEGE OF NURSING
Since 1976

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 1.N.A

Initial BP reading Systole Diastole 150 100

Final BP readings Systole Diastole 120 80

32 UNIVERSITY OF PERPETUAL HELP SYSTEM -

JONEL TA
Sto. Nio, Bian, Laguna

COLLEGE OF NURSING
Since 1976 2.E.L 3.A.N 4.S.B 5.F.O 6.L.F 7.U.D 8.R.D 9.S.R 10.S.L 11.J.R 12.N.R 13. L.S 14. N.L 15. O.M 120 140 130 130 140 140 120 140 200 140 140 130 150 190 90 90 80 60 70 70 80 70 160 100 90 90 90 100 120 110 130 130 130 90 110 110 180 130 120 130 130 190 90 90 70 60 80 60 80 60 160 90 90 90 80 100

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

33 UNIVERSITY OF PERPETUAL HELP SYSTEM -

JONEL TA
Sto. Nio, Bian, Laguna

COLLEGE OF NURSING
Since 1976 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
PARAMETER SYSTOLIC MEAN 1 PRE 145.33 MEAN 2 POST 127.33 MEAN DIFFERENCE -18.00 COMPUTED t-VALUE 4.89 INTERPRETATION SIGNIFICANT

DIASTOLIC

89.33

79.33

-10.00

1.49

NOT SIGNIFICANT

0.05 level of significance Critical t-value= 2.145 Degree of freedom= 14

n1=15

n2=15

34 UNIVERSITY OF PERPETUAL HELP SYSTEM -

JONEL TA
Sto. Nio, Bian, Laguna

COLLEGE OF NURSING
Since 1976

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 go down. 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.

35 UNIVERSITY OF PERPETUAL HELP SYSTEM -

JONEL TA
Sto. Nio, Bian, Laguna

COLLEGE OF NURSING
Since 1976

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.

36 UNIVERSITY OF PERPETUAL HELP SYSTEM -

JONEL TA
Sto. Nio, Bian, Laguna

COLLEGE OF NURSING
Since 1976 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 it thus 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.

37 UNIVERSITY OF PERPETUAL HELP SYSTEM -

JONEL TA
Sto. Nio, Bian, Laguna

COLLEGE OF NURSING
Since 1976

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 the respondents to maintain lifestyle modification. 3. For future researchers to categorize what lifestyle modification would be beneficial to hypertensive patients.

38 UNIVERSITY OF PERPETUAL HELP SYSTEM -

JONEL TA
Sto. Nio, Bian, Laguna

COLLEGE OF NURSING
Since 1976

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, 217223.

39 UNIVERSITY OF PERPETUAL HELP SYSTEM -

JONEL TA
Sto. Nio, Bian, Laguna

COLLEGE OF NURSING
Since 1976 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

40 UNIVERSITY OF PERPETUAL HELP SYSTEM -

JONEL TA
Sto. Nio, Bian, Laguna

COLLEGE OF NURSING
Since 1976 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

41 UNIVERSITY OF PERPETUAL HELP SYSTEM -

JONEL TA
Sto. Nio, Bian, Laguna

COLLEGE OF NURSING
Since 1976 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

42 UNIVERSITY OF PERPETUAL HELP SYSTEM -

JONEL TA
Sto. Nio, Bian, Laguna

COLLEGE OF NURSING
Since 1976

APPENDIX A
(Systolic and Diastolic BP Reading before and after Lifestyle Modification)

43 UNIVERSITY OF PERPETUAL HELP SYSTEM -

JONEL TA
Sto. Nio, Bian, Laguna

COLLEGE OF NURSING
Since 1976

Figure 1 Systolic Reading of subjects Before and After Lifestyle Modification

OA NL SU NA JR SO Subjects SR RD UD LF OF SB AN EL NA 0 100 200 300 BEFORE-SYSTOLIC AFTER-SYSTOLIC

Systolic Reading

44 UNIVERSITY OF PERPETUAL HELP SYSTEM -

JONEL TA
Sto. Nio, Bian, Laguna

COLLEGE OF NURSING
Since 1976

Figure 2 Diastolic Reading of Subjects Before and After Lifstyle Modificaton

OA NL SU NA JR SO Subjects SR RD UD LF OF SB AN EL NA 0 50 100 150 200 BEFORE-DIASTOLIC AFTER-DIASTOLIC

Diastolic Reading

APPENDIX B

45 UNIVERSITY OF PERPETUAL HELP SYSTEM -

JONEL TA
Sto. Nio, Bian, Laguna

COLLEGE OF NURSING
Since 1976

(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

46 UNIVERSITY OF PERPETUAL HELP SYSTEM -

JONEL TA
Sto. Nio, Bian, Laguna

COLLEGE OF NURSING
Since 1976 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.

47 UNIVERSITY OF PERPETUAL HELP SYSTEM -

JONEL TA
Sto. Nio, Bian, Laguna

COLLEGE OF NURSING
Since 1976

Name: ______________________ Age: __________ Gender: __________ Educational Attainment: _________ Economic Status: ______________

Date: _______________ Lifestyle: Smoker Alcoholic Drinker Coffee Drinker Unhealthy Diet No exercise