Research Paper on "Blood Pressure Treatment Compliance With Lifestyle Modifications"

Research Paper 5 pages (2219 words) Sources: 10

[EXCERPT] . . . .

Blood Pressure Treatment Compliance With Lifestyle Modifications

Heart disease is unfortunately one of the most frequent killers in the United States. So many Americans suffer from various conditions involving heart disease, including hypertension. It is this reason that it is so important to catch potential problems early, and to attack them with strength and effective execution. Understanding how to attack the problem from all sides is crucial within the healthcare field, making it crucial to understand how to combine strategies to provide the most effective solution. In pre-hypersensitive adults this includes the combination of traditional therapies with changes in diet and lifestyle. The healthcare field must embrace the fact that not everyone will be dedicated to lifestyle changes, and thus help provide further support through monitored lifestyle modifications including patient education on self-management in order to help reduce dangerous high blood pressure levels.

Literature Review

The treatment of high blood pressure in patients with hypertension can vary depending on each individual case. In fact, Weber et al. (2009) show that often times popular drug treatments, even in collaboration with one another, can not be relied on to lower blood pressure levels to a safe enough level on their own. Weber et al. (2009) conducted a clinical trial working with patients with hypertension that had been slow to respond to traditional treatments alone. The study incorporated 379 patients and used drugs like diuretic in the experimental group, with a placebo in the control group. Minor blood pressure reductions were recorded, but with side effects including fluid retention and accumulation. The findings of this study do posit the idea that drug therapy alone may not be entirely successful in reducing blood pressure to safe levels as successfully as when combined with dedicate lifestyle modifications. Another study conducted by Wexler et al. (2009) stated "Physicians often overestimate their effectiveness of the care they provide," often because of a lack of training tools provided to both themselves and the patients they care fore (2). Wexler et al. (2009) shows that physicians often take a backseat role in supervising proposed lifestyle changes, and often fail to provide clear guidelines that their patients are enforced to follow. Here, the data shows that physicians often only facilitate the problem of their patients' noncompliance. This then brings up the question regarding what else is needed in order to provide more effective results in promoting healthier lifestyles and appropriate self-management. This has lead to the creation of studies that evaluate new control measures to facilitate greater patient awareness through physician monitoring and training.

There is the common thought that lifestyle changes including dietary regulation, physical activity, and weight loss combined with drug therapies prove more successful than drugs used alone. One study, Cohen et al. (2011) showed that the practice of Iyengar Yoga was actually successful in helping lower blood pressure levels when compared to a control group. Blumenthal et al. (2010) conducted a study which reviewed the impact of combining the DASH (Dietary Approaches to Stop Hypertension) diet and lifestyle modifications in terms of lowering blood pressure in patients. The DASH diet is a strict dietary regulation process that restricts individuals' consumption of various fats but supplemented with low-fat diary products, vegetables, and foods rich in fiber. The study itself participants were drafted who were currently not taking antihypertensive medications. Other requirements included a minimum age of 35, BMI of between 25 to 40, and finally a mean systolic BP of 130 to 159 (Blumenthal 2009). Monitoring of blood pressure levels was conducted through the use of clinic measured BP, ambulatory BP monitoring, the measuring of pulse wave velocity, flow-mediated dilation, baroreflex sensitivity, and left ventricular mass index. Nutritional and weight assessments were made, but conducted by self-reporting measures using a food frequency questionnaire. This was augmented through enforced interventions, where subjects were placed on two-week long periods of controlled feeding. This then represents a strict regulation and supervision of dietary measures and changes in diet reflecting the need to establish new lifestyle habits. Strict adherence of the DASH diet combined with lifestyle changes coached often by lifestyle counseling provide to have a significant impact on patient blood pressure levels, much more so than less regulated dietary changes. On the other hand, DASH diet restrictions are not as successful without such lifestyle changes, which show how necessary lifestyle counseling is in order to provide the best results for adult patients with high blood pressure.

This correlates with another study, Balady et al. (2007) which showed that more direct and monitored interventions in lifestyle can have the greatest impact in reduction of blood pressure and overall cardiovascular health. This study gave several strategies of more direct and involved physician intervention in patient lifestyles including working with patients to create feasible treatment plans with realistic goals in lifestyle changes. However, the study clearly shows the limitations in current practice regarding the active role physicians need to be planning in more effective treatment programs to reduce blood pressure levels, and only provides solutions that are minor in supervision and often retroactive in terms of overall assessment of treatment goals. Another study conducted by Tuomilehto et al. (2009) used lifestyle counseling as a way to provide successful intervention strategies for another common complication experienced by overweight patients. The study examined lifestyle counseling and its role in helping patients better manage their weight in order reduce symptoms of obstructive sleep apnea (OSA). Although this is much different than using patients with high blood pressure, the study helps examine the importance of lifestyle counseling in executing successful results, as well as helping provide a strong and effective model for other healthcare practitioners to emulate models for patients with other complications, such as high blood pressure as seen in the case of pre-hypertensive adults in need of strict lifestyle changes. The study duration lasted over the period of a year and examined seventy two overweight individuals suffering from mild OSA and with a body mass index between 28 and 40. The study pitted two groups against each other, one control group which received lifestyle counseling, and an experimental group which highly supervised lifestyle counseling readily enforcing a very low calorie diet in order to produce results of weight loss. This group was exposed to a rigorous 12-week course that was followed up with continual post-counseling meetings with healthcare professionals and lifestyle counselors. Researchers used statistical analysis by measuring the apnea-hypopnea index along with a predesigned scale of the 15-D Quality of Life Tool (Tuomilehto et al. 2009). Results did show over time that there was a statistically significant difference between the two groups, with the experimental group receiving more supervised lifestyle modification training being more successful in reducing body weight by an average of -3.5 on the BMI scale. This group then also saw a high reduction rate in OSA as well as higher ratings on the 15-D Quality of Life Scale. Researchers concluded that "intensive lifestyle counseling with an initial weight reduction program can be effective" in reducing BMI and poor dietary routines in overweight patients, in fact much more so than less strictly supervised counseling on lifestyle and dietary choices. This lead researchers to make the conclusion that the more supervision involved in the lifestyle modification training and counseling lead to greater success rates of lowering body weight to a healthier range. With other studies, Aizawa (2009), showing similarities between the success rates of lifestyle modification intervention strategies in comparison between diabetes and pre-hypertension patients, such strategies provided by Tuomilehto et al. (2009) could prove incredibly effective if adopted to reduce blood pressure levels as well as weight.

However, Dusek (2008) shows that there are other treatment strategies that often work more successfully than supervised lifestyle modification strategies. This study compared stress management treatments, specifically using relaxation response training were statistically more effective in reducing blood pressure levels in patients to a safe enough level to end medication regiments. Participants in the study were over the age of 55 and participated in a double-blind randomized trial that was later measured through changing SBP levels over a period of eight weeks. This study helps show that lifestyle modification alone is not always as effective as some literature presents it, and that other treatments in training patients self-management prove effective as well. Yet, the idea that these trials depended on heightened physician training of methods does correlate with the idea that alternative treatment strategies should implement elements of monitoring and supervision throughout the treatment process. Additionally, Bonds et al. (2010) presented their evaluation of the Guideline Adherence for Heart Health (GLAD) with a trial of 61 primary care practices, some provided with multifaceted intervention strategies. Such strategies included education on medical strategies as well as audits and feedback on intervention adherence in correlation with automated blood pressure monitoring. Yet, the study found no statistical difference between the two groups, signifying that more multifaceted intervention strategies may not be as effective as physicians within the field would have hoped. Yet, a 2008 study, Smith et al.… READ MORE

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