CHAPTER 1

Background of the Study

Hypertension is a global health problem. The prevalence of hypertension

worldwide was 26% in 2000, and the total number of adults with hypertension will reach an

estimated 1.56 billion in 2025. Elevated blood pressure (BP) is a leading cause of cardiovascular

diseases, disability, and premature death . Along with population ageing, the burden of

hypertension on our societies is predicted to increase continuously. However, hypertension is

modifiable ; and well-controlled BP can prevent clinical complications, enhance quality of life,

and improve prognosis . The optimal BP for adults with hypertension can be achieved through

pharmacological treatment and nonpharmacological interventions. Daily preventive practices of

the affected individual are essential for BP control. During the past decades, the hypertension

treatment rate has increased remarkably, especially in some countries including South Korea;

and the BP control rate among hypertensive adults treated with medication has also substantially

improved. The reason for this may be that self-management of medication has become easier

with alleviation of potential barriers surrounding pharmacological treatment, i.e., limited health

care, drug expense, inconvenience of dosing, and severity of side effects . However, recent

indices of hypertension management have remained stable; and a considerable number of

medicated adults with hypertension do not reach the optimal BP control level. Lifestyle

modifications such as healthy diet, low sodium consumption, sufficient physical activity, and

limited alcohol consumption have been strongly recommended for all hypertensive individuals.

These modifications can serve as an initial treatment before the start of medication or as an

adjunct to medication in persons already on pharmacological treatment . There are few studies
focusing on hypertensive individuals’ lifestyle management practices and their effects on BP

control.

According to some previous studies, adherence to lifestyle modification,

particularly dietary modification, is much lower than that of medication compliance . This is true

despite the noted beneficial impact of lifestyle modification in many clinical trials and

epidemiologic studies. Contrary to pharmacological treatment, lifestyle modification has few or

no harmful side effects and leads to improved overall cardiovascular health in addition to BP

reduction. Lifestyle modification can reduce the requirement for BP lowering drugs. Therefore, a

more aggressive movement from pharmacological treatment toward lifestyle modification seems

necessary. To the best of our knowledge, there are few studies that evaluate dietary management

practices and their effects on BP control among adults diagnosed with hypertension. Thus, we

aimed to investigate the association of self reported dietary management, dietary quality, and BP

control among Korean adults with known hypertension.

Theoretical Framework

This study was anchored on the theory of Orem’s Self-care deficit and on Jeans Watson’s

Philosophy of nursing.

Orem’s self-care deficit theory comprises those activities performed independently by an

individual to promote and maintain personal well-being throughout life. The individual’s ability

to perform self-care activities and the actions or measures used to provide self-care.

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 ans restoring health. It

focuses on health promotion and treatment of disease. She believes that holistic 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

This conceptual framework discussed by the problems posited in the study. For the

variables used in the study, the Researchers utilized the daily Blood Pressure reading of the

respondentsbefore 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 Effects of lifestyle

Reading Before Modification in the Blood

Lifestyle Pressure reading of the

respondents 15 days after.

Modification
Statement of the Problem

This study aims to determined at finding the effects of dietary management of

hypertensive patient.

Specifically they sought at finding the answers to the following questions:

1. What is the initial BP reading of the respondents before start of the diet?

2. What is the effect of dietary management of the hypertensive patient in the blood pressure
reading of the respondents 15 days after ?

3. Is there a significant difference in the effect of dietary management in the blood pressure
reading before and 15 days after it started?
Significance of the study

The study will be significant the following:

Health Practitioners. This study can be a big help for other members of the health care

providers in renedering their care to other people. They can use this study to give health teaching to

their patient especially those who are at risk in developing persistent hypertension.

Respondents. It 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 And it helps to give more information about dietary management of hypertensive

individuals

Families. It helps them to realize the significance of diet towards hypertension

management and help promote wellness among their relatives and significant others.

Future Researchers. It helps the most to the future researchers which is serves as a basis

information for the future or similar researches with stress in the need to changes in lifestyle to

hypertension management.
Scope and Delimitation of the Study

In general the focus of this study is the effects of dietary management of hypertensive

patient based on the Blood Pressure reading of the respondents during 15 days of observation. This

study was conducted in selected areas in Lanao Del Norte. This study involved interviews and

observations of the respondents regarding their diet and history of hypertension regardless of whether

they are under maintenance or medication.this study was conducted for 15 days with intervals of two

times a day of blood pressure taking. The respondents were closedly monitored by the researchers

who assumed the veracity of the information given to them.

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.

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.

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. is a cardiac chronic medical condition in which the systemic arterial

blood pressure is elevated.

Lifestyle. is the way a person live to one’s own ability.

Diet. A special course of food to which one restricts onself, either to lose weight or for medical

reasons.

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

Statement of Hypothesis

The following hypothesis was tested in the study.

Ho1. There is no significant difference in the effect of lifestyle modification in the Blood

Pressure reading before and 15 days after it started

REVIEW OF RELATED LITERATURE AND STUDIES
Related Literature
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 symptoms appear late.

(Nelson S. Abelard, 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.Abelard 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.

Abelard 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 (NH’s 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

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 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.

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, digoxin 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. 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 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, t’ai 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 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, no significant 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 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 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

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 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 medications to help counteract the increase in blood pressure

that occurs in the early morning hours. Stress reduction may help blood pressure control. Yoga,

t’ai 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.

According to (Gajewska, Danuta, Niegowska, Joanna and Kucharska 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 21.6±6.5 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 ld. (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 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 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 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. Fern Vivaldi,(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. Vivaldi 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 Olivares, 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, Olivares 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 exposure of the population to some of the risk factors particularly smoking, unhealthy

diet, and lack of physical activity, through population-based interventions.

(Baroques 2008), as a remedy to avoid hypertension, Baroques 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 NH’s 2003-2004

said that one of the important applications of the NH’s 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 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 Baroques said it is a remedy to avoid hypertension, Baroques

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 NH’s 2003-

2004 said that one of the important applications of the NH’s 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 III
RESEARCH 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 observations. The problem with this approach is subjects may modify their

behavior 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; wherein the primary

data were taken from the respondents themselves and the secondary data were taken from books,

journals, thesis and information’s 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 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_____

√∑D² - (∑D) ²

n(n-1)

Where:
D- The mean Difference between the pre-test and post-test
∑D²- 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-test
n- Total sample size

“DIETARY MANAGEMENT OF HYPERTENSION PATIENT”

Quantitative Research

Presented to
The faculty of College of Nursing

In Fulfillment of the requirements in

Practical Research II
 Bautista, Rizalie B.
Juanillo, Vissey
Labasano, Nikki B.
Macalolon, Ansar-Billy R.
Villarazo, Michelle Mae C.