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ASSESSMENT OF DIETARY COMPLIANCE AND PHYSICAL EXERCISE AMONG HYPERTENSIVE PATIENTS ATTENDING MEDICAL OUTPATIENT CLINIC IN UNIVERSITY OF NIGERIA TEACHING
Background to the Study
Hypertension is fast emerging as a modern epidemic in the world, Developed countries are considering it as a leading cause of death but even developing countries do not lag behind being affected by it. Hypertension is classified as either primary (essential) or secondary. It is a killer disease associated with the blood pressure that occurs due to over contraction or over relaxation of the ventricles. Many carriers of this disease are unaware of it because there is no immediate symptom which makes the carriers get along without knowing it. The danger, according to Aburto, Hansan, Gulierrez, Hooper, Elliott Cappuccio, (2013) comes when the unchecked, resultant effect usually called cardiovascular accident attacks which results to cardiac arrest, stroke, constant fainting, and continuous loss of energy. Blood pressure is expressed by two measurements, the systolic and diastolic pressures, which are the maximum and minimum pressures, respectively, in the arterial system. The systolic pressure occurs when the left ventricle is most contracted; the diastolic pressure occurs when the left ventricle is most relaxed prior to the next contraction. Normal blood pressure at rest according to Arguedas, Leiva & Wright (2013), is within the range of 100–140 mmHg systolic and 60–90 mmHg diastolic. Hypertension is present if the blood pressure is persistently at or above 140/90 millimeters of mercury (mmHg) for most adults; different criteria apply to children.
Hypertension according to Basiotis, Carlson, Gerrior, Juan & Lino (2012), usually does not cause symptoms initially, but sustained hypertension over time is a major risk factor for hypertensive heart disease, coronary artery disease, stroke, aortic aneurysm, peripheral artery disease, and chronic kidney disease. Even though hypertension is one of the leading cardiovascular disease and is called “a silent killer” (Bhavnager, 2009), it is however easily detectable and manageable. It is linked with changes in diet and life style factors and poor knowledge about the management of the disorder (Verma, 2007). A healthy life style is one in which individuals are aware of risks to their health and can make informed choices for maintenance. These choices include stopping smoking, consuming little quantity of alcoholic drinks per day, weight reduction and regular exercises. In addition, a diet with low sodium, low fat and plenty of fresh fruit and vegetable are required (Peltzer, 2002).
Dietary and lifestyle changes can improve blood pressure control and decrease the risk of health complications, although treatment with medication is still often necessary in people for whom lifestyle changes are not enough or not effective. Losing some excess weight can make a big difference. Blood pressure according to Ilo et al (2014) can fall by up to 2.5/1.5 mmHg for each excess kilogram which is lost. Losing excess weight has other health benefits too. For example brisk walking, swimming, cycling, dancing etc. Regular activity can lower blood pressure in addition to giving other health benefits. Physical exercise regimes which are shown to reduce blood pressure include isometric resistance exercises, aerobic exercise, resistance exercise and device-guided breathing (Brook, Appel, Reubenfire et al, 2013). Regular moderate exercise such as walking briskly or performing aerobic exercise (lasting for at least 30 minutes, at least three times per week) can lower systolic blood pressure considerably (Miller et al, 2002). The reductive effect is synergistic with other modifiable factors such as dietary modification and a reduction in alcohol consumption. Whelton et al, (2002) found that regular physical exercise alone can lead to a reduction in systolic blood pressure by 4 -9mmHg.
Dietary compliance as it concerns a hypertensive patient looks at strict adherence to food regulations given by experts on diets to regulate the health of the patient, to avoid complications arising from careless eating, to ensure that medications on hypertension go as prescribed by the medical expert Kearny, Whelton & Reymolds (2004).
The symptoms of hypertension include headache, heaviness in the head, sluggish movements, general redness and warm to touch feel of the body, prominent distended and tense vessels, fullness of the pulse, coloured and concentrated urine, loss of appetite, weak sight, impairment of thinking, yawning, drowsiness, vascular rupture and haemorrhagic stroke, law, Wald &Morris (2003). The therapeutic approach for the treatment of hypertensive disease according to Lewington et al (2002), included changes in lifestyle and dietary programme for patients (avoiding the consumption of wine, meat and pastries, reducing the quantity of food in a meal, maintaining a low energy diet and the dietary usage of spinach and vinegar).
According to Kotchen (2011), treatment of hypertension was chiefly medical in medieval times. As times progressed it became clear that dietary modification and physical exercises could be used as preventive or curative measures. Compliance to dietary modification and physical exercise as a treatment of Hypertension is evaluated by this research among patients attending outpatient clinic of University of Nigeria Teaching Hospital, Ituku-Ozalla.
Statement of the Problem
Hypertension also called high blood pressure has virtually no initial symptom of identification which makes many people ignorant that they are carriers of the disease though walking around.
The management of hypertension is tripartite in nature: medication, physical exercise and dietary modification. While medication is curative, physical exercise and dietary modification are both preventive and curative. In the curative part, they play reductionist roles which really is what the patient needs at the long run. Physical exercise done moderately keeps the body fit, but requires a lot of discipline to allocate time to it and still meet up with daily activities. Hypertensive patients who should be at the fore front of this curative measure rarely do it with the resultant effect that even the medication does not seem to have effect in the long run. Exercises like jogging, walking, hopping which are mild but very helpful to health are not often done by hypertensive patients (Kearney etal, 2005). This often aggravates their situation.
In the area of diet, it is observed by Schiffrin (2002) that even as they age, people still consume lots of fatty foods, high sugar beverages, much of red meat, which all increase the tendency of saturating the blood with fat and making the left ventricle to contract more than required leading to hypertension, (Chobanian, 2007). Others find it difficult to reduce stress and constant anger in their lives and do not sleep enough in a day to relax the body which causes relaxation of the left ventricle more than is required leading to hypertension (Diao etal, 2012). Dietary modification in terms of reducing much intake of red meat which increases cholesterol in the blood is rarely adhered to by most people probably including hypertensive patients. Also, according to Schooling et al (2006) good intake of white meat, snail, bird, snake, fowl and such like are rarely consumed by people in this part of the world due to cultural beliefs and taboos. Compliance to dietary and physical exercises among hypertensive patients seem to be ignored while much attention is focused on medication, Sorof & Daniel, (2002). The study aims to assess dietary compliance and physical exercises among hypertensive patients attending MOP Clinic of UNTH Ituku-Ozalla.
Purpose of the Study
The purpose of the study is to assess compliance with dietary modification and physical exercise among hypertensive patients attending Medical Outpatient Clinic in UNTH Ituku-Ozalla.
Objectives of the Study
Specific objectives are to:
- identify dietary practices adopted by hypertensive patients in the study population
- determine the extent of compliance with dietary modification among hypertensive patients that attend UNTH Medical Outpatient Clinic
- determine the extent of compliance with physical exercises among hypertensive patients in UNTH Medical Outpatient Clinic
- establish the relationship between demographic factors and compliance to dietary practices and physical exercise activities among the study population.
The following research questions were raised to guide the study:
- What are the dietary practices adopted by hypertensive patients in the study population?
- What is the extent of compliance with dietary modification among hypertensive patients in Medical Out Patient of UNTH?
- What is the extent of compliance with physical exercise activities among hypertensive patients in UNTH?
- What is the relationship between demographic factors and compliance to modifications in dietary practices and physical exercise activities among hypertensive patients in UNTH, Enugu?