Control of blood pressure is one of the major public health challenges. Uncontrolled blood pressure is linked to cardiovascular diseases. Adhering to lifestyle modification strategies would ensure adequate blood control and therefore reduce cardiovascular morbidity and mortality. The objective of this study was to measure knowledge, attitude and practices amongst clients with hypertensive. The study also sought to determine barriers influencing the adherence to lifestyle modification strategies. A hospital based study was conducted in the Cape Coast Metropolis involving three hospitals namely Cape Coast Teaching Hospital, Metropolitan Hospital and University of Cape Coast Hospital. Among participants of the study, 85 (21.5%) were obese and 118 (29.8%) were overweight. Overall, 70.7% had good knowledge on hypertension. However only 32.8% had controlled blood pressure and the majority (67.2%) had uncontrolled blood pressure. Additionally 55.1% had adequate knowledge on lifestyle modification strategies. However only 17% had positive attitude towards lifestyle modification. It is therefore recommended that health care workers should motivate clients to adapt to lifestyle modification strategies.

This chapter presents the background, problem statement, objectives of the study, research questions and the conceptual framework for the study.

Background to the Study
Hypertension is one of the most prevalent chronic diseases, a leading risk factor for cardiovascular disease, and the number one cause of death globally (Manju, 2012). An estimated 17.7 million people died from cardiovascular diseases (CVDs) in 2015, representing 31% of all global death (WHO, 2015). Over 80% of cardiovascular disease’s deaths take place in low-and middle-income countries and occur almost equally among men and women (Smith, Ralston & Taubert, 2012). The increasing prevalence of hypertension in developing countries is of great concern.

Trends in hypertension prevalence and incidence continue to grow in Ghana (Bonsu, 2010). Effective control of hypertension is one of the most important preventable measures for premature morbidity and mortality. Despite all that has been shown about adverse health consequences, high blood pressure is still poorly controlled. For example in the United States, only about one third of patients with hypertension have achieved the National High Blood Pressure Education Program goal of 140/90 mmHg or lower (Cutler, Sorlie, Wolz, Thom,

Roccella, 2008). Studies from African countries have shown lower high blood pressure control. Kenya reported a control rate of 29% (Mathenge, Foster

Kuper, 2010). In Ghana, the control rate of hypertension ranges from 1.7% in the rural communities to 12.7% in the urban communities (Addo, Agyemang, Smeeth, de-Graft Aikins, Edusei & Ogedegbe, 2012).

This makes it necessary for understanding the disease and controlling it with lifestyle modification measures are key to the reduction of high prevalence of high blood pressure in a developing country like Ghana.

Prescribers in Ghana assess the indices of hypertension such as cholesterol level, body mass index and blood pressure to evaluate the effectiveness in the management of hypertension. High cholesterol is associated with an elevated risk of cardiovascular disease, which includes coronary heart disease, stroke, and peripheral vascular disease. High cholesterol has also been linked to diabetes and high blood pressure (D’Agostino, et al., 2008). The American Heart Association recommends total cholesterol levels of < 200 mg/dL for ideal cardiovascular health (Lloyd-Jones, Hong, et al., 2010).

Health practitioners must recognize the hurdles they face when advocating for lifestyle changes. In the United States the mainstay of hypertensive therapy is pharmacotherapy (Wexler & Aukerman, 2006). Interventions such as lifestyle and dietary modification are often overlooked (Okwuonu, Ojimadu, & Okaka, 2014). The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure recommends lifestyle modification for all patients with hypertension or prehypertension. (Cornelisse & Smart, 2013).

Authors of major position statements and systematic literature reviews have concluded that lifestyle modification has a major impact on prevention and management of hypertension (Chobanian, Bakris, Black, Cushman, Green, Izzo et al., 2003). Studies have revealed that healthy eating, active living, and achieving a healthy weight have a major impact on prevention and management of hypertension (Dietz et al, 2015). More specifically, the risk factors such as overweight, physical inactivity and high sodium intake appear to be major independent contributors to hypertension (Simces, Ross & Rabkin, 2012). A paper published by the American Heart Association’s Council on Epidemiology and Prevention suggested that a multidisciplinary approach, combining diet, exercise, and behavior change, is more effective in reducing risk factors for cardiovascular disease than treatment options that promote only one of these variables alone (Kumanyika et al., 2008). Five lifestyle modifications are recommended for reducing blood pressure: (1) reducing sodium intake, (2) increasing exercise, (3) moderating alcohol consumption, (4) following the Dietary Approaches to Stop Hypertension (DASH) and (5) losing weight. These modifications have been shown to reduce blood pressure, although their direct impact on morbidity and mortality is not yet known (Wexler & Aukerman, 2006).

Lifestyle modification is recommended for all patients with hypertension, regardless of drug therapy, because it may reduce the need for antihypertensive drugs (Shah, Maxwell, Shapiro, & Joseph, 2015). United States Healthy People 2000 (2010), guidelines are primarily prevention focused and have strongly recommended lifestyle modification to prevent and treat hypertension (Rakumakoe, 2011). In non-hypertensive individuals, including those with pre-hypertension, lifestyle modifications have the potential to prevent hypertension and more importantly to reduce blood pressure (BP) and lower the risk of BP-related clinical complications. In hypertensive individuals, lifestyle modifications can serve as initial treatment before the start of drug therapy and as an adjunct to drug therapy in persons already on medication. These therapies can facilitate drug step-down in individuals who can sustain lifestyle changes. In addition to the immediate goal of lowering blood pressure, the recommended lifestyle changes confer a range of health benefits, including better outcomes of common chronic diseases (Huang, Duggan & Harman, 2008).

Weight loss is an important lifestyle modification in reducing blood pressure. A reduction of 10 pounds can help reduce blood pressure or prevent hypertension (Rocha-Goldberg et al., 2010). A reduction of approximately 20 pounds (9 kilograms) may produce a reduction in systolic blood pressure of 5 to 20 mmHg. The PREMIER clinical trial by Funk et al. (2008) assessed the impact of comprehensive lifestyle changes on blood pressure. Participants in the lifestyle changes-only group had a greater reduction in blood pressure than those in the usual care group. This was further enhanced with the addition of the DASH (Dietary Approaches to Stop Hypertension) eating plan. This was the first trial to demonstrate that all recommended lifestyle changes can be combined to reduce blood pressure successfully.

Limiting alcohol consumption is an important lifestyle modification for reducing blood pressure. In a meta-analysis of a randomized control trails by Hollis et al., (2008), reductions of 3 mm Hg in systolic blood pressure and 2 mmHg in diastolic blood pressure for patients in the alcohol reduction groups (average reduction of 67% from an average intake of 3 to 6 drinks per day at baseline) was seen. As part of a comprehensive lifestyle program, it was recommended that men should have no more than two alcoholic drinks per day and women not more than one per day.

Studies have shown that aerobic exercise has positive effects on blood pressure whether or not a person has hypertension, producing average reductions of 4 mmHg in systolic blood pressure and 3 mmHg in diastolic blood pressure (James, Oparil, Carter et al., 2014). The authors recommended that patients with prehypertension or hypertension should exercise for 30 minutes on most days of the week.

Smoking cessation is an additional important lifestyle change. Nicotine released while smoking cigarettes is believed to impact blood pressure through arousal of the sympathetic nervous system followed by the release of norepinephrine and epinephrine (Al-Shammari, 2012). In one study, cigarette use caused a 4 mmHg increase in systolic blood pressure and a 3 mm Hg increase in diastolic blood pressure compared with placebo (Weber et al., 2014). Although some lifestyle modifications may seem to offer only minimal blood pressure–lowering effects, they should not be discounted (Wexler & Aukerman, 2006).

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Item Type: Ghanaian Topic  |  Size: 113 pages  |  Chapters: 1-5
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