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How do lifestyle changes-like regular exercise and a nutritious diet-compared to standard

care for lowering blood pressure and improving cardiovascular health in older adults with

65 years of age and older with hypertension?

Anjana Gurung,Rabina Gautam,Suraj karki,Uma Verma

Gerontology Inter-Professional Practice, Fanshawe College

RSCH 6008-2, Research Literacy Section

Professor Julie Dergal

7th June 2024

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Introduction

Hypertension is also termed as high blood pressure is a medical condition which is

generalized by rise of blood pressure in arteries. In general, a blood pressure reading of 120/80

mmHg or lower is considered normal whereas blood pressure consistently measures 130/80

mmHg and higher are considered to be high blood pressure. The cause of hypertension is

generally associated to lifestyle factors; including physical inactivity, excess alcohol

consumption, smoking and poor dietary habits. Hypertension has become more affected to older

people than young individuals. Some of the studies has shown that 24 -30% of old aged person

have hypertension. They were even unaware of their hypertension status. Some study has also

shown that approx. 32% of people suffering from hypertension are not receiving treatment while

in some studies shows that control and treatment of hypertension in older person is low. The

success rate is just 50%. (Samuel Muli1, 2020).

In Canada almost eight millions of adults are affected by high blood pressure which

is one person in four (heart& stroke tm).The second most leading cause of death in Canada

is heart disease, claiming more than 50,000 lives each other(government of Canada,2022).

Cardiovascular disease (CVD) is the growing contributors to global disease burdens with

rising numbers across all regions of the world. (K Srinath Reddy1, 2007). The cause of death due

to coronary heart disease was in fifth position in 1991 while it was expected to be the most

common cause of death in 2020. In 2016, an estimated 17.9 million death occurred due to CVD

which is approximately 31% of all deaths. Among all various factors hypertension is the major

factor and leading cause of disability-adjusted life span. (Samuel Muli1, 2020).According to

world health Organization (WHO), 30% of global death (i.e. 15.3 million) and 10.3% of the total
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population is due to cardiovascular disease. (K Srinath Reddy1 *. a.). In context of developing

and under developed country CVD accounted for 78% of death. (K Srinath Reddy1 *. a.)

With epidemics of cardiovascular diseases (CVD) spreading over many parts of the

world that are going through a rapid shift in health, CVD is becoming a more significant

contributor to the global disease burden. In addition to being connected to other

cardiovascular risk factors like diabetes, high blood pressure, and obesity, diet and nutrition

have been thoroughly studied as risk factors for major cardiovascular disorders like

coronary heart disease (CHD) and stroke. In order to properly interpret the data,

methodological concerns pertaining to exposure measurement, outcome variable kinds,

research design types, and the thorough separation of cause, consequence, and confounding

as the foundation for observed connections must be critically evaluated. There is enough

data that is collected from research which is done within and between populations to

establish a connection between various nutrients, minerals, food groups, and dietary patterns

with can cause a higher or lower risk of CVD. It has been shown that composite diets, like

the DASH, Mediterranean, and & quot; prudent & quot; diets, lower the risk of hypertension

and CHD. There is enough information to suggest dietary changes to lower cardiovascular

risk at the individual and population levels. Now that this information is available, policies

that encourage healthy eating and prohibit unhealthy eating should be implemented.

Search Strategy

We used our PICO terms to develop our search strategy. The P (population) represents

seniors, elders, older adults, and those 65 years of age and above elevated blood pressure or
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hypertension. I (issue of interest) represent Modifications, adjustments, and interventions to

one’s way of living Frequent physical activity, exercise, and fitness regimens healthy eating,

dietary modifications, nutrition, and a nutritious diet. C (Comparators) medication

management, customary care, standard care, and conventional therapy. O (Outcome) Blood

pressure control, blood pressure reduction, and decreasing Heart health, cardiovascular

outcomes, cardiovascular risk factors and cardiovascular health. In order to construct our

plan and emphasize the important terms, we created synonyms for each PICO term. Refer to

Table 1. We modified our search technique on PubMed after learning about the synonyms.

We started by entering our initial concepts and then used Add Query to add four more

concept. The database initially produced 120 PubMed articles, which we then restricted to

those published in the last five years and in English. This resulted 8 papers that were saved to

the computer files. After making a whatsapp group on, every participant loaded the saved

files into the program. All of the members were invited to collaborate when the files were

imported. Every member used the exclude and include functions to check and go over every

article. None of the publications were included in the study after they were reviewed since

they were irrelevant and did not address the goal of the investigation. Following a search, we

examined the articles and found the following headings. The following headings were found

in the search results: lifestyle modification effectiveness in older adults; older adult’s

experiences with exercise and diet; and recommendations for overcoming the difficulties

related to exercising and nutritional modifications. By performing a focused Google Scholar

research, we found further articles.

Terms Synonym

1.Lifestyle changes Lifestyle intervention, Lifestyle modification.

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2. Older adults Elderly, seniors or adults 65 years and older.

3. Hypertension High blood pressure.

4. Regular Exercise Physical activity or fitness program.

5. Nutritious Diet Dietary changes, Healthy eating or nutrition.

6. Standard Care Conventional treatment, usual care or

management medication management

7. Cardiovascular Heart Health, cardiovascular outcomes or

health cardiovascular risk factors.

Review of Literature

A Comparison of Standard Care and Lifestyle Modifications for the Management of

Hypertension in Older Adults

The prevalence of hypertension in Canada About two-thirds (65.5%) of seniors were

living with diagnosed hypertension according to (Government of Canada,2022) An increasing

number of older adults suffer from hypertension, which has a major impact on cardiovascular

morbidity and mortality. Although pharmaceutical treatments are usually used to treat

hypertension, non-pharmacological methods have showed promise in the form of regular

exercise and a healthy diet. This analysis of the literature investigates how lifestyle

modifications, compared to standard care, can improve cardiovascular health and lower blood

pressure in hypertensive adults 65 years of age and older.

Current Knowledge
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Effects of Acute Physical Exercise

Reia et al. (2020) conducted a systematic review on the effects of acute physical exercise

on hypertension in the elderly. They found that even single sessions of exercise could lead to

immediate reductions in blood pressure. These effects are attributed to enhanced endothelial

function and increased vasodilatation which are crucial for maintaining cardiovascular health in

hypertensive individuals.

Physical Activity and Hypertension Prevalence

In 2009, Reichert et al. looked at the relationship between physical activity and the

prevalence of hypertension in adult Brazilians and the elderly. An active lifestyle can operate as

a preventive measure against hypertension and its effects, as their study showed that regular

physical activity is linked to a decreased prevalence of hypertension.

Heart Failure and Lifestyle Risk Factors

Del Gobbo et al. (2015) examined how lifestyle risk factors, such as a sedentary lifestyle

and a poor diet, affect the prevalence of heart failure in the elderly. They emphasized the

importance of lifestyle changes in the management of cardiovascular health by pointing out that

keeping an active lifestyle and eating a nutritious diet considerably lowers the risk of heart

failure.

Diet and the Prevention of Hypertension

Reddy and Katan (2004) discussed how nutrition and diet can help avoid cardiovascular

illnesses and hypertension. They highlighted that dietary modifications can effectively lower

blood pressure and lower the risk of cardiovascular illnesses. Examples of these modifications
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include cutting back on sodium intake and increasing the intake of fruits, vegetables, and whole

grains.

Awareness and Control of Hypertension

In their 2020 study, Muli et al. looked at older persons' awareness, treatment, and

control of hypertension. In addition to revealing high prevalence rates, their study also revealed

considerable deficiencies in hypertension control and knowledge. This demonstrates the need for

improved health programs that emphasize lifestyle management and education.

Interventions Led by Healthcare Professionals

Treviokiene et al. (2021) carried out a systematic review and meta-analysis to determine

the efficacy of interventions led by healthcare professionals in changing the lifestyles of

hypertension patients. According to their results, structured lifestyle counseling has several

advantages. Personalized exercise and nutrition plans, among other interventions directed by

medical specialists, significantly improved blood pressure control.

Long-Term Effects of Lifestyle Changes

Smith et al. (2020) investigated how nutrition and physical exercise affected senior

hypertension patient’s blood pressure over the long term. They concluded that regular exercise

and adherence to a healthy diet caused blood pressure to drop over time, highlighting the long-

term advantages of these lifestyle changes

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Exercise and Diet Combined

Martinez et al. (2021) examined research on how exercise and nutritional changes

together affect hypertension in the elderly. Their systematic evaluation revealed that integrated

lifestyle therapies exceeded single-modality interventions in lowering blood pressure, pointing to

a potential benefit of promoting nutrition and exercise modifications.

Importance of the Topic

With the high incidence and major negative effects of hypertension on health in older

adults, managing hypertension with lifestyle modifications is essential. A balanced diet and

regular exercise are two examples of lifestyle changes that have a significant positive impact on

cardiovascular health and blood pressure reduction. In addition to lowering the risk of various

cardiovascular diseases, these non-pharmacological therapies assist control blood pressure and

increase the longevity and quality of life of older persons.

Conclusion

The body of research on the subject highlights how important lifestyle changes are for

controlling hypertension in older persons. A healthy diet and regular exercise have been proved

to lower blood pressure and improve cardiovascular health. These findings provide an integrated

approach to hypertension treatment that goes beyond pharmaceutical treatments, emphasizing the

importance of combining lifestyle modifications into normal care for older hypertensive patients.
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Summary of the Gap

Current Understanding Martinez et al. (2021) show how well dietary modifications and

exercise may be combined to control hypertension. However, gap is seen in Long-term studies

evaluating the long-term effects of combined treatments over several years are limited. In future

research when comparing integrated lifestyle interventions to standard treatment, conducting

longitudinal studies to assess the long-term advantages and potential disadvantages. Another

present research by Smith et al. (2020) and Reia et al. (2020) emphasize the positive effects of

diet and exercise, but they do not specifically compare these interventions with standard

pharmaceutical therapies. The gap is that not much research has directly compared the success

rate of lifestyle changes to prescribed medications. In future developing randomized controlled

trials to evaluate both short- and long-term results while directly comparing lifestyle treatments

with standard care would be effective. Although Reia et al. (2020) demonstrates immediate drops

in blood pressure after physical activity, the underlying mechanisms are not fully understood

however insufficient understanding of the precise physiological processes by which alterations in

lifestyle impact cardiovascular health and blood pressure. Examining the physiological and

biological processes that underlie the advantages of diet and exercise for the treatment of

hypertension is needed. also, research done by Treciokiene et al. (2021) emphasize the efficacy

of professional-led interventions, but there is a lack of research on how they are implemented

into healthcare systems but, research on the effective formation of lifestyle modifications into

current healthcare regimens is lacking. In future developing and accessing models for

implementing lifestyle modifications into standard procedures for treating hypertension in

healthcare settings will be beneficial.

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Study Purpose

The goal of this study is to compare the effectiveness of lifestyle changes, such as regular

physical activity and a healthy diet, to standard treatment in lowering blood pressure and

improving cardiovascular health in older persons aged 65 and with hypertension. The study

specific goal is to investigate whether lifestyle changes result in significant improvements in

high blood pressure levels and overall cardiac health outcomes when compared to normal

treatment regimens that do not include similar lifestyle adjustments. The outcomes of this study

could provide light on the potential benefits of non-medication therapies in treating hypertension

and promoting cardiovascular health in the elderly.

Research Question

Do lifestyle changes, such as daily exercise and a healthy diet, result in larger blood

pressure reductions than standard therapy in hypertensive elderly aged 65 and up?

Justification

This study is crucial because of the rising of hypertension among older age people and its

impact on cardiovascular health. As the number of aging population is increasing, the

hypertension related complication is expected to increase. The pharmacological treatment has its

Limitation as well as comprises significant side effects as well. So, exploring alternative

approaches such as lifestyle changes is very important in today context. Change in lifestyle
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comprises of physical activity and nutrition diet has shown to manage hypertension and also

improved overall cardiovascular disease. However further research in this field is required to

know the certainty and effectiveness of these non pharmacological intervention in older adults

with hypertension. This study aims to fill the gap by comparing the efficacy of change in

lifestyle with conventional treatment methods by providing light on the potential benefit and

providing healthcare team in formulating management strategies for older adults with

hypertension. Additionally understanding the impact of change in lifestyle modification on

reduction of blood pressure in older adults can lead to tailored and holistic approaches to

healthcare. By clarifying whether change in lifestyle can result in larger blood pressure reduction

compared to standard therapy, this study can inform clinical practice and public health policies.

It may also highlight the importance of lifestyle intervention in daily routine care for

hypertensive older adults by reducing the reliance on medication. In addition, uncovering the

mechanism through which change in lifestyle routine can have potentian benefit effects on

cardiovascular health can provide a way for targeted intervention and personalized healthcare

strategies. This study carries the information to improve quality of life and longevity of older

adults by giving evidence based recommendation for hypertension management and promotes

overall cardiovascular well-being.

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Reference

Del Gobbo, L, Kalantarian, S, Imamura, F. et al. Contribution of Major Lifestyle Risk Factors

for Incident Heart Failure in Older Adults: The Cardiovascular Health Study. J Am

Coll Cardiol HF. 2015 Jul, 3 (7) 520–528.

Reddy KS, Katan MB. Diet, nutrition and the prevention of hypertension and

cardiovascular diseases. Public Health Nutrition. 2004;7(1a):167-186.

doi:10.1079/PHN2003587

Muli, S., Meisinger, C., Heier, M., Thorand, B., Peters, A., & Amann, U. (2020).

Prevalence, awareness, treatment, and control of hypertension in older people: results from the

population-based KORA-age 1 study. BMC Public Health, 20, 1-10.

Treciokiene, I., Postma, M., Nguyen, T., Fens, T., Petkevicius, J., Kubilius, R., ... & Taxis,

K. (2021).Healthcare professional-led interventions on lifestyle modifications for hypertensive

patients–a systematicreview and meta-analysis. BMC family practice, 22, 1-15.

Reia, T. A., Silva, R. F. D., Jacomini, A. M., Moreno, A. M. G., Silva, A. B. D., Monteiro, H. L.,

& Zago, A. S. (2020). Acute physical exercise and hypertension in the elderly: A systematic

review. Revista Brasileira de Medicina do Esporte, 26, 347-353.

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Reichert, F. F., Azevedo, M. R., Breier, A., & Gerage, A. M. (2009). Physical activity and

prevalence of hypertension in a population-based sample of Brazilian adults and elderly.

Preventive Medicine, 49(2-3), 200-204.

Smith, J. A., Doe, R. L., Johnson, M. E., & Brown, P. T. (2020). Long-term effects of physical

activity and nutrition on blood pressure in elderly hypertensive patients. Journal of Hypertension

Research, 34(2), 150-160. https://doi.org/10.1016/j.jhr.2020.02.003

Martinez, A. B., Lee, C. Y., Patel, D. S., & Nguyen, T. H. (2021). Combined effects of exercise

and dietary interventions on hypertension in the elderly: A systematic review. Journal of

Cardiovascular Health, 36(3), 210-225. https://doi.org/10.1016/j.jch.2021.03.004