Effects of weight status on the recommendations of and adherence to lifestyle modifications among hypertensive adults

Abstract

Overweight and obese hypertensive patients can greatly benefit from high adherence rates for lifestyle modifications. The objectives of this paper were to investigate how patients' weight status affected physicians' recommendations of lifestyle modifications and patients' adherence after they received the recommendations. The patients were adults (18 þ years of age) with hypertension (prehypertension, Stage I and Stage II hypertension). The National Health and Nutrition Examination Survey (NHANES) 1999-2000 was used. Weight status was categorized as normal/underweight, overweight and obese. Physicians' recommendations of and patients' adherence to lifestyle modifications (weight control, exercise, sodium intake reduction, alcohol intake reduction) were examined using descriptive and multivariate analyses, controlling for weight status, hypertension stage, comorbidities and demographic characteristics. About 57.0% of the US adult population in 1999-2000 had prehypertension, Stages I or II hypertension. Among the hypertensive adults, 30.3% were normal/underweight, 32.6% were overweight and 37.2% were obese. We found that physicians were more aggressive in recommending lifestyle modification for obese patients. In contrast, obese hypertensive patients were not found to be more likely than normal/underweight patients to adhere to lifestyle modification recommendations. In addition, adherence rates for sodium and alcohol consumption reduction were higher than that for either exercise or weight control. In conclusion, more aggressive approaches should be taken by physicians to educate obese patients about the benefits of lifestyle modifications and to improve adherence to enhance the effects of antihypertensive medications.

Accumulation of 30 min of moderately intense physical activity is a clinically meaningful treatment to reduce systolic blood pressure in prehypertension

“…13,14 Specifically, adherence rates for exercise were shown to be lower than those for sodium and alcohol consumption reduction with obese patients, showing particularly poor adherence to lifestyle modification recommendations. 15 Reframing this uncomfortable knowledge from a behavioral medicine perspective, the data presented by Park et al actually provide good news for the treating physician and his patient alike. Prehypertensive patients may be recommended to split their daily amount of exercise into three sessions of 10 min.…”

“…16 Weight reduction then might further reduce blood pressure at rest and during exercise 17 and enhance the motivation to modify lifestyle. 15 Third, increasing evidence suggests that elevated systolic blood pressure is of greater importance as a major cardiovascular risk factor than is diastolic blood pressure, 18 because the former continuously increases with age, whereas the latter tends to level off after the age of 50 years. 1 In older age, systolic hypertension has become the most prevalent form of hypertension.…”

Adiponectin and hypertension: a putative link between adipocyte function and atherosclerotic risk?

“…With increasing evidence implicating circulating adiponectin concentrations as a marker of 'vascular protection' (against the clustering of multiple cardiovascular risk factors), a firmer understanding of this ubiquitous protein is certainly needed. From a clinical perspective, given the links between hypertension (and its complications) and obesity, [47][48][49][50] as well as the so-called 'metabolic syndrome', urgent action is clearly required.…”

Adherence to healthy lifestyle in hypertensive patients: ample room for improvement?

“…For example, among hypertensive participants from the National Health and Nutrition Examination, participants of non-Hispanic black ethnicity, men, and those with cardiovascular risk factors (high cholesterol, diabetes and overweight), were more likely to report receiving lifestyle modification counselling. 11,12 However, those receiving advice are not necessarily more likely to adhere to the recommendations, as adherence to the Dietary Approaches to Stop Hypertension diet was associated with non-black ethnicity, higher education and known diabetes mellitus, 8 and other data have shown greater levels of nonadherence in obese hypertensives. 11 A second important issue may be that when anti-hypertensive drug treatment is initiated healthy lifestyle changes seem less crucial to patients.…”

“…11,12 However, those receiving advice are not necessarily more likely to adhere to the recommendations, as adherence to the Dietary Approaches to Stop Hypertension diet was associated with non-black ethnicity, higher education and known diabetes mellitus, 8 and other data have shown greater levels of nonadherence in obese hypertensives. 11 A second important issue may be that when anti-hypertensive drug treatment is initiated healthy lifestyle changes seem less crucial to patients. Unfortunately, this issue could not be explored by Scheltens et al 9 although some earlier evidence has shown that participants taking cardiovascular medication for primary prevention report lower levels of health enhancing physical activity.…”