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

Journal of Human Hypertension volume 19, pages 365–371 (2005)Cite this article

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+ 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.

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References

  1. Joint National Committee. The sixth report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure. Arch Intern Med 1997; 157: 2413–2446.

  2. Chobanian AV et al. The Seventh Report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure: the JNC 7 report. JAMA 2003; 289: 2560–2572.

    Article  CAS  Google Scholar 

  3. Costa FV . Non-pharmacological treatment of hypertension in women. J Hypertens 2002; 20 (Suppl 2): S57–S61.

    CAS  Google Scholar 

  4. Egede LE . Lifestyle modification to improve blood pressure control in individuals with diabetes: is physician advice effective? Diabetes Care 2003; 26: 602–607.

    Article  Google Scholar 

  5. Schoberberger R, Janda M, Pescosta W, Sonneck G . The COMpliance Praxis Survey (COMPASS): a multidimensional instrument to monitor compliance for patients on antihypertensive medication. J Hum Hypertens 2002; 16: 779–787.

    Article  CAS  Google Scholar 

  6. Burt VL et al. Prevalence of hypertension in the US adult population. Results from the Third National Health and Nutrition Examination Survey, 1988–1991. Hypertension 1995; 25: 305–313.

    Article  CAS  Google Scholar 

  7. Karppanen H, Mervaala E . Adherence to and population impact of non-pharmacological and pharmacological antihypertensive therapy. J Hum Hypertens 1996; 10 (Suppl 1): S57–S61.

    PubMed  Google Scholar 

  8. Egede LE, Ye X, Zheng D, Silverstein MD . The prevalence and pattern of complementary and alternative medicine use in individuals with diabetes. Diabetes Care 2002; 25: 324–329.

    Article  Google Scholar 

  9. Pronk NP et al. Meeting recommendations for multiple healthy lifestyle factors. Prevalence, clustering, and predictors among adolescent, adult, and senior health plan members. Am J Prev Med 2004; 27 (2 Suppl): 25–33.

    Article  Google Scholar 

  10. Women's Health Initiative Study Group. Dietary adherence in the women's health initiative dietary modification trial. J Am Diet Assoc 2004; 104: 654–658.

  11. Hebl MR, Xu J, Mason MF . Weighing the care: patients' perceptions of physician care as a function of gender and weight. Int J Obes Relat Metab Disord 2003; 27: 269–275.

    Article  CAS  Google Scholar 

  12. Drury CA, Louis M . Exploring the association between body weight, stigma of obesity, and health care avoidance. J Am Acad Nurse Pract 2002; 14: 554–561.

    Article  Google Scholar 

  13. Rosen AB, Schneider EC . Colorectal cancer screening disparities related to obesity and gender. J Gen Intern Med 2004; 19: 332–338.

    Article  Google Scholar 

  14. Weir MR et al. Implications of a health lifestyle and medication analysis for improving hypertension control. Arch Intern Med 2000; 160: 481–490.

    Article  CAS  Google Scholar 

  15. National Center for Health Statistics. National Health and Nutrition Examination Survey. CDC. Available at: http://www.cdc.gov/nchs/nhanes.htm,accessed 15 June 2004.

  16. Lohman TG . Anthropometric Standardization Reference Manual. Human Kinetics Books: Champaign, IL, 1988.

    Google Scholar 

  17. CDC. Available at: http://www.cdc.gov/nccdphp/dnpa/obesity/, accessed 10 June 2004.

  18. Apter AJ et al. Modifiable barriers to adherence to inhaled steroids among adults with asthma: it's not just black and white. J Allergy Clin Immunol 2003; 111: 1219–1226.

    Article  Google Scholar 

  19. Berrigan D et al. Patterns of health behavior in US adults. Prev Med 2003; 36: 615–623.

    Article  Google Scholar 

  20. Kleeberger CA et al. Determinants of heterogeneous adherence to HIV-antiretroviral therapies in the Multicenter AIDS Cohort Study. J Acquir Immune Defic Syndr 2001; 26: 82–92.

    Article  CAS  Google Scholar 

  21. Jorgensen WA, Polivka BJ, Lennie TA . Perceived adherence to prescribed or recommended standards of care among adults with diabetes. Diabetes Educ 2002; 28: 989–998.

    Article  Google Scholar 

  22. Polley BA et al. The effects of health beliefs on weight loss in individuals at high risk for NIDDM. Diabetes Care 1997; 20: 1533–1538.

    Article  CAS  Google Scholar 

  23. Jakicic JM, Wing RR, Butler BA, Robertson RJ . Prescribing exercise in multiple short bouts versus one continuous bout: effects on adherence, cardiorespiratory fitness, and weight loss in overweight women. Int J Obes Relat Metab Disord 1995; 19: 893–901.

    CAS  Google Scholar 

  24. Hajjar I, Kotchen TA . Trends in prevalence, awareness, treatment, and control of hypertension in the United States, 1988–2000. JAMA 2003; 290: 199–206.

    Article  Google Scholar 

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  1. Department of Family & Community Medicine, School of Medicine, Texas Tech University Health Science Center, Lubbock, TX, USA

    K T Xu & R M Ragain

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  1. K T Xu
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  2. R M Ragain
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Correspondence to K T Xu.

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Xu, K., Ragain, R. Effects of weight status on the recommendations of and adherence to lifestyle modifications among hypertensive adults. J Hum Hypertens 19, 365–371 (2005). https://doi.org/10.1038/sj.jhh.1001828

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