Introduction
As the medical field evolves, numerous pharmaceutical and lifestyle modification therapies are offered to patients suffering from various conditions that may vary in cost and effectiveness. Therefore, it is critical that medical professionals are aware of numerous available treatments for different conditions as patients may be resistant to some therapies for personal reasons, or their lifestyle may inhibit their effectiveness. The current research focuses on the following PICOT question: in middle-aged Caucasian obese females, how do lifestyle modifications compare against daily administration of ACE inhibitors in controlling blood pressure after six months? Diet, exercise, and stress reduction are lifestyle modifications that can be offered to patients resistant to pharmaceutical options. The research aims to investigate high blood pressure in middle-aged Caucasian women with a history of obesity and excessive weight. The study will evaluate the cost-effectiveness and outcomes of lifestyle changes made by the patient
Search Criteria
Several scholarly databases were selected for the relevant literature search. Google Scholar was chosen as it aggregates articles from various databases and indicates if full text is available. In addition, PubMed Central and Science Direct were utilized as these databases focus on research in health care and medicine. A decision was made to limit the date range to 2017-2022. The focus on the last five years can be explained by medical research constantly evolving, with new hypotheses being tested, confirmed, or rebuffed daily. In addition, the scientific tradition demands that each effort builds on previous research. Therefore, it is crucial to focus on the latest research as it reviews more dated studies while providing new evidence.
Several relevant keywords were selected for the search request to yield relevant results. These are as follows: “high blood pressure,” “hypertension,” “obesity,” “women,” “lifestyle changes,” “ACE inhibitors,” and “Caucasian.” The use of the listed keywords yielded numerous results in the selected databases. Thus, Google Scholar showed 83 search results, while PubMed Central and Science Direct lost 23 and 10 articles, respectively. However, the full text was unavailable for all pieces found in these databases. Therefore, the number of studies was reduced to 63 full-text articles in Google Scholar and 6 in Science Direct.
Ten sources were selected for the current research on the effectiveness of lifestyle changes, compared with ACE inhibitor intake, in reducing hypertension in middle-aged obese women. For example, Cameron et al. (2020) and Wenger et al. (2018) discuss high blood pressure in different stages of a woman’s life, whereas Hines et al. (2021) investigate racial disparities in high blood pressure in women. Fisher and Curfman (2018) discuss hypertension as a global public health problem, with Rodgers & Gibbons (2020) considering hypertension during COVID-19. Meanwhile, Valenzuela et al. (2020), Sanchez et al. (2019), Munter et al. (2020), Putri and Sumarni (2021), and Messerli et al. (2018) examine and compare different treatment options available for high blood pressure, including ACE inhibitors and lifestyle modifications. The selected articles will be pivotal in answering the posed PICOT question.
A study by Cameron et al. (2020) on pre-pregnancy hypertension among women in rural and urban areas in Unite states between 2007 and 2018 established that both rural and urban women experienced an increase in the pre-pregnancy hypertension rates per 1,000 live births (13.7 to 23.7) (10.5 to 20.0) among 47.949,381 live births, with the highest annual percentage changes in rural and urban areas between 2016 and 2018, two major inflection points were found in 2010 and 2016. All age groups saw similar increases, even though younger women in rural and urban areas had lower absolute rates than older women.
A study by Wenger et al. (2018) on hypertension across woman’s life cycles illustrated that hypertension poses a greater burden for women and is a significant risk factor in the development of circulatory system disease, other diseases, and death. According to the authors, women are affected by hypertension at all stages of their lives. However, there are particular traits related to risk factors and primary prevention for adolescent and youthful adult women, pregnancy, use of contraceptive methods and assisted fertility treatment, breastfeeding, anovulation, or hormone therapy, high blood pressure in older women, and concerns of ethnicity and race.
A study on racial discrepancies in hypertension among young white and black women by Hines et al. (2021) demonstrated that even though the young have hypertension that doesn’t necessitate treatment intervention, the young black women were found to have higher average hypertension compared to the white women. They were twice more likely to develop high blood pressure related to other health and sociodemographic factors. More significant magnitude discrepancies were deduced in this study and comparatively low race-specific prevalence approximation.
Fisher and Curfman (2018) discuss hypertension as a public health global crisis. According to the writers, hypertension is a hugely important global issue. Untreated or unmanaged high blood pressure is the most common cause of cardiovascular disease, including cardiac arrest, cerebrovascular disease, and coronary artery problems. It also plays a significant role in renal disease. The last few decades have seen advancements in knowledge of the connection between hypertension and clinical outcomes and the creation of numerous antihypertensive treatments that lower the risk. With new knowledge comes a responsibility to combat the escalating global high-blood pressure epidemic.
In 2020, Rodgers & Gibbons (2020) researched obesity and hypertension during Covid 19. The results of the studies indicate a high prevalence of obesity and hypertension with racial linkage. The authors explain that the two conditions are linked to severe health problems, including renal disease, heart failure, stroke, and death. They argue that these two conditions have increased in prevalence with reduced over the years with a decrease in control efforts.
Comparing Mexican American men to non-Hispanic White men, the prevalence of obesity has increased most among Mexican American men. All subgroups of non-Hispanic White women (39.8% and 11.3%) have seen an increase in obesity and severe obesity, but non-Hispanic Black women (56.9% and 18.9%, respectively) and Mexican American women (49.6% and 14.5%) have seen a more significant increase in both. The authors propose compelling evidence that the physical environment and social context of a child’s birth development and aging significantly impact that child’s tendency to become obese over their lifetime.
On the other hand, several authors have discussed different treatment options for hypertension and lifestyle modifications. Valenzuela et al. (2020) discuss the various lifestyle interventions available for the prevention and management of hypertension. According to the authors, despite notable advancements in drug treatment, hypertension still affects about one-third of the world’s adult population and is a significant cause of early death. A growing body of research validates the effectiveness of lifestyle changes in the management and prevention of hypertension.
Conclusion
This study demonstrates that the advantages of routine and physical activity for treating and preventing high blood pressure are well supported by research. In people who are overweight or obese, bringing their weight down to normal lowers their risk of developing hypertension, but more research is required to determine how effective this tactic is in the long term. Restricting sodium intake lowers blood pressure, especially in hypertensive patients, and the DASH diet is the most effective nutritional strategy for preventing hypertension.
References
Cameron, N. A., Molseberry, R., Pierce, J. B., Perak, A. M., Grobman, W. A., Allen, N. B., Greenland, P., Lloyd-Jones, D. M., & Khan, S. (2020). Pre-pregnancy hypertension among women in rural and urban areas of the United States.Journal of the American College of Cardiology, 76(22), 2611–2619. Web.
Hines, A. L., Zare, H., & Thorpe, R. J. (2021). Racial disparities in hypertension among young, black and white women. Journal of General Internal Medicine, 37(23), 2123-2125.
Fisher, N. D., & Curfman, G. (2018). Hypertension – A public health challenge of global proportions. JAMA, 320(17), 1757–1759.
Messerli, F. H., Bangalore, S., Bavishi, C., & Rimoldi, S. F. (2018). Angiotensin-converting enzyme inhibitors in hypertension: To use or not to use?Journal of the American College of Cardiology, 71(13), 1474–1482. Web.
Munter, P., Hardy, S. T., & Fine, L. J. (2020). Trends in blood pressure control among U.S. adults with hypertension, 1999-2000 to 2017-2018.JAMA, 324(12), 1190–1200. Web.
Putri, N. R. & Sumarni, T. (2021). The effect of slow-deep breathing and isometric hand grip exercise on patients with hypertension blood pressure. International Conference on Health and Medical Sciences (AHMS 2020) (pp. 96-99). Atlantis Press.
Rodgers, G. P., & Gibbons, G. H. (2020). Obesity and hypertension in the time of COVID-19. Jama, 324(12), 1163-1165.
Sanchez, A., Chung, S. C., Mejia, A., Ramirez, F. E., Shavlik, G. W., Bivens, R. L., Brown-Fraser, S., & Gallant, R. D. (2019). Multiple lifestyle interventions reverse hypertension. Cogent Medicine, 6(1), 121-131.
Valenzuela, P. L., Carrera-Bastos, P., Galvez, B. G., Ruiz-Hurtado, G., Ordovas, J. M., Ruilope, L. M., & Lucia, A. (2020). Lifestyle interventions for the prevention and treatment of hypertension.Nature Reviews Cardiology, 18(5), 251–275. Web.
Wenger, N. K., Arnold, A., Bairey Merz, C. N., Cooper-DeHoff, R. M., Ferdinand, K. C., Fleg, J. L.,… & Pepine, C. J. (2018). Hypertension across a woman’s life cycle. Journal of the American College of Cardiology, 71(16), 1797–1813.