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      The effect of the behavior modification program Dietary Approaches to Stop Hypertension (DASH) on reducing the risk of hypertension among elderly patients in the rural community of Phayao, Thailand

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          Abstract

          Aim

          The purpose of this study was to evaluate the effect of the Dietary Approaches to Stop Hypertension (DASH) program with self-efficacy on reducing the risk of hypertension among elderly patients in the rural community of Phayao Province in Northern Thailand.

          Patients and methods

          A quasi-experimental study was employed among elderly patients in the rural community of Phayao. Multistage random sampling was used to select a study area with similar characteristics. Ninety elderly participants were placed in the intervention group and 85 elderly participants from the same village were placed in the control group. The intervention group used the behavior modification guidelines of the DASH program with self-efficacy for 3 months, including 45-minute weekly group education meetings, 25-minute group activity training sessions, and a 15-minute individual checklist. A control group received no intervention. Data were collected by using self-administered questionnaires. The analyses included descriptive statistics, the Mann−Whitney U-test, and sample t-testing. Three different time periods were examined using repeated measures ANOVA.

          Results

          More than half of the participants (65.7%) were aged 60–69 years. The results from comparison of the intervention and control groups showed that the perceived severity of hypertension and self-efficacy had increased and preventive behaviors toward hypertension had improved in both groups. There were statistically significant differences after the intervention and at 3-month follow-up ( P<0.001). After the intervention, the systolic blood pressure and diastolic blood pressure of the elderly people in the intervention group had decreased ( P<0.001)

          Conclusion

          The behavior modification guidelines of the DASH program with self-efficacy, were effective in improving the mean score of perceived severity, self-efficacy, and preventive behaviors among elderly participants with a high risk of hypertension. Furthermore, the program was effective in lowering blood pressure and it may be useful in controlling stage 1 hypertension in elderly people.

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          Most cited references10

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          Lycopene and Vascular Health

          Lycopene is a lipophilic, unsaturated carotenoid, found in red-colored fruits and vegetables, including tomatoes, watermelon, papaya, red grapefruits, and guava. The present work provides an up to date overview of mechanisms linking lycopene in the human diet and vascular changes, considering epidemiological data, clinical studies, and experimental data. Lycopene may improve vascular function and contributes to the primary and secondary prevention of cardiovascular disorders. The main activity profile of lycopene includes antiatherosclerotic, antioxidant, anti-inflammatory, antihypertensive, antiplatelet, anti-apoptotic, and protective endothelial effects, the ability to improve the metabolic profile, and reduce arterial stiffness. In this context, lycopene has been shown in numerous studies to exert a favorable effect in patients with subclinical atherosclerosis, metabolic syndrome, hypertension, peripheral vascular disease, stroke and several other cardiovascular disorders, although the obtained results are sometimes inconsistent, which warrants further studies focusing on its bioactivity.
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            Dietary approaches to prevent hypertension.

            Elevated blood pressure arises from a combination of environmental and genetic factors and the interactions of these factors. A substantial body of evidence from animal studies, epidemiologic studies, meta-analyses, and randomized controlled trials has demonstrated that certain dietary patterns and individual dietary elements play a prominent role in the development of hypertension. Changes in diet can lower blood pressure, prevent the development of hypertension, and reduce the risk of hypertension-related complications. Dietary strategies for the prevention of hypertension include reducing sodium intake, limiting alcohol consumption, increasing potassium intake, and adopting an overall dietary pattern such as the DASH (Dietary Approaches to Stop Hypertension) diet or a Mediterranean diet. In order to reduce the burden of blood pressure-related complications, efforts that focus on environmental and individual behavioral changes that encourage and promote healthier food choices are warranted.
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              The effect of dietary patterns on blood pressure control in hypertensive patients: results from the Dietary Approaches to Stop Hypertension (DASH) trial.

              To determine the impact of dietary patterns on the control of hypertension we studied the subgroup of 133 participants with systolic blood pressure (BP) of 140 to 159 mm Hg and/or diastolic BP of 90 to 95 mm Hg enrolled in the Dietary Approaches to Stop Hypertension (DASH) study. Participants were fed a control diet for a 3-week period and were then randomized to receive for 8 weeks either the control diet; a diet rich in fruits and vegetables, but otherwise similar to control; or a combination diet rich in fruits, vegetables, and low-fat dairy products, including whole grains, fish, poultry, and nuts, and reduced in fats, red meats, sweets, and sugar-containing beverages. Sodium intake and body weight were held constant throughout the study. The combination diet significantly reduced systolic BP (-11.4 mm Hg, P < .001) and diastolic BP (-5.5 mm Hg, P < .001). The fruits-and-vegetables diet also significantly reduced systolic BP (-7.2 mm Hg, P < .001) and diastolic BP (-2.8 mm Hg, P = .013). The combination diet produced significantly greater BP effects (P < .05) than the fruits-and-vegetables diet. Blood pressure changes were evident within 2 weeks of starting the intervention feeding. After the 8-week intervention period, 70% of participants eating the combination diet had a normal BP (systolic BP < 140 and diastolic BP < 90 mm Hg) compared with 45% on the fruits-and-vegetables diet and 23% on the control diet. In patients with hypertension, the DASH combination diet effectively lowers BP and may be useful in achieving control of Stage 1 hypertension.
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                Author and article information

                Journal
                J Multidiscip Healthc
                J Multidiscip Healthc
                Journal of Multidisciplinary Healthcare
                Journal of Multidisciplinary Healthcare
                Dove Medical Press
                1178-2390
                2019
                31 January 2019
                : 12
                : 109-118
                Affiliations
                [1 ]School of Medicine, University of Phayao, Phayao 56000, Thailand, eungkaew@ 123456gmail.com
                [2 ]School of Nursing, University of Phayao, Phayao 56000, Thailand
                Author notes
                Correspondence: Katekaew Seangpraw, 19/2 School of Medicine, University of Phayao, Phayao 56000, Thailand, Email eungkaew@ 123456gmail.com
                Article
                jmdh-12-109
                10.2147/JMDH.S185569
                6362921
                35fccc16-e3fa-465d-8b14-294738647aaf
                © 2019 Seangpraw et al. This work is published and licensed by Dove Medical Press Limited

                The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

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                Categories
                Original Research

                Medicine
                risk hypertension,behavior modification,dash,elderly patients,self-efficacy,rural community
                Medicine
                risk hypertension, behavior modification, dash, elderly patients, self-efficacy, rural community

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