| Abstract: |
I. Research purpose:As the number of hypertension patients increases sharply around the world, the prevention and treatment of hypertension become particularly prominent. In view of this, this study probes into the combined intervention of exercise and diet for primary hypertension patients, in order to provide scientific basis for the promotion of hypertension prevention. II. Research methods(I) Research object1. Screening criteria for the subjects Patients with primary hypertension who meet the inclusion criteria in the outpatient department of the hospital; patients, who voluntarily accept and are able to satisfy the requirements of dietary intervention, have not been treated with drugs at the first visit or are in the stable phase for drugs taken (patients whose antihypertensive drugs and sorts of drugs have been adjusted in the latest 3 months).2. Exclusion criteriaA. Hypertension patients in the 2nd phase or more severe currently (whose systolic pressure >160mmHg and/or diastolic pressure>100mmHg); B. patients who took anti hypertension drugs currently or within a month; C. patients with clinical history of cardiovascular and cerebrovascular diseases, including chronic heart failure, severe arrhythmia, coronary heart disease, cardiomyopathy, pericardial disease, valvular heart disease, rheumatic heart disease, congenital cardiovascular disease, tumor in the main artery dissection or dissecting aneurysm, aorto-arteritis, pulmonary heart disease, stroke, chronic obstructive pulmonary disease, pulmonary arterial hypertension, and peripheral arterial disease; d. patients with secondary hypertension and orthostatic hypotension; e. patients who currently suffered from kidney disease (urine protein >50mg/L); f. patients with a history of diabetes currently and patients who took insulin or oral hypoglycemic drugs; g. patients who suffered from severe liver disease and liver dysfunction in the past two years; h. patients with active peptic ulcer disease; i. pregnant or lactating women, and patients with abnormal thyroid function, severe anemia, infectious diseases and tumors, who can not tolerate relevant tests; g. patients who currently adhere to a low salt diet.In the end, 100 middle-aged and elderly subjects, 50 males and 50 females aged 40-69, were evenly distributed among different age groups.(II) Experimental methods1. Preparations before experiment: before the experiment, some medical examinations are necessary to conduct so as to exclude the exercise taboos of the people tested and understand their living habits, diet conditions, medication and exercise habits.2. Implementation of intervention program:Combined intervention, DASH dietary patterns and 5-7 times one-hour exercise (with five options of brisk walking, dancing, running, gymnastics and cycling) with moderate intensity, for 6 months are conducted.Principles of DASH diet: plenty of fruits, vegetables and low-fat dairy products; reducing the intake of food that are rich in saturated fat, cholesterol and trans fat; appropriate amount of whole grains, poultry, fish and nuts; control the intake of sodium, dessert, sugary drinks and red meat. As for DASH diet, reduction of sodium plays a key role. In addition to standard DASH diet (daily intake of 2300mg), a low sodium version (daily intake of 1500mg) is available for different health needs.3. Test indexes: (1) Index for the survey of basic conditions: personal basic information, disease, daily physical activity, drugs, and diet. (2) Blood pressure monitoring. It should be completed by the same tester and the cuff should be fixed on the right upper arm of the patient. During the automatic test, the upper arm should remain relatively steady to ensure the validity of the data obtained; the test time is 8:00-10:00 am. (3) Blood biochemical indexes. All subjects should fast for more than 12 hours, and 5ml venous blood sample should be taken the next morning for the test of total cholesterol (TC), triglyceride (TG), fasting blood-glucose and other indicators.4. Test instruments: (1) Glucometer produced by Roche Group is used in fingertip blood glucose of FBG; (2) the enzyme method is used in TC and TG.(III) Statistical MethodsThe SPSS 10.0 statistical software is used to analyze the one-way variance. The comparison between groups and the paired t test before and after the intervention are conducted for statistical analysis. The difference was statistically significant with p<0.05.III. Findings(I) Comparison of blood pressure (mmHg) before and after interventionAfter the intervention, the systolic blood pressure decreases. There are significant differences between the two groups before and after intervention with p<0.001; diastolic blood pressure decreases after intervention, and the difference was significant before and after the intervention, with p<0.0001, which is available in table 1.Table 1 Systolic and diastolic blood pressure levels (x + s) after interventionSystolic blood pressure Diastolic blood pressureBefore intervention After intervention t p Before intervention After intervention t p155.42±17.71 129.24±6.19 21.25 <0.0001 93.48±11.56 80.89±6.20 12.01 <0.001(II) Control of blood pressure after interventionThe rate of blood pressure control after intervention is 84%; which is available in table 2. Table 2 Blood pressure control after intervention Number of people surveyed Number of people under blood pressure control Control rate（%）The intervention group 100 84 84(III) Comparison of blood glucose (mmol/L) levels before and after interventionThere are significant difference in blood glucose before and after intervention (t=6.23, P<0.001). After intervention, blood sugar decreases by 0.48 + 0.90 mmol/L, and blood sugar in intervention group decreases obviously, which is available in table 3.Table 3 Blood glucose level (x + s) after the interventionBefore intervention After intervention D-value t p5.63± 1.20 5.15± 0.504 -0.48±0.90 6.23 <0.001(IV) Comparison of cholesterol (mmol/L) levels before and after interventionAfter intervention, the serum cholesterol level decreases obviously, and the difference is significant (17.55, P<0.001), which is available in table 4.Table 4 Cholesterol level after intervention (x + s)Before intervention After intervention D-value t p5.10± 1.10 4.13± 0.24 -0.97± 1.01 17.55 <0.001(V) Comparison of triglyceride (mmol/L) levels before and after interventionAfter the intervention, the serum triglyceride level decreases obviously, and the difference is significant (t=11.62, P<0.001), which is available in table 5.Table 5 Triglyceride level (x + s) after the interventionBefore intervention After intervention D-value t p2.13± 0.97 1.60± 0.43 -0.53± 0.64 11.62 <0.001IV. Analysis and discussionAfter 6 months of combined intervention, the average systolic pressure of the subjects decrease by 26.28mmHg, and the average diastolic pressure decrease by 12.59mmHg. In China, seniors with isolated systolic hypertension account for 53.21% of the total population who suffered from hypertension. The increase of systolic blood pressure and pulse pressure to a certain extent reflects the disease of arterial sclerosis, and it has been proved through study as the independent risk factor of various cardiovascular and cerebrovascular diseases. Therefore, after the combined intervention, the systolic blood pressure drops in elderly hypertensive patients is greater than that of diastolic blood pressure, which is extremely beneficial to preventing cardiovascular and cerebrovascular diseases of the elderly people that is caused by the increase of systolic blood pressure.According to the results of randomized controlled trails in the west, if the systolic pressure decreases by 10-14mmHg or diastolic blood pressure decreases by 5-6mmHg, the risks of suffering from strokes and coronary heart disease can be reduced by 2/5 and 1/6 respectively. Moreover, the occurrence of cardiovascular disease in the same group can be reduced by 1/3. If the decrease of systolic blood pressure by 10mmHg and/or the decrease of diastolic pressure by 5mmHg are treated as an effective criterion in blood pressure reduction, falling range of most subjects’ blood pressure can be seen as effective value.Effect of comprehensive intervention on blood lipids in elderly patients with hypertension. Related studies show that the increase of serum total cholesterol (TC) or low-density lipoprotein cholesterol (LDL-C) is one of the independent risk factor for coronary heart disease and ischemic stroke. From 3.63mmol/L, the risk of ischemic cardiovascular disease increases with the increase of TC level. As LDL-C and TC are in parallel, the risk tendency and degree of ischemic cardiovascular disease is similar as that of TC with the increase of LDL-C. In this study, average TC levels of the elderly patients with hypertension before and after the intervention are 5.1mmol/L and 4.13mmol/L respectively. TC level after the intervention is still higher than 3.36mmol/L, which suggests that the risk of ischemic cardiovascular disease in elderly hypertensive patients is still high.The main content of diet and exercise intervention is to reduce saturated fat and cholesterol intake, and to achieve energy balance by controlling the total calories and increasing physical activity. At the same time, salt intake should be reduced so as to prevent hypertension. The goal of dietetic treatment is to ensure that the subjects have a healthy diet and balanced nutrition by taking into account the specific factors of gender, age and labor intensity.V. Conclusion(I) Reducing the intake of cooking oil, salt and livestock, and increasing the intake of vegetables, fruits and low-fat dairy products are necessary and effective measures for the prevention and treatment of hypertension.(II) Through balanced dietary intervention and exercise, systolic blood pressure under comprehensive intervention decreases significantly. |