Statement of Objective
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 the available pharmaceutical options. The research aims to investigate high blood pressure in middle-aged Caucasian women with a history of obesity and excessive weight. The research will evaluate the cost-effectiveness and outcomes of lifestyle changes made by the patient, such as exercise and dietary changes, to ACE inhibitor medication, in managing high blood pressure after six months.
Search Criteria
Several scholarly databases were selected for the relevant literature search. Google Scholar was selected 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 the fact that medical research is a constantly evolving field, with new hypotheses being tested, confirmed, or rebuffed on a daily basis. 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 yielded 23 and 10 articles, respectively. However, the full text was unavailable for all articles found in these databases. Therefore, the number of studies was reduced to 63 full-text articles in Google Scholar and 6 in Science Direct. It should be noted that all articles initially found in PubMed Central were available in full text with downloadable pdf files offered. The list of the results was further reduced after the exclusion of the articles dedicated to male or pediatric patients. The articles written in languages other than English were not included in the review.
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.
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 blood pressure of patients with hypertension. In 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.