Best Evidence for Hypertension Treatment: A Systematic Review

This paper evaluates the best evidence for hypertension treatment through a systematic review of three scientific papers. The best evidence suggests that monitoring blood pressure levels and administering minimal physical exercise can be an effective strategy to reduce risks associated with hypertension. The paper also discusses the implementation of these findings into nursing practice.

Running head: EVIDENCE BASED RESEARCH
EVIDENCE BASED RESEARCH
Name of the Student:
Name of the University:
Author Note:

1EVIDENCE BASED RESEARCH
Introduction:
Hypertension has been reported to be a common problem that affects the in-patients
placed at a health care environment. Often it has been seen that the patients are admitted
because of separate health issues, however during the process of care are affected with
symptoms related to hypertension (Gab et al., 2016,p.63). This causes trouble to the
caregivers in devising appropriate treatment intervention for hypertension. The underlying
cause of hypertension has been identified to be mental stress and anxiety. Every year a large
segment of the elderly people placed within the care environment experience fatal
consequences of hypertension in the form of acute cardiac arrest. This paper aims to evaluate
the best evidence in favour of the treatment care of Hypertension on the basis of a systematic
review of three scientific papers.
Best Evidence:
On the basis of scientific studies carried out in context of Hypertension, it has been
said that monitoring the blood pressure level can be an effective strategy to reduce risks
associated with hypertension (Shimamoto et al., 2014,p.254). This could be done by
administering minimal physical exercise to the patients that would help in regulating the
glucose level in the blood.
Annotated Bibliography:
Chen, K. H., Yeh, M. H., Livneh, H., Chen, B. C., Lin, I. H., Lu, M. C., ... & Yeh,
C. C. (2017). Association of traditional Chinese medicine therapy and the risk of
dementia in patients with hypertension: a nationwide population-based cohort study.
BMC complementary and alternative medicine, 17(1), 178.

2EVIDENCE BASED RESEARCH
There are 8 eight authors belong from the Department of Medical Research and
Department of Chinese Medicine in the Dalin Tzuchi Hospital. The aim of the research is to
investigate the effect of the Traditional Chinese Medicine in the patients that are suffering
from the hypertension. This research employed a longitudinal cohort study of the 143,382
patients that have hypertension. The patients are aged from 20 to 90 years and have received
treatment in between the years 1998 to 2007. The study included a Cox Proportional hazards
regression model to calculate the ratio of the hazard of the patients that are suffering from
dementia and had received traditional Chinese medicine. The results highlighted that the
patients that have used traditional Chinese medicine are having less risk from dementia in
comparison to the non- traditional Chinese medicine. The Conclusion of the study support the
effects of the traditional Chinese medicine in reducing the risks of dementia and is a potent
prevention strategy.
Yu, Y., Gao, Q., Xia, W., Zhang, L., Hu, Z., Wu, X., & Jia, X. (2018). Association
between Physical Exercise and Biomarkers of Oxidative Stress among Middle-Aged and
Elderly Community Residents with Essential Hypertension in China. BioMed research
international, 2018.
The 7 authors belong from the Bengbu Medical College, China. The aim of the
research is to investigate the different types of the physical exercises and the levels of the
oxidative stress among the elderly residents and middle aged communities in China that are
suffering from hypertension. The research employs a cross sectional survey and it is
conducted in 7 sub districts with 45 to 79-year-old individuals. 402 individuals with essential
hypertension are considered and 1047 individuals are selected without the cardiovascular
disease. A multilevel linear regression is used to analyse the association between the
oxidative stress biomarker level and physical exercise. The results of the study highlight that
frequent participation in yoga, taiji, square dancing and walking can decrease the oxidative

3EVIDENCE BASED RESEARCH
stress biomarker levels and the hypertension. Thus, it can be said that the physical exercise is
effective in reducing hypertension among the surveyed people.
Bulas, J., Potočárová, M., Murín, J., Kozlíková, K., Luha, J., & Čaprnda, M. (2017).
Central systolic hypertension in patients with well-controlled hypertension. BioMed
research international, 2017.
There are 6 authors that belong from the Comenius University, Institute of medical
physics, and Institute of medical biology. The aim of the research is the assessment of the
central systolic blood pressure among the hypertensive patients. 100 patients were analysed
through a Arteriograph that had controlled hypertension. The study employed an approach
called single point measurement. The results of the highlighted that the central systolic blood
pressure is associated with the return time, height and sex. The issues of hypertension are
more in females than in males. The conclusion of the study suggested that central systolic
blood pressure, sex and height must be considered. The study took very small sample and did
not suggested any remedial measures of hypertension.
Justification:
According to my perspective, the study conducted by the authorsYu et al. (2018) can
be considered as the best evidence. The study aims at evaluating the effect of physical
exercise on the biomarkers of oxidative-stress level. The biomarkers that were considered in
the process included evaluating the activity level of the enzyme Superoxide Dismutase,
Malonidialdehyde and 4-hydroxynonenal (Yu et al., 2018,p.67). The authors have conducted
the study based upon a cross-sectional design. The sample size that has been considered by
the authors include participants who are in between the age group of middle to old. The effect
of introducing the participants to a physical regime was evaluated. Interesting, the findings
revealed a positive outcome on patients who were subjected to a stringent fitness regime (Yu

4EVIDENCE BASED RESEARCH
et al., 2018,p.67). The underlying reason of hypertension has been identified to be elevated
blood pressure. Physical exercise helped in reducing the systolic and diastolic blood pressure,
thereby reducing the activity of the biomarker enzymes Malonidialdehyde and 4-
hydroxynonenal. However, the activity of the biomarker enzyme Superoxide Dismutase was
found to increase. The authors considered a large set of sample population that involved
participants from care homes across 7 locations in the city (Yu et al.,2018,p.65). Also, the age
group that was considered as the inclusion criteria comprised of patients ranging from middle
age to old age (Yu et al., 2018,p.67). Therefore, it can be said that on the basis of the large
sample population, the findings of the paper can be generalized. Also, it should be critically
noted that the research paper had been published in one of the most reputed journal ‘BioMed
Research Journal’ which makes it an authentic research paper. In addition to that, the paper
has a good impact factor value which makes the research findings even more authentic to be
generalised for a wider set of population. Also, the authors of the paper have conducted the
research study in China which has been reported to have the maximum percentage of patients
suffering from hypertension.
Hence, the findings reveal an impressive outcome that can potentially be incorporated
across health care organizations in Australia. The limitations of the study can be considered
as the short span of time. It can be said that the findings reveal the short term outcome goals.
Hence, the research findings do not comprehend long term goals or back up the fact that the
results would remain constant for a longer period of time. The barriers for the implementation
of the strategies devised in the paper into professional nursing practice would include, lack of
professional training in managing elderly patients who are reluctant to take up the physical
fitness activities and the lack of cultural competence. It is important to realize that dealing
with old-age patients is not easy because of the problems related to their patience level and

5EVIDENCE BASED RESEARCH
anxiety in perceiving things. Hence, it is important for the professionals to be culturally
competent in order to administer proper care to the patients.
Implementation of the evidences into nursing practice:
On the basis of the discussion on the research findings, it can be said that
incorporation of a physical fitness regimen would effectively help in controlling the elevated
blood pressure in old-age patients, which has been reported to be the major cause of
hypertension. Along with this, specific attention must be paid to involve the patients in a
holistic care environment. The idea of holistic care is based upon the principle of providing
complete care with respect to the physical as well as mental wellness of the patient
(Alhawassi et al.,2015,p.488). The primary principle that should be considered is the cultural
background of the patient. It has been stated in research studies that the ability of the care
giver to provide a culturally safe treatment intervention helps in fetching positive patient
outcomes (Lackland, 2013,p.12). It would also help in the creation of a therapeutic
relationship and the process of administering the care plan would become easier. This would
also help in easing the communication process between the patient and the carer to a
significant extent. The clinical expertise of the caregivers also play a significant role in
attaining positive outcome (Turong,Paradies & Priest, 2014,p.2014). This means that the
professionals must possess and efficient decision making ability which would consequently
make the implementation procedure easier. Hence, to sum up the available research
evidences reveal two central ideas. The first being the positive implication of the Chinese
drug in controlling the elevated blood pressure and the second being the effective use of
physical exercise to reduce the effect of biological oxidative stress. Hence, with the effective
incorporation of a physical fitness regimen that would involve minimal exercise, walking and
yoga the blood pressure level can be appropriately monitored.

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References:
Alhawassi, T. M., Krass, I., & Pont, L. G. (2015). Hypertension in older persons: a systematic
review of national and international treatment guidelines. The Journal of Clinical
Hypertension, 17(6), 486-492. DOI: https://doi.org/10.1111/jch.12536
Bulas, J., Potočárová, M., Murín, J., Kozlíková, K., Luha, J., & Čaprnda, M. (2017). Central
systolic hypertension in patients with well-controlled hypertension. BioMed research
international, 2017. DOI: https://doi.org/10.1155/2017/8158974
Chen, K. H., Yeh, M. H., Livneh, H., Chen, B. C., Lin, I. H., Lu, M. C., ... & Yeh, C. C.
(2017). Association of traditional Chinese medicine therapy and the risk of dementia
in patients with hypertension: a nationwide population-based cohort study. BMC
complementary and alternative medicine, 17(1), 178. DOI: 10.1186/s12906-017-
1677-4
Gabb, G. M., Mangoni, A., Anderson, C. S., Cowley, D., Dowden, J. S., Golledge, J., ... &
Schlaich, M. (2016). Guideline for the diagnosis and management of hypertension in
adults—2016. mortality, 3(4). DOI: 10.5694/mja16.00526
Lackland, D. T. (2013). Hypertension: joint national committee on detection, evaluation, and
treatment of high blood pressure guidelines. Current opinion in neurology, 26(1), 8-
12. DOI:10.1097/WCO.0b013e32835c4f54
Shimamoto, K., Ando, K., Fujita, T., Hasebe, N., Higaki, J., Horiuchi, M., ... & Ito, S. (2014).
The Japanese Society of Hypertension guidelines for the management of hypertension
(JSH 2014). Hypertension Research, 37(4), 253-390. DOI: 10.1038/hr.2014.20

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Truong, M., Paradies, Y., & Priest, N. (2014). Interventions to improve cultural competency
in healthcare: a systematic review of reviews. BMC health services research, 14(1),
99. DOI: https://doi.org/10.1186/1472-6963-14-99
Yu, Y., Gao, Q., Xia, W., Zhang, L., Hu, Z., Wu, X., & Jia, X. (2018). Association between
Physical Exercise and Biomarkers of Oxidative Stress among Middle-Aged and
Elderly Community Residents with Essential Hypertension in China. BioMed
research international, 2018. DOI: https://doi.org/10.1155/2018/4135104