2. Literature review
This chapter reviews the literature on hypertension and hyperlipidaemia and their relation to risk factors including age, gender, genetics, diet and weight, alcohol, smoking, lack of activity and co-morbidity. It also examines mediating factors including economic factors, stress/personality, medications, lifestyle modifications and complementary therapies including foot reflexology and foot massage. Finally, it reviews outcomes (quality of life) including physiological, psychological and socioeconomic changes.
2.1 Background to the literature review
The occurrence of hypertension, a chronic condition, is increasing in developing countries such as Thailand due to the sociological, political and economic changes and the associated alterations in people’s lifestyles. This follows similar trends in western countries (National Economic and Social Development Board 1997). These lifestyle changes can cause chronic health problems, as a result of poor habits in food and alcohol consumption, lack of physical activity, smoking, and increased stress (National Economic and Social Development Board 1997). Data from an observational health survey in 1995 of Thai people aged 50 years and over demonstrated that the incidence of hypertension in urban females was 1.7 times that of rural females, for two age groups (less than 60 years of age, and 60 years or more). Similarly, for urban males it was 1.7 and 1.5 times that of rural males, for both age groups respectively (Chuprapawan et al 1995).
In addition, age, gender, ethnicity, genetic background, family health history and dyslipidaemia are likely to influence hypertension (Kaplan, Lieberman & Neal 2002; Mancia et al 2002; Manger & Gifford 2001; National Heart Foundation of Australia 2003).
People with a chronic disease may seek ways to reduce their suffering by using both conventional treatment and complementary therapies. Foot reflexology, one of the complementary therapies, is chosen for patients with chronic diseases as a means of improving their quality of life (Hodgson 2000; Milligan et al 2002).
This literature review aimed to investigate what is known from previous studies relating to the relationship between hypertension or hyperlipidaemia and: • risk factors including age, gender, genetics, diet and weight, alcohol, smoking, lack of activity and co-morbidity • mediating factors including financial difficulties, stress or personality, medications, lifestyle modifications and complementary therapies such as reflexology and massage • quality of life
The conceptual framework guiding this study is shown in Figure 2.1.
Figure 2.1 Study framework Risk factors gender Mediating factors Outcomes (quality of life)
economic factors (financial difficulties)
lifestyle modifications eg diet, level of activity
physiological /pathological changes
diet/ weight stress/ personality alcohol/ smoking foot reflexology
lack of activity
2.2 Risk factors for hypertension and hyperlipidaemia
Research has demonstrated that many factors including age, gender, genetics, diet, alcohol, smoking, lack of activity, and co-morbidity independently influence risk and also interact to contribute to hypertension or hyperlipidaemia.
2.2.1 Age and gender Increased age and male gender are important risk factors for cardiovascular disease (National Heart Foundation of Australia 2003). Males have a gene that influences hypertension more than females, when compared at the same age; interestingly, however in postmenopausal women and men of the same age, there is no difference in findings (Williams et al 2000).
A study based in a semi-rural Michigan population examined ambulatory blood pressure, related to the effects of age and sex, in 131 patients who had more than two prior office diastolic blood pressure measurements greater than 90 mmHg and...
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