The present study assessed adherence to the healthy lifestyle in different subgroups hypertensive patients. Based on the official guidelines on hypertension treatment, lifestyle modification is the first line of treatment for hypertensive patients, and it is expected that people’s awareness of hypertension result in changes in people’s lifestyles. However, the results of our study showed no significant difference in lifestyle between people with hypertension who were aware of their illness and those who were not aware of their illness. Nevertheless, it is expected that aware patients modify their lifestyle, or at least behave in a way different from those who are not aware of their illness.
The only significant difference between the two groups was in terms of salt consumption and cigarette smoking. There are some studies reporting that the awareness of hypertension can affect people’s lifestyle and results in changes, while there are some other studies indicating no significant difference in lifestyle between the two groups of patients; those who are aware and those who are unaware of their illness. As stated above, some studies have reported changes in lifestyles after being informed of the disease; this finding may be attributed to a number of reasons. First, the difference observed in many articles is very small; on the other hand, a large number of these articles have reached such a conclusion through questioning people about the modification of their lifestyle. Nevertheless, some studies have shown that patients usually overestimate the modification of their lifestyle. the results of this study indicate that awareness of the disease resulted in a reduction in salt intake and cigarettes smoking, but did not affect other lifestyle risk factors. Our results are in line with the results of other studies conducted in European countries. Based on the results of such studies, there is a significant difference between those aware of their illness and those unaware of their illness in terms of salt and alcohol consumption and smoking, but there is no significant difference between the two groups in terms of other lifestyle risk factors. In a study conducted in Korea and Spain, it was found that people who were aware of their hypertension, as compared with those who were not aware of their illness, consumed less salt and smoked less frequently. This is probably due to the extensive trainings on the effect of these two variables on hypertension.
There are a few justifications for the lack of change in lifestyle and the lack of significance difference in lifestyles between those aware of their illness and those unaware of their disease. As the first justification, there are not adequate and scientific trainings for those whose disease is diagnosed. Aparently, there are broad and extensive trainings for patients to reduce the consumption of salt, but there are not enough training about the consumption of fruits and vegetables and other lifestyle risk factors. On the other hand, patients with hypertension seem to assume that taking antihypertensive drugs is enough to control the disease and thus they do not feel the need for lifestyle modification. Finally, lifestyle modification is difficult and adherence to a healthy lifestyle is not an easy task, as it requires appropriate trainings and interventions.
The lack of a relationship between lifestyle and hypertension control in people who are taking medication may be due to different reasons. For instance, people who are taking medication are likely to have a higher level of hypertension than those who do not take medication; in the earlier group, lifestyle modification may not have a remarkable effect on hypertension control and they may still need to take medications. Moreover, uncontrolled hypertension in people taking drugs may be due to irregular use of medications. However, as we do not have any information about the medication compliance, we cannot make any conclusion in this area.
It is worth noting that people who were not aware of their disease had higher levels of physical activity, as compared with those who were aware of their disease. As a reason, it might be related to age. People who were not aware of their disease were younger and they were more likely to have a higher level of physical activity than older people with hypertension. Moreover, health policymakers should pay attention to the fact that people who were not aware of their illness had a lower mean age than other patients, indicating the need for more frequent screening the disease in younger people.
As an interesting point in the present study, we observed different results when we limited our analysis to people who were aware of their illness and divided them into two groups of patients who were taking antihypertensive drugs and those who did not take any medication. Indeed, there was a significant relationship between lifestyle and taking antihypertensive drugs and their effect on hypertension control. People who were aware of their illness and did not take medications had a better lifestyle than those who had hypertension and take antihypertensive medication. On the other hand, hypertension control in people who did not use any drug had a significant relationship with ahealthy lifestyle, while such a relationship was not observed in people taking medications. Nonetheless, a large percentage of this group of patients had uncontrolled hypertension. This may be due to two reasons. First, the lack of such a relationship in people who were taking antihypertensive drugs is not due to the absence of a relationship but is rather due to the lack of adequate difference in lifestyle between the two groups with controlled and uncontrolled hypertension. Second, as noted above, patients who are taking antihypertensive drugs do not feel a need to modify their lifestyle. Some studies have shown that the use of antihypertensive drugs increases the odds ratio of non-adherence to a healthy lifestyle, which can be a justification for our finding. It is clear that a large number of patients do not have a healthy lifestyle, and hypertension is not controlled in a large number of them, although they are aware of their illness. Therefore, health professionals and physicians must put more emphasis on lifestyle modifications when counseling patients or managing hypertension.