High blood pressure in children and adolescents is a growing health problem, along with the worldwide epidemics of obesity physical inactivity and nutritional factors (Wang, et al., 2019). There is evidence of a consistent link between vitamin D and blood pressure, the study highlighted the relationship between vitamin D deficiency and hypertension in adolescents, supplementation with vitamin D and encouragement to partake in physical activities can be used as a preventive strategy in an adolescent with common and repeatedly reported impaired vitamin D status (deficiency/insufficiency) (Alsedairy, et al., 2018).
The current study cleared that thirty-four percent of hypertensive adolescents had family history from obesity at a far relative degree. Following a study done by (Souza, et al., 2017) who supported that the nutritional status was significantly associated with the increase in systolic and diastolic blood pressures, being higher in overweight and obese children. The highest prevalence of high blood pressure was found in children classified as obese. (Malatesta-Muncher, & Mitsnefes, (2012) get these results that obesity, environmental factors such as negative smoking, and a sedentary lifestyle are important in development of hypertension even in preschool age children.
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The present study indicates improvement in the healthy lifestyle of hypertensive adolescents after the healthy lifestyle program. 96.3% and 89.3% of teens after the program also agreed that physical activity should take place every two to three days every week from thirty minutes to one hour. (Dobbins, et al., 2013) this study recommends the necessity of promoting continuous physical activity due to its evidence of positive effects on lifestyle behaviors and physical health status measures where physical inactivity is associated with elevated blood lipids and hypertension for children. The Greek a dolescents study of (Tsioufis, et al., 2011) analyzed data from 496 students aged 12–17 years who concluded that physical activity should be practiced at a moderate intensity level in everyday life. According to study of (Riley, et al., (2018) who stated as all children with hypertension and vitamin D deficiency should make lifestyle changes to lower blood pressure as referred for comprehensive, intensive, family-oriented behavioral intervention programs as healthy diet, sports, and regular exercise. Other study (Lips, et al., 2014) found that vitamin D status can be improved through combination of sunlight exposure, nutrition, food fortification, and supplements is desirable to obtain sufficient vitamin D. These studies in the same line with current study confirm that the highest proportion after the program was in the appropriate diet as it limits foods rich in sugar and sodium. The best healthy lifestyle in the vitamin D source was natural sun exposure/ultraviolet B irradiation.
In our study there was a statistically significant relationship between sociodemographic characteristics of adolescents as female gender with age between 14-18 years old, secondary education, appropriate economic status, and healthy house conditions with their healthy lifestyle. After healthy lifestyle program 94%, 60%, and 55,7% was male adolescent with age between 11-14 years old, a physically active and non-appropriate economic status respectively. In study of there was a relationship between Children with an average socioeconomic status, with there being physically active, and normal body weight. In female adolescents, were lived in urban areas, less likely were underweight, and assessed their health status as average or poor. Previous research indicated that was strongly highly associated with social class, as measured by education, income, and a healthy lifestyle (Gharipour, et al., 2013). In another study in Iran, it was found significant relationships between a healthy lifestyle and education, also, there are close relationship between lifestyle interventions and urbanization (Khajedaluee, et al., 2016).
The present study reported that there was a statistically significant difference between the adolescent knowledge level before and after the healthy lifestyle program. The adolescents were having a good knowledge level noted by 90% and 71% for signs and symptoms and avoid complications of hypertension respectively. This finding was supported by (Jarelnape, et al., 2016) he found that regarding correct knowledge of the studied group before and after the healthy lifestyle program and the different aspects of hypertension, showed that there was a significant improvement of the patients' knowledge after healthy lifestyle program concerning the correct knowledge of the definition of hypertension, signs and symptoms of hypertension, compliance to drug types of treatment dietary management, importance of exercise and complications of hypertension, (P < 0.001). (Ribeiro, et al., 2015) The study demonstrated that educational interventions increased participants’ levels of knowledge about hypertension and had a positive influence on their beliefs about improved blood pressure control, adherence to therapy. As well as heighten awareness about disease progression and complications.
Regarding monitoring blood pressure after two months from healthy lifestyle program the adolescents adhere to maintain a healthy lifestyle the researcher found high percentage from male and female adolescent become had controlled blood pressure. In (Jarelnape, et al., 2016) study post-test after intervention 92% of patients controlled blood pressure and good knowledge to adjust their blood pressure lifestyle changes involving dietary and exercise being effective in significant decrease in weight, and effective in improving patient’s knowledge. These finding supported by (Damasceno, et al., 2011) that examined the associations of BP with fruits, vegetables, and fruit juice consumption among a random sample of 794 adolescents from 12 private schools in northeast Brazil. Regular consumption of fruits (more than twice per day) was associated with lower systolic and diastolic BP, whereas consumption of vegetables was associated with a significant decrease in systolic BP only. (Tam, et al., 2020) highlighted the effectiveness of the educational intervention to control blood pressure and adherence to lifestyle modifications. Our study Similarly, most of the adolescents with 25-hydroxy vitamin D deficiency transfer from deficient and insufficient to optimal that recorded at their medical file after two months from the healthy lifestyle program. (Alami, et al., 2019) A quasi-experimental study was used to enroll 175 adolescent girls aged 12–14 years attending community-based practices in the Gonabad, Iran, indicating that adolescents change multiple behaviors for vitamin D supplements significantly improved in the intervention group compared to the control group (p < 0.001).
In common with the findings of the current study (Yi, et al., 2015) concluded that appropriate training for an adolescent to home blood pressure self-monitoring is effective. The aneroid manometer was appropriate for home use in children ages 4 to 18 years. high adolescent skills for measuring blood pressure after training. Correspondingly our study explored that an improvement in adolescent practice related to the measurement of blood pressure after healthy lifestyle program with statistically significant difference compared by before program. The best practice of adolescents was observed after the program by one hundred percent as a good choice for the stethoscope, a blood pressure measurement instrument, and no talking during the reading
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