Lowering High Blood Pressure Naturally: A Bibliography Plan Jennifer Hamada LIS 601 Dr. Nahl Fall 2010 Table of Contents I. Introduction ............................................................................................................................................... 3 A. Topic .................................................................................................................................................... 3 B. Scope, Organization and Audience ...................................................................................................... 3 C. Style Explanation ................................................................................................................................. 3 II. Search Strategy ......................................................................................................................................... 4 A. Library of Congress Subject Headings ................................................................................................ 4 B. Library of Congress Call Numbers ...................................................................................................... 4 C. Reference Sources ................................................................................................................................ 4 i. Balay’s Guide to Reference Books .................................................................................................... 4 ii. Encyclopedia Britannica Online ....................................................................................................... 4 C. OPACs.................................................................................................................................................. 5 i. Hawaii State Public Library System (HSPLS) .................................................................................. 5 ii. Hawai‘i Voyager: Libraries of University of Hawai‘i ...................................................................... 5 D. Indexes ................................................................................................................................................. 6 i. Academic Search Premier .................................................................................................................. 6 ii. Alt Healthwatch ................................................................................................................................ 6 iii. CINAHL (Cumulative Index to Nursing and Allied Health Literature) .......................................... 7 iv. Consumer Health Complete ............................................................................................................. 7 v. Health Source Consumer Edition ...................................................................................................... 8 vi. Ingenta ............................................................................................................................................. 8 vii. LexisNexis Academic ..................................................................................................................... 8 viii. MasterFILE Premier ...................................................................................................................... 9 ix. Medline .......................................................................................................................................... 10 III. Conclusion ............................................................................................................................................ 10 Appendix A: Search Strategy Relevancy Tables ........................................................................................ 11 Appendix B: Sample Annotated Bibliography with Sub-Topics ................................................................ 16 End Notes .................................................................................................................................................... 18 I. Introduction A. Topic High blood pressure is often referred to as a “symptomless disease” affecting millions of Americans, which left untreated can lead to serious health problems including heart failure, stroke, kidney damage, and other major complications.1 Lifestyle changes can help to control blood pressure and lower a person’s risk of high blood pressure leading to further complications. Prescription drug treatment is available for individuals who are diagnosed with high blood pressure (hypertensive or pre-hypertensive); however naturally lowering high blood pressure through lifestyle changes is preferred by physicians and believed to be in the best interest for the patient. Lifestyle changes combined with drug therapy may also increase the effectiveness of the patient’s current prescription or may prevent higher dosages in the future. B. Scope, Organization and Audience This bibliography plan provides resources with information on lowering high blood pressure naturally for individuals who have been diagnosed with high blood pressure (hypertension) or who are at risk of developing high blood pressure. Materials are selected with the patient in mind, focusing on sources that are useful and readable to the general public. Although older materials may still be useful, this plan is focused on materials published within the last twenty years. (Searches were not restricted by date, but if results returned were older than twenty years, they were considered not relevant.) Professionals in the healthcare field may find it useful to direct patients to this resource. The purpose of this bibliography plan is to be a supplement for individuals who are consulting with their physicians or health care specialists. C. Style Explanation Citations in this bibliography plan are formatted using Kate Turabian’s A Manual for Writers of Research Papers, Theses, and Dissertations.2 Subject headings (CV) are indicated by capital letters, natural language (NL) search terms are in lowercase, and truncated terms are marked with an asterisk *. II. Search Strategy A. Library of Congress Subject Headings Subject headings were located from searching the Library of Congress Online Catalog. 3 BLOOD PRESSURE—REGULATION HYPERTENSION—DIAGNOSIS HYPERTENSION—DIET THERAPY HYPERTENSION—EXERCISE THERAPY HYPERTENSION—PREVENTION HYPERTENSION—THERAPY HYPERTENSION – TREATMENT B. Library of Congress Call Numbers RC685.H8 Hypertension C. Reference Sources i. Balay’s Guide to Reference Books4 I started my search by consulting Balay’s Guide to Reference Books. I could not find any resources using the terms “Hypertension” or “Blood Pressure.” I widened my search and browsed “health care” and found several sources. Although the print resources seemed to be too broad or off topic (pointing to public aspects of medicine), three indexes listed looked promising: National Library of Medicine (U.S.) Index, Consumer Health and Nutrition Index, and Medline. Unfortunately, currently I only have access to the Medline index (which will be discussed later in this bibliography plan). ii. Encyclopedia Britannica Online5 In Encyclopedia Britannica Online, I began with a keyword search on “hypertension” which yielded over a hundred results. “Hypertension (pathology)” was at the top of the list, but all articles mentioning “hypertension” were listed. Several of the results had a connection to the term (such as stroke, renal (kidney) disease, potassium, and cardiology), but did not fit the purposes of this bibliography plan. I did further searches for the terms “hypertension prevention,” “hypertension treatment,” and “lowering blood pressure;” which reduced the number of results, but did not produce a higher relevant result group. However, the Additional Content menu (located on the left sidebar) results for the search on “hypertension” did lead me to a highly useful article titled Morning Hypertension6, detailing the importance of measuring blood pressure in the morning when it is at its highest. Although I wouldn’t recommend Encyclopedia Britannica Online as a resource in itself for healthcare information, it does have an article on hypertension and provides links to further resources and can operate as a starting point for someone exploring the topic. C. OPACs i. Hawaii State Public Library System (HSPLS)7 I expected the Hawaii State Public Library System (HSPLS) to be an excellent resource for this bibliography plan and was not disappointed. I started my search doing a subject browse search using previously listed LCSH terms which yielded highly relevant results. Since this is a public library the results that came up were already aimed at a public readership, as opposed to a technical or clinical readership. Almost all of the resources were on the topic of helping the general public understand hypertension and what individuals can do for themselves to lower hypertension through diet, exercise, and stress management. I also did keyword searches for “hypertension” and “blood pressure,” both searches provided a larger number of highly relevant results. Many results from the previous subject browse searches were included, but other resource on topics such as diet, meditation, and yoga which were not on the subject of hypertension, but had claim to reducing hypertension were included. A resource that came up in the keyword search was subject classified under “CARDIOLOGY—POPULAR WORKS,” but would be an good resource for hypertension was the American Medical Association Guide to Preventing and Treating Heart Disease: Essential Information You and Your Family Need to Know about Having a Healthy Heart.8 I would strongly recommend HSPLS as a source of highly useful information on the topic of hypertension. ii. Hawai‘i Voyager: Libraries of University of Hawai‘i9 Again I started my search doing a subject browse of previously listed LCSH terms in Hawai‘i Voyager. Because this is an academic library catalog, some of the sources that came up were related to the search terms, but were not aimed at the general public and did not fit the purpose of this bibliography plan. Although a subject browse search for HYPERTENSION yielded 103 results, several results dealt with pharmacology, pathophysiology, and clinical studies or aspects of hypertension and were not relevant for this bibliography plan. One subject heading yielded highly relevant results, a subject browse search on “HYPERTENSION—PREVENTION” brought up several government document sources, Your Guide to Lowering Blood Pressure10 for instance, created by the National Heart, Lung, and Blood Institute, National Institute of Health, U.S. Department of Health and Human Services is an excellent resource educating the public about hypertension, risk factors of high blood pressure, and what people can do to prevent or reduce their risk. Other subject heading searches yielded somewhat relevant results, consisting of a combination of technical/clinical sources mixed with general information sources. D. Indexes i. Academic Search Premier11 Academic Search Premiere is a multidisciplinary index of scholarly publications. I collected my controlled vocabulary for this index, by searching the thesaurus. Searches of CV and Boolean searches combining CV with keywords yielded a large number of results, but the majority of articles on the topic of hypertension were clinical studies meant for an audience in the healthcare field. Within the clinical articles, some were written with enough plain language and were relatable enough that the general public could get useful information out of. One such example was Caffeine and Blood Pressure Response: Sex, Age, and Hormonal Status, a clinical study examining the effects of caffeine on the blood pressure, concluding that men and women of all ages should seriously consider removing caffeine from their diet to help lower blood pressure.12 Usability of this index depends on the reading level and patience of the searcher. I’m not sure if they would find it useful to dig through a large number of clinical studies to find small gems of information. ii. Alt Healthwatch13 Alt-HealthWatch is an index focused on information sources of holistic, complimentary, and integrated approaches to healthcare and wellness. I gathered my controlled vocabulary by doing a subject heading search of the database and then proceeded to do both subject searches using controlled vocabulary and Boolean searches using controlled vocabulary and natural language. My best results came from a combined search of controlled vocabulary and natural language with truncation: HYPERTENSION and natural* and treatment*. Because the database is focused on alternative medicine, this turned out to be an excellent resource of information for applying natural treatments to lowering blood pressure. One such article, Yoga and Ayurveda for Reducing High Blood Pressure, suggests yoga as not just as an alternative form of exercise, but also a natural means of lowering stress and anxiety which have a major role in raising blood pressure levels.14 iii. CINAHL (Cumulative Index to Nursing and Allied Health Literature)15 CINAHL is a comprehensive database index for nursing and allied health literature. CINAHL has its own set of subject headings based on the terminology of the health care field. Before starting my search, I searched CINAHL headings for “hypertension” to come up with my controlled vocabulary (CV) for this index. Using CV, my searches yielded hundreds of articles, but only some of them were relevant to the purposes of this bibliography. Mixing CV and natural language, did not yield a higher relevancy of results, but did focus results to different aspects of lowering high blood pressure. The subject heading HYPERTENSION—PREVENTION AND CONTROL combined with “self care,” yielded several sources emphasizing the importance of patients monitoring their own blood pressure daily. Meanwhile, the same subject heading HYPERTENSION—PREVENTION AND CONTROL combined with “exercise,” yielded hundreds of sources emphasizing the importance of exercise. One interesting article, “Effects of the DASH Diet Alone and in Combination with Exercise and Weight Loss on Blood Pressure and Cardiovascular Biomarkers in Men and Women with High Blood Pressure: The ENCORE Study” reveals that DASH diets tend to be successful in the short term, but exercise and weight loss leads to a higher success rate and improvements in patient’s vascular health.16 Because this index is directed to individuals in the healthcare field, many resources are about clinical trials and studies and are heavy with medical jargon. Depending on the reading level of the non-expert who might use this resource, individuals might not find this index useful even though it does hold useful information. iv. Consumer Health Complete17 Consumer Health Complete is an index of consumer-oriented health resources. Although the database is described as being directed toward consumers (which I understand to be a nonmedical professional), several resources that came up were highly clinical, including reports of research filled with statistical data and medical jargon. One such example was Blood Pressure Regulation and Vegetarian Diets, which sounds promising from the title, but as soon as you start reading the authors describe their research as limited to “human studies” and begin to discuss blood viscosity.18 Combining subject headings in Boolean searches, I was able to filter out relevant resources. However, depending on the reading level of the user, consumers may not find this resource useful. v. Health Source Consumer Edition19 Health Source Consumer Edition is an index of consumer health periodicals. Unlike Consumer Health Compete, this database produced articles that were directed at the non-expert. For this database my challenge was to filter out articles related to drug treatment of high blood pressure and articles that were about health issues (such as diabetes and kidney disease) that mention hypertension as a symptom. Using controlled vocabulary collected from a subject search, I was able to excellent results with a Boolean search of HYPERTENSION and PREVENTION. Combining subject headings HYPERTENSION or BLOOD PRESSURE with lower* and natural* also yielded highly relevant results. One article, Time Out, Yoga Style, was informative and instructional introducing the reader to deep breathing and beginner yoga poses to help relieve stress and in effect lower blood pressure.20 vi. Ingenta21 Ingenta is an index of academic and professional journal articles. The database does not use subject headings, but does allow for Boolean searches and truncation. However, when I did create my search strings, the database would time out and give me a message that I need to modify my search to narrow the results. I found this very frustrating being forced to narrow my results before even seeing any results. To narrow my results, I removed my truncation and did separate Boolean searches with different terms such as “lower” and “lowering.” This database produced irrelevant results. Results yielded were all highly clinical, often about drug studies and/or rat experiments. One such example is Effect of Cross-Fostering on Blood Pressure and Renal Function in the New Zealand Genetically Hypertensive Rat.22 vii. LexisNexis Academic23 LexisNexis Academic is a multidisciplinary database. In power search mode, the user is allowed to search either by using “terms & connectors” (which uses Boolean searching) or simply by “natural language” which actually appears to be a keyword search. (LexisNexis does not use subject headings, so all searches are natural language.) I started with a Boolean search of major publications entering the search string: (hypertension or blood pressure) and treatment. Shortly after hitting the search button, the search engine interrupted the search with a message saying that my current search is yielding over 3,000 results and I need to narrow/restrict my searching. I reduced my results by removing my “or” from my Boolean search string and searched “hypertension” and “blood pressure” separately in different search strings. Each Boolean search string, yielded a moderate number of results, but they were not relevant. Many included the words somewhere in the article, but were on unrelated topics (such as menopause and hair loss). There were also a large number of duplicate results (some articles were repeated as many as five times) throughout the search results which makes me believe the number of results is largely inflated. Not finding relevant results using Boolean searching, I decided to try the natural language search option: “Hypertension natural treatment,” “lower* blood pressure,” “natural blood pressure treatment*,” and “lower* hypertension natural.” Surprisingly, the natural language search brought up a much larger number of results (averaging about 1,000) per search, and the results given were somewhat relevant. There were still off-topic and duplicate results, but there were some useful articles scattered throughout. One source that came up was How Diet Can Change Blood Pressure, a brief introduction to healthy eating for heart health.24 viii. MasterFILE Premier25 MasterFILE Premier is an index of general periodicals. Because my target audience is the general public, I thought this index would be a promising resource. I started by collecting my controlled vocabulary by doing a subject search of terms. I did a search of the subject heading HYPERTENSION, which yielded thousands of results on a range of subjects. Several articles that include HYPERTENSION as a subject heading are actually primarily on a subject of another medical condition (such as diabetes or kidney disease) that has hypertension as a symptom. Because of the types of sources indexed in this database, articles were in plain language and much more accessible and relatable than other databases. One article that immediately stood out was Speaking Up to the Silent Killer: Designing a Safe and Effective Workout for the Hypertensive Client, an informative article on the topic of understanding the risks of hypertension taking safety measures in creating aerobic workouts for individuals who have high blood pressure that would be useful for not only fitness instructors, but people starting to work out to lower their blood pressure.26 The best search results came out of a subject search of HYPERTENSION—PREVENTION. Combining CV produced highly relevant, but narrow results focused on different aspects (such as FOOD HABITS and PHYSICAL FITNESS). ix. Medline27 Medline is an index of authoritative medical information. I collected controlled vocabulary, by searching the database subject headings, which are the National Library of Medicine’s Medical Subject Headings (MeSH). I did both subject searches and keyword searches. The keyword searches yielded non-relevant results since “hypertension” and “blood pressure” can be symptoms that show up in many kinds of different medical conditions and produced a wide variety of articles off topic. Subject searches produced a more relevant set of results. However, the results yielded were extremely clinical written towards an audience who is in the medical field. Although there is relevant information, it is difficult to read through. One useful article was Management of Chronic Hypertension in Older Men: An Exploration of Patient Goal-Setting.28 Because it was about self-care activities (as opposed to clinical trials measuring blood viscosity for example), encouraging the collaboration of patients and healthcare providers to create goals to work towards, this article was one of the more readable ones. III. Conclusion This assignment helped me become aware of my search strategy, refine my selection of terms, and explore a range of databases. As I did my searches I realized I was using the search strategy of successive fractions starting out looking at a large pool of results and working my way down towards my focus (which is why I did subject searches simply on hypertension, knowing I would get a large batch of unfocused results back). I also realized after the fact as I tabled my results, that I could have created better Boolean search strings by incorporating “or” into my searches, for example: (HYPERTENSION or BLOOD PRESSURE) and lower* and natural*, and reduce the number of repetitive searches I did using the same string with different terms switched out. Although I did subject heading searches of databases (when possible), I developed the habit of examining the listed subject headings in an article’s detailed record. And I discovered subject headings that I would not have considered searching for, such as FOOD HABITS and PHYSICAL FITNESS. I found that keyword searching produced highly relevant results in the OPACs looking for book resources, but in databases indexing journal articles keyword searching produced many irrelevant results. Often, items subject indexed in a journal database have several subject headings which increase access points, but do not necessarily point towards the main topic of the article. This is a double edged sword of sorts. Often, subject searches of HYPERTENSION brought up articles about diseases with hypertension as a symptom. However, it also did bring up useful articles, for example in my searches I cited two articles about yoga which can be applied towards lowering hypertension. I learned a great deal about my topic which I choose because both my mother and myself are affected by high blood pressure. My own doctor often tells me that I need to incorporate lifestyle changes to help improve my health, but other than that short nag when I see him, I’m left out on my own. Although mining through the medical journal articles was frustrating at times, I was pleased to find a wealth of sources in books, government publications, and journal articles directed towards the general public. I think high blood pressure not viewed as an urgent problem (because it can be managed somewhat by drugs) until it leads to major health complications. I imagine that further developed, this bibliography plan could be a valuable resource that health care professionals can point patients to. Appendix A: Search Strategy Relevancy Tables Key: These tables correspond to the databases in the order that they are listed. Controlled vocabulary (CV) search terms are in ALL CAPS. Exact phrases are enclosed in quotations. Boolean connectors (and, or) are italicized. An asterisk (*) indicates truncation or stemming. Search Fields: SU= Subject (CV) KW= Keyword (Natural Language) TX= All text Relevancy: HR= Highly relevant, most items were relevant. SR= Somewhat relevant, mix of relevant and non-relevant items. NR= Not relevant, very few relevant items. Encyclopedia Britannica Online Relevancy SR SR SR SR Search String Hypertension Hypertension prevention Hypertension treatment Lowering blood pressure Search Fields KW KW KW KW Results 142 9 67 28 Search Fields SU SU Results 23 6 SU SU SU SU KW KW KW KW KW KW KW KW KW 9 1 8 3 98 3 9 14 118 14 17 24 14 Search Fields SU SU SU Results 17 103 13 Hawaii State Public Library System Relevancy Search String HR HYPERTENSION HR HYPERTENSION—ALTERNATIVE TREATMENT HR HYPERTENSION—DIET THERAPY HR HYPERTENSION—EXERCISE THERAPY HR HYPERTENSION—PREVENSION HR HYPERTENSION—TREATMENT HR Hypertension HR Hypertension and natural HR Hypertension and lower HR Hypertension and treatment HR Blood pressure HR Blood pressure and lower HR Blood pressure and treatment HR Blood pressure and therapy HR Lower blood pressure Hawaii Voyager Relevancy HR SR SR Search String HYPERTENSION—PREVENTION HYPERTENSION HYPERTENSION -- TREATMENT SR SR SR SR NR HYPERTENSION—DIET THERAPY BLOOD PRESSURE—REGULATION HYPERTENSION—THERAPY HYPERTENSION—ALTERNATIVE TREATMENTS HYPERTENSION—EXERCISE THERAPY SU SU SU SU 10 7 4 2 SU 0 Search Fields SU SU SU SU & TX Results 68 24 628 53 SU SU & TX SU & TX SU & TX SU & TX 2 53 449 1,263 572 Search String HYPERTENSION and natural* and treatment* HYPERTENSION—PREVENTION HYPERTENSION and DIET THERAPY BLOOD PRESSURE and high and treatment* HYPERTENSION—TREATMENT BLOOD PRESSURE and elevated and treatment* HYPERTENSION—TREATMENT and natural* HYPERTENSION and EXERCISE THERAPY Search Fields SU & TX SU SU SU & TX SU SU & TX Results 99 78 15 199 83 64 SU & TX 21 SU 2 Search String HYPERTENSION—DIET THERAPY HYPERTENSION—EDUCATION HYPERTENSION—PREVENTION AND CONTROL HYPRETENSION--THERAPY Search Fields SU SU SU Results 279 138 2,293 SU 1,686 Academic Search Premier Relevancy SR SR SR SR SR SR SR NR NR Search String HYPERTENSION and DIET THERAPY HYPERTENSION and EXERCISE THERAPY HYPERTENSION and PREVENTION HYPERTENSION and PREVENTION and natural* HYPERTENSION and HOLISTIC MEDICINE BLOOD PRESSURE and low* and natural* BLOOD PRESSURE and alternat* and therap* HYPERTENSION and natural* and treatment* BLOOD PRESSURE and high and natural* and treatment* Alt-HeathWatch Relevancy HR HR HR SR SR SR SR SR CINAHL Relevancy SR SR SR SR SR SR SR SR HYPERTENSION—PREVENTION AND CONTROL and “self care” HYPERTENSION—PREVENTION AND CONTROL and exercise HYPERTENSION—PREVENTION AND CONTROL and natural* HYPERTENSION—PREVENTION AND CONTROL and alternat* therap* SU & TX 73 SU & TX 304 SU & TX 50 SU & TX 132 Search Fields SU Results 69 SU SU SU SU SU SU & TX SU & TX SU & TX SU & TX SU & TX SU & TX SU & TX KW SU & TX SU & TX 48 25 19 4,628 3,303 2,157 1,088 1,006 396 320 275 165 27 349 209 Search Fields SU SU & TX SU & TX SU & TX SU SU SU SU & TX SU & TX Results 165 151 143 49 25 7 1,638 192 179 Consumer Health Complete Relevancy Search String HR BLOOD PRESSURE and PHYSICAL FITNESS HR HYPERTENSION and FOOD HABITS HR BLOOD PRESSURE and FOOD HABITS HR HYPERTENSION and PHYSICAL FITNESS SR HYPERTENSION SR BLOOD PRESSURE SR HYPERTENSION and prevent* SR HYPERTENSION and diet SR HYPERTENSION and exercise SR HYPERTENSION and lower* and natural* SR BLOOD PRESSURE and lower* and natural* SR HYPERTENSION and natural and therap* SR BLOOD PRESSURE and natural and therap* SR Hypertension control NR HYPERTENSION and natural and treatment* NR BLOOD PRESSURE and natural and treatment* Health Source Consumer Edition Relevancy HR HR HR HR HR HR SR SR SR Search String HYPERTENSION and PREVENTION HYPERTENSION and lower* and natural* BLOOD PRESSURE and lower* and natural* BLOOD PRESSURE and manage* and natural* HYPERTENSION and DIET THERAPY HYPERTENSION and EXERCISE THERAPY HYPERTENSION BLOOD PRESSURE and manage* HYPERTENSION and natural* and manage* Ingenta Relevancy NR NR NR NR NR NR Search String Hypertension and preventsion Hypertension and patient and prevention Hypertension and natural* and therapy “Blood pressure” and lower and natural* “Blood pressure” and lowering and natural* Hypertension and self-care and patient Search Fields KW KW KW KW KW KW Results 1,545 199 68 52 20 8 Search String HYPERTENSION – PREVENTION HYPERTENSION and PHYSICAL FITNESS HYPERTENSION and lower* and natural* BLOOD PRESSURE and FOOD HABITS HYPERTENSION and FOOD HABITS HYPERTENSION BLOOD PRESSURE BLOOD PRESSURE and PHYSICAL FITNESS BLOOD PRESSURE and lower* and natural* Search Fields SU SU Results 244 45 SU & TX SU SU SU SU SU 44 25 18 4,596 3, 137 69 SU & TX 25 Search String HYPERTENSION—PREVENTION AND CONTROL HYPERTENSION—DIET THERAPY HYPERTENSION—THERAPY and EXERCISE THERAPY HYPERTENSION—THERAPY and SELF CARE HYPERTENSION—PREVENTION AND CONTROL and SELF CARE “Blood pressure” and lower* and natural* Hypertension and lower* and natural* Search Fields SU Results 7,379 SU SU 1,737 348 SU 127 SU 78 TX TX 532 474 MasterFILE Premier Relevancy HR HR HR HR HR SR SR SR SR Medline Relevancy SR SR SR SR SR NR NR Appendix B: Sample Annotated Bibliography with Sub-Topics Comprehensive Introductory Guides Casey, Aggie, Herbert Benson, and Brian O’Neill. The Harvard Medical School Gide to Lowering Your Blood Pressure. New York: McGraw Hill, 2006. [RC685.H8 C37 2006] A comprehensive introductory book that defines high blood pressure (and hypertension) in plain language, explains the health risks and possible causes of high blood pressure, and offers a balanced lifestyle program to manage blood pressure levels. Provides dietary guidelines based on the Dietary Approach to Stop Hypertension (DASH) eating plan, exercise guidelines, and recommendations on managing chronic stress. Includes an appendix of easy heart-healthy recipes. A good starting point for individuals diagnosed with high blood pressure. American Heart Association. American Heart Association. American Heart Association. 2010. [online] available from http://www.heart.org/HEARTORG/ (accessed 14 November 2010). An excellent resource for individuals diagnosed with high blood pressure (or other heart related conditions). Articles are written in plain language explaining different heart conditions, giving definitions of medical terms, and warning about health risks involved. The Getting Healthy section has numerous informative articles about making heart healthy diet and lifestyle choices. Includes web tools (such as a grocery list builder), calculators, and charts to personalize and customize users own goals. Comprehensive and well organized, site is also accessible in multiple languages. Dietary Approach Kapiolani Community College. A DASH of Aloha: Healthy Hawaii Cuisine and Lifestyle. Honolulu: Watermark Publishing, 2007. [TX724.5.H3 D37 2007] Introduces the Dietary Approach to Stop Hypertension (DASH) eating and activity plan targeted toward a Hawaii based demographic. Contains 70 recipes emphasizing locally (Hawaii) grown produce, with nutritional information listed. Includes fruit and vegetable seasonality chart (especially useful since the DASH diet promotes a high level of fruit and vegetable intake) and nutritional fact chart. Jefferson, Angie, and Fiona Hunter. High Blood Pressure: Food, Facts, & Recipes. New York: Sterling Publishing, 2005. [RC685.H8 J4 2005] An informative resource that provides dietary guidelines to lowering blood pressure naturally through diet. Rather than restrictive rules and numbers to track, this source aims to guides readers to making healthy choices. Breaks down the nutritional guideline information into simple and easy to apply goals for readers. Contains 50 heart healthy recipes, with nutritional information listed and bonus nutritional tips about different recipes. Maintaining Lifestyle Changes Young, Deborah R., William M. Vollmer, Abby C. King, Ann J. Brown, Victor J. Stevens, Patricia J. Elmer, Shirley Craddick, Dana L. Sturtevant, David W, Harsha, and Lawrence J. Appel. “Can Individuals Meet Multiple Physical Activity and Dietary Behavior Goals?” American Journal of Health Behavior 33, no. 3 (May/June 2009): 277-286. Although a clinical study on a group of pre- or early hypertension individuals applying dietary and physical activity, readers can take away useful ideas for their own successful implementation of lifestyle changes. Reports that most people who are given more goals are more successful in maintaining changes (as opposed to being overwhelmed or being unable to meet multiple goals at once). Points to useful methods such as specific goal setting, self-monitoring, and social support. End Notes 1 American Heart Association, Why Blood Pressure Matters, American Heart Association. [online] available from http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/WhyBloodPressureMatters/ Why-Blood-Pressure-Matters_UCM_002051_Article.jsp (accessed November 2010). 2 Kate L Turabian, A Manual for Writers of Research Papers, Theses, and Dissertations: Chicago Style for Students and Researchers, 7th ed., rev. by Wayne C. Booth, Gregory G. Colomb, Joseph M. Williams et al (Chicago: University of Chicago Press, 2007). [LB2369.T8 2007] 3 Library of Congress, Library of Congress Online Catalog, Library of Congress. available from http://catalog.loc.gov/ (accessed November 2010). 4 Robert Balay, ed., Guide to Reference Books, 11th ed. (Chicago: American Library Association, 1996). [Z1035.1 .G89 1996] 5 Encyclopedia Britannica Online [electronic resource]. (Chicago, IL: Britannica Online, 2010). Available from http://micro189.lib3.hawaii.edu/ezproxy/details.php?dbId=2522 (accessed November 2010). 6 Chuck Dushman, “Morning Hypertension” Drug Store News (August 13, 2007): 25-26. [HD9666.1 .D74] 7 Hawaii State Public Library System, HSPLS Catalog [home page online], available from http://ipac.librarieshawaii.org/ (accessed November 2010). 8 Martin S. Lipsky, Marla Mendelson , Stephen Havas,and Michael Mille, American Medical Association Guide to Preventing and Treating Heart Disease: Essential Information You and Your Family Need to Know about Having a Healthy Heart. (Hoboken, N.J. : J. Wiley, 2008). [HSPLS 616.12 Am] 9 University of Hawaii at Manoa, Hawaii Voyager Library Catalog [home page online], available from http://uhmanoa.lib.hawaii.edu:7008/vwebv/searchBasic?sk=manoa (accessed November 2010). 10 National Heart, Lung, and Blood Institute, Your Guide to Lowering Blood Pressure. National Heart, Lung, and Blood Institute. [online] available from http://www.nhlbi.nih.gov/health/public/heart/hbp/hbp_low/hbp_low.pdf (accessed November 2010). 11 Academic Search Premier [database online], (EBSCO Publishing, 2010) available from http://micro189.lib3.hawaii.edu/ezproxy/details.php?dbId=2323 (accessed November 2010). 12 Noha H. Farag, Thomas L. Whitsett, Barbara S. McKey, Michael F. Wilson, Andrea S. Vincent, Susan A. Everson-Rose, and William R. Lovallo, “Caffeine and Blood Pressure Response: Sex, Age, and Hormonal Status,” Journal of Women’s Health 19:6 (June 2010): 11711176. [RA564.85 .J68] 13 Alt-HealthWatch [database online], (EBSCO Publishing, 2010) available from http://micro189.lib3.hawaii.edu/ezproxy/details.php?dbId=38070 (accessed November 2010). 14 Meggan Brummer, ”Yoga and Ayurveda for Reducing High Blood Pressure,” Positive Health no. 139 (September 2007): 41-44. 15 CINAHL [database online], (EBSCO Publishing, 2010) available from http://micro189.lib3.hawaii.edu/ezproxy/details.php?dbId=53428 (accessed November 2010). 16 James A. Blumenthal, Michael A. Babyak, Alan Hinderliter, Lana L. Watkins, Linda Craighead, Pao-Hwa Lin, Carla Caccia, Julie Johnson, Robert Waugh, and Andrew Sherwood, “Effects of the DASH Diet Alone and in Combination with Exercise and Weight Loss on Blood Pressure and Cardiovascular Biomarkers in Men and Women with High Blood Pressure: The Encore Study,” Archives of Internal Medicine 170:2 (25 January 2010): 126-135. [R11 .A87] 17 Consumer Health Complete [database online], (EBSCO Publishing, 2010) available from http://micro189.lib3.hawaii.edu/ezproxy/details.php?dbId=54700 (accessed November 2010). 18 Susan E. Berkow and Neal D. Barnard, “Blood Pressure Regulation and Vegetarian Diets,” Nutritional Reviews 63:1 (January 2005): 1-8. [RA 421 .N97] 19 Health Source Consumer Edition [database online], (EBSCO Publishing, 2010) available from http://micro189.lib3.hawaii.edu/ezproxy/details.php?dbId=38069 (accessed November 2010). 20 Judith Hanson, “Time Out, Yoga Style,” Natural Health 34:11 (December/January 2005): 8085. 21 IngentaConnect [database online], (Cambridge, MA: Ingenta, 2010) available from http://micro189.lib3.hawaii.edu/ezproxy/details.php?dbId=38215 (accessed November 2010). 22 N. Ashton, P. Kelly, and J.M. 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