Document Type : Original Article



BACKGROUND: Health‑promoting behaviors can affect the psychological and physical consequences 
of hypertension. For the prevention and control of hypertension, lifestyle modification has been 
recommended. This study aimed to investigate the health‑promoting behaviors of patients with 
hypertensive heart disease in Iran and compare them with those of healthy people.
MATERIALS AND METHODS: This was a descriptive comparative study with cross‑sectional 
design. Participants were 141 patients with hypertensive heart disease (mean age = 39 ± 10.2 years) 
referred to the cardiac clinic of Madani Hospital in Khorramabad, Iran, and 141 healthy people 
selected from those referred to the hospital. The Persian version of the revised Health‑Promoting 
Lifestyle Profile‑II (HPLP‑II) was used to evaluate the health‑promoting behaviors of participants. 
After collecting data, they were analyzed in SPSS v. 22 software using descriptive statistics and 
statistical tests including independent t‑test and one‑way ANOVA.
RESULTS: The overall HPLP‑II score was 142.34 ± 30.48 in patients and 150.52 ± 37.07 in 
controls. The highest and lowest HPLP‑II dimension scores in both groups were related to health 
responsibility and stress management dimensions. There was a significant difference between 
groups only in dimensions of nutrition (P = 0.017) and physical activity (P = 0.016), and in the overall 
score (P = 0.044), whose scores were lower in patients compared to controls. The difference in 
HPLP‑II score of patients with different demographic characteristics (marital status, place of residence, 
gender, age, educational level, and occupation) was not statistically significant.
CONCLUSION: Patients with heart disease caused by high blood pressure in Iran have poorer diet 
and physical activity compared to healthy people. Educational interventions with a focus on the 
importance of dietary regime and exercise are recommended for them.


1. World Health Organization. Global Health Risks: Mortality and 
Burden of Disease Attributable to Selected Major Risks. Geneva: 
World Health Organization; 2009.
2. Fryar CD, Ostchega Y, Hales CM, Zhang G, Kruszon‑Moran D. 
Hypertension prevalence and control among adults: United 
States, 2015‑2016. NCHS Data Brief 2017;289:1‑8.
3. Oori MJ, Mohammadi F, Norozi K, Fallahi‑Khoshknab M, 
Ebadi A, GheshlaghRG. Prevalence of HTN in Iran: Meta‑analysis 
of published studies in 2004‑2018. Curr Hypertens Rev 
4. Williams B, Poulter NR, Brown MJ, Davis M, Mclnnes, GT, Potter, 
JF, et al. British Hypertension Society guidelines for hypertension 
management 2004 (BHS-IV): summary. BMJ. 2004;328(7440):634640. 
5. Wiseman M, Cannon G, Butrum R. Policy and Action for Cancer 
Prevention. Food, Nutrition, and Physical Activity: A Global 
Perspective. Washington, DC: World Cancer Research Fund/
American Institute for Cancer Research; 2009.
6. Zanchetti A, Thomopoulos C, Parati G. Randomized controlled 
trials of blood pressure lowering in hypertension: A critical 
reappraisal. Circ Res 2015;116:1058‑73.
7. Mo Phoenix KH, Winnie WS. The influence of health promoting 
practices on the quality of life of community adults in Hong Kong. 
Soc Indic Res 2010;95:503‑17.
8. Musavian AS, Pasha A, Rahebi SM, Atrkar Roushan Z, 
Ghanbari A. Health promoting behaviors among adolescents: 
A cross‑sectional study. Nurs Midwifery Stud 2014;3:e14560.
9. Jalili Bahabadi F, Estebsari F, Rohani C, Rahimi Khalifeh Kandi Z, 
Sefidkar R, Mostafaei D. Predictors of health‑promoting lifestyle 
in pregnant women based on pender’s health promotion model. 
Int J Womens Health 2020;12:71‑7.
10. Ghezelbash S, Ghorbani A. Lifestyle modification and 
hypertension prevention. ARYA Atherosclerosis J 2012;8:S202‑7.
11. Walker S, Hill-Polerecky DM. Psychometric Evaluation of Health 
Promoting Lifestyle Profile II. Unpublished Manuscript, Lincoln: 
University of Nebraska Medical Center, College of Nursing; 1997. 
Available from:
20. [Last accessed on 2020 Jan 10].
12. Rathnayake N, Alwis G, Lenora J, and Lekamwasam, S. 
Applicability of health promoting lifestyle profile-II for 
postmenopausal women in Sri Lanka; a validation study. Health 
Qual Life Outcomes.2020; 18 (122):1-6.
13. Karimi N, Saadat‑Gharin S, Tol A, Sadeghi R, Yaseri M, 
Mohebbi B. A problem‑based learning health literacy intervention 
program on improving health‑promoting behaviors among girl 
students. J Educ Health Promot 2019;8:251.
14. Ayodapoa AO, Olukokun TA. Lifestyle counselling and 
behavioural change: Role among adult hypertensives in a rural 
tertiary institution. S Afr Fam Pract 2019;61:91‑6.
15. Buda ES, Hanfore LK, Fite RO, Buda AS. Lifestyle modification 
practice and associated factors among diagnosed hypertensive 
patients in selected hospitals, South Ethiopia. Clin Hypertens 
16. Cao W, Hou G, Guo C. Guo Y, Zheng J. Health-promoting 
behaviors and quality of life in older adults with hypertension as 
compared to a community control group. J Hum Hypertens.2018; 
32 (8-9): 540–547.
17. Kemppainen J, Bomar PJ, Kikuchi K, Kanematsu Y, Ambo H, 
Noguchi K. Health promotion behaviors of residents with 
hypertension in Iwate, Japan and North Carolina, USA. Jpn J Nurs Sci 2011;8:20‑32.
18. Mansoorian M, Qorbani M, Shafieyan N, Asayesh H, Shafieyan Z, 
Maghsodloo D. Association between life style and hypertension 
in rural population of Gorgan. J Health Prom Manag 2012;1:23‑8.
19. Fatourehchi S, Sotoodeasl N. Comparison of lifestyle between 
hypertension patients and healthy people. Ebnesina J Med 
20. Samiei Siboni F, Alimoradi Z, Atashi V. Health‑promoting 
lifestyle: A considerable contributing factor to quality of life in 
patients with hypertension. Am J Lifestyle Med 2021;15:191‑9.
21. Mohammadi Zeidi I, Pakpour Hajiagha A, Mohammadi Zeidi B. 
Reliability and validity of Persian version of the health‑promoting 
lifestyle profile. J Mazandaran Univ Med Sci 2012;21:102‑13.
22. Saber Moghaddam M, Rajabzade R, Nasiri D. Relationship 
of lifestyle and hypertension in administrative employees 
in Bojnourd rural areas. North Khorasan Univ Med Sci 
23. Hosseini F, Farshidi H, Aghamolaei T, Madani A, 
Ghanbarnejad A. The impact of an educational intervention 
based on PRECEDE‑PROCEED model on lifestyle changes 
among hypertension patients. Iran J Health Educ Health Promot