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Blood Pressure Basics Julie Hetteman, PhD Wellness Specialist Martha Lowry, MS Wellness Coordinator Cindy Modlin-Adams, RN, MSN, ANP, BC Coordinator, Nursing Center for Family Health What is blood pressure? Measures force of blood in the arteries High blood pressure (HBP) = hypertension (HTN) How is BP measured? Blood pressure cuff mm mercury 2 numbers shown as a fraction Systolic/Diastolic Ex. 120/80 Systolic The top number in blood pressure readings Measures the pressure in arteries when heart is beating Diastolic The bottom number in blood pressure readings Measures pressure when heart is at rest Values Systolic Category Normal Pre-hypertensive (top number) Less than 120 120-139 Diastolic (bottom number) Less than 80 80-89 High Blood Pressure Stage 1 Stage 2 140-159 160 and higher 90-99 100 and higher Who is at risk for HBP? Individuals With Family History Parents, brother, sister Increasing age Gender Women - after menopause Early middle age more common in men Race More common among blacks (Occurs earlier) These factors are beyond our control. Risk Factors Factors Within our Control Excess weight Increases volume of blood Increases pressure/resistance that heart has to pump against--enlarged heart muscle Inactivity Heart is not used to “work” = heart beats harder/faster = more force on arteries = uses more oxygen per beat = higher heart rate at rest Tobacco use Can lead to damage of artery wall, increases heart rate, encourages narrowing of arteries Stress Causes unpredictable blood pressure and pulse increases along with potential inflammation in the vessel walls. Risk Factors More Factors Within Our Control Sodium intake Leads to more fluid/water in the vessels = increased blood pressure Low potassium intake Potassium helps balance sodium in cells and control heart rhythm Excessive alcohol Long term: damages liver and pressure within our circulation and heart. How do I know if I have it? Very few people experience symptoms. This is a silent disease. Damage is done before symptoms develop. Some symptoms may be: Headaches Dizzy spells More nosebleeds than normal This is why we screen for HBP! Primary vs. Secondary Hypertension Most cases are called “primary” No identifiable cause Family history likely ~5-10% are secondary Caused by underlying conditions: Kidney abnormalities Tumor of adrenal gland Congenital heart failure defects What effect does it have on the body? Uncontrolled high blood pressure can damage vital organs Heart: heart attack and heart failure Brain: stroke and “mini strokes”/transient ischemic attacks Kidneys: slow loss of function Eyes: small vessel damage—blindness Arteries: narrowing in legs and bulging in aorta: aneurysm Prevention of High Blood Pressure Maintain a healthy weight Be physically active most days of the week Eat healthfully Quit smoking Limit alcohol Reduce stress Treatments for HBP Diet Lifestyle change Medication Treating HBP with DASH diet Developed by the National Heart, Lung & Blood Institute Eating plan that is… Low in saturated fat Low in cholesterol Low in total fat Emphasizes Fruits Vegetables Low fat and fat free milk Potassium, calcium and magnesium Type of food Number of servings for 1600 - 3100 Calorie diets Servings on a 2000 Calorie diet 6 - 12 7-8 Fruits 4-6 4-5 Vegetables 4-6 4-5 Low fat or non fat dairy foods 2-4 2-3 1.5 - 2.5 2 or less 3 - 6 per week 4 - 5 per week 2-4 limited Grains and grain products (include at least 3 whole grain foods each day) Lean meats, fish, poultry Nuts, seeds, and legumes Fats and sweets Goals of the DASH diet Total fat 27% of calories Sodium 2,300 mg Saturated fat 6% of calories Potassium 4,700 mg Protein 18% of calories Calcium 1,250 mg Carbohydrate 55% of calories Magnesium 500 mg Cholesterol 150 mg Fiber 30 g DASH menu example (2,300 mg sodium) Breakfast 1/2 cup instant oatmeal 1 mini whole wheat bagel 1 Tbsp peanut butter 1 medium banana 1 cup low-fat milk Lunch chicken breast sandwich 3 oz chicken breast, skinless 2 slices whole wheat bread 1 slice (3/4 oz) natural cheddar cheese, reduced fat 1 large leaf romaine lettuce 2 slices tomato 1 Tbsp mayonnaise, low-fat 1 cup cantaloupe chunks 1 cup apple juice DASH menu example (2,300 mg sodium) Dinner Snacks 1 cup spaghetti 3/4 cup vegetarian spaghetti sauce 1/3 cup almonds, unsalted 1/4 cup dried apricots 3 Tbsp Parmesan cheese spinach salad 1 cup fresh spinach leaves 1/4 cup fresh carrots, grated 1/4 cup fresh mushrooms, sliced 1 Tbsp vinaigrette dressing 1/2 cup corn, cooked from frozen 1/2 cup canned pears, juice pack 1 cup fruit yogurt, fat-free, no sugar added Potassium Potassium Works with sodium to regulate water balance and heart to beat regularly Potassium rich foods are suggested over supplements for HBP Orange juice, Prune juice Cottage cheese, Milk Avocado, Raisins Careful if taking certain medicines Potassium supplements, water pills, ACE inhibitors Calcium Low calcium intake ↑ risk of hypertension Suggested intake: 1,000 mg for adults 1,200 mg for adults over 50 Milk 1% (1 cup) 290 mg Sardines (3 oz) 325 mg Broccoli (1 cup raw) 43 mg Spinach (1 cup boiled) 245 mg Fortified orange juice (1 cup) avg. 351mg Medications Most Americans will be on more than two medicines to get blood pressure to normal values. Three main types are: Diuretics Beta-Blockers Ace inhibitors All work in different ways so more than one is commonly used to treat HBP Diuretics Also known as “Water pills” Reduce blood volume Cause kidney’s to release more sodium and water in urine Shown to be the key in preventing heart failure caused by HBP Dyazide and Lasix Beta-Blockers Blocks effect of hormone norepinephrine on beta receptor sites in body. Heart beats slower and with less force, but more efficiently per beat therefore: Reduces work load on heart Work better when combined with diuretics Especially in African Americans Examples Toprol XL, Tenormin & Inderal Angiotensin-converting enzyme (ACE) Inhibitors Relax blood vessels Blocks formation of natural chemical that narrows blood vessels Also blocks production of aldosterone Retention of sodium and water Examples Altace & Vasotec Other Common Medications Calcium channel blockers Angiotensin II Receptor Blockers Combination Drugs Questions to ask your doctor Do I already have any damage to my organs from HBP? How do you find out? What’s the name of my drug? What are the side effects? Can I stop it? How do I know the medicine is working? How often should I check my blood pressure? Who do I call if I have questions? Lifestyle Changes Weight loss Increase physical activity Reduce stress Limit alcohol Even healthy people can have blood pressure increases with alcohol use Quit smoking Injures artery wall Speeds up hardening of arteries Reduce sodium Read the label Banish the shaker! Prepare food with less salt Weight Reduction & Physical Activity ↑ Physical activity can result in weight loss Take small steps at first Take stairs Park farther away Walk the dog one extra time Just keep moving Stress Reduction Can reduce blood pressure Not replacement for medication Examples Yoga Meditation Whatever relaxes YOU! Treating HBP Many methods Lifestyle changes Diet changes – DASH Medication Combination approach very popular and necessary Best results for many Blood Pressure High blood pressure is preventable. High blood pressure is silent. High blood pressure is also treatable.
