blood pressure basics
TRANSCRIPT
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Blood Pressure BasicsJulie Hetteman, PhD
Wellness Specialist
Martha Lowry, MSWellness Coordinator
Cindy Modlin-Adams, RN, MSN, ANP, BCCoordinator, Nursing Center for Family Health
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What is blood pressure?Measures force of blood in the arteries
High blood pressure (HBP) = hypertension (HTN)
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How is BP measured?Blood pressure cuffmm mercury2 numbers shown as a fraction
Systolic/DiastolicEx. 120/80
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Systolic The top number in blood pressure
readingsMeasures the pressure in arteries
when heart is beating
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DiastolicThe bottom number in blood pressure
readingsMeasures pressure when heart is at
rest
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ValuesCategory
Systolic
(top number)
Diastolic
(bottom number)
Normal Less than 80 Less than 120
Pre-hypertensive
High Blood Pressure
80-89
Stage 1
Stage 2 160 and higher 100 and higher
90-99 140-159
120-139
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Who is at risk for HBP?Individuals With Family History
Parents, brother, sister Increasing ageGender
Women - after menopauseEarly middle age more common in men
RaceMore common among blacks (Occurs earlier)
These factors are beyond our control.
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Risk FactorsFactors Within our Control
Excess weightIncreases volume of bloodIncreases 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 useCan 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.
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Risk FactorsMore Factors Within Our Control
Sodium intakeLeads to more fluid/water in the
vessels = increased blood pressureLow potassium intake
Potassium helps balance sodium in cells and control heart rhythm
Excessive alcoholLong term: damages liver and
pressure within our circulation and heart.
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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:
HeadachesDizzy spellsMore nosebleeds than normal
This is why we screen for HBP!
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Primary vs. Secondary HypertensionMost cases are called “primary”
No identifiable causeFamily history likely
~5-10% are secondaryCaused by underlying conditions:
Kidney abnormalitiesTumor of adrenal glandCongenital heart failure defects
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What effect does it have on the body?Uncontrolled high blood pressure can damage vital
organsHeart: heart attack and heart failureBrain: stroke and “mini strokes”/transient ischemic
attacksKidneys: slow loss of functionEyes: small vessel damage—blindnessArteries: narrowing in legs and bulging in aorta:
aneurysm
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Prevention of High Blood PressureMaintain a healthy weight Be physically active most days of the weekEat healthfullyQuit smokingLimit alcoholReduce stress
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Treatments for HBPDietLifestyle changeMedication
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Treating HBP with DASH dietDeveloped by the National Heart, Lung &
Blood InstituteEating plan that is…
Low in saturated fatLow in cholesterolLow in total fatEmphasizes
FruitsVegetablesLow fat and fat free milkPotassium, calcium and magnesium
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Type of food Number of servings for 1600 - 3100 Calorie diets
Servings on a 2000
Calorie diet
Grains and grain products (include at least 3 whole grain foods each day) 6 - 12 7 - 8Fruits 4 - 6 4 - 5Vegetables 4 - 6 4 - 5Low fat or non fat dairy foods 2 - 4 2 - 3Lean meats, fish, poultry 1.5 - 2.5 2 or less
Nuts, seeds, and legumes 3 - 6 per week4 - 5 per
weekFats and sweets 2 - 4 limited
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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
Goals of the DASH diet
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DASH menu example (2,300 mg sodium)Breakfast1/2 cup instant oatmeal
1 mini whole wheat bagel
1 Tbsp peanut butter
1 medium banana
1 cup low-fat milk
Lunchchicken breast sandwich3 oz chicken breast, skinless
2 slices whole wheat bread
1 slice (3/4 oz) natural cheddar cheese, reduced fat
1 large leaf romaine lettuce2 slices tomato
1 Tbsp mayonnaise, low-fat
1 cup cantaloupe chunks1 cup apple juice
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DASH menu example (2,300 mg sodium)Dinner1 cup spaghetti3/4 cup vegetarian spaghetti sauce
3 Tbsp Parmesan cheese
spinach salad1 cup fresh spinach leaves1/4 cup fresh carrots, grated1/4 cup fresh mushrooms, sliced
1 Tbsp vinaigrette dressing
1/2 cup corn, cooked from frozen
1/2 cup canned pears, juice pack
Snacks1/3 cup almonds, unsalted
1/4 cup dried apricots
1 cup fruit yogurt, fat-free,no sugar added
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PotassiumPotassium
Works with sodium to regulate water balance and heart to beat regularly
Potassium rich foods are suggested over supplements for HBPOrange juice, Prune juiceCottage cheese, MilkAvocado, Raisins
Careful if taking certain medicines Potassium supplements, water pills, ACE
inhibitors
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CalciumLow calcium intake ↑ risk of hypertensionSuggested intake:
1,000 mg for adults1,200 mg for adults over 50
Milk 1% (1 cup) 290 mgSardines (3 oz) 325 mgBroccoli (1 cup raw) 43 mgSpinach (1 cup boiled) 245 mgFortified orange juice (1 cup) avg. 351mg
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MedicationsMost Americans will be on more than two
medicines to get blood pressure to normal values.
Three main types are:DiureticsBeta-BlockersAce inhibitors
All work in different ways so more than one is commonly used to treat HBP
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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
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Beta-BlockersBlocks 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 heartWork better when combined with
diuretics Especially in African Americans
Examples Toprol XL, Tenormin & Inderal
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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
ExamplesAltace & Vasotec
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Other Common MedicationsCalcium channel
blockersAngiotensin II
Receptor BlockersCombination Drugs
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Questions to ask your doctorDo 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?
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Lifestyle ChangesWeight lossIncrease physical activityReduce stressLimit 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
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Weight Reduction & Physical Activity↑ Physical activity can result in
weight lossTake small steps at first
Take stairs Park farther away Walk the dog one extra
time Just keep moving
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Stress ReductionCan reduce blood pressureNot replacement for
medication Examples
Yoga Meditation Whatever relaxes
YOU!
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Treating HBPMany methods
Lifestyle changes Diet changes – DASH Medication
Combination approach very popular and necessary Best results for many
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Blood PressureHigh blood pressure is preventable.
High blood pressure is silent.
High blood pressure is also treatable.