blood pressure basics julie hetteman, phd wellness specialist martha lowry, ms wellness coordinator...
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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
What is blood pressure?Measures force of blood in the arteries
High blood pressure (HBP) = hypertension (HTN)
How is BP measured?
Blood pressure cuffmm mercury2 numbers shown as a fraction
Systolic/DiastolicEx. 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
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
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.
Risk FactorsFactors 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 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.
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.
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!
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
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
Prevention of High Blood PressureMaintain a healthy weight Be physically active most days of the
weekEat healthfullyQuit smokingLimit alcoholReduce stress
Treatments for HBPDietLifestyle changeMedication
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
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 - 8
Fruits 4 - 6 4 - 5
Vegetables 4 - 6 4 - 5
Low fat or non fat dairy foods 2 - 4 2 - 3
Lean meats, fish, poultry 1.5 - 2.5 2 or less
Nuts, seeds, and legumes3 - 6 per week
4 - 5 per week
Fats and sweets 2 - 4 limited
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
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
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
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
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
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
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-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
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
Other Common MedicationsCalcium channel
blockersAngiotensin II
Receptor Blockers
Combination Drugs
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?
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
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
Stress ReductionCan reduce blood pressureNot replacement for
medication Examples
Yoga Meditation Whatever relaxes
YOU!
Treating HBPMany 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.