Blood Pressure Basics

1. 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

2. What is blood pressure? • Measures force of blood in the arteries • High blood pressure (HBP) = hypertension (HTN)

3. How is BP measured? • Blood pressure cuff • mm mercury • 2 numbers shown as a fraction • Systolic/Diastolic • Ex. 120/80

4. Systolic • The top number in blood pressure readings • Measures the pressure in arteries when heart is beating

5. Diastolic • The bottom number in blood pressure readings • Measures pressure when heart is at rest

6. Category Diastolic (bottom number) Systolic (top number) Values Normal Less than 120 Less than 80 Pre-hypertensive 120-139 80-89 High Blood Pressure Stage 1 140-159 90-99 Stage 2 160 and higher 100 and higher

7. 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.

8. 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.

9. 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.

10. 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!

11. 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

12. 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

13. 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

14. Treatments for HBP • Diet • Lifestyle change • Medication

15. 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

17. 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

18. Breakfast 1/2 cup instant oatmeal 1 mini whole wheat bagel 1 Tbsp peanut butter 1 medium banana 1 cup low-fat milk DASH menu example (2,300 mg sodium) 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

19. Dinner 1 cup spaghetti 3/4 cup vegetarian spaghetti sauce 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 Snacks 1/3 cup almonds, unsalted 1/4 cup dried apricots 1 cup fruit yogurt, fat-free, no sugar added DASH menu example (2,300 mg sodium)

20. 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

21. 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

22. 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

23. 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

24. 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

25. 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

26. Other Common Medications • Calcium channel blockers • Angiotensin II Receptor Blockers • Combination Drugs

27. 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?

28. 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

29. 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

30. Stress Reduction • Can reduce blood pressure • Not replacement for medication • Examples • Yoga • Meditation • Whatever relaxes YOU!

31. Treating HBP • Many methods • Lifestyle changes • Diet changes – DASH • Medication • Combination approach very popular and necessary • Best results for many

32. Blood Pressure • High blood pressure is preventable. • High blood pressure is silent. • High blood pressure is also treatable.