Blood Pressure Basics
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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

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Blood pressure basics

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

What is blood pressure?

  • Measures force of blood in the arteries

  • High blood pressure (HBP) = hypertension (HTN)


How is bp measured

How is BP measured?

  • Blood pressure cuff

  • mm mercury

  • 2 numbers shown as a fraction

    • Systolic/Diastolic

    • Ex. 120/80


Systolic

Systolic

  • The top number in blood pressure readings

  • Measures the pressure in arteries when heart is beating


Diastolic

Diastolic

  • The bottom number in blood pressure readings

  • Measures pressure when heart is at rest


Values

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


Who is at risk for hbp

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

    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 factors1

    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

    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

    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

    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

    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

    Treatments for HBP

    • Diet

    • Lifestyle change

    • Medication


    Treating hbp with dash diet

    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


    Goals of the dash diet

    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

    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


    Dash menu example 2 300 mg sodium1

    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)


    Potassium

    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

    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

    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

    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

    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

    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

    Other Common Medications

    • Calcium channel blockers

    • Angiotensin II Receptor Blockers

    • Combination Drugs


    Questions to ask your doctor

    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

    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

    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

    Stress Reduction

    • Can reduce blood pressure

    • Not replacement for medication

    • Examples

      • Yoga

      • Meditation

      • Whatever relaxes YOU!


    Treating hbp

    Treating HBP

    • Many methods

      • Lifestyle changes

      • Diet changes – DASH

      • Medication

    • Combination approach very popular and necessary

      • Best results for many


    Blood pressure

    Blood Pressure

    • High blood pressure is preventable.

    • High blood pressure is silent.

    • High blood pressure is also treatable.


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