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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

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
  • The top number in blood pressure readings
  • Measures the pressure in arteries when heart is beating
  • The bottom number in blood pressure readings
  • Measures pressure when heart is at rest



(bottom number)


(top number)



Less than 120

Less than 80




High Blood Pressure

Stage 1



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

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)


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

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


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
    • 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
  • 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

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
  • 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
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.