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.