High Blood Pressure (aka Hypertension) Suggested Handout Ways You can Prevent or Lower High Blood Pressure Script: Many people in the United States have high blood pressure. Unfortunately this disease can do a lot of damage before anyone realizes it because few people have any symptoms. Today we will talk about what high blood pressure is and how we can control it.

Blood pressure is determined by the strength of the heart contraction when it beats, heart valve function, and blood vessel wall tension. Let’s start off by talking about what our hearts do. I want you to think of what a heart looks like. Do you have a good picture in your mind? The heart does not look very much like the shapes people draw on Valentine’s Day. And it certainly isn’t flat, like a paper valentine! A real, live heart is shaped something like an ice-cream cone, with a pointed bottom and a rounded top, like two scoops of ice cream. It is hollow and can fill up with blood. 2

The body has mechanisms to alter or maintain blood pressure by specialized nerve cells called baroreceptors.

120/80 Blood Pressure Top number (systolic) Bottom number (diastolic) -measures the force of blood on arteries when the heart beats 120/80 Bottom number (diastolic) - measures force of blood on arteries between beats Blood pressure is the force of blood against the walls of the arteries. Blood pressure is typically recorded as two numbers - the systolic (as the heart beats) over the diastolic (as the heart relaxes between beats) The diastolic number (bottom number) is most important for young people. As people get older, the diastolic lowers and the systolic becomes more important. People older than 55 often have normal diastolic and elevated systolic. This is a better predictor of the risks of high blood pressure.

Systolic blood pressure for healthy adults falls between 90 & 120mm of mercury. Normal diastolic blood pressure falls between 60 & 80mm of mercury.

3 Ways to Measure Blood Pressure Aneroid Monitor Blood pressure can be measured using different methods. Today, I am going to discuss three of these methods with you. The first way you could measure your blood pressure is to use an aneriod monitor. Most of us have probably had our blood pressured measured this way in the past. An aneroid monitor has a dial gauge that is read by looking at a pointer. The cuff is hand inflated by squeezing a rubber bulb, and heart sounds are heard through a stethoscope. Nowadays, we use digital monitors to read blood pressure. A digital monitor is easy to use, and it provides your results on a small screen. These types of monitors range in price from about $30 to over $100. Another blood pressure monitor on the market is the finger or wrist blood pressure monitor. These devices do not measure blood pressure very accurately. They are also extremely sensitive to position and body temperature and are also very expensive. Finger/Wrist Monitor Digital Monitor http://familydoctor.org/online/famdocen/home/common/heartdisease/treatment/128.html 6

What Is High Blood Pressure? Blood pressure that stays elevated > 140/90 > 130/80 if you already have: diabetes mild kidney disease heart disease Blood pressure rises and falls during the day. When it stays high over time, it is called high blood pressure. A consistent blood pressure of 140/90 or higher is considered high blood pressure. If you have diabetes, heart disease, or have had a stroke, your blood pressure is considered high if it’s over 130/80.

Effects of High Blood Pressure on Your Body Artery Damage Uncontrolled high blood pressure causes damage to the blood vessels -- hardening of the arteries, build up of plaque, and narrowing of the arteries.

Effects of High Blood Pressure on Your Body Hardening of the arteries Stroke Heart attack Kidney damage Blindness -High blood pressure is associated with hardening of the arteries. This causes the heart and kidneys to work harder -A blocked or ruptured blood vessel to your brain can lead to a stroke. -High blood pressure increases the risk of heart attacks and congestive heart failure. Thickening of the heart walls makes it difficult to pump enough blood. This causes fluid to build up in your lungs or in your legs and feet -Weakened or narrowed arteries in the kidneys cause the kidneys to not work as well to remove waste products from the blood. -Thickened, narrowed, or torn blood vessels in the eyes can cause vision loss

Signs and Symptoms Called the “silent killer” because most people have no signs or symptoms Headaches, nosebleeds, and dizziness don’t occur until blood pressure is dangerously high Many people do not view high blood pressure as life-threatening because it has few, if any symptoms. That’s why it’s called the “silent killer”. There are usually no signs or symptoms of high blood pressure until it gets dangerously high. Therefore, it’s important to check it yourself or get it checked regularly.

Causes of High Blood Pressure Often-times unknown Narrowing of the arteries Fast heart rate Kidney disease Medications Thyroid disease The causes of high blood pressure vary, although usually the cause is unknown. Narrowing of the arteries, rapid heart rate, kidney disease, some medications, and thyroid disease can cause high blood pressure. Any of these conditions can cause increased pressure against the artery walls.

Who Gets High Blood Pressure? People who: are older are overweight have families members with high blood pressure High blood pressure is common. It is very common in African Americans, who many get it earlier in life and more often than whites.African Americans are also more likely to die of a heart attack or stroke related to high blood pressure. Your risk of high blood pressure increases as you get older. Your risk also increases if you are overweight or have a family history of high blood pressure.

How Do You Know If You Have High Blood Pressure? Have your blood pressure checked at least every two years Blood pressure varies during the day At least 3 readings on different days are needed to diagnose high blood pressure If your blood pressure is usually normal, you should have it checked at least every two years. If it’s high, your doctor will want it checked more often. Since blood pressure varies during the day and some people have higher readings when they’re at the doctor’s office (called white coat syndrome), it’s important to take at least three readings on different days at the same time of the day to diagnose high blood pressure.

Controlling Your Blood Pressure Lifestyle Changes Healthy eating plan Limit sodium Achieve a healthy weight Exercise/physical activity even without weight loss Although high blood pressure cannot be cured, it can be controlled. Adopting healthy lifestyle habits is an effective first step in both preventing and controlling high blood pressure.

Controlling Your Blood Pressure Lifestyle Changes Don’t smoke Limit alcohol Manage stress * These are good to follow IN GENERAL! If lifestyle changes alone are not effective, it may be necessary to add blood pressure medications.

Follow a Healthy Eating Plan Eat more fruits, vegetables, low-fat dairy foods Include whole grains, poultry, fish and nuts Eat less fat, red meat, sweets and sugared beverages Drink a lot of water Research has shown that following a healthy eating plan can both prevent and lower high blood pressure. The DASH study (Dietary Approaches to Stop Hypertension) showed that a diet emphasizing whole grains, fruits, vegetables, and low-fat dairy products lowered high blood pressure. The diet was also low in red meat, fat, and sweets.

Limit Sodium and Salt Research shows that eating less sodium and salt lowers blood pressure Lower your sodium intake by: Eating out less often Buying fresh, frozen or unsalted canned foods Choosing foods with less than 400 mg/serving Buying low- or reduced-sodium, or no salt added foods Using less salt when cooking Be aware of processed foods! Another study called DASH-Sodium, showed that reducing sodium intake also lowered blood pressure. The most effect was seen by people who consumed the least amount of sodium, 1500 mg/day. Most Americans get too much sodium from processed foods, restaurant foods, and the salt shaker. The current recommendation is to get less than 2400 mg of sodium per day. One teaspoon of salt contains 2400 mg of sodium. You can lower your sodium intake by eating less restaurant food, more fresh foods in place of processed foods, and choosing foods in the grocery store that are low- or reduced sodium, no added salt, or have less than 400 mg sodium /serving. In addition, try to use herbs or spices in place of salt in cooking and limit salt at the table.

Get Enough Potassium Potassium helps lower blood pressure Helps balance the amount of sodium in your body (BOTH needed for proper hydration) If you don’t get enough potassium, you can accumulate too much sodium Foods high in potassium include: Fruits, vegetables, dairy, and fish Recent studies show that potassium is also important in regulating your blood pressure and that not getting enough potassium can increase your risk of high blood pressure. Try to include foods high in potassium each day like fruits, vegetables, dairy foods and fish.

Lose Weight if Overweight Heavier people need more blood to supply nutrients to the body Losing even 10 pounds can lower blood pressure Check with your doctor to see if this is necessary Being overweight increases your risk of developing high blood pressure and heart disease. Blood pressure rises as body weight increases. When you carry more body weight, you need more blood to supply nutrients to the various parts of your body. The volume of blood increases and causes extra force on your artery walls. Losing even 10 pounds can lower your blood pressure.

Be Physically Active Inactivity increases your risk of being overweight Heart muscles have to work harder with each contraction, increasing the force on the arteries Walking 30 continuous minutes a day helps lower blood pressure Strive for 10,000 steps/day (~5 miles) Being physically active is one of the most important steps you can take to prevent or control high blood pressure. It doesn’t take a lot of effort to become physically active. Walking for a total of 30-40 minutes each day can help lower your blood pressure, even if you don’t lose weight. You can spread out your walking if it’s too hard to do all at once. Try walking 10-15 minutes several times a day.

Stop Smoking Smoking damages blood vessel walls and causes early hardening of the arteries (remember the noodle analogy?) Nicotine narrows your blood vessels and forces your heart to work harder Smoking also increases the risk for high blood pressure. Once you quit smoking, your risk of having a heart attack is reduced after the first year.

Limit Alcohol Heavy drinking (3 or more drinks/day) can damage your heart muscle Cutting back to a moderate level of drinking can lower your blood pressure no more than 2 drinks a day for men no more than 1 drink a day for women People who regularly drink more than 3 drinks a day are much more likely to have high blood pressure. One drink is considered 12 ounces of beer, 5 ounces of wine, or 1 ounce of distilled liquor like whiskey. If you decrease your alcohol intake from heavy to moderate, you can lower systolic BP by 5 points and diastolic by 3.

Manage Stress High levels of stress can temporarily cause a dramatic increase in blood pressure Develop relaxation techniques to deal with stress The effects of stress are usually only temporary on your blood pressure. But if you have stress regularly, it can produce increases in blood pressure that can damage your arteries, heart, brain, kidneys and eyes. You can better cope with stress by making changes in your normal routine and by developing relaxation techniques (deep breathing exercises, muscle relaxation exercises, meditation, tai chi and yoga)

Blood Pressure Medications If lifestyle changes haven’t worked, a doctor may prescribe medication Blood Pressure Rx diuretics beta-blockers ACE-inhibitors calcium channel blockers If your blood pressure is still high after making lifestyle changes, your doctor may decide to start you on blood pressure medication. There are many different types of medication that work in different ways. You may require more than one type to control your blood pressure. Diuretics help your kidneys get rid of excess sodium and water, reducing blood volume (often the first and most effective medication you’ll be given) Beta-blockers cause your heart to beat more slowly and less forcefully so there is less pressure on the heart and arteries. ACE-inhibitors help blood vessels relax Calcium channel blockers - help relax muscles of blood vessels

Points to Remember Lifestyle changes that can prevent and control high blood pressure include: Healthy eating - emphasizing fruits, vegetables and low-fat dairy foods Choosing and preparing foods with less salt and sodium (sodium is a preservative) Losing weight IF overweight Increasing physical activity Drinking in moderation if you drink alcoholic beverages Remember that making changes in your lifestyle can prevent and control high blood pressure.

Tips for Accurate Use Same time of day Use the same arm Don’t measure Dominant Don’t measure immediately upon waking up, or immediately after exercising. Wait an hour. Take your blood pressure at consistent times, such as in the morning and in the evening. Use the same arm whenever you take your blood pressure. Note -- many digital monitors are meant for use only on the left arm. Don’t measure your blood pressure immediately after you wake in the morning. Wait an hour or so. If you exercise after waking, take your blood pressure before exercising. 26

Let’s try it! Use your dominant arm Make sure arm is in resting position (relaxed) Cuff is around bicep with tube on top Cuff is tight enough to fit one finger in between cuff and bicep Press the ON/OFF button Press START Stay relaxed!!

What Does Your Blood Pressure Reading Mean? Normal Less than 120 Less than 80 Pre-hypertension 120-139 80-89 High Blood Pressure – Stage 1 140-159 90 – 99 High Blood Pressure – Stage 2 160 or higher 100 or higher Normal blood pressure is 120/80 or lower. High blood pressure is 140/90 or higher. If your blood pressure is between 120/80 and 140/90, you have something called “pre-hypertension” (you are in the beginning stages and at risk of high blood pressure). Only your doctor can tell you whether you have high blood pressure. Most doctors will check your blood pressure several times on different days before deciding that you have high blood pressure. If you have high blood pressure or pre-hypertension, you need to check your blood pressure regularly and keep in touch with your family doctor. As you can see – there are 2 stages of hypertension or high blood pressure. If you have diabetes or chronic kidney disease – there is an exception to these numbers. You are considered to have high blood pressure when your blood pressure reads 130/80. http://familydoctor.org/online/famdocen/home/common/heartdisease/treatment/128.html http://www.nhlbi.nih.gov/health/dci/Diseases/Hbp/HBP_WhatIs.html 28