1. Keeping your blood pressure in check! May 21, 2008 Presented by: Kimberly Reid

2. What is blood pressure?  Blood pressure is the force exerted by the circulating blood on the walls of the arteries.  When the pressure cuff is used, the height of mercury in a column is measured which reflects the circulating pressure and therefore is read in units of mmHg. However, mercury is rarely used anymore.

3. Measuring your blood pressure  Blood pressure can change throughout the day and therefore you should measure at the same time.  If monitoring at home, a good time is right after you wake up, before you do anything else and your body is still at rest.

4. Reading your blood pressure  Blood pressure is read as 2 numbers, systolic and diastolic pressure.  Systolic is the top number and is the maximum pressure, which is when the heart contracts and pumps blood into the arteries.  Diastolic is the bottom number and is the minimum pressure, which is when the heart is relaxed between beats.  Heart rate is the rate at which the blood is pumped by the heart.

5. Reading your blood pressure  Optimal values = less than 120/80 mmHg  Pre-hypertensive = 120/80 – 139/89 mmHg  Elevated (high) = greater than 140/90 mmHg

6. Hypertension  Hypertension is a diagnosis of continually elevated blood pressure.  180/110 mmHg = hypertension  160/100 – 179/109 = test again within 4 weeks, if still high, hypertension  140/90 – 159/99 = test again within 2 months, if still high, hypertension  120/80 – 139/89 = prehypertension, test again in 4- 6 months

7. Hypertension  If you have to return to recheck your blood pressure, it is recommended to test at home a few times in between visits to track the trends.  Sometimes people’s blood pressure is elevated just from being in their physician’s office, and therefore may be lower at home.

8. High blood pressure  High blood pressure can be dangerous because the heart is working harder than it should be.  Increased force of the blood can damage the arteries, heart, kidneys, brain, and eyes.  If left uncontrolled, high blood pressure can lead to heart disease, kidney disease, stroke, or blindness.

9. High blood pressure  Blood pressure increases with age and obesity, therefore as we become an older and heavier society, there will be more people with high blood pressure.  Blood pressure increases with high blood glucose. People with Diabetes or those with high levels of sugar in their blood have thicker blood and therefore applies more pressure to the arteries.

10. High blood pressure  Blood pressure increases with dietary salt intake.  High levels of sodium (salt) disturbs the balance in the body and causes water to flow into the blood stream, increasing the blood volume and therefore the blood pressure.  Can also be caused by excessive alcohol consumption and sleep apnea.

11. Low blood pressure  Can be caused from gravity (when you go from sitting to standing). The gravity reduces the blood flow from the veins below the heart back up to the heart. There is then less blood to be pumped out in each contraction and therefore lowering blood pressure.  Can also be caused by infections, hemorrhage (blood loss), toxins, or hormonal abnormalities.

12. Non-pharmacological recommendations  Weight loss Maintaining a healthy weight can reduce blood pressure as well as the need for medications. A loss of 10kg or 22lbs can reduce systolic pressure by 6mmHg and diastolic by 4.6mmHg

13. Non-pharmacological recommendations  Sodium restriction Restrict to the upper limit of 2300mg/day (1 tsp salt) Even better is the adequate intake level of 1500mg/day, which has been shown to further reduce blood pressure. Average sodium intake in the US is 4200mg for men and 3300mg for women. (limited Canadian statistics) Lowers systolic pressure by 5–10mmHg and diastolic pressure by 2–6 mmHg Most significant in the elderly

14. Non-pharmacological recommendations  Moderate alcohol consumption Limit intake to no more than 2 standard drinks/day with a maximum of 9 drinks/week for women and 14 drinks/week for men

15. Non-pharmacological recommendations  Moderate alcohol consumption Limit intake to no more than 2 standard drinks/day with a maximum of 9 drinks/week for women and 14 drinks/week for men Standard drink = 13.6g alcohol 12 ounces of beer 4 ounces of wine 1.5 ounces of spirits Coolers often provide more than 1 standard drink

16. Non-pharmacological recommendations  Be physically active Health Canada recommends a minimum of 60 minutes/day working up to a minimum of 30 minutes/day of moderate to vigorous activity 4 days/week. Moderate to vigorous activity includes biking, jogging, swimming, hockey, basketball, and dancing Include a variety of endurance, strength, and flexibility exercises in your regular activity.

17. Non-pharmacological recommendations  Quit smoking Your blood pressure immediately and temporarily spikes with every cigarette by about 5–10 mmHg

18. Non-pharmacological recommendations  Summary Maintaining a healthy weight, following a diet low in sodium, drinking alcohol in moderation, and being physically active can all help to reduce blood pressure but can also prevent high blood pressure.

19. Pharmacological recommendations  If diagnosed with hypertension by your family physician they may choose to prescribe an anti-hypertensive medication.

20. DASH Diet  Dietary Approaches to Stop Hypertension Lower in total fat, saturated fat and cholesterol Higher in vegetables and fruits, whole grains, and low fat dairy products Moderate in meat, fish and poultry Higher in nuts, seeds, and legumes Rich in magnesium, potassium and calcium Rich in protein and fiber Lower in sodium

21. DASH Diet  Grain products – 7-8 servings/day 1 slice whole grain bread, ½ cup oatmeal, ½ cup whole grain pasta  Vegetables – 4-5 servings/day 1 cup mixed greens salad, ½ cooked vegetables Aim for at least 1 dark green and 1 orange vegetable/day  Fruits – 5 servings/day 1 medium fruit (tennis ball size), ½ cup canned fruit, ¼ cup dried fruits

22. DASH Diet  Low fat or non-fat dairy products – 2-3 servings/day 8 ounces (1 cup) skim or 1% milk, ¾ cup low fat yogurt, 1 ½ ounces low fat cheese (<30% M.F.)  Meats, fish, and poultry – 1-2 servings/day 3 ounces lean cuts of meat with visible fats and skins removed, 3 ounces fish

23. DASH Diet  Nuts, seeds, and dry beans – 4-5 servings/ week 1/3 cup almonds, peanuts, or walnuts, 2 Tbsp. seeds, ½ cup cooked legumes (lentils, kidney beans, black beans)  Fats and oils – 3 servings/day 1 tsp. soft margarine or vegetable oil, 1 Tbsp low fat mayonnaise, 2 Tbsp low fat salad dressing

24. DASH Diet  Tips to reduce salt intake Take the salt shaker off the table Limit salt in cooking to ¼ tsp per day Choose fresh or frozen fruits and vegetables Rarely eat smoked, cured, pickled, or salted foods Do more home cooking: make your own soups, sauces, and dressings

25. DASH Diet Avoid convenience foods and fast foods restaurants Rinse canned products prior to using Read the labels! Limit products listing ingredients such as salt or sodium or items containing sodium, choose lowest %DV on nutrition facts table when comparing “No salt” – Doesn’t contain sodium but contains potassium (check with your doctor before using)