Blood Pressure Basics

by DeLois Weekes, RN PhD

High blood pressure is preventable. High blood pressure is silent. High blood

pressure is also treatable.

What is blood pressure?

  • Measures force of blood in the arteries                                                                                     
  • High blood pressure (HBP) = hypertension (HTN)                            

How is Blood Pressure Measured?

Blood pressure cuff measures BP in mm mercury. Two numbers are shown as a fraction:

Systolic/Diastolic Ex. 120/80. The Systolic is the top number in blood pressure readings and measures the pressure in arteries when heart is beating. The Diastolic is the bottom number in blood pressure readings and measures pressure when heart is at rest.

Who is at Risk?

Factors beyond our control:

  • Individuals with Family History: Parents, brother, sister 
  • Increasing age
  • Gender:
  • Women - after menopause
  • Early middle age more common in men
  • Race:  High Blood Pressure mcore common among blacks (Occurs earlier)

Factors Within our Control:

  • Excess weight which increases volume of blood and increases pressure/resistance that heart must pump against---enlarged heart muscle
  • Inactivity—heart becomes unused to “work” = heart beats harder/faster = more force on arteries = uses more oxygen per beat = higher heart rate at rest
  • Tobacco use which 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.

How do I know I have High Blood Pressure/Hypertension?

Very few people experience symptoms. This is a silent disease. The damage is done before symptoms develop. Some symptoms may be so it’s important to screen for HBP!

  • Headaches
  • Dizzy spells
  • More nosebleeds than normal

Primary vs. Secondary Hypertension

Most cases are called “primary”—have no identifiable cause. Family history likely ~5-10% are secondary.

Secondary HBP is likely caused by underlying conditions such as Kidney abnormalities, Tumor of adrenal gland, and Congenital heart failure defects.

What Effect does Hypertension have on the Body?

  • Uncontrolled high blood pressure can damage vital organs like the:
  • 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 Hypertension by:

  • Maintaining a healthy weight
  • Being physically active most days of the week
  • Eating healthfully
  • Quitting smoking
  • Limiting/not using alcohol
  • Reducing stress

Treatments for Hypertension

  • Diet
  • Lifestyle change
  • Medication
  • Treating with DASH Diet which was developed by the National Heart, Lung & Blood Institute. The DASH 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
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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 by reading the label, banishing the shaker, and preparing food with less salt

Weight Reduction & Physical Activity can be accomplished by ↑ Physical activity. Take small steps at first:

  • Take stairs
  • Park farther away
  • Walk the dog one extra time
  • Just keep moving

Stress reduction can reduce blood pressure, yet may not be a replacement for medication. Work with your Health Care Provider.

Examples:

  • Yoga
  • Meditation
  • Whatever relaxes YOU!

Goals of 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

Example of a DASH Diet:

Breakfast

1/2 cup instant oatmeal

1 mini whole wheat bagel

1 Tbsp peanut butter

1 medium banana

1 cup low-fat milk

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

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

 

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

1.     Diuretics—also known as “Water pills”, reduce blood volume and cause kidneys to release more sodium and water in urine. They have been shown to be the key in preventing heart failure caused by HBP

  • Commonly used diuretics are: Dyazide and Lasix

2.     Beta-Blockers—blocks the effect of hormone norepinephrine on beta receptor sites in the 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

3.     Angiotensin-converting enzyme (ACE) Inhibitors—relax blood vessels

  • Blocks formation of natural chemical that narrows blood vessels. Also, blocks production of aldosterone and retention of sodium and water
    • Examples: Altace & Vasotec

4.     Other Common Medications—Calcium Channel Blockers and Angiotensin Receptor Blockers

5.     Questions to ask your Health Care Provider:

  • 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?

Remember that high blood pressure is preventable and treatable. The methods shown to be most effective include:

  • Lifestyle changes
  • Diet changes – DASH
  • Medication
  • Combination approach very popular, necessary and yields best results for many