Blood Pressure Control: a matter of choices by Pritchett & Hull Associates, Inc.

A M AT T E R O F C H O I C E S

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This book is written to help you find out more about hypertension. It should NOT be used to replace any of your doctor’s advice or treatment.

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Table of contents A matter of choices..........................................................2 What is blood pressure...............................................3–5 When blood pressure is high.................................4 Risk factors...............................................................5 Treatment...................................................................6–31 Take medicine................................................... 6-11 Eat a heart-healthy diet.................................. 12-22 Limit or avoid alcohol...........................................23 Do exercise....................................................... 24-26 Lose weight............................................................27 Avoid tobacco smoke..................................... 28-29 Reduce stress................................................... 30-31 Taking your own blood pressure.......................... 32-36 How to take your blood pressure......................... 34-35 You can do it...........................................37 Resources................................................38 Blood pressure chart.............................39 Blood pressure treatment plan...........40

A matter of choices In the early stages, high blood pressure causes few problems. Since there are few symptoms, most people aren’t even aware that they have it. (That’s why it’s called “The Silent Killer.”) But over time, uncontrolled high blood pressure begins to damage the kidneys, heart, blood vessels, brain and eyes. You can reduce your risk of heart disease and stroke! Make wise choices about medicines, food, body weight, exercise, smoking, alcohol and stress. Play an active role in controlling your blood pressure. Talk with your doctor if you think any part of your treatment is not working. The choices you make determine how well you control high blood pressure and your health.

What is blood pressure? Blood pressure (BP) is the force that pumped blood puts on the artery walls.

Systolic pressure Peak pressure in the arteries when the heart pumps blood out to the body.

artery stretched peak pressure (systolic)

Between heartbeats, the arteries are more relaxed.

Diastolic pressure Pressure left in the arteries after the heart has pumped and is at rest between beats.

artery relaxed diastolic pressure

When blood pressure is high Blood pressure (BP) is recorded with a set of two numbers such as 110/ 67. The top number (110) is the systolic pressure, and the bottom number (67) is the diastolic pressure. High blood pressure is when two or more BP checks taken at rest show: • Top number (systolic) BP greater than or equal to 130 and/or • Bottom number (diastolic) BP greater than 80 Example:

Systolic 110

(The 2017 guidelines published by the AHA and the ACC defined normal BP in adults as less than 120/80.)

Diastolic 67

Systolic Diastolic

(top number)

(bottom number)

Elevated BP

120–129

less than 80

and

Stage 1 Hypertension

130–139 or 80–89

Stage 2 Hypertension 140 and over

90 and over

As time goes on, your doctor may adjust your target goal based on how you respond to medication and lifestyle changes.

! 4

CAUTION: Call your doctor right away for any BP reading of 180 or more systolic or 120 or more distolic.

Risk factors There are many things that increase the risk of having high blood pressure (HBP). These are called “risk factors”. Although some of these things can’t be changed, like your age or family history, others can. From the list below, check all the risk factors that apply to you:

q I smoke or am exposed to a lot of second hand smoke.. (see pages 28-29)

q I am overweight. (see page 27) q I take birth control pills. (Taking these increases a woman’s risk of high blood pressure.)

q I could manage my diabetes better. q I have too much sodium in my diet and may not eat as healthy as I could. (see pages 12-22)

I am very stressed. (see pages 30-31)

I don’t get much exercise. (see pages 24-26)

My cholesterol level is over 200.

q I drink more than 2 alcoholic drinks a day. (See page 23 for details on how much alcohol is OK.)

Use the risk factors you checked to help fill in your HBP treament plan on page 40.

Treatment You and your doctor will be partners in controlling your blood pressure. Don’t be afraid to ask questions and be honest with your doctor about what you are doing to improve your BP. This will help determine if and when changes need to be made. Lowering your blood pressure will likely include: • taking medicine

Treatment—Take medicine

• eating a heart-healthy diet, low in sodium, unhealthy fat and with the right number of calories

• exercising and losing weight (if needed) • avoiding tobacco smoke • limiting or avoiding alcohol • reducing stress

Medicine Although medicine is often needed to get high blood pressure (HBP) under control, you can expect help from the lifestyle changes you make. Many people can take less HBP medicine when they reach a normal weight, exercise regularly, give up smoking, avoid or limit alcohol and reduce stress in their life. You will be able to see the benefit of making these changes as you check your BP at home (or your doctor’s office).

Many HBP drugs relax your blood vessels. Since blood vessels also relax with tub/hot tub bathing and saunas, follow these safety rules: • keep temperature from getting too hot • limit time to 10-15 minutes • don’t drink alcohol at the same time

• have someone go with you Keep your BP chart (see page 39) up to date. Write down any major life events as well. As changes occur in your life (moves, marriage, divorce, children, job changes, weight gain, etc.), the added stress may cause a need for an increase in your medicine for a time. When this happens, your doctor may adjust your medicine to keep your blood pressure within the desired range. Your doctor may also adjust your medicines based on other conditions you have or your risk for heart attack or stroke.

Treatment—Take medicine

• avoid sudden hot and cold temperature changes

CAUTION: Never change the dose or stop taking your medicine unless your doctor tells you to. And never, EVER take anyone else’s medicine or let anyone take yours!

Always take your high blood pressure (HBP) medicine just as your doctor prescribes. If there are side effects, be sure to let your doctor know right away. Sometimes side effects go away with time, but anytime you feel dizzy or weak, check your BP and tell your doctor. It may take several weeks to know if a particular drug or drug combination is working. Many people have to try several drugs before finding the right one.

Treatment—Take medicine

You may need one or more of these drugs to control your HBP:

Type of medicine

What it does

Diuretics (water pills)

help your body get rid of excess salt and water

ACE inhibitors

block the making of a body chemical that causes arteries to tighten

Angiotensin II receptor blockers (ARBs)

keep your arteries from being too tight

Beta-blockers

slow down your heart rate; help keep your heart from beating too hard

Calcium antagonists (also called calcium channel blockers)

keep your artery muscles from squeezing too tight

Vasodilators

relax your artery muscles so they stay open

Sympathetic nerve inhibitors

keep your arteries from being too tight

Combined alpha and beta blockers

help prevent your arteries from being too tight; help keep your heart from beating too fast or too hard

Possible side effects

dizziness, change in potassium levels, coughing, swelling, skin rash diarrhea, headache, dizziness, nasal congestion dizziness, fatigue, changes in sexual desire or function, high blood sugar, insomnia, depression dizziness, headache, constipation, stomach pain, drowsiness, nausea, hot flashes, sore throat, swelling dizziness, headache, swelling dizziness, constipation, dry mouth

Treatment—Take medicine

change in potassium levels, dehydration, high blood sugar, abdominal cramping, constipation

high blood sugar

Your medicine chart Use this chart to keep track of your medicine(s):

Medicine

When to take

How much to take

What it does

Treatment—Medicine

Treatment—Take medicine

Over-the-counter (OTC) drugs People with high blood pressure should not use over-the-counter drugs unless directed by a doctor. Some non-prescription drugs can raise blood pressure by causing blood vessels to become more narrow. These types of over-the-counter drugs may cause problems: • decongestants • cough medicines • supplements or natural medicines

Treatment—Take medicine

CAUTION: Some non-prescription drugs (such as many antacids) are high in sodium. This can raise your BP. Before choosing an over-the-counter medicine, talk with your doctor or pharmacist about the sodium content, unless your doctor has told you it is OK.

Diet The DASH (Dietary Approaches to Stop Hypertension) food plan* has been shown to help lower HBP. It is a flexible and balanced eating plan that is heart healthy and can be followed for life. The plan includes:

Treatment—Eat a heart-healthy diet

• Eating vegetables, fruits, and whole grains. • Including fat-free or low-fat dairy products, fish, poultry, beans, nuts, and healthy fat oils such as olive. • Limiting unhealthy foods, such as fatty meats, full-fat dairy products, and tropical oils such as coconut, palm kernel, and palm oils. Avoiding transfats. • Limiting sugar-sweetened beverages and sweets. • Limiting sodium to no more than 2300 mgs per day. Limiting to 1500 mgs will lower BP more. • Choose foods rich in potassium, calcium, magnesium, fiber, and protein.

Using the DASH food plan • Choose what to eat from eight food groups listed in the left-hand column of the DASH chart on page 13. • The Daily Servings column tells you how many servings you can have from each food group. • The Serving Size column shows you how much food is in one serving. • Some people taking a diuretic (water pill) are given a potassium supplement in addition to being told to eat potassium-rich foods.

* From the National Heart Lung and Blood Institute at NIH - nhlbi.nih.gov/ health-topics/dash-eating-plan

The DASH food plan The daily servings on this page are for a food plan of 2,000 calories per day. It limits sodium to 2,300 mg/day, which can help you control your BP. The number of daily servings that would meet your needs from each food group is based on your age, calorie needs for men vs. women and on how active you are. Adjust the daily servings to meet your body’s needs.

Serving Size

Sample Foods

Notes

Grains & grain products

4-13

1 slice bread 1 oz dry cereal 1/2 cup cooked rice, pasta

whole wheat bread, English muffin, pita bread, bagel, cereals, grits, oatmeal, crackers, unsalted pretzels and popcorn

major source of energy & fiber

Vegetables

3–6

1 cup raw, leafy vegetable 1/2 cup cooked vegetable 6 oz vegetable juice

tomatoes, potatoes, carrots, peas, squash, broccoli, turnip greens, collards, kale, spinach, artichokes, beans, sweet potatoes

rich sources of potassium, magnesium & fiber

Fruits

3–6

6 oz fruit juice 1 medium fruit 1/4 cup dried fruit 1/2 cup fresh, frozen or canned fruit

apricots, bananas, dates, grapes, oranges, orange juice, prunes, raisins, grapefruit, grapefruit juice, mangoes, melons, peaches, pineapples, tangerines and strawberries

important sources of potassium, magnesium and fiber

Low-fat or nonfat dairy foods

2–4

8 oz milk 1 cup yogurt 11/2 oz cheese

skim or 1% milk, skim or low-fat buttermilk, nonfat or lowfat yogurt, lowfat and nonfat cheese

major sources of calcium and protein

3 oz cooked meats, poultry or fish

select only lean meats; trim away visible fats; broil, roast or boil instead of frying; remove skin from poultry

rich sources of protein & magnesium

Meats, poultry & fish

3–9

Nuts, seeds & dry beans

3–5 a week

11/2 oz or 1/3 cup nuts 1/2 oz or 2 Tbsp seeds 1/2 cup cooked dry beans

almonds, filberts, mixed nuts, peanuts, walnuts, sunflower seeds, kidney beans, lentils

rich sources of energy, magnesium, potassium, protein, fiber

1–4

1 tsp soft margarine 2 Tbsp lowfat mayonnaise 2 Tbsp light salad dressing 1 tsp vegetable oil

soft margarine, lowfat mayonnaise, light salad dressing, vegetable oil (such as olive, corn, canola, or safflower)

DASH has 27% of calories as fat, including fat in or added to foods

1 Tbsp sugar 1 Tbsp jelly/jam 8 oz lemonade

maple syrup, sugar, jelly, jam, fruitflavored gelatin, jelly beans, hard candy, fruit punch, sorbet, ices

Sweets should be low in fat

Fats & oils

Sweets

limited

Treatment—Eat a heart-healthy diet

Daily Food Group Servings

Treatment—Eat a heart-healthy diet

Sodium

Studies show you can get even lower BP readings if you limit your sodium intake to 1,500 mg of sodium/day. If you are having trouble reaching your BP goal with a DASH eating plan (2,300 mg of sodium), your doctor may ask you to aim for 1,500 mg of sodium/day. This will mean looking at the sodium content on food labels more carefully.

NOTE: The 2 most common sources of sodium are restaurant and processed foods.

One level teaspoon of salt has about 2,300 mg of sodium.

How to buy and fix lower sodium foods • Season foods with fresh or dried herbs, vegetables, fruits or no-salt seasonings. Avoid soy, teriyaki, Worcestershire and other high-sodium seasonings. • Do not cook with salt or add salt to foods.

• Eat fresh or unsalted canned or frozen vegetables. These have less sodium than most processed foods. Example:

Instead of:

Use:

1 cup of canned green beans: 320 mg of sodium

1 cup of cooked, fresh green beans: 5 mg of sodium

1 cup of cooked canned peas: 400 mg of sodium

1 cup of fresh, cooked peas: 2 mg of sodium

1⁄ 2

cup of Minute Long Grain and Wild Rice: 570 mg of sodium

cup of cooked rice: 1 mg of sodium

Treatment—Eat a heart-healthy diet

• Make your own breads, sauces, salad dressings, vegetable dishes and desserts when you can.

Sodium contents of foods from USDA Handbook #456.

• Use low-sodium tuna or salmon when possible. If you only have oil-packed, break it up and soak it for 3 minutes in cold water. Rinse, drain and squeeze out the water.

Treatment—Eat a heart-healthy diet 16

Reading about sodium on food labels Food labels will tell you how much sodium is in one serving of the food you are buying. The label will also tell you: • how large a serving size is. (This should be the same as in the DASH plan. When it is different, stick to the DASH serving size.)

• the % Daily Value. This number gives you the % of an entire day’s sodium that is in 1 serving of this food.

Fats The type and amount of fat you eat is important if you are concerned about heart health and HBP. The fats most harmful to your body are saturated fat and trans fat. Both can raise your risk for heart attack and stroke.

You can help prevent this artery buildup by eating less unhealthy fat and only small amounts of healthy fat (olive oil, avocado). The food choices in the DASH plan will help you choose the right foods. Many times a drug is needed to reduce your risk of heart attack and stroke.

Treatment—Eat a heart-healthy diet

When there is too much cholesterol in the blood, fatty plaque builds up on the artery walls, and the arteries become narrow. If blood can’t pass through a clogged artery to the heart, a heart attack or stroke can occur.

How to buy and fix foods on the DASH eating plan

Treatment—Eat a heart-healthy diet

• Bake, broil, steam, roast, poach or boil foods. Serve without fatty sauces. Don’t fry. A vegetable oil spray, used lightly and sprayed onto the food or on the pan, will keep foods from sticking to the pan.

• Cook more fish and poultry (light meat). Limit lean red meats to less than 3 times a week. Trim off all excess fat before cooking. It’s OK to cook poultry with the skin on, but don’t eat the skin. It contains a lot of fat. • Buy meats that have less visible fat and marbling (streaks of fat in the meat). Avoid processed and cured meats. • Drain all meats on a paper towel after cooking. The towel will soak up extra grease or fat. • Season foods with herbs and low sodium bouillon. Do not cook with saturated fat like butter, lard, ham hocks, fatback, bacon or sausages.

• Cook with small amounts of vegetable oils. Use 1 Tbsp or less per dish. Make salad dressings with small amounts of monounsaturated or polyunsaturated oil such as canola or olive oil.

Reading about fats on food labels Food labels will tell you how many grams of fat, saturated fat and total fat are in 1 serving.

Nutrition Facts Serving Size 1 cup (228g) of Macaroni & Cheese Servings Per Container 2 Amount Per Serving Calories 250 Calories from Fat 110 % Daily Value* Total Fat 12g 19% Saturated Fat 5g 25% Trans Fat 1.5g Cholesterol 25mg 9% Sodium 650mg 28% Total Carbohydrate 30g 10% Dietary Fiber 0g 8% Sugars 5g Protein 5g Vitamin A Calcium

3% • Vitamin C 15% • Iron

2% 5%

• Percent Daily Values are based on a 2,000 calorie diet. Your daily values may be higher or lower depending on your calorie needs: Calories 2,000 2,500 Total Fat Less than 65g 80g Sat Fat Less than 20g 25g Cholesterol Less than 300mg 300mg Sodium Less than 2,400mg 2,400mg Total Carbohydrate 300g 375g Dietary Fiber 25g 30g Calories per gram: Fat 9 • Carbohydrates 4

•

Protein 4

Treatment—Eat a heart-healthy diet

The DASH diet recommends that 30% of your daily calories come from fat, with very little of that from saturated fat.

Potassium

Treatment—Eat a heart-healthy diet

The DASH eating plan is designed to be rich in potassium. Shoot for a target of 4,700 mg potassium daily. Eating a diet high in potassium can work along side your effort to reduce sodium intake to control your blood pressure.

High potassium foods • dried fruit

raisins, prunes, apricots, dates

• fresh fruit bananas, strawberries, watermelon, cantaloupe, oranges, grapefruit, kiwi, nectarines • fresh vegetables avocados, potatoes, broccoli, greens, spinach, peas, tomatoes, mushrooms • dried vegetables

beans, peas

• fresh meats

turkey, fish, beef

• fresh juices

orange, grapefruit

• canned juices

grapefruit, prune, apricot

Most diuretics (water pills) cause you to lose potassium in the extra urine that leaves the body. Ask your doctor about potassium if he or she prescribes a diuretic. Do not take a potassium supplement unless your doctor prescribes it.

CAUTION: Some people with abnormal kidney function and those taking a potassium-sparing diuretic don’t need a potassium supplement and are advised NOT to eat large amounts of foods high in potassium. Check with your doctor if you think this may apply to you.

Eating out Eating out doesn’t have to be a problem when you need to eat fewer calories, less saturated fat or sodium. Here are some tips to help you:

• Order fish, poultry or lean meats (light meat); ask that it be broiled, baked, roasted or poached (without sauces or fat). When you eat red meat, eat smaller portions. • Order baked potatoes plain. If you use butter or margarine, only use one pat or less at a meal. Sweet potatoes are a healthier option. • Order vegetables without sauces or breading. • Have a healthy snack such as a large piece of fruit or a glass of skim milk before you eat out. This will make you less hungry. • Choose restaurants that offer healthy options, fresh vegetable side dishes and substitutes.

Treatment—Eat a heart-healthy diet

• Order salad dressings on the side, and put only 1 tablespoon (Tbsp) on your salad.

Snacks The best snacks for weight and blood pressure control are foods or drinks such as these: • fresh fruit such as a bowl of berries or an apple • raw vegetables and hummus

Treatment—Eat a heart-healthy diet

• dips made from hummus or guacomole

• popcorn without butter, oil or salt (limit portion size to 3 cups or less) • One Tbsp of peanut or almond butter on a rice cake (sodium content varies from 35–300 mg per serving)— limit to 140 mg or less each day • low-fat and low-sugar yogurt with granola • unsalted nuts, seeds and dried fruit mix (1/4 cup)

Alcohol Alcohol can raise your blood pressure and cause problems when you have HBP. If you drink alcohol and have HBP you may need to reduce the amount of alcohol that you drink. The risk is the same with beer, wine and liquor and increases with the amount you consume. Women should limit their alcohol to no more than one serving a day. Men should have no more than two servings a day.*

• 11⁄ 2 oz of 80 proof spirits or 1 oz of 100 proof spirits, or • 5 oz of wine, or • 12 oz of beer

CAUTION: If you are trying to lose weight, keep in mind that alcoholic drinks add calories that would be better spent on more nutritious options.

Treatment—Limit alcohol

One serving of alcohol is:

Alcohol interferes with some BP medicines and can make side effects more intense. *

New guidelines recommend limiting alcohol to one drink a day - for men and for women.

Exercise

Treatment—Do exercise

Being physically active is important for a strong heart, controlling HBP, managing weight and stress, as well as overall good health. The best activities for your blood pressure are aerobic ones such as brisk walking, jogging and cycling. To help control your blood pressure, it is best to do 90 to 150 minutes of aerobic activity per week. Brisk walking or an activity you enjoy five days a week for 30 minutes would meet this. Also include flexibility and stretching exercises as well as two muscle strengthening sessions.

According to the American Heart Association, even mild physical activities in 10 minute increments can help you control HBP. These may include: • walking for pleasure • gardening • housework The most important thing is that you make some type of physical activity a regular part of your life. Plan your physical activity and find an exercise partner to ensure success and make it FUN!

NOTE: Once you have talked with your doctor and have an exercise plan, here are some tips: • To avoid injury, warm up before you exercise. Then cool down and stretch after you exercise. • Start off slowly. If you aren’t already physically active, you can begin with small amounts of walking, gardening or yard work, for example.

• Do something you enjoy. It’s harder to keep doing an exercise if you don’t like it. This is why walking is a great choice. It’s easy and can be done indoors or outside. Good shoes and comfortable clothes are the only expense for walking. • Don’t say “there’s not enough time.” It can be hard to squeeze exercise into a busy schedule. But even 10 minutes a day may make a difference in your health. Make exercise a priority and consider it like taking a medicine. • Choose an exercise partner. If you need an extra push, a friend, dog or video exercise program can help you plan and stick to an exercise routine.

Treatment—Do exercise

• Exercise regularly. It is better to do small or moderate amounts of exercise most days of the week than to go all out only once a week.

CAUTION: Before you begin exercising, talk to your doctor.

Muscle strengthening Get approval from your doctor and make sure your blood pressure is controlled before you start. Tips:

Treatment—Do exercise

• Learn and use proper form when lifting to reduce the risk of injury

• Don’t hold your breath. • Start with a low amount of weight and gradually increase over time. • Lift lighter weights more times. You can challenge your muscles with lighter weights by increasing the number of repetitions you lift.

NOTE: Have an instructor or physical trainer teach you the best weight training routine and how to stay safe while gaining benefit for your health.

• Alternate between upper and lower body exercises to let your muscles rest during exercise

Weight If you are overweight, your doctor will most likely tell you to lose weight. By losing weight, you will decrease the amount of work your heart has to do and make it easier to control your blood pressure. Losing even a few pounds may make a difference! If you are overweight, losing as little as five to 10 pounds may help lower your blood pressure and can be the difference of needing another medicine to control your blood pressure

Avoid diets that claim a “quick fix” of fast weight loss in a short time. In the long run, these diets make weight loss harder. And very low calorie diets can be dangerous for some people taking blood pressure medicine. The best weight loss plans also include regular exercise and having a lifestyle in which you are more physically active all the time. Talk to your doctor about a safe exercise routine.

Treatment—Lose weight

One of the keys to losing weight is reducing calories and portion sizes. On a heart-healthy diet (like the DASH food plan— see page 13), you lose weight slowly without risking your health by reducing the number of servings you have each day.

My target body weight is _________

Treatment—Avoid tobacco smoke

Tobacco

If you have high blood pressure and are also a smoker, your risks for heart disease, lung disease and stroke are much higher. Each cigarette you smoke raises your blood pressure for a number of minutes. Smoking is even more dangerous for women who use oral contraceptives (birth control pills). Tobacco in any form is bad for you. This includes chewing, vaping and e-cigarettes.

NOTE: Your own hospital is a good place to call about a stop-smoking clinic. There are also medicines and nicotine patches to help you avoid withdrawal. Ask your doctor to help you choose a way to quit smoking.

The US Surgeon General reports that after you quit smoking for: • 20 minutes, your heart rate drops • 12 hours, carbon monoxide levels in your blood return to normal

• 1 to 9 months, your coughing and shortness of breath decrease • 1 year, the risk of coronary heart disease is half that of a smoker • 5 years, your risk of stroke is reduced to that of a non-smoker • 10 years, your lung cancer death rate is about half that of a smoker. Your risk of cancers of the mouth, throat, esophagus, bladder, kidney and pancreas decrease • 15 years, your risk of coronary heart disease is back to that of a non-smoker

Treatment—Avoid tobacco smoke

• 14-90 days, your heart attack risk begins to drop and your lung function begins to improve

Stress management One way to relax (plan for 20 minutes): 1. S it or lie quietly in a comfortable position away from interruptions (TV, pets, children, phone, etc.).

Treatment—Reduce stress

2. C lose your eyes.

3. B egin to relax each muscle of your body, working up from your feet to your face. Don’t rush. When you feel no tightness, stay quiet and still. 4. B reathe easily through your nose. Become aware of your breathing. Each time you exhale, repeat the word “one.”* 5. W hen you feel that it is time to come out of this relaxed state, open your eyes slowly. Sit quietly for a minute before getting up.

Another way to relax (plan for 20 minutes): 1. S it or lie quietly in a comfortable place where you can’t be disturbed. In many homes, this is a hard place to find, but do your best.

3. T hink of a time or place that was a lot of fun for you. Think about everything that made it fun. Remember the sounds, smells, feelings or people that may have been there. 4. C ontinue to relax and think of this fun time. If you really lose yourself in this memory, your body will begin to relax. 5. A s your private time comes to an end, open your eyes slowly. Lie or sit quietly for a few minutes before getting up. Plan another quiet time for tomorrow.

Treatment—Reduce stress

2. C lose your eyes. Take a few slow, deep breaths. As you breathe out, let your body go loose. Breathe slowly and easily.

Taking your own blood pressure The American Heart Association strongly encourages home BP monitoring. Ask your doctor or pharmacist to suggest a good device and bring it to your next doctor’s visit to compare readings. Upper arm BP devices are usually best (rather than wrist devices). You should also know that BP: • may be different in each arm, so after your doctor checks, find out which arm you should use in future readings • is often lower when you have been asleep • goes up as you wake up and become more active • can rise in a few seconds due to sudden stress or pain • can sometimes be higher in the doctor’s office than at home When you take your own BP, take it at about the same time each day and in the same place. If you’ve been active, empty your bladder and then rest for at least 5 minutes before you take it. Avoid caffeine and nicotine in the 30 minutes prior to taking your BP.

Digital blood pressure monitor The most popular type of blood pressure device today is a digital monitor. These are not too costly, and it is easy to read your BP on the small screen.

NOTE: • Compare readings with your digital BP device to those at your doctor’s office to make sure they are accurate. • All digital BP devices come with instructions. Read them carefully before taking your blood pressure. • Store your BP device at room temperature. Extreme heat or cold can cause it to give false readings. • The height at which you hold your arm can affect the BP reading. Keep the arm with the blood pressure cuff at about heart level. Do this by propping that arm on a table, sofa edge or other flat surface. • Make sure the blood pressure cuff you are using is the appropriate size. Ask the pharmacist to help you select the best cuff.

How to take your blood pressure Read through these steps before starting. 1. S it at a table where you can place your arm and equipment comfortably. Make sure your bladder is empty and avoid caffeine, exercise or nicotine for 30 minutes before taking your BP. 2. W rap the blood pressure cuff around your bare arm (not over your clothes) an inch above the elbow. The cuff should fit snugly, but with enough room so that one finger can be slipped under the cuff. Wrap the cuff evenly.

cuff

1 inch above elbow

snug, but room for a finger under cuff

3. R est your elbow and lower arm on a flat surface so that the upper arm is level with the heart. Stay still and quiet.

upper arm level with heart

4. T urn the power on.

A. I f your device measures BP automatically, press ‘start’ button for the reading and remain still until the device displays the final reading.

B. I f your device has a rubber bulb, inflate the cuff until it is tight around your arm. After you stop inflating, the machine will display your systolic and diastolic pressure on the screen. Turn or press the exhaust button to release all of the air from the cuff.

read blood pressure numbers here

rubber bulb

5. T urn power off.

NOTE: • Taking your blood pressure over clothes or rolling up your shirt or jacket over the cuff can cause false or high readings. • Many machines offer only one cuff size. But cuffs must be large enough to get a true reading. Measure the distance around the middle of your upper arm. If it is more than about 13 inches, you will need a large rather than a standard size cuff. • Have your blood pressure device checked to be sure it is accurate. Do this when you buy it and at least once a year after that. You can check it at your doctor’s office or at a nearby fire station that has a mercury device. • Your equipment should be stored with care. If you are not likely to use it for a few months, remove the batteries. Before you use it again, check rubber tubing for cracks or leaks. Make sure the tubing is not twisted. Store it away from heat and dust. • If you have had breast cancer surgery, always have your blood pressure checked on the side that was not affected.

! 36

CAUTION: Call your doctor right away for any BP 160 or greater systolic or 100 or greater diastolic. Report if you have any of these symptoms: severe headache, shortness of breath, nosebleeds or severe anxiety.

You can do it As you bring your BP down, stay in touch with your doctor. He or she needs to know your progress and change treatment when needed. Don’t wait until kidney disease, heart attack, stroke, or vision problems prove to you that HBP is serious. Remember the choices you need to make to control your BP: • Take your medicines as prescribed. • Achieve and stay at a healthy weight. • Follow a DASH eating plan and keep sodium to 1,500 - 2,300 mg/day. • Exercise five times a week and increase physical activity all day • Don’t use tobacco and avoid secondhand smoke exposure. • Limit alcohol. • Reduce and learn to manage your stress.

Resources • T he DASH Diet Weight Loss Solution by Marla Heller • T he DASH Diet for Hypertension by Thomas J. Moore and Mark Jenkins https://www.nhlbi.nih.gov/health-topics/dash-eating-plan • A merican Heart Association Low-Salt Cookbook, 4th Edition: A Complete Guide to Reducing Sodium and Fat in Your Diet by American Heart Association • Y our Guide to Lowering Your Blood Pressure with DASH by National Heart, Lung and Blood Institute “Google” the title to download this guide.

• M y doctor:

(name)

(phone number)

Blood pressure chart

My target blood pressure is ________.

Use this page to keep track of your progress. Date Time

Systolic Pressure (top number)

Diastolic Pressure (bottom number)

Comments

My blood pressure is: ______________.

Blood pressure treatment plan Check off your blood pressure stage below:

Systolic Diastolic (top number) (bottom number)

q Elevated BP

..............................................

120–129..................and.............. less than 80

q Stage 1 Hypertension

130–139.................... or......................... 80–89

q Stage 2 Hypertension

140 or more............... or.................. 90 or more

...................

..............

Using your risk factors on page 5, ask your doctor to check off the actions he recommends for you from the following list:

Begin taking medicine and monitoring BP at home.

q Lose ________________ lbs. q Start the DASH food plan (found on page 13). q Cut back on sodium in my food to 1,500-2,300 mg a day. q Lower my cholesterol by eating healthy and taking medicines as ordered.

q Be more active. Try to walk 5 days a week.

Limit or avoid alcohol.

q Stop smoking and limit secondhand smoke exposure.

q Reduce my stress and learn to relax. (see pages 30 & 31 for suggestions)

CAUTION: Call your doctor right away for any BP reading of 160 or more systolic or 100 or more distolic.

Suggested questions It is important to talk with your doctor about your HBP. Here are a few questions to get you started: • What is my target BP goal? • Will I always have to take HBP medicine?

• What is a good weight for me? • Which of the DASH calorie diets would work best for me? q 1,200 calories q 2,000 calories, q 1,800 calories q 2,400 calories

• What type of exercise should I do and how often?

• Should I limit coffee and high-energy drinks?

• What can I do if I just can’t afford my medicine?

AU T H O R S : W. Dallas Hall, MD Professor of Medicine and Director of

We believe that you have the right to know

The Division of Hypertension (Retired)

as much as you can about your health. Our

Emory University School of Medicine

goal is to give you enough facts to get the

and Grady Memorial Hospital,

main points clearly in mind. We do this

Atlanta, GA

with medical accuracy, warmth and humor.

Julia Ann Purcell, RN, MN, FAAN Clinical Nurse Specialist,

The result for you: less tension, more healing and a good idea of what to ask your doctor, nurse or others.

Cardiology, 1968–1996 Emory University Hospital, Please let us know how this booklet

Atlanta, GA

is helping you (or your patients).

Yvonne Payne, RD, LD

Share your comments at

Thanks to reviewers of previous editions of this book.

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